Lo (2012) defines ethical dilemmas as situations that cannot be resolved using a satisfactory answer. The solution of an ethical dilemma varies depending on the situation, and the philosophy to which the affected individuals subscribe. Ethical dilemmas are a common occurrence in the nursing field. The profession not only requires the professional interaction between nurses and the patients in delivering efficient care, but also demands extensive knowledge in maintain boundaries during these interactions.
The growing cultural diversity implies the interaction of nurses with patients from a variety of backgrounds, bearing varying beliefs and customs that have the potential to impact healthcare services. Ethical dilemmas affect nursing in a variety of ways, including lack of satisfaction by the nurses and the patients, and inefficiency delivering care services. This paper will explore 8 healthcare journals regarding ethical dilemmas in nursing, with the aim of better understanding the dynamics of ethical dilemmas and their impact on nursing.
Ethical Dilemma: Determinants of Surrogate Decision-maker Confidence
Common ethical dilemmas experienced in practice by the nurses can be categorized into 5 categories; Prochoice versus prolife, freedom versus control, truth-telling versus deception, distribution of resources, and empirical knowledge versus personal belief (Lo, 2012). Resolution of these dilemmas is determined by a variety of factors, including morals, social beliefs, empirical knowledge, and the specific situation from which the dilemma arises. Also, resolution of nursing ethical dilemmas is guided and informed by tools such as the Code of Ethics for Nurses, and the core concepts of the nursing profession (autonomy, beneficence, no malificence, and justice) (Lo, 2012).
One area that continues to arouse differences in the nursing field is research. Research is defined as the systematic investigation of materials and sources, with the sole purpose of establishing facts and reaching new conclusions. In nursing, research is essential, as it facilitates the development and implementation of innovative ideas meant to enhance efficiency and quality of nursing care. However, research may sometimes require participation of human subjects, and such participation may actually pose a risk to the wellbeing of the participants.
Research is one of the major sources for ethical dilemmas, as its importance and benefits contradict with the possible harms. In addition, getting participants into a research study is a challenging task for researchers. An article by Bolcic-Jankovic et al. (2014) that sought to explore the determinants of surrogate decision-maker confidence from ICU patients revealed that surrogates are less likely to agree to participation than the patients. Advances in the medical and nursing fields have to undergo thorough testing before they are certified as fit for use in patients. However, to achieve the level of acceptance required, the advancements must be tested using the relevant population that intends to utilize it, such as the patients in the ICU.
Unfortunately, such patients may not be in a position to give their informed consent regarding participation, and permission can only be sought from surrogates. Patients in the ICU are mostly incapacitated, and cannot make such decisions, facilitating the role of a surrogate. However, the representation of patients by surrogates arouses moral issues, such as the extent to which a surrogate is will represent the needs of the patient. The study by Bolcic-Jankovic et al. (2014) shows that patients in the ICU are more likely to participate in research if they represent themselves, compared to when they are represented by surrogates. This indicates a sharp disparity in the representation of patients’ needs by surrogates.
With the advent of technology physicians and other healthcare practitioners are using the internet and social platform forums to exchange information regarding health. The information shared by a patient on such platforms is available to the public, hence, subject to use by third parties (Saunder, Kitzinger & Kitzinger, 2015). This raises an ethical dilemma as to how such information should be used, if it should at all be used, in research. Participants should provide their informed consent before engaging in research studies. However, users of information from the internet may not seek informed consent of the owner of the information. The article by Bond et al. (2013) explored the views of different participants on the use of information available on the internet. While some felt that the information is in the public domain and can be used by others without consent, others felt that regardless of the availability of the information online, they should maintain control over own information.
A study by Manzar et al. (2013) shows that embryonic stem cell research is another source of ethical dilemmas in nursing. Stem cell research involves the derivation of stem cells from embryos. Stem cell research offers the medical realm with hope for finding treatments for some of the most complex diseases. However, the derivation of stem cells for research implies destruction of potential human life. The ethical dilemmas surrounding use of stem cells for research revolve around alleviating suffering and protecting human life (Manzar et al., 2013).
Another ethical dilemma that researchers have to contend with is the unintended consequences. Medical research that involves human participants has the potential for unintended outcomes, such as adverse events. Narayanasamy (2015) observed that while research is important for alleviating the suffering of those that will benefit from the findings of a research, it also puts at risk the lives of the participants, regardless of measures taken to avoid such outcomes.
