Resolving Clinical Ethical Dilemma

Ethical Dilemma- A Framework

Ethical Dilemma

Taking into account ethical concerns is one of the key components in providing healthcare in the therapeutic nurse-patient relationship (Rosenbaum, 1982). Nurses face ethical uncertainty, distress and conflict in their day-to-day work. When more than one ethical value applies to a particular case, and all of them recommend following a different course of action, then an ethical dilemma exists in such a case a nurse would be not be sure of which value takes precedence (College of Nurses of Ontario, 2009). This specific case involves a 6-year-old who is by law a minor and thus a physician must obtain informed consent from their legal guardian. However, the child's primary guardian is his non-biological mother who is citing her religious reason to refuse medical treatment, while the biological father who resides in another state wants the kid to be treated, a situation that leaves the medical team confused as the two choices could lead to total different outcomes. Thus in making a decision regarding this case it is crucial that the medical team uses a decision-making model to find out the most ethical and levelheaded approach to get a solution to this dilemma.

To make a decision on ethical dilemmas, healthcare professionals need to be aware of their personal values. Nurses, in this case have to be aware of clinical ethics, and they need to have the ability to analyze a problem logically and reach a proper decision that they can justify using ethical values. Identifying and finding solutions to ethical dilemmas requires intellectual curiosity, commitment and sensitivity. If in doubt, nurses should consult their senior colleagues. By analyzing and discussing ethical values and reviewing case histories, nurses can ready themselves to solving ethical problems (College of Nurses of Ontario, 2009). Kitchener in his 1984 work identified 5 moral principles that he regarded as key to ethical guidelines. The five ethical principles identified are justice, non-maleficence, beneficence, autonomy and fidelity, each of which is an absolute truth in itself. Reviewing these ethical principles with a specific case in mind can help clarify key issues in a given situation. At times this process of reviewing alone will help a nurse to easily see the means of solving the dilemma (Forester-Miller & Davis, 1996).

Guide to decision-making

In this paper I have incorporated the works of Sileo and Kopala (1993), Forester-Miller and Rubenstein (1992), Haas and Malouf (1989), Stadler (1986), Kitchener (1984) and Van Hoose and Paradise (1979) into a pragmatic, 7-step decision-making model.

Step 1: Identify the Problem.

The physician needs to collect as much information as possible that will enable him or her to clearly analyze the situation. In doing so, it is crucial for one to be as specific and as objective as possible. Writing the information gathered on paper can help the physician to gain clarity. One should highlight the facts and filter out suspicions, hypotheses, assumptions and innuendos (Forester-Miller & Davis, 1996).

Step 2: Apply the ACA Code of Ethics.

After the doctor has clarified the dilemma, he or she should refer to the Code of Ethics (ACA, 2005) to check whether the issue has been handled there. If there is an applicable standard and it is specific to the issue and clear, the course of action recommended in the Code could help in resolving the dilemma. For one to effectively apply standards, it is crucial that he or she reads them carefully and understands fully the standard's implications. If the solution cannot be found here then it is a true ethical dilemma and one needs to take the next step in the decision-making process (Forester-Miller & Davis, 1996).

Step 3: Determine the nature and dimensions of the dilemma.

There are several factors to consider for one to make sure that he or she has examined the ethical problem in all dimensions. One should first consider the ethical principles of justice, non-maleficence, beneficence, fidelity and autonomy, and decide which of these applies to or takes precedence in this case. In theory each of these principles is of the same value as the other and thus the issue of which takes precedence becomes a challenge. The physician should also go through the current ethical clinical literature to make sure that he or she is utilizing the latest type of professional thinking reaching a decision. One can also consult senior colleagues or national professional associations to see if they can provide any form of help (Forester-Miller & Davis, 1996).

Step 4: Generate potential courses of action.

The physician should then brainstorm on as many courses of action as possible. He or she should be creative and consider all options available. If possible one should ask for the assistance of another colleague to help them in this step (Forester-Miller & Davis, 1996).

Step 5: Determine the best course of action.

By taking into account all the information collected and the priorities that he or she has set, the physician should examine each of the options outlined in step four and assess the likely consequences for all the parties involved. One should think about the implications to his or her client and remove the options that do not result in desired results or will potentially cause more problems. The physician can then choose a course of action, by going through the remaining options to check which one best fits the situation and addresses the priorities that he or she has set (Forester-Miller & Davis, 1996).

Step 6: Evaluate the selected course of action.

One should then review the chosen cause of action and see if it brings about any new ethical dilemmas (Forester-Miller & Davis, 1996).

Step 7: Implement the course of action.

Implementing the chosen action in an ethical dilemma is usually difficult. The final step is all about the physician strengthening his or her mental fortitude to enable them to implement their plan. It is good practice for the physician to follow up on the patient to check whether their plan had the intended consequences (Forester-Miller & Davis, 1996).

Communicating with those concerned