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The nurse is often a moral spectator observing decisions made by others and dealing with the patient’s response to those decisions.

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Analyze an article about a situation where a decision by a physician, insurance company, government agency or health institution adversely affected a patient or countermanded a patient’s wishes.

Write a mini-paper of three pages that addresses the following points:

· The nurse’s role in affirming the patient’s wishes and risks involved

· The social and economic consequences of reversing this decision

· Guidance from the Code of Ethics that sheds light on this situation

· Guidance from the Spirituality in Nursing which affects the situation

· The lessons to be learned for similar future situations

· The moral residue that haunts the nurse

The paper should be an APA formatted paper. The components should include a title page, the body of the paper with a conclusion, and a reference page. You will have in-text citations APA cited and you will have the reference page APA formatted. You should have at least three (3) references that support your viewpoint.

Please make sure your work is your own and do not copy and paste from an article. The faculty will be checking plagiarism so please do not plagiarize. If there is plagiarism you will receive a zero on the paper.

Respond to two students

Student 1

1. From an ethical and legal standpoint how should a physician handle these situations? The physician must respect the patient’s decision and follow the advanced directive. The physician would be maintaining the patient’s autonomy in this situation. Autonomy is the ability of the patient to make their own personal decisions about their care or treatment (Holman et al., 2019). 

2. If the patient can indicate that he wishes to accept platelets at this time, should his Advanced Directives be disregarded? If the patient were to verbally express, they want treatment the advanced directive can be overridden. 

3. Would the situation be different if the patient were a minor and the parent’s refused transfusion? If the patient was a minor and the parent refused life saving measures the physician would be obligated to involve child welfare (Mahaswaren, 2007). Also, if it was an emergency, by law the physician would have to complete the transfusion (Mahaswaren, 2007). 

Student 2

1. From an ethical and legal standpoint how should a physician handle these situations?

From an ethical standpoint, it is complicated because two important ethical principles involve beneficence and non-maleficence; by not giving the patient the platelet transfusion he needs, the physician can be doing more harm than good for the patient. Another important ethical principle is respect for autonomy; it is the patient’s right to refuse the platelet transfusion as part of his religious beliefs, even if it is needed to save his life. From a legal standpoint, an Advanced Directive is a legal document that outlines the patient’s desired medical care if they can non longer make decisions for themselves; if it is valid and applicable to the situation, it must be followed (Bonner et al., 2009). 

2. If the patient can indicate that he wishes to accept platelets at this time, should his Advanced Directives be disregarded?

If the patient is competent and states that he wishes to accept platelets, they can be disregarded because the purpose of the Advanced Directives is to outline desired medical care if the patient is no longer able to make decisions on their own. However, it is difficult to say that he is completely competent to make this decision because the article states that he is only oriented to person due to his illness; this excludes orientation to place, time, and situation. Since he is not fully competent, the argument can be made that he cannot make sound medical decisions for himself and the Advanced Directives must be followed instead.

3. Would the situation be different if the patient were a minor and the parents refused transfusion?

If the patient were a minor, according to Mahaswaren (2007) the physician would be required to give a transfusion in an emergency situation even if it went against the parents’ wishes. The physician would be required to notify child welfare authorities to provide administrative consent in the place of parental consent (Mahaswaren, 2007).

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