Ethical Dilemmas in Nursing

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Nurses face ethical dilemmas in their day-to-day practice. This is regardless of where they work. Ethical dilemmas can affect either positively or negatively on both the patient and the nurse. Ethical dilemmas present problems that do not have a precise solution. This makes it hard for nurses to determine if the decisions they make in such a case are appropriate. However, ethical dilemmas do not have particular right or standard solutions. These call for the nurse to apply their knowledge of ethics, in order to come up with a solution that will not cause harm and that is ethically right. However, a nurse’s past experiences, values, and beliefs may influence this solution. In addition, one ethical dilemma can be solved in a variety of ways. In this paper, I will give a case of an ethical dilemma in nursing, and discuss how this can be resolved using the 2009 Ethical Decision-making algorithm by Catalano.

Ethical issues vary and may involve legal issues, pro-life issues, deception versus truth telling, quantity versus quality of life, control versus freedom, among others. A nurse will react differently to each of these ethical dilemmas (Lipe & Beasley, 2003). My case of ethical dilemma is a pro-life versus pro-choice situation, experienced some time ago by a friend who is a practicing nurse. This involved a fifty-year old woman in the ICU. She had been in the ICU for over one year, and shows no probability of getting better; instead, she gets worse each day. The patient wants her life to be terminated to save her the pain. However, her family does not agree with her wish, and advise the nurses to keep her. She undergoes multiple painful surgeries for her sustenance. The hospital knows that if they prolonged her life, it will be of low quality and full of pain. They however cannot perform anesthesia on her as the family threatened to sue the hospital if they took that step. On the other hand, the patient is bitter that her wish of ending her life has not been granted.

This is a perfect example of an ethical dilemma. All the parties involved express different wishes and interests. The patient wants her life terminated to escape the pain; her family wants the nurse to prolong her life, while the nurse wants to save her patient much pain by performing mercy killing. Each party faces obstacles in fulfilling their desires. The patient’s family is the main obstacle as they threaten the nurse with suing if she terminates the patient’s life. Now, the nurse is to come up with a decision that will be neutral on side of the patient as well as that of her family. If the nurse prolongs the patient’s life, she will be prolonging her suffering, thus causing her harm. On the other hand, if the nurse complies with her patient’s wish, she may get in trouble with the patient’s family, and so cause a strained relationship, which sounds unethical. Catalino’s ethical decision-making algorithm would have come in handy in directing the nurse to the most appropriate decision (Denier, Casterlé, De Bal, & Gastmans, 2010).

According to Catalino’s ethical decision-making algorithm, decision-making starts with assessment. This involves determining the party that will be most affected by the decision. Enough facts, including the potential risks of the patient, are gathered to arrive at this. The second step is to collect, analyze and interpret data. Here, the nurse makes use of the information they have to determine possible outcomes. Thirdly, the dilemma is identified and stated. In this case, the identified dilemma is to grant the patient her wish or to listen to her family (Deshpande, 2009).

Next is to decide if the nurse can resolve the dilemma or not. If no, the nurse should not take any action, if yes, the possible solutions to the dilemma should be stated. Acceptable and unacceptable consequences are then identified. If the consequences are acceptable, an ethical decision can be taken, if they are unacceptable, no action is to be taken. If ethical decision is taken, the dilemma is resolved. Here, if the nurse grants the patient her wish, the family will be disappointed; however, the patient will have been relieved of pain (Sugarman & Sulmasy, 2010).

In this case, the needs of the patient are of more importance than those of her family. Prolonging her life will subject her to endless pain and suffering, the nurse therefore has the mandate of relieving the patient of pain and suffering, against the wish of her family. If at all the nurse finds herself in legal wrangles with the patient’s family, she remains innocent, as long as she has evidence to prove her case.

References

Deshpande, S. P. (2009). A study of Ethical Decision Making by Physicians and Nurses In

Hospitals. Journal of Business Ethics, 90(3), 387-397.

Denier, Y., Dierckx de Casterlé, B., De Bal, N., & Gastmans, C. (2010). It’s intense, you

know. Nurses’ Experiences in Caring For Patients Requesting Euthanasia. Medicine, Health Care and Philosophy, 13(1), 41-48.

Lipe S, & Beasley S. (2003). Critical Thinking in Nursing: A Cognitive Skills

Workbook. London: Lippincott Williams &Wilkins.

Sugarman, J., & Sulmasy, D. P. (2010). Methods in Medical Ethics. Georgetown: Georgetown

University Press.

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