A Case Study of Respect for Autonomy in Pregnant Women

Nurses and physicians are expected to operate within a given set of principles

Such frameworks aim at streamlining their efforts and the delivery of care. There are four major principles of healthcare ethics which guide nurse initiatives. The four principles include respect for autonomy, beneficence, non-maleficence and justice. Respect for autonomy as a healthcare ethics principle calls for the involvement of the patient in the decision-making process. Beneficence calls for the prioritization of the patient’s health. The principle of non-maleficence discourages the intentional harming of the patient through omission or commission. Lastly, the principle of justice recommends the provision of fair services and correct distribution of resources to meet patient needs. One of the major healthcare concerns revolves around the care of pregnant women. While it is expected that women will participate actively in the mitigation of threats to the fetus, some women will act in a way that is contrary to fetal wellbeing. The current case study seeks to examine the steps that a midwife nurse would take in a scenario that involves a female patient who refuses treatment and acts in a way that jeopardizes the safety of the fetus (Tracy et al., 2015). Such an intervention will be aimed at protecting the lives of both the fetus and the mother. An efficient healthcare practitioner will be expected to integrate various steps which are predicated on the four principles of healthcare ethics to prevent the patient from harming the fetus, and instead embrace positive behavior.

Acknowledging and Respecting the Patient’s Wishes - Respect for Autonomy

The first step in addressing the situation calls for the respect of the patient’s wishes. Essentially, the nurse will be expected to listen to the patient’s wishes and terminate any interventions that had been instituted prior to the former’s refusal. Such an action will be in line with the principle of autonomy. Mainly, the patient is a rational human being who understands the implications of her actions. Given that she is of sound mind, there is a need to consider all of the factors that the patient had highlighted and involve them in the generation of an appropriate treatment procedure. While the physician may recommend the appropriate behavior and actions to engage in the treatment process, it is the duty of the patient to determine whether they will embrace the identified measures. The study “Management of Pregnant Patients Who Refuse Medically Indicated Cesarean Delivery” suggests that maternal autonomy should override any decision that is made in the event of refusal by the pregnant woman. According to Deshpande & Oxford (2012), the conflict regarding maternal autonomy exposes the challenges that physicians have to maneuver through to realize efficiency in treatment initiatives. Respecting the patient’s autonomy entails the intrinsic reflection of their concerns. The first step will require the involved practitioner to listen to their reasons. Alternatively, the nurse will be called to understand or reflect on the issue from the patient’s perspective. The engagement of the alternative perspective will provide an opportunity to assess matters from the expectant mother’s point of view and thus infer relevant solutions (Page, 2012). Respect for autonomy directs the nurse to listen to the patient’s rational contextualization irrespective of my interpretation, beliefs and ideas. As a medium of promoting the realization of a suitable solution, respect for autonomy leads to the realization of a collective perspective. The initiative is the first step towards the realization of an efficient solution.

Augmentation of the Patient’s Understanding- Principle of Beneficence

The patient’s decision may be predicated on misinformation or ignorance. After engaging the principle of respect for autonomy to observe the situation from the patient’s perspective, enhancing the patient’s understanding should be predicated on the principle of beneficence. Essentially, since the pregnant woman had refused treatment, informing her about the need to reconsider the perspective and the negative implication of the decision on the child might inspire a shift in patient’s thought patterns. The principle of beneficence is relevant at this stage because it calls for the provision of the best services to the patient with the intention of improving her health. As a parameter of ethics, beneficence directs physicians to engage a treatment pattern or plan that meets the patient’s immediate needs. In reflecting on the criticality of beneficence in nursing, Burkhardt & Nathaniel (2013) argue that enhancing the patient’s understanding will facilitate the identification of factors which inspire their reservations regarding the given intervention. The indispensability of beneficence lies in the goal of the framework. Mainly, each action which is guided by the principle is aimed at achieving optimal and positive outcomes for the patient. Taking positive steps to prevent further damage on the fetus reflects the consideration that physicians have for both the mother and the unborn child. Since the woman may be unaware of the implications of her actions on the fetus, enhancing their understanding will play a vital role in mitigating their stance on the decreed healthcare interventions. The principle of beneficence considers the needs of the immediate patient and the community around them. Subsequently, it is aimed at generating the optimum solution to be applied in the mitigation of healthcare concerns. Jansen (2013) suggests that beneficence is a healthcare ethics principle which is predicated on stewardship. Rather than considering the interests of only one party in a given healthcare scenario, beneficence will facilitate the reflection of the woman’s decision on both the child and the fetus.

