There are many varied ethical dilemmas nurses can face in their clinical practice. Understanding the underlying philosophical concepts will help the nurse to find intelligent solutions to these issues. In the health field, increased attention to ethics is associated with the development of controversial issues, including advances in technology, as well as a decrease in health and financial resources (Butts & Rich, 2016). Understanding the role of the professional nurse in ethical decision-making helps nurses to articulate their ethical position and acquire the skills necessary to make ethical decisions. This paper aims to apply the four topics method to a challenging situation in the nursing career that required considering the ethical dimensions.
In the considered case, the patient with a terminal condition said that if he dies, he wants everything possible to be done. On the other side, the physician and the patient’s family have made the decision not to tell the patient that he is close to death and not to administer resuscitation if he stops breathing. In this situation, there is the ethical problem caused by the conflict of moral claims of the patient’s relatives and the doctor who seek to protect the patient from suffering in connection with the diagnosis, and the nurse who wants to tell the patient the truth according to his request.
Taking medical indications into account, there were no probabilities of success of any of the treatment options. This patient could not benefit from any medical or nursing care. According to the principle of beneficence and nonmaleficence, harm to the patient’s moral comfort could be avoided when he did not know the truth about his terminal condition (Pozgar, 2014). However, taking into account patient preferences, the principle of respect for autonomy contradicts the principle of nonmaleficence. From this viewpoint, the patient must be informed of his terminal condition, know and understand this information, and give his consent.
As for the quality of life, there were no prospects for this patient to return to normal life. In his case, there were no biases that might prejudice the evaluation of the patient’s quality of life. Both the physician and the relatives understood that if the person was resuscitated, most of the body’s functions would stop working and the rest of the time the patient will spend in a coma. Since he was in a terminal condition, quality-of-life assessments did not raise any questions regarding changes in treatment plans (Butts & Rich, 2016). Therefore, the doctor and the relatives decided to make sure that in obviously ambiguous situations the patient would not be saved at any cost.
What concerns contextual features, there were no professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of this patient. Neither clinicians nor family members did not have any interest in the clinical decision not to reanimate the patient. There were no financial factors that created conflicts of interest. Neither the allocation of scarce health resources nor any religious or legal issues could influence the decision. Only the patient’s terminal condition was the issue that forced the physician and relatives to come to such a difficult decision. The principle of justice and fairness was not violated since the benefit to the patient exceeded the scientific or public interest (Pozgar, 2014). In this case, for the terminal stage of the disease, the patient could not benefit from further treatment or resuscitation.
However, there were conflicts of interest within the hospital that affected the clinical decision. The patient was mentally capable to make any decisions on future actions. Therefore, following the principles of bioethics, the patient was told the truth about his diagnose, and he was able to decide on further interventions. This information came from the doctor with a nurse present who helped the patient understand the terminology and provide further support. The nurse acted as an advocate for the patient’s rights and was familiar with the rules regarding the patient’s right to make decisions and resolve this ethical issue. Finally, the patient has understood the situation and made a difficult decision that he will not be resuscitated.
The four topics method and the application of the principles of bioethics have shaped the decision of the nurse to tell the patient about his condition, which resulted in the process of informed consent. This is a valid process that helps to resolve an ethical dilemma when it is difficult to clearly distinguish one dominant principle. The reviewed case is the ethical dilemma where there is a clear conflict between several moral principles, and the nurse has to choose the lesser of two evils. Such situations cause moral and ethical uncertainty when it is impossible to determine which moral principles are applicable in a given case. Nurses must be able to freely discuss moral and ethical situations, even though such a dialogue will be difficult for everyone involved.
References
Butts, J. B., & Rich, K. L. (2016). Nursing ethics; Across the curriculum and into practice (4th ed.). Jones & Bartlett Learning.
Pozgar, G. D. (2014). Legal and ethical issues for health professionals (4th ed). Jones & Bartlett Learning.