Discussion of Three Solutions
Discussion of Three Supporting Points
Ethical dilemma is a social phenomenon that cuts across disciplines, which means that it is not exclusive to the nursing science. However, there are dilemmas peculiar to the science, which nurses encounter on a daily basis. As such, frequently, reference must be made to the American Nursing Code of Ethics in order to salvage one’s morality dealing with these situations on a daily basis. In the following pages of this document the writer will explore the best ways in which a case study ethical dilemma could be resolved utilizing the premise of justice and autonomy of a patient’s right to make decisions for him/herself.
Nursing Fundamentals: Nursing Ethical Dilemma Case Study
Introduction
The situation in this case study scenario depicts a dilemma whereby Mr. S. Z refuses medication or rather scientific medicine and turns away to herbal remedies. Consequently, he finds himself with an uncontrolled blood sugar level of 589 being diagnosed with hyperglycemia. More importantly, it is his third admission in six months, indicative that he has not been using his medications or maybe, his medications no longer lower the blood sugar if he is taking them.
Subsequently, his daughter confirms that he was not taking his medications. However, being hospitalized Mr. S.Z’s blood sugar level returns to normalcy and he is discharged to go home with a frustrated daughter. She asks the nurse to have his doctor re-admit her father even though his condition has been resolved. His daughter implores the nurse to tell the doctor that he does not take his medications, which is very obvious. Further, she insists that he goes to a nursing home.
Nursing dilemmas can be created from the perspective of beneficence, doing no harm to the patient. Secondly, malificence, harming for the best possible outcome and thirdly justice whereby the allocation of care becomes need based rather than status (Arries, 2005). As such, three possible solutions in resolving this nursing ethical dilemma encounter is first politely letting Mr. S.Z’s daughter know that as a nurse telling the doctor to readmit a discharged patient is beyond my functional capacity.
Secondly, I would encourage her to meet with the doctor and discuss her concerns. Thirdly, I would let her know that I could arrange a conference between herself and the doctor, but I cannot predict the outcome since the final decision rests with Mr. S.Z. Therefore, the thesis statement is that a patient’s autonomy pertaining to respect of the right in making his/her own decision regarding health care is always the focal point of justice and a legal pre-requisite for nursing intervention.
Discussion of Three Solutions
In relating my position of being incapable of telling the doctor to readmit a discharged patient who did not request to remain in hospital, would be a violation of Mr. S.Z’s right to make decisions concerning his care. It would also, subtly give the indication to Mr. SZ’s daughter that she too does not have that right to deprive Mr. S.Z of justice. The other two solutions are intertwined into the first. Speaking with doctors may not solve the ethical dilemma immediately neither in its entirety since they will have to consult with the patient who is still capable of reasoning and making decisions. The third solution is partial and linked to the first too, because merely saying that I will make arrangements for a conference among the parties is a far fetched solution, which may take months to manifest.
Discussion of Three Supporting Points
My position as the nurse in the ethical dilemma
This first point is closely related to my role as a nurse in decision making for any patient. Studies have shown where nurses tend to be reluctant in making ethical decisions based on the autonomy of patient care. Pinch’s (2005) study on ‘Ethical Dilemmas in Nursing: The Role of the Nurse and perceptions of Autonomy;’ related the variable ‘perceptions of autonomy’ towards three nurse patient relationships citing Murphy’s theory explaining that establishing autonomy is necessary for patient advocacy as it pertains to nurse patient relationship ( Pinch, 2005).
In choosing the position of autonomy as it relates to justice above beneficence or malificence I feel justified that I have professionally executed my nursing role. Pinch (2005) further emphasized that the three models of nurse- patient relations emanating from his study revealed the nurses were less likely to choose an autonomous decision making position, the attitude towards this model was low and less professional. Thirdly, nurses were reluctant in taking the risk (Pinch, 2005).
Another study, ‘Virtue Ethics: an approach to moral dilemma in nursing” conducted by Arries (2005) supported Pinch’s (2005) advocacy of autonomous decision making model to reveal that ‘moral dilemmas are often analyzed using the principle-based approach which applies the four moral principles of justice, autonomy, beneficence, and non-malificence’ (Arries, 2005)
Suggestions to meet with the doctor
Once the approach of autonomy as it relates to justice has been established the ethical dilemma is transferred out of my jurisdiction. In my professionalism it is believed that the situation is now out of my control. However, the moral responsibility is still mine to see justice through to the end.
Theoretically, it has been suggested by great minds of the science that there are three steps in resolving ethical dilemma. First, the nurse must analyze the consequences. Secondly, analyze the action and thirdly make a decision from a point of justice (White 2003). In suggesting that Mr. S.Z’s daughter speaks with his doctor is not only removing myself from the initial stages of the dilemma, but also projecting the resolution at a much higher level where it is believed Mr. S.Z’’s situation will be justified and decisions made for him with his consent. A furious daughter is incapable of creating justice even in the presence of apparent dysfunctional behavior.
Precisely, the American Nurses’ Association Code of Ethics clarifies roles and responsibilities of Nurses when faced with ethical dilemmas as the one offered in this case study to point out that nurses are expected to ‘ provide services with respect for human dignity and the uniqueness of the client, unrestricted by the considerations of social or economic status; personal attributes, or the nature of the health problem’ (American Nurses Association, 2012).Therefore the decision to have the doctor intervene is ethical.
I cannot predict the outcome since the final decision rests with Mr. S.Z
This is an action taken to subtly alert Mr. SZ’s daughter to the boundaries within which decisions are made in health care professions and the parameters around which decisions are made. Consequently, there are no considerations what so ever for malificence in the decision making process.
Conclusion
In the foregoing discourse the author offered three proposals for resolving an ethical dilemma involving an elderly Hispanic male diabetic whose daughter suggests that he remains in hospital or be transferred to a nursing home without his consent. Subsequently, she has been seeking the cooperation of nurses and doctors in executing her plan.
In dealing with ethical dilemma my transparency was expressed regarding the limitation of even suggesting this to his doctor. Secondly, it was advised that she speaks with his doctors regarding her concerns and thirdly she was cautioned that the final decision rests with her father whose autonomy must be respected.
American Nurses Association Code of Ethics (2012). Board of Nursing. Resolution No. 220:
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Arries, E (2005). Virtue ethics: an approach to moral dilemmas in nursing. Curations: 28(3):64-
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Pinch, J (2005). Ethical dilemmas in nursing: the role of the nurse and perceptions of autonomy.
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White Thomas (2003) Philosophical Ethics. New York. McMillan
