Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family. Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state (Alabama). Explain two strategies that you, as an advanced practice nurse, would use to guide your decision-making in this scenario, including whether you would disclose your error. Be sure to justify your explanation. Explain the process of writing prescriptions, including strategies to minimize medication errors.

Ethical and Legal Implications of Prescribing Drugs

This article reviews a scenario involving an 85-year-old female patient, MA, residing in a long-term care facility. MA has significant cognitive decline. Her physician notes that her death is near as she has terminal health issues such as renal failure and CHF. She has been on blood thinners for two decades due to a valve replacement procedure. She is always in pain during lab draws for her INR. This scenario raises the ethical and legal question of whether continual monitoring of the INR is needed given her terminal status and presents the ethical and legal implications of prescribing drugs.

Ethical and Legal Implications of the Scenario on All Stakeholders Involved

There are various stakeholders involved in caring for MA. These include the prescriber, the pharmacist, the patient, and the patient’s family. MA’s situation has varied ethical and legal implications for each stakeholder involved. For instance, the prescriber in the case has the prescriptive authority to prescribe the INR for continuous monitoring of MA’s condition. Various laws and standards for prescription drugs govern prescriptive authority, whether full or limited authority. Having a prescriptive authority gives one a responsibility to ensure the safety of the patient and avoid complications related to errors in the medication process. Safe and competent prescription and management of medications require an understanding of the drugs and the health conditions they are used for (Rosenthal & Burchum, 2021). It also requires a consideration of the existing regulations and ethical obligations of the health professional prescribing the drugs. The prescriber is ethically and legally obligated to ensure that the benefits of the continued INR outweigh the suffering MA undergoes during every lab draw and ensure that the continued INR monitoring is conducted per the patient’s end-of-life wishes.

The pharmacist is also legally and ethically obligated to ensure that the continued prescription and administration of blood thinners to MA is correct and does not complicate the patient’s current physical and mental health status. Additionally, the pharmacist must ensure the blood thinner therapy improves MA’s quality of life in her end days. The pharmacist should continuously communicate with the prescriber on all orders made for INR to ensure reduced risks for potential errors in the prescription of blood thinners. In collaboration with the prescriber, the pharmacist has the practitioner’s role and responsibility of providing information to the patient and their family and helping them understand the details of the therapy, including the intended therapeutic effect, risk of side effects and unwanted outcomes, and the approaches to be adopted in case of unwanted and unexpected outcomes (Arcangelo et al., 2017, p. 46).

As the patient and recipient of care in the scenario, MA has the right to autonomously decide whether she needs the INR and care provided to continue or discontinued. On the other hand, the patient’s family needs to be a part of the decision-making process in a relational capacity. They can make the end-of-life decision for MA in case her declining cognitive abilities incapacitate her to make such decisions. Healthcare providers must respect the patient’s and her family’s decisions. Ensuring autonomy at the end of life can help support decisions on treatment and care as well as support the patients’ engagement in the care plan as they actively prepare for dying (Houska & Loučka, 2019).

Disclosure and Nondisclosure Strategies in Alabama

In MA’s case, the physician believes that her death is near based on her current terminal status. The physician has the responsibility of disclosing this information to the patient and her family. However, disclosure and nondisclosure in end-of-life care must consider both legal and ethical perspectives. In the state of Alabama, the law provided in the 206 Code of Alabama, AL Code § 22-8A-1 (2016) Section 22-8A-1, the Alabama Natural Death Act, provides procedures for the termination of medical and other life-sustaining procedures. In the disclosure, the physician must provide details on the INR monitoring and the patient’s status to gain informed consent to discontinue treatment at the end of life. Although Alabama has no specific death with dignity legislation, the Alabama Natural Death Act has a provision that requires health providers to disclose the patient’s condition to the patient and their family. The Alabama Natural Death Act provides competent adults to decide on the withdrawal of life-supporting care in the case of permanent terminal conditions resulting in prolonged or permanent unconsciousness.

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