Ethical Dilemma in Nursing: Case Analysis Ethics

Ethical Dilemma in Nursing: Case Analysis

Ethics is a significant portion in any profession. In nursing professional ethics is part of the daily practices of nurses. Nurses require building up skills to react ethically to mistakes and make ethical choices (Finkelman & Kenner 2012, p.182). Particularly, nurses require the knowledge of ethical reflection in order to discern moral dilemmas and injustices. Nevertheless, a nurse practitioner is required to stick to ethical principles that ensure that patient care is considered a primary focus in the nursing practice. There are certain situations where a doctor or a nurse practitioner is required to conceal a patient's health condition in order to prevent harm to the well-being of a patient. This happens to terminally ill patients perhaps through a request from family or friends. The protective attitude of family and the society to the critically or terminally ill patient is usually convoyed by a paternalistic role of the health providers (Finkelman & Kenner 2012, p.182). Sometimes it is argued that the patient has the right to know his/her health condition. This raises ethical dilemmas between a patient, family, doctors and nurses.

Statement of Case

Nursing is a challenge career given that nurses are sometimes faced with additional task of ethical and moral dilemmas (Finkelman & Kenner 2012, p.182). It becomes challenging when a nurse has to compromise her ethical and moral principles. It is not a nurse's wish to betray the moral and ethical principles but circumstances compels them. Determining what is wrong or right is as well challenging. As a nurse in surgical/medical floor working with a large hospital, I am required to uphold moral and ethical principles of a nurse practitioner. However, a female patient is admitted for a series of medical test. Unfortunately, the results reveal a terminal illness, lymphocytic leukemia, and she is required to stay in hospital in order to manage the illness.

The patient has not been informed of her condition citing adverse effects putting into consideration that she has some other disturbing domestic issues. The patient wants to know when she will be discharged. More specifically, the physician attending to female patient and the patient's daughters want me to remain silent or lie to the patient concerning her discovered health condition. Evidently, there are practical reasons why the patient should not be informed about her terminal illnesses. Disclosing such information will be detrimental to her health, psychologically and emotionally. The physician attending to the woman suggests that we tell the patient that she has a less critical illness.

As a nurse, I consider this as unfair and unethical putting into consideration that the woman is of sound mind and as a result, she holds the right to know about her diagnosis and prognosis. On the other hand, if I choose to tell the patient about her health condition, this will be contradictory to the best medical care of the patient and instead will worsen her health condition. Nonetheless,, I am not sure what way to follow given that failure to inform the patient of her heath condition violates the rights of the patients while on the other hand, disclosing the information to her will be contrary to the best medical care for the patient.

Statement of Issue

Ethical dilemmas in nursing are described as recurrent conflicts between responsibilities and rights entailing human rights concerns (Finkelman & Kenner 2012, p.182).The dedication to offer services with respect to human dignity is founded on respect for humans as freedoms, entitlements and claims holder and as an end in itself. Translating the perspective of human beings into special nursing activities entails the procedure of reasoning about what should be done for the patient. With respect to the case at hand, the patient has the right to know about health condition.

Apparently, she is eager to go back to work and she does not know the reason why her stay in hospital has been prolonged. As a nurse attending to her, I feel that it is not right to lie to the patients and besides she has a right to be informed of her health condition. Nevertheless, through observing and judging how the patient will react to the news of her terminal illness, telling the patient the truth will be detrimental to her health besides contravening best medical practice for the patients. As a result, the case challenges delivery of care in a way that meets the requirements and respect the rights of the patient and delivery of care consistent with the objectives and goals of the best medical care for the patient. This is an ethical dilemma created through conflicts in obligations and loyalties to family, physician and a nurse. It is a decision between two equally justifiable options.

List of Options for Actions

The nurse should follow the direction of the physician and lie to the patient that she has refractory anemia

The nurse should disclose the news of the patient's terminal illness to her.

The nurse can choose to remain silent

The nurse choose to consult the hospital's ethical committee and nursing board

Statement of Other Relevant Facts and the Consequences of Each Option

The Nurse Should Follow The Direction Of The Physician And Lie To The Patient That She Refractory Anemia

Lying is an infrequent but unavoidable portion of human social interaction. It helps in fulfilling human social requirements notwithstanding its disadvantages. Human beings are subject to scores of social constraints that influences suitability and reasonability of deception. Lying is a major issue in ethics and holds numerous potential unenthusiastic consequences (Callahan 1988, p.141). This is because it destroys relationships once discovered, as relationships require trust. For instance, if the nurse chooses to follow the direction of the physician, when the patient discovers that she was lied to; her relationship with the nurse will automatically be negatively affected.

However, this will depend whether the lie is justifiable or not. For instance, false excuses help in preventing something else to happen despite the fact that they can cause as much harm just like active lies (Callahan 1988, p.141). Lies to the sick violate their rights to make informed choices. For lies that can be justified, they must demonstrate lack of alternative course of action. The moral arguments for such lies should outweigh moral arguments against such lies. Mores, lies to the sick must confirm that an individual with no personal interest in the upshot would approve the lie. However, telling lies to patients is unacceptable and contravenes the rights of patients. Deception harms the patients besides destroying the clients trust to the nurse, physician and the whole medical profession (Bok 1978, p.141).

