Ethical decision making

A 6-year-old develops a high fever accompanied by violent vomiting and convulsions while
at school. The child is rushed to a nearby hospital. The attending physician makes a diagnosis
of meningitis and requests permission to initiate treatment from the parents. The child’s
parents are divorced. The mother, who is not the biological parent of the child, has primary
custody. She is a Christian Scientist who insists that no medical treatment be offered for
religious reasons. The biological father, who resides in another state, is also contacted. He
insists that treatment be given and seeks independent consultation from another physician.
Assignment:
In a formal, written paper of 800-1,200 words, answer the following questions:

  1. What is the ethical dilemma here?
  2. Describe the decision-making model you selected from your readings.
  3. How would you resolve this dilemma using the model?
  4. Include, at the end of your paper, a 200-word dialog in which you explain your decision to
    the family. (Remember to use language that the family would understand).

Ethical decision making model

The controversies between cultural beliefs and the health care systems have existed for a long
time. In this case study, the people involved includes the 6 year boy who is diagnosed with
meningitis. His biological father is also involved because he is reached to give his advice, and
acknowledges the need to treat the child. He even consults a different healthcare provider
about the issue (Park, 2011). The paediatric healthcare provider is also involved as he is faced
by ethical dilemma between delivering quality care to the child who is in critical condition or
following the nursing morals (cultural competency) or the nursing code of ethics autonomy-
following the wish of the child’s mother. The child mother is also involved. She is the main
hindrance to quality of care. She is not the child’s biological mother, but has been given
custody of raising the boy. She strictly follows her religious beliefs and cultural values. The
other hindrance is that the child parents are separate, which complicates the concepts of
delivering care within the family centred orientation (Ganz, Wagner, & Toren, 2014).
The case study presents the ethical dilemma that exists between acceptance or rejection of
the professional duty of health promotion as well as health restoration as established by the
law, professional standards and nursing code of ethics; and making decision that ensures that
cultural competence is upheld. In such scenarios’ it is important to use the decision making
models as it facilitates in the guiding the healthcare providers on the exact steps that should

Ethical decision making model
be taken, to ensure that the decisions made are cognitive oriented and objective. In this
context, the Uustal (1993) model for ethical decision making will be used. This model is
identified because it is supported by evidence based practice, and it facilitates the integration
of the value clarification as well as the principles of the nursing process (Uustal, 1993).
Healthcare provider professional values
The nursing professional values are to ensure that they help restore health to the sick. The
main goals of nursing care include a) health promotion, b) disease management, c) health
restoration and d) preventive measures that are culturally competent. In this case study, the
first objective was to restore health of the young boy. This would involve administering child
antibacterial treatment via intravenous route. This intervention will stabilize the child’s
condition (Pesut, 2012). The second intervention would be to transfer the child to the local
community health care facility, where the child would be admitted for few days, until his
health is restored and recuperated. Denying the child medication for any reason would be
affecting nursing code of ethics, beneficence and maleficence to be particular. This would
possibly result to adverse reactions such as death. The two aforementioned interventions fit in
the healthcare provisions and values, as it is congruent with the nursing code of ethics and
professional standards (Park, 2011).
Alternative reflections and ethical care solutions
Evidently, the child needs urgent medical care. The child’s father and mother views conflict
each other, and the mother’s views are not congruent with the professional standards and
code of ethics. In this context, there is need to reach to a common ground. The several
alternatives that can be used to address the problem include (Park, 2011):
a) Follow the mother’s ideas of incorporating spirituality in treatment process
a) Homeopathy, where there will be a holistic body and soul therapies using the herbal
remedies

Ethical decision making model
c) Following the laws on child rights to access medical attention
Analysis of the solutions available
The child’s live with his mother who is described as Christian Scientist and is strongly
against the use of modern medication. Her wish is to perform religious rituals such as prayer
chants and laying of hands to rebuke and chase the evil spirits. She believes in spirituality
means of redemption using interventions such as shamanism. This occurs when patient is
healed by channelling the supernatural energies when the patient encounters the spirits. This
option is highly risky as it is not scientifically proven, thus the solution could be placing the
child into more danger (Park, 2011).
The second solution is the use of the homeopathy. This mode of medication is supported by
many cultures as it is believed to control a myriad of diseases. It entails holistic approaches in
that the patient is guided through various exercises to ensure that the soul connects to the
body and mind. In this type of treatment, the herbal remedies are used, and often
supplemented using nutritional supplements such as megavitamins. This activity
acknowledged by law only if delivered by a certified physician. Although the strategy is not
scientifically proven, its mode of practice is congruent with the nursing professional values
and standards. However, this method singly could be risky for the child (Pesut, 2012).
The last alternative is following the USA law in solving the conflict. The law permits that the
child parent or guardian is permitted to make medication decision for children below 18
years. The law accepts that some of the medical procedures can be exempted based on the
patient cultural values and religious beliefs. In this case, two parents are involved in this case
study, each with conflicting point of view. As a nurse, the ethical thing to do is to follow the
biological parent decision, because the primary goal is to save the patient life. Denial of
patient treatment will result to a loss of life, which could lead to a law suit for clinical

