ANALYSIS OF AN ETHICAL DILEMMA IN CLINICAL SETTING 8
Analysisof an Ethical Dilemma in Clinical Setting
Analysisof an Ethical Dilemma in Clinical Setting
Ethicaldilemmas are challenging situations that have clashing moral claimsand a person can experience difficulties in making decisions while insuch situations(Sneesby, 2009). I found myself in an ethical dilemma after a patient 19-year old,revealed to me that he was considering committing suicide. My patienthad been suffering from depression and has a long history of takingcocaine. However, after a long counseling session with him, hepromised not to embrace such thoughts that might hurt his familyespecially his mother. He also asked me not to say any word to themother. However, I got very worried about him. His mother sometimesaccompanies him for the appointments. I thought of speaking to themother but was facing challenges to take that bold step since thepatient had asked for confidentiality.
Asmany studies indicate, the Uustal decision making model guidesindividuals to make sound decisions without any obstruction.According to Lynn(2009), in making decisions especially when encountered with ethicaldilemmas, it is important to follow the right procedure such as theUustal model. The ethical dilemma in the above described scenario isthat my patient’s life was at risk but as a nurse I was supposed toobserve confidentiality with my patient’s personal information. Insuch a situation one has to make the decision whether to value thepatient’s life and inform the mother or practice code of ethics asa nurse on confidentiality. This paper outlines Uustal decisionmaking model and describes in detail how each of the nine steps couldbe used in solving the described ethical dilemma.
Step1: Identify the problem
Theproblem is that the patient is extremely depressed and consideringsuicide which is a threat to his life. The people involved are thepatient, I as the nurse, the patient’s mother and his entirefamily. Another problem is that the patient does not want the motherto know about his condition and she is a person who can be termedvery close to his son, and hence can offer him emotional support toprevent him from committing suicide.
Step2:State your values and ethical position
Asa nurse, I have learnt to embrace code of ethics such asconfidentiality. However, my patient’s life is at risk and what ispreventing me from taking a step to save his life is confidentiality.I am a staunch Christian and since childhood I have been taught tovalue life since it is a gift from God. Faced with the describedethical situation, I decided to inform the mother secretly about hisson’s suicidal thoughts. However, I cautioned the mother on the howto approach the son and counsel him from as a mother and giver himall the support that he needs. I broke code of ethics onconfidentiality and choose to protect my patient’s life.
Step3: Take into consideration factors that relate to the situation andgenerate options for solving the dilemma
Apartfrom involving the mother to help his son, there were various factorswhich could be considered to generate options to solving the ethicalcrisis. According to Johnston(2009), nurses and other health care workers are faced with difficultsituations and it is highly important to consider all options beforearriving at a final decision. An option would to observeconfidentiality and believe that the patient would not commitsuicide. However, since the patient was suffering from depression, hewas not in a good state of mind to evaluate the consequences ofcommitting suicide.
Step4: Categorize alternatives, identify those that are consistent andinconsistent with your personal values
Asidentified in step three, the alternative would to observeconfidentiality and fail to inform the mother about his son’ssuicidal thoughts. However, as I explained I am staunch Christian andthe value I accord to life is higher than confidentiality. Therefore,informing the mother to save his son’s life is consistent with mybelief and world prioritize it over the option of observingconfidentiality. According to Stiggelboutetal,(2006),in making decisions to solve some ethical dilemmas, it is importantto consider the consequences resulting from the various options andchoose the alternatives with fewer or less serious consequences.Under my situation the option of observing confidentiality had moreserious implications and hence could not choose it.
Step5: Predict all possible outcomes for those acceptable alternativesConsiderphysical, psychological, social, and spiritual consequences, bothshort-term and long-term.
Frommy point of view, I predicted that the option of being confidentialwith my patient’s information may result into his death. Thepatient’s state of mental depression may have led him intocommitting suicide since he had already though and even disclosed histhoughts to me. On the other hand, the option of violating nurses’code of ethics and disclosed my patient’s information to his motherwould have prevented him in one way or another, from committingsuicide. However, the patient would be psychologically and sociallyaffected of the thought that he could never trust me and to a largeextent all medical professionals with his personal ideas andinformation.
Step6: Prioritize acceptable alternatives. Put them in order from most toleast acceptable
Asstated earlier, the dilemma under discussion had only two options, ofwhich only one is acceptable (informing the patient’s mother of hisson’s suicidal thoughts to help save his life).
