Ethical Considerations in Smoking Cessation: Decision Making

This article is an essay about ethical considerations in smoking cessation. It specifically covers the ethics of decision making. Study it to learn how to write similar essays and follow it to gain insights into how you can get expert essay writing help.

Ethical Considerations in Smoking Cessation: Decision Making

According to the University of California, School of Medicine (2010), Autonomy is the “personal rule of the self that is free from both controlling interferences by others and from personal limitations that prevent meaningful choice.” Although Mrs. Cheng is a cancer patient with only one month to live, nowhere is mentioned that she could be of unsound mind or suicidal as certified by a doctor so her decision to smoke is then made while in a state of sound mind.

The principle of autonomy states that patients are to be allowed to make their own decision without influence or coercion from another. Clearly, Mrs. Cheng’s decision was not to give up smoking. Asking Mrs. Cheng to decide not to go to the garden to smoke because of manpower constraints or any other reason which is not of the patient’s own is a violation of her autonomy which is definitely not ethical.

According to Beauchamp (2008), Beneficence is a “moral obligation to act for the benefit of others, helping them to further their important and legitimate interests, often by preventing or removing possible harms”. Smoking is generally bad for health, and more so for people who already have cancer. Smoking is known to increase the size and extent of cancerous cells and metastases. (Zow, Hsu, and Eng, 2004). Thus the nursing staff should advise and encourage Mrs. Cheng to stop or reduce the number of cigarettes she smokes as it will worsen her condition by possibly hastening her death.

Non-maleficence is defined as not deliberately causing unnecessary harm or injury to the patient, either through acts of commission or omission, “above all, do no harm” (McCormick, 2008). By restricting Mrs. Cheng to go out to smoke, the nursing staff is depriving Mrs. Cheng of possibly the only thing that she enjoyed in what is thought to be the last month of her life thus affecting her quality of life Mrs. Cheng has.

Mrs. Cheng might then become unhappy and miserable which might gradually cause her to become depressed or even suicidal since there is also no caregiver support for her as the rest of her family died in the tsunami. Thus, the nurse should not ask Mrs. Cheng to refrain from going out to smoke as they will be doing harm to the patient and violating the ethical principle of non-maleficence.

Justice refers to what the general public deems as right and fair (Hawley, G., 1997, p.26). To deprive an elderly patient of what she would like to do in the last month of her life is simply cruel and unjust. To utilize manpower to accompany a patient just for smoking 5 hours a day when the nurse would be able to do more for other patients in the ward is a waste of manpower as well as taxpayers’ money.

It is also unfair to the other staff that has to cover extra duties while this particular staff is away in the garden with Mrs. Cheng. Due to a shortage of manpower and unfinished work, the staff might have to stay back to finish their work, taking up their personal time which could be spent with their own family. Quality and duty of care to the rest of the patients might be in question if the remaining nurses in the ward have to rush to finish their work before the shift ends.

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Identify ethical conflicts

Beneficence versus Non-maleficence

Often a healthcare professional’s good intention might not be what is best for the patient. Though stopping smoking has its benefits to health, it seems almost futile to ask a person who only has one month of lifespan to quit smoking. For a smoking cessation program to succeed, it would take more than a month, not to mention Mrs. Cheng has to endure the unpleasant withdrawal effects and unhappiness in the last few weeks of her life of not having to smoke (Zow, Hsu, and Eng, 2004). To resolve the conflict between the two principles of ethics, one needs to weigh the risk and benefits between the two to make a decision (Pantilat, 2008).

Autonomy versus Beneficence

Autonomy requires the staff to respect the patient’s decisions whereas beneficence requires the staff to make decisions in the patient’s best interest, to remove harm and to do good. These two principles conflict as a result when what a patient wants is deemed harmful to her health and as a healthcare worker, the responsibility is to remove the harm. To resolve it, the healthcare worker should respect the patient decision as long as it is made in a state of sound mind and continue to try to convince the patient otherwise by making sure that the patient has all the information she needs to make a correct decision (Pantilat, 2008).

Consider the Law

Duty of care

A nurse owes a duty of care to a patient, and there is a nurse-patient relationship that creates that duty. (Corcoran, 2000) In this case, the staffs of the medical ward owe Mrs. Cheng a duty to see to her needs and wellbeing, ensuring safety by accompanying Mrs. Cheng to the garden being one of them. The nurse accompanying has the option of wearing an N95 mask supplied by the hospital for protection against the organic vapors from cigarette smoke. (Mask and More, 2010)

Patient advocacy

According to Singapore Nursing Board (SNB), Code of Ethics and Professional Conduct, Value Statement (2006), the nurses need to advocate in the best interest of the clients, by “ensuring clients’ interests and needs are recognized and considered by the entire healthcare team” and also protecting the clients from any form of coercion to involuntarily agreed to accept or change their decision.