Interdisciplinary Approach - Principle of Justice

The interdisciplinary approach to care calls for the involvement of all stakeholders in the realization of positive health outcomes. Subsequently, the midwife nurse should embrace the framework as a medium through which the current scenario is addressed. The approach will be predicated on the principle of justice. Primarily, the healthcare ethics principle advocates for the element of fairness in the provision of care (Ter Meulen, 2015), for instance, engaging in a collective decision which will favor the interests of both the mother and the child will be the major priority (Engum & Jeffries, 2012). Some of the participants of the initiative will include ethics consultants, the patient’s family members, social workers and religious leaders among other individuals (Holden et al., 2013). Such an intervention will be aimed at generating a solution that is plausible to the patient. The refusal to engage given treatment option as highlighted by the nurse exposes the unborn child to numerous dangers.

Court Action - Principle of Non-Maleficence

If the patient continues to engage in reckless behavior which may endanger the fetus after attempts instituted to enhance their understanding, the nurse should resort to obtaining a court order. The action will be predicated on the principle of non-maleficence. The solicitation of court order for the patient to engage the recommended treatment option acts as the last resort in the attempts which are initiated to protect the life of the fetus and the mother. A court-ordered intervention will only be feasible if all the attempts by the nurse to rectify the client’s perception are not successful. In the subject case, non-maleficence is aimed at protecting the life of both the mother and the fetus. Grace (2017) suggested that nonmaleficence as a nursing code of ethics streamlines healthcare practice into the realization of treatment and interventions that are beneficial to both the patient and the community. A court order will compel the pregnant woman to engage the given interventions. Such an intervention will play a crucial role in generating positive health outcomes for the both the mother and the child. Expectedly, the court action is often discouraged in care process. In examining the implications of court action on patient-nursing relationships, Feutz-Harter (2012) suggests that such an action may jeopardize relations between the two parties. A court action is a negation of the principle of autonomy which calls for the respect of the patient’s decision. However, in the current scenario, the decision will be aimed at protecting the life of the unborn fetus. Given that the fetus cannot air their concerns regarding the treatment option, the nurse will be expected to uphold and reinforce practices which promote their sustainability. Based on the premise, the decision to overlook the treatment options recommended, exposes the fetus to immediate danger and threat to their life. Expectedly, court action infringes on the rights of the pregnant woman. Nonetheless, there is also need to reflect and protect the rights of an unborn child given that it cannot express its opinions regarding the decision taken by the mother.

Conclusion

The four healthcare ethics principles can be used to define the interventions that are applied in addressing a refusal by a pregnant woman to partake in the treatment initiatives that are defined by the nurse. To address the issue, the nurse should involve four main interventions which include the acknowledgement and respect of the patient’s wishes, the enhancement of the patient’s understanding, engagement of an interdisciplinary approach and the integration of court action. The interventions will be pegged on respect of patient autonomy, the principle of justice, principle of non-maleficence and the principle of beneficence. Of all the interventions, court action is the most contentious given that it infringes on the rights of the individual. However, to protect the life of the unborn fetus, such an action will be aimed at compelling the mother to embrace health behaviors that promote the wellbeing of both parties.

References

Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Ontario: Nelson Education.

Deshpande, N. A., & Oxford, C. M. (2012). Management of pregnant patients who refuse medically indicated cesarean delivery. Reviews in Obstetrics and Gynecology, 5(3-4), 144. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23483714

Feutz-Harter, S. (2012). Legal and ethical standards for nurses. London: PHC Publishing Group.

Grace, P. J., & DRN, P. (Eds.). (2017). Nursing ethics and professional responsibility in advanced practice. Burlington, MA: Jones & Bartlett Learning.

Engum, S. A., & Jeffries, P. R. (2012). Interdisciplinary collisions: bringing healthcare professionals together. Collegian, 19(3), 145-151. https://www.ncbi.nlm.nih.gov/pubmed/23101349

Holden, R. J., Carayon, P., Gurses, A. P., Hoonakker, P., Hundt, A. S., Ozok, A. A., & Rivera-Rodriguez, A. J. (2013). SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11), 1669-1686. doi: 10.1080/00140139.2013.838643

Jansen, L. A. (2013). Between beneficence and justice: The ethics of stewardship in medicine. Journal of Medicine and Philosophy, 38(1), 50-63. doi: 10.1093/jmp/jhs058

Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision making? BMC medical ethics, 13(1), 10. doi: 10.1186/1472-6939-13-10.

Ter Meulen, R. (2015). Solidarity and justice in health care. A critical analysis of their relationship. Diametros, (43), 1-20. doi: 10.13153/diam.43.2015.710

Tracy, S. K., Thorogood, C., Pincombe, J., & Pairman, S. (2014). Midwifery: Preparation for practice. Edinburgh, London: Elsevier Health Sciences.