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Chapter 6
A nurse is caring for a 36-year-old patient with a brain tumor who is dying. The patient has undergone surgery and chemotherapy, but nothing has worked so far to stop the growth of the tumor. The physician offered the patient one further treatment plan that could prolong life for a few weeks, but the treatment has painful side effects. The patient tells his nurse that he is at peace with the prognosis and wants to stop all further treatment. The nurse is troubled by the patient's response. She feels confident that the side effects could be managed, and, for her, refusing treatment violates a belief in the sanctity of life. Which of the following accurately describes ethical principles at stake in this situation? (Select all that apply.)

1. Even though the patient does not want it, making sure that the patient gets all possible treatments including experimental treatments will show a commitment to justice for this patient.

2. Respect for the patient's autonomy is a fundamental ethical commitment and needs to be taken into consideration when making clinical decisions with a patient.

3. The principle of beneficence implies that the providers need to ensure the patient receives the treatment because it could possibly work to the patient's benefit.

4. The nurse will remain committed to advocacy for this patient, speaking for the patient's point of view even though it conflicts with her own beliefs. Her commitment reflects a professional commitment to fidelity.

5. The nurse's concern about managing difficult side effects represents the practice of nonmaleficence, the commitment to do no harm.
Chapter 6
A new nurse on your unit brings up a concern during a staff meeting about a patient on your unit. The nurse thought the patient was male based on the patient's name and the notes in the medical record. However, during her initial assessment, she discovered that the patient has female anatomy. The nurse has never been assigned to care for a transgender person and is uncomfortable taking care of this patient. The manager listens to the nurse's concerns but states that she cannot reassign this patient without making sure that another nurse is willing and available to take the assignment. Otherwise, the assignment will need to stand as is. She promises to conduct an in-service about caring for transgender patients as soon as possible. Which of the following accurately describes the ethical principles reflected in the nurse manager's response? (Select all that apply.)
1. The nurse manager demonstrates fidelity, the professional promise to the patient for quality care and a refusal to abandon the patient.

2. The nurse's willingness to make a change in assignment reflects her willingness to do no harm to staff nurses, or nonmaleficence.

3. The nurse manager is trying to take a positive action to help the new nurse as well as the work unit as a whole, which is an example of beneficence.

4. By taking into account the new nurse's discomfort, the nurse manager strives to respect the autonomy of the nurse as a provider, while at the same time respecting the autonomy of the patient.

5. The best way to ensure the principle of justice for this patient would be to consult with an attorney about local laws pertaining to transgender individuals.