Essay An Ethical Dilemma
Select a case study from the list below and address the following points.
- Identify the stakeholders including two health care professionals in the case scenario;
- Identify the ethical and legal conflicts and consider them from the following
perspectives:
The dignity and rights of all stakeholders in this case
The principles and virtues of health care ethics that inform professional practice
The relevant codes of ethics and/or codes of professional conduct - Propose a legally and ethically defensible resolution to these conflicts
Case scenario give below
CASE STUDY TWO
Alex Ng, a senior paramedic in a regional centre, is called out to attend a motor vehicle
accident on the main highway, involving two cars and a large transport truck. On arrival
at the scene, Alex finds passengers trapped in both cars; two children in a small car are not
moving and show no other signs of consciousness while the female driver is slumped over
the steering wheel, bleeding from a head wound. The male driver of the other car is
conscious but trapped in the wreckage; he tells Alex’s partner that he cannot feel or move
his lower limbs. The male truck driver is walking around the wreckage and appears
confused and disorientated; at a glance, he does not appear to be physically injured. A
woman who was driving past stops her car and comes forward; she tells Alex that she is an
emergency physician and can help. Alex is grateful for the offer of help and asks her to
attend to the children, however, he notices the smell of alcohol on her breath when she
walks past him. After opening the door of the other car, Alex notices that the trapped
driver is wearing earphones attached to his mobile phone and the phone screen indicates
that he was on a call when the accident occurred. The driver is alone and Alex recognizes
him as the local magistrate, and a good family friend. Just then, he hears the screech of
brakes and turns to see that the truck driver has walked up the highway and into oncoming
traffic. He is lying on the road and does not appear to be breathing.
Health Care Ethics
Introduction
HEALTHCARE ETHICS
Ethics affects every part of healthcare setting and this calls for healthcare providers to be
vigilant when providing health care services. These settings includes, when providing direct care
to patients, resource allocation and staffing. It is important to note that in some situations ethics
do not provide answers but instead, they lead to getting solutions (Burkhardt & Nathaniel, 2013).
Sometimes, healthcare providers are faced with situations which may or may not be life
threatening and they make decisions which go beyond their profession or technical concerns.
Nurses and physicians often encounter challenges on what ought to be done event in ordinary
situations despite the laid down ethics and professional code of conduct (Corey & Callanan,
2014).Consequently, it leads to the health care providers being faced with ethical dilemmas,
where one is expected to make a choice from two alternatives. When dealing with ethics,
healthcare professionals requires possessing skills, in processes of value clarification, ethical
decision making. Health care professionals should be aware that when faced with ethical
dilemmas evoke powerful emotions and strong opinions however, these emotions and opinions
are not enough to solve ethical dilemmas (Corey & Callahan, 2014).
Professional nursing actions are both legal and ethical. Generally, there are various
factors which fuel discrepancies between law and ethics .They include, ethical opinions that
reflect individual differences, human behaviors are usually complex to be accurately reflected in
law, the legal system judge’s action rather than intention. Finally, laws change according to
social and political influences. Therefore, some issues that may appear to be ethically right may
in real sense may appear to be legally wrong and those that are legally right may be ethically
wrong, therefore posing a challenge in provision of care by health care providers.
From the case scenario, the magistrate appeared to have been in a conversation through
the earphones during the time the accident occurred. According to the law, it is wrong to drive
HEALTHCARE ETHICS
while communicating with a cell phone. In this case, it appears like the accident occurred as
result of the magistrate being on a call.
Patient Rights
Every person has the right to be respected and be treated in dignity, to make decisions
regarding provision of care and be actively involved in treatment plan. However, nurses and
other health care providers are supposed to act as advocates for those clients who are
unconscious, the minors and those that are not in their right mind. These rights apply regardless
of the setting of delivery of care. Awareness of the client’s rights increases the health care
providers’ awareness of the need to treat the clients in an ethical manner and ensure that the
rights of the patients are protected. When nurses are providing care, they should always respect
the values, customs and beliefs of their clients.
In the event of accident victims, like in the case of Alex, nurses and other health care
providers might have a challenge in attending the accident victims since everybody is entitled to
provision of care but due to the limited number of health care providers in the scene one might
not be sure who to attend to first. This is due to the fact that everybody at the accident scene was
entitled to medical attention.
Ethical Principles
Ethical principles direct or govern on the best course of action. Ethical decisions are
based on principles such as autonomy, nonmaleficence, beneficence, justice and veracity
(González-PA chon & Romero, 2016). They reflect on what is best for the patients. When these
HEALTHCARE ETHICS
principles are employed in the nursing field, nurses are in a better position in solving ethical
conflicts. Furthermore, they can be used as guidelines in analyzing ethical dilemmas and provide
rationales to solving ethical problems. However, these principles are not absolute; hence there
can be exemptions to every principle in any given situation.
The principle of autonomy outlines that an individual has a right to make a decision and
act on it and nurses should respect the client’s rights and protect those unable to decide for
themselves. Nurses uphold this principle by accepting the client’s decision even if they are not
patient’s best interest. No maleficence means that every health care provider has a duty not to
cause physiological, physical, social or spiritual harm to others either potential or actual. A nurse
is responsible for weighing the potential risks and benefits of any plan of action. When
upholding this principle, healthcare providers practices according to their profession and laid
down legal standard (González-Pachón & Romero, 2016).
