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Ethics in Healthcare: Addressing a Complex Dilemma

Clinical Situation

Ethics is a crucial component of nursing since it is the responsibility of a nurse to ensure that a vulnerable population is safe and provided with proper services. However, to address patients’ needs properly, a nurse often has to face difficult dilemmas. A recent case involved a nurse confronting the mother of a child patient who needed a vaccination. Although the tetanus vaccination was crucial to the future well-being of the child, the mother claimed that it was her right to choose not to vaccinate her child. On the one hand, the nurse could not act against the will of the patient’s parent; on the one hand, not administering the vaccine would have meant causing harm to the child.

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The patient is a 10-year-old boy, who has not been eating properly, which caused his mother’s concern and made her address a nurse expert. Upon considering the patient’s record, it was discovered that he had never received a tetanus vaccination. The patient seems exhausted and confesses to having been experiencing difficulties studying, particularly, memorizing information. Minor fatigue was observed during the patient examination. The mother of the patient seems to be strictly against vaccinations, in general, as she believes that they weaken the immune system. Therefore, the patient is under the threat of contracting tetanus if exposed to the relevant threat factors, such as cutting himself with sharp rusty objects (Grasse, Meryk, Schirmer, Grubeck-Loebenstein, & Weinberger, 2016). Therefore, it is the responsibility of a nurse to administer the vaccination, yet, seeing that the mother is strictly against it, a nurse cannot act against the will of the patient’s legal guardian.

Bioethical Decision Making Model

To adders the problem, one will have to approach it from the perspective of the Bioethical Decision-Making Model (BDMM). In the case under analysis, the threat of contracting tetanus and, thus, causing the patient irreparable harm defines the choices of a nurse. Based on the BDMM framework, the first three stages, which involve the location of the problem, collection of data, and identification of key factors, have already been completed (Sugarman, ‎2015). According to BDMM, an ethical analysis of the situation followed by decision-making must take place next.

The ethical principles that will define the choice of an appropriate measure to take are those of beneficence and patient autonomy. The specified ideas, however, collide in the observed scenario since the former implies acting based on the needs of patients, and the latter supports a patient’s right to make a decision. Put differently, the principles of utilitarianism are in discord with the ones of deontology in the identified case. Since the patient’s choices are dictated by his guardian’s lack of awareness, however, it will be reasonable to use the strategy based on patient education. Once a nurse provides the mother with detailed information about the threat of tetanus, the conflict is likely to be resolved, and the mother will agree to vaccinate the child.

In case a nurse fails to persuade the mother to vaccinate the child, it will be necessary to accept her choice. Although acting on behalf of the patient might seem as the legitimate step to take, a nurse must also recognize patients’ right to make a choice, even though it may be erroneous. In either case, a nurse must offer detailed information about the threat to which the mother subjects the child, as well as about the available vaccination options and the means of avoiding tetanus. For instance, it will be crucial to mention the need to avoid physical injuries that involve the contact with metal, such as cuts.

Nursing Advocacy and the Nurse’s Role

In the case under analysis, a nurse is responsible for convincing the patient to make the right choice and accept the tetanus vaccination. Put differently, a nurse has to provide extensive information about the threat to which the boy will be subjected unless the vaccination is administered to him. To accomplish the specified goal, a nurse must assume the roles of a leader and an educator, thus motivating the patient’s mother to change her mind about the tetanus vaccine.

The role of an educator is especially important in the identified situation since it will help the mother make the right decision. A nurse may fail to convince her to vaccinate the child straightaway (Dalal et al., ‎2016). However, the information provided to the mother must be enough to help her evaluate the problem afterward and decide to follow the nurse’s advice after the mother considers it at home.

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The follow-up process may include offering the mother of the patient tools for contacting a nurse in case of further questions, as well as providing important resources for patient education. The suggested materials should concern not only the issue of tetanus but also the problem of vaccination, in general. It is essential to convince the mother that she can ask a nurse for help and clarification of health issues, as well as consultations and other important services for maintaining health. Thus, a nurse can enhance the well-being of the patient and his mother.


Dalal, S., Samuelson, J., Reed, J., Yakubu, A., Ncube, B., & Baggaley, R. (2016). Tetanus disease and deaths in men reveal need for vaccination. Bulletin of the World Health Organization, 94(8), 613-621. Web.

Grasse, M., Meryk, A., Schirmer, M., Grubeck-Loebenstein, B., & Weinberger, B. (2016). Booster vaccination against tetanus and diphtheria: Insufficient protection against diphtheria in young and elderly adults. Immunity & Ageing, 13(1), 26-34. Web.

Sugarman, J. (2015). Is shared decision making an appropriate analytic frame for research on medical practices? The American Journal of Bioethics, 15(9), 18-20. Web.

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