Step7: Develop a plan of action, determine what you are going to do aboutthis dilemma
Thefirst action taken was informing the mother of his son’s healthstatus and suicidal thoughts. Then I guided the mother on theappropriate approach in helping his son. I volunteered 2 hours of myfree time three times a week to give my patient company and help himcome out his depression by indulging into activities such astravelling, hiking and swimming. Finally, I assigned my patient to amedical expert in counseling, who would help counsel him and offerthe necessary guidance and assistance needed to become mentallystable.
Step8: Implement the plan
Iimplemented my plan and was effective. My patient did not commitsuicide and with time, through my help, the help of the counselor andhis mother, the patient successfully stopped taking cocaine andstarted living a normal life.
Step9: Evaluate the action taken
Owingto the fact that ethical code of conduct requires any medicalpractitioner to uphold confidentiality, from an ethical point ofview, I was not supposed o disclose my patient’s secrets. Thepatient had every right to ask me not to inform his mother of hissuicidal thoughts. However, as Sneesby(2009), some ethical dilemmas may require one to violate code ofethics if this is done to prevent severe consequences such as loss oflife. From a personal point of view, the action taken was appropriateand effective despite the fact that it forced me violate ethicalcode of conduct. Life is considered important in clinical settingand having saved my patient’s life make my action more importantthan just comply with the ethical principle on confidentiality.
Discussionof Teammate 1 answer
Fromthis answer, it is clear that divorce is an ethical dilemma thatforces an individual to consider so many alternatives beforeimplementing it. The major problem in many divorces is unhappymarriage. Unhappiness results into emotional torture, forcing anindividual to think of ending the marriage. However, as teammate oneexplains, divorce is a serious dilemma since many people areaffected, especially the children. It is important to consider allthe consequences of staying in the marriage and getting a divorce andchoose the option that seems to be inconsistent with someone’sbeliefs. I concur with teammate one argument that marriage is asacred institute and should be respected. Before getting a divorce,it is important to consider all possible alternatives to safe amarriage.Teammate2 answer discussion
Teammate2 is confronted with a dilemma of allowing a daughter make thedecision on behalf of her mother who desperately needs palliativecare, but she is not willing her go. As the author of teammate twopoints out, many of us find themselves in very difficult situationswhen our loved ones are in pain and there is nothing much can be doneto change their health status. Ethically, it is wrong to let anindividual die or suffer for a long period of time without pursuingall ways possible to relieve the pain or prevent the death. I agreewith the author of this answer that it is wrong to make decision onbehalf of a person who is great pain. Since physician had diagnosedthe patient with several serious conditions, there was no other bestalternative other than palliative care and honor the wishes of thepatient.
Teammate3 answer discussion
Itis clear from their answers that teammate two and three are facingsimilar ethical dilemmas of encouraging people to let their lovedones receive palliative care. As the author points out in his answer,decisions surrounding end of life care are challenging for manypeople. However, I concur with this answer that end of life careallows a patient to experience less trauma and lives a comfortablelife with less pain as he or she enters the last stage of life.Uustal nine steps have been clearly explained and their importancerevealed in solving an ethical dilemma concerning palliative care.
Teammate4 answer discussion
Euthanasiais a topic that many people find it difficult to discuss since it hasserious ethical implications. The author of the answer points outthat people has diverse and contradicting views on euthanasia. Theanswer points out that despite the fact that many people find it easyto assist their loved die instead of experiencing a lot of pain, lifeis sacred and should be protected through all means possible.Alternatives such as pain management and palliative care have lesssevere ethical implications and should be sought instead ofeuthanasia. Uustal decision making model is an effective strategy toassist in solving dilemmas related to euthanasia. From the answer, bythe time an individual arrives at step nine of Uustal decision makingmodel, better alternatives compared to euthanasia will come up andassist in solving such dilemmas effectively.
JohnstonM.J. (2009). Bioethics,a nursing perspective(5th ed.), vol. 7(9) Churchill Livingston, Sydney, pp. 178–180.
LynnA. J. (2009). “Consensus and Independent Judgment in ClinicalEthics,” Journalof Clinical Ethics 20,no. 1, 56-63.
SneesbyB. (2009). The human face behind an ethical dilemma: reflecting onattempted suicide and outcomes of a case study.Int J Palliat Nurs,15 (9), pp. 456–462
Stiggelbout,A. M., Elstein, A. S., Molewijk, B., Otten, W., & Kievit, J.(2006). Clinical ethical dilemmas: convergent and divergent viewsof two scholarly communities. Journalof medical ethics, 32(7),381-388.