The principle of beneficence state that every health care provider has a fundamental duty
to do good and prevent harm. Justice is a principle which is based on the fairness concept, both
benefits and burdens should be distributed fairly. All individuals should be treated equally
,unless there is justification of unfair treatment (Myers & Venable, 2014)
A close relationship exists between ethics and values and this makes it difficult for the
nurses to balance between principles of health care delivery and those of the client. Therefore,
nurses should examine their own value system to be in a position to provide care to clients whose
values may differ. (Myers & Venable, 2014)It is important for nurses to note that values are
individual rather than universal; therefore, nurses should not impose their own values on clients.
Provision of ethical nursing care is directed to ones values.
HEALTHCARE ETHICS
Code of Conduct
Professional code of conduct outlines the nurse’s obligations to clients and the society at
large. The ethical code provides broad principles for determining and evaluating nursing care
.There are professional bodies which reprimand nurses for unprofessional conduct that results
from violation of the ethical code. For example, a nurse is supposed to provide care with respect
to human dignity and the uniqueness of the client without considering their social, economic
status, personal attributes and nature of health problems.
Nurses and other health care providers draw their moral guidance from their families,
religious beliefs, family and parental values. However, they may not be the only guidance in
professional ethics
Ethical Conflicts/Ethical Dilemmas
Ethical conflicts results when a person if faced with a decision to make and none is clear
since it collides with morality, ethics, justice or personal situations. In health care settings,
healthcare providers should evaluate the best choice to take since in some situations doing what
is termed as morally right may yield negative impacts while doing morally wrong may result in a
positive outcome. Furthermore, the moral position can be substantiated or not substantiated. Alex
and the colleague might have been faced with a dilemma on the accident victim to attend to.
However, when an ethical conflict is encountered, any healthcare provider should make
the best decision which is in line with principles, laid down rules and the law. In the event a
person is unable to resolve the conflict, he shall be required to address the consequences. It is
therefore important for a person to consult a colleague before undertaking any plan of action and
HEALTHCARE ETHICS
in case a conflict is unresolved, it will necessitate further consultation from the relevant
professional body or legal counsel.
From the case scenario, both Alex and his colleague might have been faced with a
dilemma parting the first victim to attend to. Health care providers are supposed to attend to
victims who urgently need care and for this case that’s what Alex did. Unfortunately, the truck
driver appeared to be stable despite the orientation and he passed on before being attended to. It
is unethical for health care professional to attend to clients when they are under the influence of
alcohol. However, it becomes challenging in the event of an accident due to the limited number
of healthcare providers at a scene
Ethical Theories
When making a choice between two alternatives, there are various ideas that can be
employed so as to help in solving the ethical dilemmas. Ethical theories are used to analyze
ethical problems rather than provide answers to ethical conflicts. Teleology is an ethical theory
that states that the value of a situation is determined by its consequences, thus, the outcome of an
action rather the action, determines the goodness of the action. This theory is based on the
principle of utility which states that any act must result in a positive benefit for the greatest
number of people in any given situation. Every alternative is assessed for positive and negative
outcomes. The selected action is the one that results in most benefits and least amount of harm
for all.
Deontology is an ethical theory that applies the criteria of the action itself to determine
what is good rather than the consequence. This theory is based on the categorical imperative
HEALTHCARE ETHICS
concept which points out that one should take action if the act applies a universal principle. This
means taking an action that one would take when faced with a similar situation.
Resolution to Ethical Conflicts and Ethical Dilemmas
When an ethical conflict of choice manifests itself, the nurse should be able to identify it
and come up with the relevant resolutions. The following are some of the issues that should be
factored in to before coming up with a resolution. This includes ethical theories, principals
involved, parties that will be affected and the consequences of ethical options. Nurses can be
able to make decisions to resolve ethical dilemmas if only they are done systematically (Lo, B,
2012). There exists a need to help address the ethical concerns in health care setting. Formation
of an ethics committee will go a long way in addressing the ethical dilemma issue. In addition,
this committee should formulate policies and procedures which will help in prevention and
resolutions of the dilemmas (Kangasniemi, Pakkanen & Korhonen, 2015).
It is of significance for nurses to understand the basis on which they make their decisions. This
means that they should think through what needs to be done in an orderly manner to provide
justification of actions based on principles (Shapiro & Stefkovich, 2016). Therefore, it would be
important for healthcare providers to know that the decisions they make cannot be based entirely
on intuition and emotions instead they should be based on an ethical basis. Ethical decision
making should be made in situations in which the right decision is not clear or where there are
conflicts of rights and duties (Shapiro & Stefkovich, 2016).
Conclusion
As professionals, nurses and physicians are obliged to protect the client’s rights and
interests. Consequently, sound nursing practice involves making ethical decisions. In every
HEALTHCARE ETHICS
healthcare setting, health care providers are usually faced with ethical concerns and they are
required to balance their ethical responsibilities with their professional obligations. Often a
conflict results when a nurse is trying to balance the two. It is therefore necessary for health care
providers handle situations from an ethical point of view. This should necessitate the application
of different principles in the profession, justification of actions through use of ethical theories.
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