Ethical Decision-Making in Nursing

Ethical Decision Making

• Ethical decision making involves the application of ethical reasoning to analyze and consider situations with ethical dilemmas
• It requires knowledge, skills, and the ability to evaluate options and provide justifications for actions, discerning right from wrong

Objectives

• Explain characteristics of ethical issues in nursing
• Illustrate situations, examples, and the decision-making process in ethical dilemmas

Content Overview

• Ethical dilemmas are reviewed
• Characteristics of ethical dilemmas in nursing are provided
• Frequently encountered ethical dilemmas in practice are highlighted
• The process of ethical decision-making is reviewed
• Factors influencing ethical decision-making are discussed
• A framework for ethical decision-making is presented
• Different models for ethical decision-making are explained

Ethical Dilemmas

• An ethical dilemma arises when faced with two or more conflicting options or situations in the same context

Ethical Decision Considerations

• The decision-making process should prioritize minimizing the negative impact on any affected party
• Options should be linked to individual rights, ethical principles, and moral standards
• Decision-making may involve multiple options, or no ideal choice
• When a choice must be made one should select the best option with the least adverse effects

Nursing Ethical Considerations

• Nursing ethical dilemmas require nurses to decide on a course of action and support it with ethical reasoning
• Nurses may find it difficult to determine the right course of action
• Ethical situations often involve multiple individuals, such as doctors, nurses, patients, and family members
• Differing values and beliefs among people can lead to conflicting views on the appropriate action

Example Ethical Dilemma Scenario

• A terminally ill cancer patient expressed to the nurse a decision to decline resuscitation
• The patient then becomes comatose and approaches cardiac arrest
• A family member insists on resuscitation, unable to accept the potential loss and clinging to the hope of continued life
• The nurse believes prolonging life via resuscitation would only increase the patient's suffering
• The nurse also believes that this is a violation their autonomy
• The ethical conflict involves choosing between resuscitation and respecting the patient's wishes not to revive

Characteristics of Ethical Dilemmas

• Arise from conflicting ethical principles
• Occur due to situational factors
• Emerge when there are multiple unsatisfactory options
• Result from conflicts in roles, duties, personal values, beliefs, and ethical principles
• Can be seen with conflicts between ethics and the law

Ethical Dilemmas: Conflicting Principles

• Conflicting ethical principles occur when adhering to one principle may violate another
• One choice aligns with one ethical principle but contradicts a different one

Ethical Dilemmas: Case Study

• Relatives of a patient with a mental illness request they be admitted to a hospital due to erratic behavior
• The patient who does not want to be admitted claims that they are in fact doing well
• The doctor must decide whether to admit the patient against their will to prevent harm

Ethical Dilemmas: Situational Factors

• Situational factors are conflicts arising within the work setting that involve institutional regulations for medical staff
• It impacts medical staff or others being treated

Ethical Dilemmas: Situational Factors Case Study

• A patient requires an emergency intubation however the laryngoscope is missing
• The staff must follow the procedure to borrow the laryngoscope from another ward
• Delays arise due to the need to complete the required paperwork
• A conflict emerges between adhering to institutional policies and providing urgent care to a patient

Ethical Considerations: Unsatisfactory Choice

• Unsatisfactory choice is when there are 2 choices where both will lead to negative consequences
• Those responsible for making a decision are required to choose
• When deciding someone must consider and chose based on matters that related to the death, life or suffering of someone

Ethical Considerations: Unsatisfactory Choice Case Study

• A patient in the terminal stages of liver and bile duct cancer experiences severe abdominal pain
• The doctor considered providing medication to ease the pain, however side-effects may also supress breathing
• The patient received comfort with the medication only to suffer and pass away
• The daughter now has to decide between medication to comfort or not

Ethical Dilemmas: Role, Values, Principles

• Role value principle is when conflicts arise from roles and duties
• It pertains to personal values, beliefs, and ethical principles

Ethical Dilemmas: Role, Values, Principles Case Study

• Following surgery, a doctor prescribes morphine injections for pain relief. The patient frequently requests these injections
• A nurse feels conflicted about administering morphine due to personal beliefs against narcotics
• The nurse faces a dilemma between alleviating the patient's suffering and personal ethics regarding narcotics

Ethical Dilemmas: Ethics vs the Law

• Conflicts arise between ethical and legal standards
• Abortion laws can trigger ethical debates on whether terminating a fertilized embryo constitutes taking a life