In this scenario when some nurses are advocating for the other patients’ quality of care, it is very important to ensure that the nurses also advocate for Mrs. Cheng’s interests and needs as well so as to ensure fair treatment of all patients regardless of race or age. (SNB Code of Ethics and Professional Conduct, Value Statement 1, 2006)

Nurses and Midwives Act

Any registered nurse or enrolled nurse found to have been guilty of misconduct or negligence shall either be imposed a fine upon, or have their registration suspended or terminated. (Nurses and Midwives Act, Section 19, 2a-d) By breaching the duty of care and not abiding by the SNB Code of Ethics and Professional Conducts, the nurses are likely to be guilty of misconduct or even negligence if relations are proven between the breach of duty and the injury caused (Nair, n.d.).

Consent to Medical Treatment & Palliative Act 1995

“Medical Practitioners in the practice of palliative care for patients in the terminal phase of a terminal illness are protected from civil and criminal liability by the Act if they administer treatment only to relieve pain and distress, even though an incidental effect of the treatment is to hasten death, provided they act with consent; in good faith and without negligence; and in accordance with proper professional standards of palliative care”. (Consent to Medical Treatment and Palliative Act 1995, Section 7.1)

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In this case, a Nicotine patch could be a consideration provided that the patient consented to use it. It can be administered to relieve the urge to smoke thus preventing the patient from suffering from withdrawal when the staff is unavailable to bring her to the garden to smoke.

Capacity to give consent

According to the Mental Capacity Act 2008, Section 3 (2, 4), a person is assumed to have mental capacity unless proven otherwise, and should not be deemed as incapable of making a decision simply just because he or she made an unwise decision. Thus it is assumed that Mrs. Cheng is capable of making decisions for herself in terms of treatment and other things. The palliative team should then come together with the patient to discuss issues, propose suggestions, provide relevant information, and allow the patient to make a decision for herself.

Relationship between the clinical-ethical decision and the law

In nursing, decisions made regarding patients’ care and needs are always based on the ethics and standard of practice that the Nursing Board or Council upholds. The Code of Ethics and Professional Conducts, Standard of Practice, and Competency Standards are all in turn, written according to the Law in terms of legislation that govern it, e.g. Nurses and Midwives Act.

Making the ethical decision

The author believes that Mrs. Cheng should be allowed to continue to go to the outside garden to smoke in the company of nursing staff if she chooses to. This decision is justified by balancing the principles of ethics and by following the Australian Nurses and Midwifery Council (ANMC) Code of Ethics and the SNB Code of Ethics and Professional Conducts.

Ethical Considerations In Smoking CessationNurses are to promote and uphold patient autonomy by respecting the informed decision made by the patient concerning their own care. (SNB Code of Ethics and Professional Code of Conduct, Value Statement 2, 2006) Thus if Mrs. Cheng’s decision is to continue smoking despite being informed and educated on the hazards of smoking, then the nurses should accept and respect that decision.

According to ANMC, Code of Ethics, Value Statement 2.3, nurses who are indifferent to their colleagues’ plight, manipulative and bullying their colleagues are basically just disrespectful towards others and are ethically intolerable. Thus some of the staff from the ward should not use resignation to coerce the management or the rest of the nurses to agree to a decision that they are in favour of but might not be beneficial to the patient.

Document the decision

Effective documentation provides evidence to show individualized nursing care and the patient’s response to that care outcome. Proper documentation of the quality of care the nurses have given ensures that they would be able to defend themselves in court if they were being subpoenaed (Henderson, 2010).

The documentation would include the date and time, names of the people who are present during the discussion, topics discussed e.g. no smoking policy, assigning additional staff on each shift, and the understanding of the patient of these topics, comments from various parties including the patients, and the final decision, the plans to follow up and schedule a time for evaluation.

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The documentation of the decision will be done in a clear manner and according to the organizational guidelines. (ANMC Registered Nurse Competency Standards 6.3 and 10.3) The patient’s mental capacity will also be documented by the team doctor present at the discussion to ensure that patient did not agree to any decision when she is in a vulnerable state of mind (A Guide for Healthcare Professionals, n.d.).

