Consider the “Four Topics Approach” (or Four Box method) to ethical decision making in Butts (below). Apply this model to a challenging situation in your nursing career that required you to consider the ethical dimensions of the patient case and the role you played in providing care. Specifically apply and address the questions within each topic area as they pertain to your situation.
In your conclusion, discuss the impact of the Four Topics process. Did applying these principles shape your decision making in any way? Does this seem like a valid process for you to apply in your practice?
Your paper should be 1-2 pages. Adhere to APA formatting throughout, and cite any outside sources you may use.
TABLE 2-1 Four Topics Method for Analysis of Clinical Ethics Cases
Medical Indications: The Principles of Beneficence and Nonmaleficence
1. What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
2. What are the goals of treatment?
3. In what circumstances are medical treatments not indicated?
4. What are the probabilities of success of various treatment options?
5. In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences: The Principle of Respect for Autonomy
1. Has the patient been informed of benefits and risks, understood this information, and given consent?
2. Is the patient mentally capable and legally competent, and is there evidence of incapacity?
3. If mentally capable, what preferences about treatment is the patient stating?
4. If incapacitated, has the patient expressed prior preferences?
5. Who is the appropriate surrogate to make decisions for the incapacitated patient?
6. Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
1. What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds?
2. On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment?
3. Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4. What ethical issues arise concerning improving or enhancing a patient’s quality of life?
5. Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
6. What are plans and rationale to forgo life-sustaining treatment?
7. What is the legal and ethical status of suicide?
Contextual Features: The Principles of Justice and Fairness
1. Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients?
2. Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
3. What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
4. Are there financial factors that create conflicts of interest in clinical decisions?
5. Are there problems of allocation of scarce health resources that might affect clinical decisions?
6. Are there religious issues that might influence clinical decisions?
7. What are the legal issues that might affect clinical decisions?
8. Are there considerations of clinical research and education that might affect clinical decisions?
9. Are there issues of public health and safety that affect clinical decisions?
10. Are there conflicts of interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions and patient welfare?
THE ETHICAL DILEMMA: A TERMINALLY ILL CANCER PATIENT WANTED HOSPICE SERVICES AND STOP ALL TREATMENT BUT THE FAMILY DID NOT WANT THAT. * THE PATIENT WAS CAPABLE OF MAKING THEIR OWN DECISIONS SO I RESPECTED THE PATIENTS DECISION *
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Ethical Frameworks Essay: Four Topics Approach for Ethical Analysis
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Ethical Frameworks Essay: Four Topics Approach for Ethical Analysis
The first section of the paper is called the introduction, yet the paper does not have a
heading that is labeled introduction. In this section, you would start with an introductory
paragraph. A well-written essay is similar to a trip. The introduction section is the planning stage
where you determine the place, time, and method of travel. You might also include the order of
the trip and stages of travel. Here is where you will introduce what your paper will be about. A
well-written introduction tries to get the reader to finish the rest of the paper. Give an overview
of a specific challenging clinical situation you have encountered in your practice that required
you to consider the ethical dimensions of the patient case and the role you played while
providing care. Make sure to maintain patient confidentiality.
Medical Indications: The Principles of Beneficence and Nonmaleficence
Medical Problem
Here you will describe the medical facts of the case. Make sure to support what you write
with resources. Address if this medical problem is acute, chronic, critical, reversible, emergent,
or terminal.
Goals of Treatment
Write what the goals of treatment include for this patient specific to this case. Address if
there are circumstances where medical treatment is not indicated.
Probable Success of Treatment Options
Write about the expected outcomes related to the various treatment options available to
the patient related to this case.
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Benefits to Patient and Avoidance of Harm
This section will be how can the patient benefit from medical AND nursing care.
Remember, medical and nursing care are different disciplines. Address how patient harm can, or
cannot be, avoided.
Patient Preferences: The Principle of Respect for Autonomy
Informed Consent
For this section include discussion of informed consent. Was the patient given all of the
information related to risks and benefits? Is the patient stating any preferences related to
recommended treatment? Include whether the patient is capable of making their own decision or
if they have been incapacitated. If that is the case, who is the patient’s decision- maker? Did the
patient name this decision-maker or were they appointed? Is the patient unwilling or unable to
cooperate with the medical treatment? If so, why?
Quality of Life: The Principles of Beneficence and Nonmaleficence and Respect for
Autonomy
Patient Prospects Related to Treatment
What are the patient’s prospected with or without treatment to returning to a normal life?
On what grounds can anyone judge that some quality of life would be undesirable for a patient
who cannot make or express such a judgment? Are there biases that might prejudice the
provider’s evaluation of the patient’s quality of life? What ethical issues arise concerning
improving or enhancing a patient’s quality of life? Do quality-of-life assessments raise any
questions regarding changes in treatment plans, such as forgoing life-sustaining treatment? What
are plans and rationale to forgo life-sustaining treatment? What is the legal and ethical status of
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suicide? You may or may not be able to address all of the above questions, depending on your
case.
Contextual Features: Principles of Justice and Fairness
Conflicts of Interest
Are there professional, interprofessional, or business interests that might create conflicts
of interest in the clinical treatment of patients? Are there parties other than clinicians and
patients, such as family members, who have an interest in clinical decisions? What are the limits
imposed on patient confidentiality by the legitimate interests of third parties? Are there financial
factors that create conflicts of interest in clinical decisions? Are there problems of allocation of
scarce health resources that might affect clinical decisions? Are there religious issues that might
influence clinical decisions? What are the legal issues that might affect clinical decisions? Are
there considerations of clinical research and education that might affect clinical decisions? Are
there issues of public health and safety that affect clinical decisions? Are there conflicts of
interest within institutions and organizations (e.g., hospitals) that may affect clinical decisions
and patient welfare? Not all of these questions may be applicable to your case.
Conclusion
When writing your conclusion, make sure to discuss the impact of the Four Topics
process. Did applying these principles shape your decision making? Does this seem like a valid
process for you to apply to in your practice? End with a conclusion where you summarize your
paper and repeat the primary points. Remember that a well-written essay is like planning a trip.
The introduction is the planning stage; the body is the journey. The conclusion allows you the
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opportunity to reflect on where the journey has taken you. This is similar to reviewing the
pictures you took on your trip and remembering the important places and experiences.
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References
Butts. J., & Rich, K. (2016). Nursing ethics. Across the curriculum and into practice. (4th ed.).
Jones & Bartlett Learning. https://online.vitalsource.com/books/9781284099096
Pozgar, G. (2016). Legal and ethical issues for health professionals. (4th ed.). Jones & Bartlett
Learning. https://online.vitalsource.com/books/9781284089530
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