The ethical dilemma
At any point in the care process, especially in matters that involve severity of illnesses and end-of-life care, patients, families and nurses may find themselves at a point where they cannot agree on matters that relate to the ethics and morality of the processes and procedures to be accorded. In the contemporary healthcare settings, patients and families are entitled to culturally competent care which is characterized by the consideration of the beliefs, values, perceptions and faith (Gastmans, 2013). These are considered to influence the spirituality, healing and restoration which is a critical element of the holistic healing process that care facilities prioritize today. In the case study, the two parents, for instance, cannot agree on the initiation of a care process due to the differences in beliefs and values that they hold.
This is worsened by the fact that the parents to the patient are divorced and there are those expected differences that could emanate in such scenarios. On the other hand, the six year old patient is a not the biological child of the mother but the mother has primary custody of the child. The biological father on the other hand lives in another state and his consultation is equally primary to ensure that the entire family is involved in the judgment and decision making process. The mother holds that the child should not be subjected to any treatment based on her Christian Scientist beliefs; a notion that actually rules out any efforts by the care team to initiate care based on the rights of the surrogate in decision making. On the other hand, the father on being consulted insists that the child should be accorded care as medically necessary. The ethical dilemma in this case is that the nurse or the care team has to choose between foregoing one of the parents’ views and doing what is medically necessary. As the primary custodian, the mother thinks that she deserves all the right to make decisions on the care process. On the other hand, the father believes that as a biological parent, he has every right to make decisions that regard his child.
The selected decision making model
The deontological theory offers a framework on which the care team or the nurse can manage to navigate such situations. Deontological ethics offers a normative position for ethical conduct that insists on the need to judge the morality and rightness of an action within the concepts of how well the action adheres to the existing rules, policies and regulations. In that case, the idea is that the situations that create the dilemma should be shelved and the focus placed on the nurse’s role from a professional perspective (Park, 2011). The deontological ethics has its focus on utilizing the ethical principles of nursing namely that of beneficence which implies that any action or decisions should be based on doing good to the patient as well as that non-maleficence which calls on the nurse or the acre team to ensure that the patient is not subjected to harm by internal or external forces (Park, 2011). The ethical position of the deontological theory is that the action taken is more important that any consequences that may emanate from the same. This it is has its position that the care team for instance should act in a manner that the actions can forth wise be regarded as applicable in a universal perspective within a similar situation in future. In that case therefore the model or theory asserts that in decisions making one should treat humanity both as a means and an end to an action. The deontological process assumes that in situations of ethical or moral disagreement someone has to act like a law maker but only within the prospect that those laws can be harmonized in the hypothetical situation of consequences otherwise known as the ‘kingdom of ends’ (Park, 2011).
How would you resolve the dilemma using the model?
I would resolve this dilemma through the use of the deontological ethics whereby the appropriateness of action is judged from duty or obligation. It my duty as the physician to pursue the most professionally endorsed approach which involves alleviating pain and suffering, protecting life alongside safeguarding the patient’s autonomy and applying the ethics of beneficence and non-maleficence (Gastmans, 2013). In this regard, I would seek to take with both parents and using a cost-benefit analysis weigh the two options as provided by the two parents and basically seek a common ground that does not relegate any of the parents’ wishes. I would thus go for instant initiation of treatment, request the mother to pray for the child as a Christian and after the child’s condition stabilizes, and then further interventions from another physician may be pursued in line with the biological father’s request. By so doing, I believe that I will have fully observed my duty to patients, which is alleviation of pain and suffering, protecting life and upholding the rights of the patient (Gastmans, 2013).
Dialog
I really understand your concern and worry with regard to the predicament facing you with regard to the six-year old. I also understand your responsibility and concerns towards the health and the well-being of the child and wish that all of us concentrate on the best and most appropriate action that promises to improve the health status of the child. In as much as differences exist on the course of action that should be taken in this case, one fact that we should all factor in our respective stands is that the child needs medical attention as soon as possible so as to alleviate the pain and the suffering and also to secure his health. In this regard, it is my wish to share with you my decision on what I believe is the most appropriate course of action to take. Please consider that my decision is a product of weighed risks and benefits for both proposed courses of action and do not in any way relegate any of the parent’s stands. It is of utmost importance to initiate medical treatment for the child right away and as a Christian, I believe that saving life is the priority as of now. Nonetheless, it is my wish that we keep the child in prayers so that the medical interventions are successful and stabilizes the health of the child before seeking further interventions, perhaps from another physician. Thank you.
References
Gastmans, C. (2013). Dignity-enhancing nursing care A foundational ethical framework. Nursing Ethics, 20(2), 142-149.
Park, E. J. (2011). An integrated ethical decision-making model for nurses.Nursing Ethics, 0969733011413491.