A participant has a right to his/her own information used for a research. The participant may choose to share this information with family members, and this presents an ethical dilemma to the researcher. While the participant has the right to information, the researcher is mandated to protect the privacy of the participants (Kaye, 2012).
Similarly, destruction of research data elicits ethical dilemma in the research arenas. For example, a participant who wishes to drop out of a research may demand destruction of his/her data. However, as the destruction might lead to the loss of other vital data for the research. According to Witt and Witt (2016), the researcher is in a dilemma whether to ruin a research study as a result of one participant, or to uphold the autonomous right of the participant and destroy the data.
Use of pseudonyms during research is an important factor to consider in maintaining the anonymity of the participants. However, some participants may not prefer use of pseudonyms in the research, consequently jeopardizing the anonymity of participant. As Saunder, Kitzinger and Kitzinger (2015) observed, researchers are in dilemma whether to protect the privacy and anonymity of participants, or to respect the wishes of the participants.
Bioethical Principles
The two major bioethics principles that relate to ethical dilemmas in nursing research include nonmaleficence and beneficence. Butts and Rich (2015) defines nonmaleficence as a principle that requires caregivers to do no harm to their patients, and beneficence as a principle that requires practitioners to only take actions that facilitate the wellbeing of their patients. Research in nursing is essential in facilitating new discoveries such as medications and technological advances that benefits a multitude. However, research also predisposes the participants to unintended outcomes. While caregivers are required to do no harm, the unintended events cannot be wholly avoided in research. Similarly, while they are required to act only in ways that benefits patients, undertaking research to benefit people leads to unintended outcomes.
Value of Personal Morality
My value of personal morality is dignity. Butts and Rich (2015) describes dignity as an intrinsic and inherent importance assigned to oneself either by society or by self. Dignity, whether personal or basic, is important as it allows a person to be treated with the worthiness that he/she deserves. The community I live in upholds the dignity of human life, and demands respect even for the dead. It is wrong to badmouth a dead person, as it is badmouthing a person who is alive. The moral values in this community have led to the aggressive rejection about abortion, and any other medical procedure that destroys possible human life. This is because the community dignifies human life.
Conclusion
In conclusion, research is an important aspect of the nursing and medical fields. However, ethical dilemmas that accompany research involving human research continue to challenge the importance of research. This paper analyzed literature on ethical dilemmas that surround research in nurses, identifying challenges such as informed consent, data sharing, protection of life versus alleviation of suffering, and destruction of data after research. The analysis of the literature not only contributed to the better understanding about ethical dilemma in nursing, but also helped identify ways through which these ethical dilemmas can be ideally handled. The paper also analyzed two bioethics principles, beneficence and nonmaleficence, and how they relate to the ethical dilemma. Dignity was identified as the value relating to moral principles of the community.
References
Bolcic-Jankovic, D., Clarridge, B. R., LeBlanc, J. L., Mahmood, R. S., Roman, A. M., &
Freeman, B. D. (2014). Exploring determinants of surrogate decision-maker
confidence An example From the ICU. Journal of Empirical Research on
Human Research Ethics, 9(4), 76-85.
Bond, C. S., Ahmed, O. H., Hind, M., Thomas, B., & Hewitt-Taylor, J. (2013). The
conceptual and practical ethical dilemmas of using health discussion board posts as
`research data. Journal of Medical Internet Research, 15(6), e112.
Butts, J. B., & Rich, K. L. (2015). Foundations of ethical nursing practice. Role
Development in Professional Nursing Practice, 117.
Kaye, J. (2012). The tension between data sharing and the protection of privacy in genomics
research. Annual Review of Genomics and Human Genetics, 13, 415.
Lo, B. (2012). Resolving ethical dilemmas: a guide for clinicians. Philadelphia: Lippincott
Williams & Wilkins.
Manzar, N., Manzar, B., Hussain, N., Hussain, M. F. A., & Raza, S. (2013). The ethical
dilemma of embryonic stem cell research. Science and Engineering Ethics, 19(1), 97
106.
Narayanasamy, A. (2015). Reflexive account of unintended outcomes from spiritual care
qualitative research. Journal of Research in Nursing, 20(3), 234-248.
Saunders, B., Kitzinger, J., & Kitzinger, C. (2015). Participant anonymity in the internet age:
Witt, M. M., & Witt, M. P. (2016). Privacy and confidentiality measures in genetic testing
and counseling: arguing on genetic exceptionalism again?. Journal of Applied
Genetics, 1-3.
