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NURS407-The Social and Moral Context of Health

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According to the ANA Code of Ethics for Nurses with Interpretive Statements (2015) Provision 1.4, nurses have a moral obligation to respect human dignity and certain patient rights, especially patient self-determination.

Create a scholarly paper and discuss and evaluate some strategies the nurse can implement to ensure the respect of human dignity and self-determination for an incompetent patient?


Social and Moral Context of Health

Nursing is a profession which is governed by certain well-outlined professional codes of ethics. All the nurses who are licensed to operate in the USA, for instance, are expected to adhere to the ethical codes of conduct set by the American Nurses Association (ANA). As an umbrella nursing body in the country, ANA has come up with nine ethical provisions each of which is aimed at improving the delivery of high-quality, safe, accommodative, individualized, and competent care to the satisfactory of the patients. The purpose of this paper is to provide the strategies that a nurse can adopt to implement provision one of the code when dealing with an incompetent patient who is not capable of making reasonable decisions regard
ing their health and treatment plan.

According to this provision, all nurses are obliged to observe passion and respect for the worth, uniqueness, and dignity of each patient. Provision 1.4 of this code specifically states that the nurses have a moral obligation to respect human dignity and certain patient rights, especially patient self-determination (Zahedi, Sanjari, Aala, Peymani, Aramesh, Parsapour & Dastgerdi, 2013). This implies that all the nurses must respect the autonomy of their patients and give them an opportunity to participate in their treatment process. Meaning, before making any decisions, the nurse must seek the consent of the patient because that it what is legally and morally-accepted (Masters, 2015). However, although that is what the provision dictates, nurses often find it challenging to apply this provision especially when presented with an incompetent patient. An incompetent patient simply refers to the one who is legally recognized to be unable to make any reasonable healthcare decision due to incapacitation-mental illness or terminal diseases. Should a nurse be confronted with this situation, a nurse might choose to adopt the following strategies to overcome it.

The first strategy that a nurse can apply to address the situation is to rely on a guardian to act in charge of the patient. A guardian, as its name suggests, is a person or group of persons who act on behalf of someone else. In this context, a guardian is used to refer to a person who was chosen by the patient to be in charge of him or her. Meaning, should the patient be incapacitated and rendered incompetent, the guardian should act on his or her behalf. That is the reason why the patients choose their guardians (Scott, Mitchell, Reymond & Daly, 2013). Since the patient is not competent, it is the guardian who should be relied upon to give consent because they are close to the patient, were appointed by the patient, and will always act for the best interest of the patient. Hence, if there is room for using a guardian, the nurse has no choice, but to involve them and give them an opportunity to consent to the treatment to be given to the patient.

The second strategy that a nurse can use to handle an incompetent patient is by resorting to surrogate decision-making. A surrogate is an agent that is selected and authorized by the court of law to act on behalf of an incompetent patient. The choice of a surrogate can be done under the hospices of the powers of the attorney. In case this happens, it is the surrogate who is charged with the responsibility of making all the decisions that were otherwise be made by the patient if at all he were competent (Fritch, Petronio, Helft & Torke, 2013). However, since it has been established that the patient is not in a position to make any contribution, it is the surrogate who will have to assume the powers ad act on his behalf. The nurse will, therefore, have to consult the surrogate and allow him to give consent before any kind of treatment is given. This is what the provision allows because it is also permitted by the common laws governing autonomy, consent, and human rights in the country.

  The third strategy that a nurse can apply when handling an incompetent patient is to rely on the advanced directives. An advanced directive, as its name suggests, refers to the instructions that had been given prior. A patient who issues an advanced directive writes his opinion when he is still competent enough to do so. Hence, in case such a patient becomes incompetent, the nurse does not have to be in a dilemma, but to rely on such a directive to make the required decisions (Torke, Sachs, Helft, Montz, Hui, Slaven & Callahan, 2014). The nurse is morally right to apply what is written in the advanced directive since it contains what they need to be done to them when incapacitated. For this reason, it should also be used as consent.  

Last, but by no means the least, the nurse should apply the principles of implied consent. Here, the nurse does not necessarily have to rely on the informed consent of the patient, surrogate or guardian, but to assume that the patient has given a consent based on some actions that might be interpreted to mean approval for medication. Implied consent might be of great help when delivering emergency care because during such times, the nurse might not have to waste any time since an immediate intervention needs to be taken to salvage the life of the patient from imminent danger (Kakar, Gambhir, Singh, Kaur & Nanda, 2014). Under implied consent, there is no need to seek for a formal consent because once it is given, the nurse assumes responsibility and takes a full charge of the patient.

In conclusion, nursing is a discipline that is governed by well-outlined ethical standards. At all times, the nurses should strictly observe the ANA provisions because they were formulated for the benefit of the public who have entrusted the nurses with their lives. Hence, to deliver satisfactory care, the nurses must ensure that they respect for the worth, uniqueness, and dignity of each patient. However, I case of incompetency, the nurse should be ready to rely on implied the guardian, and surrogate consent,


Fritch, J., Petronio, S., Helft, P. R., & Torke, A. (2013). Making decisions for hospitalized older

adults: ethical factors considered by family surrogates. The Journal of clinical ethics, 24(2), 125.

Kakar, H., Gambhir, R. S., Singh, S., Kaur, A., & Nanda, T. (2014). Informed consent: corner

stone in ethical medical and dental practice. Journal of family medicine and primary care, 3(1), 68.

Masters, K. (2015). Role development in professional nursing practice. Jones & Bartlett


Scott, I. A., Mitchell, G. K., Reymond, E. J., & Daly, M. P. (2013). Difficult but necessary

conversations—the case for advance care planning. Med J Aust, 199(10), 662-6.

Torke, A. M., Sachs, G. A., Helft, P. R., Montz, K., Hui, S. L., Slaven, J. E., & Callahan, C. M.

(2014). Scope and outcomes of surrogate decision making among hospitalized older adults. JAMA internal medicine, 174(3), 370-377.

Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., ... & Dastgerdi, M.

(2013). The code of ethics for nurses. Iranian journal of public health, 42(Supple1), 1.

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