Ethical Reasoning

The Function of Ethical Reasoning
Paul & Elder (2006) tells us that ethics examines the right and wrong, the helpful and harmful of human behavior. It is important to understand the egocentric tendencies of humans and counter those tendencies by cultivating outwardly motivated thoughts because our actions ultimately affect others (Paul & Elder, 2006). With palliative sedation, we must discuss opportunities for harm that could arise so we can be prepared to avoid the harm.

The Problem of Pseudo-Ethics
Pseudo-ethics evaluate issues using religion, social understandings, cultural ideals, political powers, and legality. It confuses a true discussion of ethics, which should be able to set standards of humanity across all social groups, regardless of politics, social status, or religious preference (Paul & Elder, 2006). For instance, one religious standard may believe that suffering is an essential part of our human existence and determine that palliative sedation violates that idea. This will not prove true across all religious views though. Staying focused on the principle of non-maleficence guides our thoughts toward protecting Annie from harm, regardless of how religion, politics, or social groups view this issue.

The Logic/ Elements of Ethical Reasoning
Paul & Elder (2006) have described eight different elements of ethical reasoning. The first is purpose. In Annie’s case, our purpose is to find a solution that produces the least amount of harm or potential for harm to her, those providing care, and society in general. Secondly, guiding this purpose, we must form a question: Is the harm of death more important than the harm of suffering? Our question will help direct our focus for the third element of ethical reasoning, the collecting of information pertinent to our issue. I found several articles that discuss this principle. Powers & McLean (2011) support the idea that if a person is terminally ill and there is no hope for life, then offering relief from suffering is a sound practice of doing no harm. Broekhaert & Lueven’s (2011) position is that the harm is attached to the intention. Since palliative sedation’s intention is to relieve suffering, not cause death, then there is no harm (Broekhaert & Lueven, 2011). Berger (2011) discusses how palliative sedation has the potential to cause dehydration enough that the patient dies from this effect of treatment, rather than the terminal illness, and then should be considered a form of killing, or harm. The fourth element of ethical reasoning has us look for concepts. In Annie’s case, the prime principle that stands out is non-maleficence, or doing no harm. Some competing principles in this scenario involve Annie’s rights to make decisions for herself (autonomy) and of course the alternate to non-maleficence, beneficence or in doing well for Annie. The fifth element relates to assumptions. The main theme I have seen throughout my research in this case is that the benefit of relief of suffering outweighs the potential for death in terminally ill patients with intractable pain. Since the positive sides of the issue are most discussed, it would be easy to assume this is most right. However, the sixth element of reasoning directs us to look at differing points of view. It is important to make efforts to search out the other side of arguments. Valko (2002) believes that palliative sedation is a way of getting around euthanasia laws and says that pain can be controlled in other ways. Billings & Churchill (2012) offer a comprehensive look at the issue by applying several different ethical frameworks to the issue. Instead of just relying on double-effect which decides moral good based on intention, they show how deontology would reject palliative sedation because it cannot be applied without harm universally (Billlings & Churchill, 2012). Considering all of this information, the seventh step is to begin drawing conclusions. I would tend to reason that Annie’s case warrants palliative sedation, but I believe these cases need to be evaluated carefully and separately. For Annie, there does not seem to be any other options to relieve her pain. The last element ponders the implications of my conclusion. If I follow my idea to pursue palliative sedation with Annie, I will contribute to relieving her suffering but also may be vulnerable to legal scrutiny. If Annie is not offered palliative sedation, while I might feel a protector of the sanctity of life and safe from prosecution, Annie continues to suffer her last days in mortality.

Advantages and Disadvantages
The advantage to ethical reasoning for advanced practice nurses is that we will be prepared to meet the challenges of healthcare concerns. As we practice applying principles to different cases, we will become skilled in how to intellectually evaluate situations and will have confidence in our conclusions. Sometimes, dissecting a situation too much may lead to more confusion on the topic and will never lead to satisfaction. We should remain focused on finding solutions that provide the best care and produces the least harm.