Ethical dilemma arises when there is conflict between ethical principles (Tigerman, 2008). The common ethical dilemma that arises in nursing include: What is the fair or just solution to this problem or to whom do I have a duty towards? When such situations arise in practice, the ability to solve the dilemma in an ethical way is very important. Ethical decision making will help to direct the nurse to the right course of action in such situations. It can also help to analyze the decision made by others in a similar situation.
A person’s personal standards of right and wrong can influence decision making. These standards, if not in line with the ethical values of nursing practice, can result in conflicts. Nursing ethical standards will help the person to make a decision in a sensitive situation. Decision making involves the cognitive process that takes into consideration different rules, virtues, relationships, and judgements to guide the decision making process. The intensity of the ethical issue, the individual factors, the organizational factors and the opportunity to make a decision, forms the framework on the basis of which ethical decision can be understood (Baumann-hölzle, Maffezzoni, & Ulrich Bucher, 2007). Analyzing the decision in this framework will help to decide if the nurse’s decision is ethical or unethical (Baumann-hölzle, Maffezzoni, & Ulrich Bucher, 2007). The intensity of the ethical issue is decided by its relative importance in the eyes of the individual or the organization. There is always a possibility that an issue that is important for the individual, is not important for the organization. The sensitivity of the individual and the organization, towards an ethical issue is very important. Individual factors can influence the decision making process. A person’s level of education and experience, can influence the decision making process. The culture and belief system of the person, can also influence ethical decision making. The level of control one has on the situation, and other factors like age, gender, etc., can influence decision outcome. When working in a healthcare organization, the values of the organization supersedes individual values. An organization that promotes ethical decision making will result in employees making ethical decisions. The conditions prevailing at the time of decision making will determine the opportunity given to the nurse to make an ethical decision. Providing rewards for acting ethically, is an example of an opportunity that will help nurses avoid unethical decision making.
I have chosen the 5 step ethical problem solving model to solve the ethical dilemma in the given situation (Husted & Husted, 1995). According to this model, the first step in solving an ethical dilemma is to gather all the pertinent facts relevant to the case. In the present situation the child is suspected to have meningitis and this necessitates immediate treatment. Delaying treatment can have adverse consequence. If everyone agrees with this, then there is no dilemma. In the given case, the mother does not want to treat the child for religious reasons, while the father wants the child to be treated right away. The father is far away and the mother is the person who is attending to the child from near. Nevertheless, she is not the child’s biological mother, while the father is. Now the ethical dilemma is to treat the child or not to treat the child.
The second step in the model is to apply the ethical maxim. According to deontology theories, the nurse is expected to act based on the rules and is bound by duty to provide care for the child. A nurse is also bound to take the consent of the guardian before initiating a crucial or risky treatment. The child needs immediate treatment, while the guardian does not provide consent to treat the child. The nurse is bound by duty to self, to the patient and to the family. Thus, in a situation like this, where conflict rises in ethical values, the nurse is expected to do what is right in the situation. Theological theories, on the other hand, focus on the consequence of the action. The nurse is expected to choose an action that will result in good consequences. It is not sensible to allow the theology of few (in this case the non-biological mother) to prevent the progress of many. The existentialism theories support the decision of the individual. According to this theory, the nurse is expected to act in the best interest of the child. In line with these theories, I would choose to initiate treatment for meningitis of the child.
Step 3 is the time factor. The decision needs to be taken immediately and delaying treatment can be detrimental to the child. There are no written rules as to how to decide the time to act. It is done based on the nurse’s discretion and experience. If delaying causes no harm to the child, then the nurse can wait for the father to come down and give his informed consent.
Step 4 involves special circumstances, which compels nurses to act against commonly followed norms. For example, euthanizing a patient who is suffering from an incurable and tormenting situation is not permitted by law. But, in certain rare and exceptional situation the decision may sound ethical. In the present case, the child needs immediate attention and this can justify the nurse’s decision in rejecting the guardian’s claims and opting to initiate treatment. The nurse’s action is done in the best interest of the child.
Step 5, is to make the choice. In the given case, I will choose to proceed with treatment for meningitis, as delaying treatment can harm the child. There are no black and white rules to make a judgement, and the judgement can vary based on the situation. My reasoning for this decision being that the child’s condition is critical and one of the parent is supportive of treatment. On the basis of my nursing knowledge, I conclude that initiating treatment is likely to benefit the child and get her out of risk. The five step model is not based on consequence, but in the process of making the right decision. I also do not see an alternative, as the child is already presented to the hospital. The fact that the mother is not biological mother and is not acting in the best interest of the child is also important in this situation. So I will act by initiating treatment for the child.
Dialogue:
Nurse: Hai! Good Morning!
Guardian: Hai! Morning!
Nurse: My name is Jenny and I am here to talk about the health of the child. Your child has inflammation in the membranes of brain and spinal cord. The condition is called meningitis and it is completely curable if treated promptly. It can be life-threatening if left untreated.
Guardian: I am a believer, and I have faith that she can get well without it. The people at the church are praying for her.
Nurse: Thank You, I completely respect your faith, but I am bound by duty to treat the child admitted to the hospital. Further, the child’s father wants him treated right away. So I have initiated the treatment. She has to continue here for a couple more days for observation.
Guardian: Butthis is wrong, who gave you permission to treat.
Nurse: The child’s father and the hospital ethical decision committee wants the child treated. In special circumstances like this one, we have the obligation to disobey the guardian who does not act in the best interest of the child according to medical science. I am bound by duty to the child, to the father and the profession. But the important fact is your child is getting better. The prayers of the church are really working; the child is beginning to recuperate.
References
Baumann-hölzle, R., Maffezzoni, M., & Ulrich Bucher, H. (2007). A framework for ethical decision making in neonatal intensive care. Acta Paediatrica, 94(12), 1777-1783. http://dx.doi.org/10.1111/j.1651-2227.2005.tb01853.x
Husted, G. & Husted, J. (1995). Ethical decision making in nursing. St. Louis: Mosby.
Tigerman, M. (2008). Ethical Dilemma. Professional Case Management, 13(2), 115. http://dx.doi.org/10.1097/01.pcama.0000314187.41565.c4
