Angelina Gambino
Biomedical Ethics
Argument Essay #2

1. Mr. S insists on using his walker to go to the bathroom alone rather than using the bedpan overnight. There are many ethical issues in this case. Mr. S is potentially putting his health and life at risk by not waiting for assistance to walk to the bathroom. The patient’s decision-making capacity must be questioned. He is capable of making current decisions, however he is lacking the ability to make future decisions regarding his health. The staff is insisting Mr. S use the call button for help, and he is potentially putting their jobs and the rehabilitation hospital at risk. The nurse believes the safest option is to place a device on his ankle, a wandering guard, that will sound an alarm if he gets out of bed. Mr. S is strongly objecting the device, saying it will hinder his independence and dignity. The patient, surrogate, and health team are all relevant individuals involved, and must be thought of when developing the next plan of action. This becomes an ethical issue because it needs to be determined if placing the wander guard will be doing the patient more harm or good.
2. Ethical principles that will help guide the team develop a plan are beneficence, autonomy, and dignity. Beneficence is a principle that states we act in a way that benefits others (Yeo, 103). It is relevant in this case because the care team is trying to make a decision that will ultimately benefit the patient rather than harm, by placing the wander guard on Mr. S. Autonomy is another principle that states that the patient has the ability to make their own decisions (Yeo, 91). Since Mr. S is lacking full decision-making capacity, he can not fully make this decision independently, thus becoming an important principle to consider. The third principle involves dignity, which incorporates the elements of self-worth, moral status and decision-making rights (RCN, 8). Dignity by definition, means to respect the patient’s values, recognize their worth, and have the patient recognize their own worth (RCN, 9). This becomes relevant in this case because Mr. S believes in his worth and that he can still be independent in his daily activities.
3. Since the wander guard is the least restrictive option, it is my recommendation that it be placed on Mr. S’s ankle. Before doing so, the team will need to explain to him how his safety is their main concern and how this option may prevent him from falling in the future. The care team will need to express their full reasoning behind the decision to place the wander guard on him and how its benefits outweigh the harms.
4. Beneficence is an ethical principle that not only acts to produce a good but to also prevent or remove harm (Yeo, 103). This principle is relevant in this case because the staff is working to try to prevent harm, or non-maleficence, by wanting to place the wander guard on Mr. S’s ankle. Mr. S is unaware that this ankle guard is necessary to keep him safe and prevent him from falling. It is necessary that the care team reduce further injury, and beneficence states that all interventions given to patients be beneficial. Beneficence is also linked closely with caring, and in this case, the nurse is using her skills and abilities to secure a beneficial outcome by being genuinely concerned for his safety(Yeo, 109). With Mr. S’s lack of ability to make independent decisions regarding his medical care, it is the team’s responsibility to ensure his safety by applying the wander guard and fulfill the principle of beneficence. The ethical principle autonomy must also be discussed in relevance to this case. Autonomy states that an individual is free to choose what they please and refuse anything they do not want (Yeo, 93). This important component of autonomy is referred to as free action. In this case, Mr. S is lacking full decision-making capacity and can not make a reasonable decision that align with his care goals. Another component of autonomy is effective deliberation, which states that an individual uses reason and is being rational about their decisions (Yeo, 94). This becomes relevant because Mr. S is unable to make rational decisions due to the nature of his injuries he sustained from a stroke. Since this patient lacks decision-making capacity, he is unable to be autonomous in his decision to decline the use of the wader guard.
5. The ethical principle that challenges this course of action is dignity. The care team must recognize Mr. S’s self worth and conserve his dignity by allowing him privacy. Since Mr. S’s ability to be independent and use the bathroom is limited, his dignity is being diminished. When an individual’s dignity is absent, people feel devalued and lack control and comfort (RCN, 8). Without dignity, Mr. S may lack confidence and be unable to make decisions for himself (RNC, 8). Mr. S strongly objects the use of the wander guard because he feels he can walk at night without the help of nurses. Privacy makes up a component of dignity, and the use of the ankle guard may have Mr. S feel ashamed and humiliated that he can not use the bathroom independently.
6. The principles of beneficence and autonomy and their ethical reasonings to place the wander guard on Mr. S outweighs the challenges presented by dignity. The main concern for Mr. S is safety, and placing the wander guard will prevent him from further injury. Beneficence states that the care team must do what is in the best interest of the patient, which means to prevent Mr. S from falling and hurting himself in the future. Since his decisions-making capacity is impaired, his autonomy to make full medical decisions for himself becomes limited. Although his dignity is being diminished, it is temporary until his health progresses and is able to fully make decisions for himself. Therefore, with the surrogate agreeing with the team to prevent Mr. S from falling, the wander guard should be placed.

Sources
Yeo, Moorhouse, Dalziel. (2010). Beneficence. Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pg 103-109.

Yeo, Moorhouse, Dalziel. (2010). Autonomy. Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pg 91-93.

Royal College of Nursing. (2008). Defending Dignity-Challenges and Opportunities for Nursing. Pg 8-9.