Ethical and Legal Implications of Prescribing Drugs
The case scenario is of an 85-year-old female admitted to a long-term care facility. She has significant cognitive decline, renal failure, and CHF. She is on blood thinners, having had a valve replacement twenty years ago. The physician’s report reveals that she is nearing her death. She can barely tolerate the lab draws necessary to check her INR.
Ethical and Legal Implications
Healthcare providers play a central role in patient care. Their roles and decision-making processes are, however, guided by a set of ethical and legal provisions. The ethical principle of beneficence implores nurses and other caregivers to protect the interests of the patients by working with them toward optimizing clinical outcomes (Akdeniz et al., 2021). In this respect, they are expected to make critical decisions that enhance the survivability of their patients. Notwithstanding, the decision to do good to the patients may sometimes be challenging. Such is the case when terminal illnesses are involved. In the case presented, the decision to continue life-sustaining interventions such as monitoring for INR may pose a dilemma to the nurses as the patient agonizes the process. While these efforts are targeted at sustaining her life, she seems not to be comfortable with them. The caregiver’s dilemma, in this case, is whether to proceed with this life-sustaining process, knowing the kind of pain the caregiver elicits in the patient. Discussing the prognostic findings and the available therapeutic options with the patient may be helpful in this respect.
Caregivers also have legal obligations toward patient care and accountability for high-quality care. As per Minnesota’s statutes, patient care involves all processes encompassed within the scope of nursing practice. This includes patient monitoring. In the case scenario presented, nurses are obligated to monitor the patient, including conducting tests that contribute to the therapeutic decision-making for the patient. Notwithstanding, understanding the plight of the patients is another mandate for nurses enshrined in the legal provision of ethical practice. Striking a balance between legally astute and ethnically sound practice and the recognition of human dignity is therefore necessary. Discussing available therapeutic options with the patient may help nurses decide whether to continue life-sustaining therapy or initiate end-of-life care.
Strategies to Address Disclosure and Non-Disclosure
Medical disclosure defines the communicative process between the caregiver and the patient, which is targeted at making specific health information available to them. Disclosure and non-disclosure policies are central to privacy protection and are legally abiding. In the case presented, nurses and other caregivers handling the patients will have to disclose the prognostic findings to the patient and her family. Several strategies can be used to disclose this information. The first step is recognizing that the patient preserves the right to know their prognosis (Nwodoh et al., 2020). Prognostic information should be based on clinical evidence and not the provider’s assumptions. In the event close family members are involved in the therapeutic process, revealing this information to the family member to, in turn, tell the patients may be helpful. When revealing such information, it is important to utilize best practices in healthcare communications, such as the demonstration of empathy and the use of simple language to explain to them the clinical situation and what informed the decision. In the absence of family members, caregivers can directly disclose the information to the patient. This should be considered only when the patients have the mental capacity to decipher this information. Likewise, caregivers disclosing this information should be empathetic, direct, and precise.
Strategies to Guide Decision-Making
In the case presented, my decision-making as to which course of action to take will be based on the ethicality and legality of nursing practice. The first strategy is to discern whether the decision is ethically sound. In this respect, my decision will be guided by the ethical provisions of beneficence and autonomy. As Elahi et al. (2020) report, autonomy grants patients authority over their clinical decision-making processes. The patient, in this respect, preserves the right to know what is ailing them, the available therapeutic options for them, and the prognostic findings. A legal angle to this will be to decide whether the decision is legally acceptable. Per the Minnesota statutes, an individual with a terminal illness has the right to receive written information about their condition. This further supports the disclosure of information. In case of a medication error, the law, per the Mnessota’s statutes, mandates disclosure of medical and medication errors to the client. In this respect, I am obligated to disclose any medical or medication errors to the client upon realizing such errors.
Process of Writing a Prescription
Writing prescriptions follows a systematic approach that starts with the establishment of an accurate diagnosis. This is followed by making a follow-through of the available medications and any information on these medications, such as the potential adverse events and the potential for drug interactions. Patient factors that may affect how the drug works or interplay in medication toxicity are then scrutinized. This includes the presence of pregnancy, age, and other underlying conditions. Patient opinions and belief systems on medications may also be interrogated to determine the suitability of one drug over another. The current national guidelines are then scanned to check for recommendations on the use of various medications. A medication is then selected. The selected medicine should be compatible with the patients, specific to the diagnosis, and effective in addressing the diagnosis. The prescription is then written and bears the patient’s information, diagnosis, and selected medication. Prescriptions should be within the prescriber’s limitations pertaining to their knowledge, legal requirements, and experience.
References
Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations in end-of-life care. SAGE Open Medicine, 9, 205031212110009. https://doi.org/10.1177/20503121211000918
Elahi, N., Rouhi-Balasi, L., Ebadi, A., Jahani, S., & Hazrati, M. (2020). Professional autonomy of nurses: A qualitative meta-synthesis study. Iranian Journal of Nursing and Midwifery Research, 25(4), 273. https://doi.org/10.4103/ijnmr.ijnmr_213_19
Nwodoh, C. O., Okoronkwo, I. L., Nwaneri, A. C., Ndubuisi, I., Chinweuba, A. U., & Iheanacho, P. (2020). Terminally-ill patients’ prognosis information preferences in an African setting: A qualitative descriptive study. International Journal of Africa Nursing Sciences, 13, 100220. https://doi.org/10.1016/
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Question 
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?
Optimizing Healthcare Performance- The Three Pillars of the Triple Aim
These are some of the questions you might consider when selecting a treatment plan for a patient.
As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs are in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore the ethical and legal implications of scenarios and consider how to appropriately respond.