Ethical decision making model
negligence. Weighing the risks and benefits involved, this strategy seems as the only feasible
strategy (Park, 2011).
Prediction of the outcome
Religious practices might make the child’s mother happy and satisfied by according her
respect and sense of identity to her family. This is important as it will boost her mental
wellbeing and enhance quality care of the child. This strategy has minimal psychosocial
disorders such as distress and anxiety, but at the expense of the child’s health and probably
life. The second alternative is the use of homeopathy which could help improve the child’s
condition through herbal remedies. This will improve patient health and minimize psychotic
disorders such as anxiety and distress. However, the alternative risks outweigh the benefits.
The legal approach is effective as the child will be treated and health restored. However, this
approach is in conflict with the patient’s spirituality and could lead to loss of identity and
increased anxiety. However, these risks are worthwhile for the child’s life (Pesut, 2012).
Prioritization of the solutions
a) Homeopathy and complementary care
b) Following the USA legislation law as indicated by risk management team
c) Use of religious and spirituality interventions
Action plan (Uustal 1993)
a) Discuss cultural and religious values with the family
b) Describe the implication of modern practice care to child’s health
c) Seek advice from the risk managers in the hospitals and the local ethical offices
d) Reaching a common ground between the persons involved
e) Outcome evaluation
Implementation of the action plan

Ethical decision making model
The healthcare providers described the religious and cultural believes with the child’s family
members in order to understand their importance. The healthcare providers described the
pathogenesis of the disease, including the possible complications if the patient was denied
treatment, and the implication of the parents and healthcare provider if the child died due to
denial of care for whatever reasons involved. The healthcare provider consulted the
healthcare facility risk managers and the local ethical offices, which advised the nurse to go
ahead and administer antibiotics to stabilize the child condition, before transferring him to a
local certified homeopathy. This resulted to a positive outcome.
Evaluation
After deliberation, a common ground was reached, which left all the involved persons
satisfied. After the discussion, the child mother understood the risk the child was facing, and
her love to his child made her express her desire to accept the decision. The child’s condition
was stabilised and her outcomes were satisfactory.

Dialogue
Childs mother: My religious beliefs do not support modern science. It is a sin to insert
chemicals into our bodies. Therefore, I will take the child to our synagogue to be prayed for
Healthcare provider: Paediatric meningitis is a life threatening life condition. If no
intervention is done within 24 hours, there are zero chances of the child’s survival. This
spirituality issue is good, but it can be done after stabilizing your child’s health
Child’s mother: What do you advice?
Healthcare provider: Your request can be followed, but if the child fails to survive, you are
responsible and could be sued by the government? The other alternative is use of herbal

Ethical decision making model
remedies to manage the disease (homeopathy). It works because it includes use of nutritional
supplements and vitamins, but the child condition must be stabilised first.
Child’s mother: Please do whatever it takes to save my child’s life
(Few calls made between risk managers and local ethical team)
Healthcare provider: We will transfer your child to homeopathy healthcare facility, but the
child condition must be stabilised. I hope this will not put you in anxiety or distress or feel
like your faith is disrespected. It is all in the name of saving your son’s life.
Child’s mother: Thank you for understanding and your assistance.

Ethical decision making model
References
Ganz, F., Wagner, N., & Toren, O. (2014). Nurse middle manager ethical dilemmas and
moral distress. Nursing Ethics, 22(1), 43-51.
Park, E. (2011). An integrated ethical decision-making model for nurses. Nursing Ethics,
19(1), 139-159.
Pesut, B. (2012). Nursing need for the idea of spirituality. Nursing Inquiry, 20(1), 5-10.

Uustal. D. B. (1993). Clinical ethics & values: Issues and insights. East Greenwich, RI:
Educational Resources in Healthcare.

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