The Nurse Should Disclose The News Of The Patient's Terminal Illness To Her

Based on the ethical morals and principles that are entrenched in Patients Right Act, the patient has the right to be informed of her health condition to allow her to make informed decisions (Surbone 1995, p.50). Truth is considered a fundamental value that proves to be foundational to a client's autonomy. A patient has the right to know of her diagnosis and prognosis. Telling truth to the patient will enhance compassionate interaction besides forming trust between the nurse and the patient. A nurse should be committed to offering proficient medical care with respect and compassion for human rights and dignity (Pellegriono 1995, p.56). On the other hand, when the patient realizes that she has a terminal illness besides other domestic issues, her health perhaps will deteriorate. On the other hand, informing the patient of her true health condition will not be consistent with the best medical care for the patient. This will put at risk the health of the patient, as she will be affected both psychologically and emotionally.

The Nurse Can Choose To Remain Silent

Nursing education and as well as professional attitude of nurses concerning patient care are focused principally towards upholding life and providing cure for diseases. While terminal illness is more challenging than an unexpected death, physicians and nurses must not remain silent as regards health information disclosure to a terminally ill patient (Surbone 1995, p.51). While silent may reduce conflicts and distrust, it adds no value to the patient and to the healthcare profession. For instance, in the case at hand, the nurse is uncomfortable when lying to the patient and she needs to uphold best medical care for her. While showing concern and compassion to the patient, the nurse should maintain composure and objectivity through informing the patient about her health condition and not through silence (Pellegriono 1995, p.56). Through denying the patient the reality of her terminal illness by remaining silent, the patient may feel disconnected and unaided, an aspect that would seriously affect her psychological and emotional health consequently affecting worsening her health condition.

Consult The Nursing Board And Hospitals Ethics Committee

Given that the family, head nurse and the physician have stated their position concerning information disclosure to the patient, consulting the nursing board and the hospital's ethics committee is an excellent idea, as the nurse will be provided with ethical guidelines and practice scope (Sheldon 2009, p.3). This will help her in options identification and a sound decision-making. This will add a knowledge base and will not harm the patient in anyway.

Statement Of Moral Principles

A nurse in all professional links must practice with kindness and high opinion the inherent dignity, value and distinctiveness of all persons. The practices should be unlimited through economic or social status, nature of the patient health issues or personal attributes considerations. The primary dedication of nurse is to the patient and he/she promotes and supports the protection of safety, rights and health of the patient. More so, a nurse should maintain nursing values in order to uphold the profession's integrity as well as its practice. Moral standards are described as statements concerning basic and broad philosophical concepts (Callahan 1988, p.130). These statements offer an establishment for creating moral rules. Notably, moral principle stresses on respect to others while moral rules stresses on telling the truth.

A nurse should not ignore the autonomy of a patient. In fact, a patient hold the right to make own choices given that every individual is unique. A patient's statements should not be disregarded and informed consent should be attained from the patient before commencement of any treatment. Moral principles in nursing also emphasis on nonmaleficence and the nurses are required not to do harm to their patients (Callahan 1988, p.131). Through moral principles, nurses are required to maintain beneficence, which is the moral duty to always do well and execute activities that are of benefits to the patients. Practicing good deeds can sometimes be harmful to the patient. Other moral principles include justice and fidelity. Fidelity obligates nurses to be strongly faithful to their responsibilities and agreement they have chosen to take. As a result, a nurse should not run away from her responsibilities. Nurses should as well as uphold veracity that requires to always telling the truth to their patients. They should be responsible for their actions and accept the effects of their behaviors (Callahan 1988, p.130). .

Statement of Your Decision

Letting patients know their diagnosis and prognosis when physician and family members hold back information is a predominant ethical condition in the field of nursing. In such a situation, nurses utilize elusive comments to their patients in order to uphold professional links with physicians and family members (Callahan 1988, p.128). I would personally refrain from pretending and telling lies to the patient. However, before telling the truth to the patient, I will talk to the two daughters to make them understand the situation and implications of withholding critical information regarding their mother's health condition. This perhaps will make them change their attitude. Given that telling lies jeopardizes the integrity of a nurse and that of the nursing profession, I will uphold veracity and disclose the news of the patient's terminal illness to her. I will do this with much care and compassionate. This way, I will allow to her make critical decision concerning her treatment thereby upholding the moral principle of autonomy.

Justification of Your Decision

Through telling the truth to the patient, I will uphold nonmaleficence; veracity, fidelity and other moral principles besides letting the patient make her own decisions relating to her health condition. Apparently, the patient is of sound mind and has the right to know about her health conditions (Callahan 1988, p.128). Listening to the family's concern will not add value to the patient and to her health condition. The family is not aware of the repeated questions that their mother is posing to me each time I visit. More so, I do not want to run from my responsibility through allowing the head nurse to assign another nurse to the patient. This will affect my role as a nurse.