Ethical Dilemma in Nursing Practices

Legal and ethical issues in nursing practices are progressively changing, and staying updated with the changes is necessary for the workers since the approach and criterion nurses use for work are also affected by the constant changes and demands in the health systems. Ensuring community health is an essential factor for the growth and development of health in society. Also, primary care and public health have constantly grown. It has been shown that they are significant for health promotion and prevention of pandemics in the community before they evolve to become a danger to the population. The evolution in the available number of nurses also plays a significant role in achieving legal and ethical nursing practices. A limited number of nurses and resources are a vulnerable part of which we must educate ourselves and create generations for health development. The primary aspect to consider at all times has been demonstrated with the adherence and observing the legal and ethical issues in the nursing practices to overcome the dilemmas encountered during nursing practices. Adhering to these codes of conduct benefits every party, including the patient, the family, and the healthcare staff. Being a professional nurse is associated with several challenges since one must comply with all these diverse obligations in political, social, and healthcare segments. Values and concepts such as fidelity are primary definers of nurses’ behavior and actions since nurses serve as mediators between patients, management of the hospital, healthcare system, and the patient’s relatives. This paper aims to discuss ethical dilemma encountered in a healthcare setting and how the dilemma was resolved. Based on the analysis of the situation, suitable ethical decision-making initiatives and theories will be suggested to handle similar cases in the future.

Massage the Dilemma

Although there are legal and ethical guidelines, ethical dilemmas are common in nursing practice. Therefore, on the ethical dilemma cases occurred in my workplace in the recent past. The dilemma occurred in the hospital, where a patient was transferred due to health complications. After several tests, it was discovered that the [patient had cancer with minimal chances of being cured. The thirty-five-year-old patient (woman) was informed about her condition upon being released from the hospital to home through her family doctor. The patient lost hope after being informed about her condition, which made her stop taking medication as prescribed and refuse essential treatment procedures such as insertion of urinary catheters for her organs and survival. Besides the family doctor’s confrontation, her family convinced her to stay at the hospital because she still had a chance of being cured. However, the doctors had discovered she was terminally ill and informed the family, which agreed not to inform the patient to avoid weakening her hope. The family started planning vacations immediately after being released from the hospital to divert the patient from her situation. However, the outcome was worse than expected since the patient died without knowing her actual medical condition. Generally, this situation involved the medical professionals, relatives, and the patient as the primary actor. Honoring the needs of the relatives pushed the nurses towards an ethical dilemma of lying and being dishonest with their patients. The situation is a common type of ethical dilemma, although it is still unclear whether doctors should confront their patients about their terminal illness or not since the case has both disadvantages and advantages.

Outline the Options

Resolve the Dilemma

Patients have the right to be fully informed about their medical condition according to the individual’s right of freedom to decide on their own behalf, with no undue manipulation from others. Patient autonomy is the ethical principle that influences these kinds of medical thoughts, which are the primary sources of ethical dilemmas. According to the International Code of Medical Ethics, as per the 57^th amendment by the WMA’s General Assembly (2006), doctors should act as per the interest of the patients when providing medical care, including respecting their decision to refuse or accept treatment (Hamric et al., 2013). Also, the Declaration of Patient Rights (2005) states that patients have the right to self-determination, while doctors should inform them about the results of their decisions (Hamric et al., 2013). The only exception to these declarations is the state of emergency where the patient in question cannot provide consent, and any further delay in treatment would result in death. In this case, the situation was different. Creating a barrier by dishonoring the declaration could not be discovered of significance since factors such as non-adherence were more influential in the presented context. Therefore, telling the truth to the patient was not good due to the chances of causing harm and disregarding associated controversies. Lying to the terminally ill patient was the only appropriate ethical action.

Act by Applying the Chosen Option

To implement the theory, it is important first to determine the appropriateness of lying by using a well-established decision-making framework. Before implementing, one has to test the patient’s ability to make informed decisions and evaluate their psychological wellbeing to ensure any slight deviation does not result in autonomous decisions. Before implementing, we also considered similar cases in the past and in practical experience to determine the features of casuistry (Butkus, 2014). It also helped in availing support by considering the option with real-life examples. We also discussed the situation with different professionals to identify gaps and reduce stress levels.

Look Back and Evaluate

After profound evaluation, casuistry theory was the most appropriate for the situation. It eliminated bias by considering the prevalence of the potential exceptions and the practical side of the ethics (Butkus, 2014). In the context of this case, the doctors who had explicit conduct with the relatives considered lying the best option for the patient. In contrast, the nurse, who directly dealt with the patient, had to experience stress and discomfort by concealing the truth. Therefore, deceiving the patient about their medical condition was considered a professional duty and obligation while being considered a potential benefit for all parties, including the doctor-patient relationship. At first, I viewed the action of family and medical personnel as wrongful as it evoked some emotions like skepticism, doubt, and frustrations. However, after profound evaluation, I found the action was logical ad ethical. If not for deceiving the patient, her condition would have worsened due to a lack of desire to continue medical treatment and increased depression.

Discussion

We chose to adhere to the family’s needs and avoid telling the patient about her medical condition, but she still died out of ignorance. The decision was mainly influenced by the patient’s unwillingness to adhere to treatment procedures and medication. Therefore, we took the decision after being subject to multiple dilemmas and the need to satisfy the controversial interests of different parties. However, the decision violated the nurse’s code of ethics and the patient’s rights and freedom.

Conclusions

The situation taught me that strictly following ethical guidelines may not always be the best option. In case of a similar problem in the future, I would use casuistry theory, as it states that every decision is highly independent of the characteristic of the situation. However, before implementing the approach, it is helpful to consider the nature of the problem individually besides the existing practical examples. Having all the necessary information about the situation helps determine whether deceiving is the appropriate approach. Apart from the complexity of making decisions and considering various factors, I will apply the theory, as it helps design logical solutions while considering the interests of various participants.

References

Butkus, M. A. (2014). Compassionate Deception: Lying to Patients with Dementia. Philosophical Practice: Journal of the American Philosophical Practitioners Association (American Philosophical Practitioners Association), 9(2).

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2013). Advanced practice nursing-E-Book: An integrative approach. Elsevier Health Sciences.

Sarafis, P., Tsounis, A., Malliarou, M., & Lahana, E. (2014). Disclosing the truth: a dilemma between instilling hope and respecting patient autonomy in everyday clinical practice. Global journal of health science, 6(2), 128.