Evaluate the decision

Ethical Considerations In Smoking Cessation: Decision Making
Ethical considerations in smoking cessation: decision making

Evaluation must be done throughout the whole process and not just at the end of it as it is a process of gathering data and analyzing it, using the information gathered to determine whether the plan is progressing towards the objectives and planned outcomes set initially (The Importance of Evaluation, 2005).

In order for the plan of care to succeed, continuous supervision, evaluation and revision of the plan of care in accordance with evaluation data is needed. (ANMC Standard of Practice, Standard 8.1 & 8.2, 2008 and Standard 3 of SNB Standard of Practice, 2006).

Reference List

  • A Guide for Healthcare Professionals: Consent to Medical Treatment and Palliative Act 1995 (n.d.). Retrieved from http://www.health.sa.gov.au/consent/documents/provisionsexplanation-pir-sahealth-1002.pdf
  • Australian Nursing & Midwifery Council. (2008). National competency standards for the registered nurse. Retrieved from http://www.anmc.org.au/userfiles/file/RN%20Competency%20Standards%20August%202008%20(new%20format).pdf
  • Australian Nursing & Midwifery Council. (2008.). Code of professional conduct for nurses in Australia. Retrieved from http://www.anmc.org.au/userfiles/file/New%20Code%20of%20Professional%20Conduct%20for%20Nurses%20August%202008(1).pdf
  • Australian Nursing & Midwifery Council. (2008). ANMC code of ethics for nurses in Australia. Retrieved from http://www.anmc.org.au/userfiles/file/New%20Code%20of%20Ethics%20for%20Nurses%20August%202008.pdf
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  • Beauchamp, T. (2008). The Principle of Beneficence in Applied Ethics. Retrieved from http://plato.stanford.edu/entries/principle-beneficence/
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  • Corcoran, M. (2000).What is negligence? BJU International, 86(3), 280-285.
  • Hawley, G. (1997). Ethics workbook for nurses. NSW: Social Science Press.
  • Henderson, J. G. (2010). Nursing: The importance of documentation and charting. Retrieved from http://www.helium.com/items/1427307-nursing-nurses-documentation-charting-quality-of-care-patients-soapie-litigation
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  • Mask and More, 2010. Retrieved from http://www.masksnmore.com/3mmasks1.html
  • McCormick, R. T. (2008). Ethics in Medicine: Principles of Bioethics. Retrieved from http://depts.washington.edu/bioethx/tools/princpl.html
  • Nair, S. (n.d) Medical Negligence: Duty of Care. Retrieved from http://www.sma.org.sg/sma_news/3307/duty_of_care.pdf
  • Pantilat, S. (2008). Ethics Fast Facts: Autonomy versus Beneficence. Retrieved from http://missinglink.ucsf.edu/lm/ethics/Content%20Pages/fast_fact_auton_bene.htm
  • Pantilat, S. (2008). Ethics Fast Facts: Beneficence versus Non-maleficence. Retrieved from http://missinglink.ucsf.edu/lm/ethics/Content%20Pages/fast_fact_bene_nonmal.htm
  • Singapore Nursing board. (2006). Code of ethics and professional conduct. Retrieved from http://www.snb.gov.sg/html/1151900236839.html#II
  • Singapore Nursing board. (2006). Standards of practice for nurses and midwives. Retrieved from http://www.snb.gov.sg/html/1153709353750.html
  • Poon, E. (n.d.). Nursing Challenge in Hospice Care. Retrieved from www.hpp.moh.gov.sg/HPP/1250487879924.html
  • Singapore Cancer Society. (2008). Colorectal Cancer. Retrieved from http://www.singaporecancersociety.org.sg/lac-fcco-colorectal-cancer.shtml
  • Singapore Ministry of Defence. (2006). Deadly for of Air Pollution. Retrieved from http://www.mindef.gov.sg/imindef/mindef_websites/topics/elifestyle/articles/smoking/deadly_form_of_air.html
  • The Importance of Evaluation. (2005). Retrieved from http://www2.guidestar.org/rxa/news/articles/2005/importance-of-evaluation.aspx?articleId=767
  • World Health Organization. (2010). Definition Of Palliative Care. Retrieved from http://www.who.int/cancer/palliative/definition/en/
  • Zow, H. C., Hsu, A. A. L., & Eng, P. C. T. (2004). Smoking cessation programme: the Singapore General Hospital experience. Singapore Medical Journal (2004), 45(9), 430. Retrieved from http://www.sma.org.sg/smj/4509/4509a4.pdf

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