Common Ethical Scenarios

• Refusal to give treatment
• Is it acceptable to tell the truth or deviate
• Do you have the authority to protect someone's secrets
• Prolong life or end suffering
• How to allocate limited essential resources
• Poor collaboration with others
• Lack of professional support
• Professionalism versus personal responsibilities

Ethical Scenarios: Refusal of Treatment

• Refusal of treatment is when a patient is unable to recieve replacement blood due to religious beliefs
• Despite the seriousness of the illness, the patient declines a blood transfusion due to religious reasons
• A conflict arises between respecting a patient's autonomy and promoting their well-being

Ethical Scenarios: Truthfulness

• Truthfulness includes challenges of caring for patients with HIV/AIDS or cancer
• The diseases are often associated with stigma, rejection, and incurability

Ethical Scenarios: Truthfulness Considerations

• Telling the truth is associated with shock, disbelief, grief, depression, and suicidal thoughts
• Withholding the truth infringes on patient rights to self-determination regarding their health

Ethical Scenarios: Confidentiality

• Confidentiality pertains to protecting patient secrets

Ethical Scenarios: Confidentiality Considerations

• A married man diagnosed with HIV requests the nurse not to inform his family, creating discomfort for the nurse
• This puts his family at risk of infection, denying them the opportunity for testing and treatment
• The ethical dilemma involves whether to maintain patient confidentiality or disclose information to prevent harm

Ethical Scenarios: Prolonging Life

• Prolonging life relates to decisions involving life, death, beliefs, and values
• When patient in the final stages are in varying conditions
• Decision-making involves patients, families, and other parties

Ethical Scenarios: Prolonging Life Considerations

• The family cannot choose to intubate and the staff are unable to decide if resuscitation is possible

Ethical Scenarios: Resource Allocation

• Resource allocation includes giving transplants
• Decision-making involves allocating resources while upholding justice and maximizing benefits

Ethical Scenarios: Resource Allocation Considerations

• The order when to transplant
• Whether the patients should receive medicine if supplies are low if multiple requests are made

Ethical Scenarios: Relationships

• Relationships deals with coordination with others
• Ethical dilemmas often arise between doctors and nurses over treatment orders, stemming from differing perspectives

Ethical Scenarios: Relationships Considerations

• A pregnant woman requests rapid labour from staff
• Staff believe that after 38 to 40 weeks the process will be not safe for herself, and decline a request despite receiving orders

Ethical Scenarios: Professional Duty

• Professional Duty relates to prioritizing others as a nurse
• Dilemmas stem from providing equitable care to all patients, regardless of their condition, potentially putting nurses at risk

Ethical Scenarios: Professional Duty Considerations

• A conflict is presented between patients' rights over a nurses right to self protection

Ethical Decision-Making

• Ethical Decision-Making requires ethics, consideration and analytics to weigh situations
• Requires special skills, knowledge, and ethics

Ethical Decision-Making: Factors

• Knowledge and Experience impacts decision making
• Susceptibility also contributes to decisions
• Rationality also contributes to decisions
• Beliefs can impact overall decisions

Knowledge and Experience Influences

• Ethics guides the overall ethics of a situation
• Utilitarianism focuses on the overall results
• Duties focus on compliance
• Virtues focus on habit
• Belief that it shouldn't cause harm
• Ethics focuses on what is best, moral and empathy skills

Ethical Sensitivity Considerations

• This is the first step when facing an ethical choice
• How things were percieved is important
• Emotions and feelings can impact ones view depending on the situation and how involved they are

Application of Reasoning

• Reason should guide the overall values as well as principles

Personal Values

• Personal values along with culture must be taken into consideration

Ethics: Case Analysis

• A pregnant woman asks for help after being raped and tested positive for HIV, and asks to not inform the husband or other relatives
• This is due to the desire to continue the blood line and protect her current relationship

Step 1: Review

• Needs, beliefs, and status must be taken into ethical consideration

Step 2: Ethical Factors

• To consider the importance

Step 3: Available Ethics

• Consider the existing available ethics that are known to be valid

Step 4: Choose the proper option

• There will be ethical reasons surrounding all choices

Step 5: Self Reflection

• Should there be other ways forward in the future

Format for Making Ethical Decisions

• Clients as the focus
• Physicians as a reference
• Bureaucracy should be in line with patients

Explore ethical decision-making in nursing, including dilemmas and factors influencing decisions. Reviews the characteristics, frequently encountered dilemmas, and provides a framework for making ethical choices. Learn about different models for ethical decision-making.