Ethical Issue in Nursing

Select one ethical issue from your exploration of the course, textbook or internet. Using the Ethical Decision-making Model from p. 163 in the textbook, create a mock case-study as your initial post. Outline the steps in the ethical decision-making model and describe how you would assess, analyze, plan, implement and evaluate your dilemma to make your decision. P163: Ethical Decision-Making Model Whether involved in a collective or individual decision, nurses need to be knowledgeable about suggested steps in ethical decision making. Table 7.4 demonstrates the similarity in the processes required in ethical decision making and the nursing process, both of which are based on sound critical thinking. A variety of ethical decision-making models are available in published literature across many disciplines and share more similarities than differences. The steps are not always necessarily sequential, nor are they intended to be rigid processes. Instead, ethical decision making is a process that guides exploration of the dilemma and examination of options to determine the best solution to a difficult situation. Table 7.4 Comparison of the Nursing Process, Ethical Decision-Making Model, and CODE Moral Courage Model Nursing Process Ethical Decision-Making Model CODE Moral Courage Model (Lachman, 2010) Assess Clarify the dilemma, gather additional data Courage: Critically evaluate does action need to be taken to address the situation? Analyze/diagnose Identify options Obligation to honor: Analyze/reflect—what is the right thing to do? Consider what is at risk with the ANA Code of Ethics for Nurses, stakeholder beliefs and values, and ethical principles. Plan Make a decision Danger management: What do I need to do to handle my fear? Evaluate Evaluate (Should reflect on situation and outcome.) The following steps can be used in ethical decision making: 1 What is the specific issue in question? Who should actually make the decision? Who is affected by the dilemma? Determine the ethical principle or theory related to the dilemma. Are there value conflicts? What is the timeframe for the decision? 2 After the ethical dilemma is clarified, in most instances more information needs to be collected. Clarity is enhanced when you have as many facts as possible about the situation. Make sure you are up-to-date on any legal cases or precedents related to the situation, because ethical and legal issues often overlap. 3 Most ethical dilemmas have several solutions, some of which are more feasible than others. Identifying more options increases the likelihood an acceptable solution will be identified. Brainstorm with others, and consider every possible alternative. 4 To make a decision, think through the identified options, and determine the impact of each option. Ethical principles and theories, as well as universal basic human values, may help determine the significance of each option. When a nurse is confronted with an ethical dilemma, they should when possible make an active decision, as opposed to refusing to make a decision (being passive). Passivity is a form of decision-making; it is a decision not to act, which may be professionally irresponsible. 5 Once a course of action has been determined, the decision must be implemented, which usually involves working collaboratively with others. 6 Unexpected outcomes are common in crisis situations that result in ethical dilemmas. Decision makers should consider the effect an immediate decision may have on future ones. Reflecting on a decision and action can help determine whether a different course of action might have resulted in a better outcome. If the action accomplished its purpose, the ethical dilemma should be resolved. If the dilemma has not been resolved, engage in additional deliberation, and reexamine alternative options. Consider the six suggested ethical decision-making steps in the context of Case Study 7.1 of Daniel, who is terminally ill and who wants you—his nurse—to help him end his life. (1) Clarify the ethical dilemma. The specific issue is the patient’s right to autonomy versus the nurse’s professional ethics and personal morals. (2) Gather additional data. Is Daniel responding to something that happened before you even got to his home today, such as an argument or a confrontation? Is he becoming depressed? (3) Identify options. Options may include the following: (a) Simply tell Daniel you will not help him die. (b) Respond to his dire request with compassion, and try to determine what is behind his sudden sense that he wants to die. (c) Determine whether there is better symptom management that you can implement to make him more comfortable. (d) With Daniel and his partner’s support, enlist the assistance of other hospice agency that might have services such as pastoral care to help him ease his spiritual distress. (Note: There are many choices available here. These are just some suggestions.) (4) Make a decision. Make sure that everyone, especially Daniel, agrees with the plan. (5) Act. This may include a number of interventions, both physical and psychoemotional. (6) Evaluate. Does Daniel continue to express his desire to die now? Is he more comfortable? Is his distress less troublesome? Is he at some level of peace with his partner, his mother, and his life? Did your actions enhance the nurse-patient relationship with mutual trust and caring? CASE STUDY 7.1Your Hospice Patient Wants to Die … and He Wants You to Help Him Daniel is a 55-year-old gay man with advanced lung cancer and is positive for human immunodeficiency virus (HIV). He has a longtime partner, Juan, with whom he has lived for more than 20 years. Daniel is miserable, with profuse secretions from his lungs; every breath is a struggle. Despite his weakened physical condition, he is still very alert. He is getting oxygen via nasal cannula. He is very image-conscious, and part of each of your visits is spent helping him groom himself and put on fresh designer pajamas. His mother is staying with him and Juan, and she has never been told that Daniel is gay or that he has HIV. He confides to you that trying to maintain the secret that he has kept from his mother is exhausting and is becoming burdensome. In the middle of your visit, he asks for a mirror to see what he looks like. You hand him a small mirror, and he is shocked at what he sees—a gray, shrunken, emaciated image looking back at him. He sets the mirror down carefully on the bedside table, looks at you evenly, and with great seriousness says, “I am ready to die, and I want you to help me.” As a new nurse, you are not ready for this. You know that in his bedside drawer there is enough oral morphine to stop his breathing. You know that his death is still probably days away, and you are very sad for him in his misery. When you say, “I can’t do that, Daniel,” he starts crying and says, “I trusted you to help me.…” What should you do in response to this situation? What does the ANA say about assisted suicide and euthanasia? What is your personal moral code in this situation? Please post your response to the assigned Discussion Question and reply to at least one peer who answered a DIFFERENT question. Reply to a Peer by Friday as that is worth half the points! Per the Rubric, you are required to use s Scholarly JOURNAL ARTICLE(s) to answer the original question. The textbook and websites are NOT "scholarly articles." Per the Rubric, you are required to use a Scholarly Source (such as a Journal Article or a Valid and Reliable website) to answer the reply to a peer. 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