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Ethical Dilemmas in Nursing Practice: Dealing With HIV & AIDS Patients


An ethical dilemma in nursing occurs when a nurse is faced with conflicting options. There may either be a hindrance to do what the nurse knows is right or uncertainty of the consequence of the action which the nurse may take (Scribd, 2011). Nurses must ensure that they have the interest of their patients at heart whenever they make decisions affecting their patients. Sometimes, they may consider implementing actions which may seem to be harmful to the patient in the short run but will likely contribute to the general well being of the patient in the long run. When a nurse is confronted by a situation with conflicting options, she/he should make a wise decision by carefully examining the options available (Oguejiofo, 2011). In this essay, I will discuss a situation whereby a nurse is in dilemma over the decision to be made.

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Description of the Dilemma

The situation of discussion in this essay involves a patient infected with HIV and AIDS but has refused to take antiretroviral drugs (ARVS). It has been shown that taking of ARVS by a person who is sexually active with more than one partner is likely to reduce the rate of HIV infection. In this light therefore, it is advisable that all those infected with HIV & AIDS and are sexually active ought to use ARVS as a protection measure for their partners. This article discusses a situation where a sexually active patient infected with HIV has refused to use ARVS (Drugs Stop AIDS, 2011).

Antiretroviral Drugs

It is recommended that patients infected with HIV & AIDS should take antiretroviral drugs so as to improve their health status as well as reduce the risk of infecting others. Though ARVS do not cure HIV & AIDS, they nevertheless alleviate the symptoms and make it possible for a patient to live for a longer period. ARVS should be taken after the numbers of CD4 cells are counted. Treatment should be started when the number of CD4 cells is equal or less than 350 cells per mm3. Their mode of action is protection of the immune system and can even help in recovery of the damaged cell that is caused by the virus. HIV & AIDS causes damage to the T- helper cells which are crucial in immune system. Damage of these cells has severe effects on the health of a patient. The number of T- helper cells drops drastically when the viral load becomes higher. It is recommended that a combination of ARVS should be taken as it is considered effective that way. This is called a combination therapy or Active Antiretroviral Therapy (HAART). This is highly recommended because using one type of the drug causes the virus to become resistant to the drug thus reducing its effectiveness (Charity, n.d.).

Ethical Dilemma: A patient who refuses to take ARV Treatment

Research on the effect of antiretroviral drugs showed great effectiveness in reducing the harm caused by the HIV virus on the body of the patient. The antiretroviral drugs not only reduce the harmful effect of the HIV virus, but also reduce the risk of infecting other sexual partners. This is a good idea but medical practitioners may find it difficult to force patients infected with HIV & AIDS to take the ARVS. The patient may refuse to take the drugs because of wrong information they may have heard about the side effects of the drugs any other thing about the drugs for that matter.

Alternatives in Making Decision

To make an appropriate decision, an ethical consideration of the diagnosis, treatment and the social impact of the disease must be taken. There are many theories which have been developed to help in decision making. For the above case, the Utilitarianism and Deontological theories may provide a model to solve the problem (Erlbaum, 2011).

Utilitarianism theory was put forward by Bentham and John Stuart Mill. Its approach was that decisions made were to focus on the final outcome of the decision after distinguishing the right from the wrong. This theory proposed that some of the good things should be sacrificed for the common good. In this case the medical practitioner should do his best for the patient to take the drugs. This would help the patient’s immune system to improve as well as reduce the risk of infecting other people. Spread of HIV and AIDS can be very fast because, one infected person becomes a risk factor for spreading HIV and this may form a long chain of risk factors. The consequences of the spread of this disease would be that it would put more people to risk of contacting the disease. Other than this, the economic burden on the health facilities would significantly shoot up (Erlbaum, 2011).

Secondly, the medical practitioner may decide to use deontological theory. Immanuel Kant made a huge contribution to the development of deontologic theory. According to the deontologic theory, a person should carry out the duties which are specifically assigned to him/her (Lea, Williams & Donahue, 2011). This theory therefore advocates for elimination of overlapping of duties and responsibilities as a person is expected to make a decision in an area where he/she has authority. When the concept of this theory is applied to the above case, the verdict is that the medical practitioner should come up with another option apart from the ARVS. The medical practitioner can not force the patient to take the ARVS. However, the effect of this is that it does not help the patient or the society.

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Plan Action

The Realm- Individual Process Situation (RIPS) is a good model which can be used to approach this problem. This should lead to an appropriate action. One should consider the client, the institution or the organization he is working for as well as the society. Moral consideration should be taken into account when making a decision. In deciding on the option to be picked, one should carefully examine the benefits of the various options and pick the best option.

For this case, it is wise that the patient is convinced to take the ARVS. Taking the ARVS will help the patient by improving his/her health and at the same time the chances of infecting her/his sexual partners are reduced. The nurse should take time and talk with the patient about the advantages of ARVS and at the same counter any negative thoughts the patient may have about ARVS (Scribd, 2011).


In conclusion, when one is faced with an ethical dilemma, making decisions between two conflicting options should be done with care. HIV & AIDS patients who refuse to take ARVS should be convinced to take the medication by informing them on the benefits of doing so. A medical practitioner should be cautious when dealing with HIV & AIDS patients as some of them may be impatient. It is worth noting that such patients may require more than one counseling session to change their mind concerning taking the ARVS.


Charity, I. H. (n.d.). Introduction to HIV and AIDS Treatment. 2011. Web.

Drugs Stop AIDS. (2011). Drugs and Aids. Web.

Erlbaum, L. (2011). Journal of Community Health Nursing. Web.

Lea, D. H., Williams, J & Donahue, P. M. (2011). Ehical Issues in Genetic Testing: Ethical Theories, Principles, and decision Making models. Web.

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Oguejiofo, N. (2011). Examples of Nursing Ethical Dilemmas. Web.

Scribd. (2011). Ethical Decision Making. Web.

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