Introduction

Healthcare professionals face complex ethical dilemmas on a regular basis. These dilemmas often involve balancing patient autonomy, confidentiality, and the potential for harm to the patient or others. This paper explores the ethical dilemma of a nurse, Sarah, who discovers a teenage patient is self-harming. We will analyze the relevant ethical principles, explore the potential consequences of various actions, and propose a solution that prioritizes the patient’s wellbeing while respecting their autonomy.

The Scenario

Sarah, a registered nurse working in a pediatric ward, is caring for a 16-year-old patient, Emily, who recently attempted suicide. During a routine dressing change, Sarah observes fresh cuts on Emily’s arm hidden beneath bandages. Sarah knows Emily is depressed but hasn’t disclosed self-harm tendencies. Emily seems reluctant to discuss personal matters with her parents, who are present during most interactions.

The Ethical Dilemma

Sarah faces a conflict between her ethical obligations. Patient autonomy dictates respecting Emily’s right to privacy. Disclosing the self-harm to her parents could erode trust and potentially lead to further emotional distress for Emily. On the other hand, failing to disclose could have severe consequences if Emily attempts suicide again. Additionally, Sarah has a duty to protect others from harm, and Emily’s self-harm poses a risk to her own well-being.

Relevant Ethical Principles

• Autonomy: Patients have the right to make their own healthcare decisions, including the right to privacy.
• Non-maleficence: Healthcare professionals have a duty to do no harm, which includes preventing self-harm and suicide.
• Beneficence: Healthcare professionals have a duty to act in the patient’s best interest, which may involve seeking help for self-harm.
• Justice: Healthcare professionals should treat all patients fairly and ensure their safety.

Exploring Options and Consequences

• Respecting Patient Autonomy: Sarah could respect Emily’s privacy and not disclose the self-harm. However, this risks Emily’s safety if she attempts suicide again.
• Direct Disclosure to Parents: This approach could create a more supportive environment but might damage trust with Emily, potentially worsening her mental state.
• Indirect Disclosure with Patient Involvement: Sarah could discuss self-harm in general with Emily, encouraging her to seek help from a counselor or therapist. This empowers Emily while addressing the issue.

Proposed Solution:

Sarah should initiate a private conversation with Emily, expressing concern for her well-being. Sarah can acknowledge the difficulty of discussing self-harm and emphasize confidentiality within limits. Highlighting the importance of professional support, Sarah can offer options: involving her parents with Emily’s consent, connecting her with a counselor, or facilitating a referral to a mental health professional. This approach respects Emily’s autonomy while prioritizing her safety and encouraging her to seek help.

Additional Considerations

• Hospital Policy and Legal Requirements: Sarah should be familiar with the hospital’s policies regarding self-harm and mandatory reporting laws concerning minors and suicidal ideation.
• Mental Health Resources: It’s helpful for Sarah to have a list of readily available mental health resources that she can share with Emily if needed.
• Support for Sarah: Facing ethical dilemmas can be stressful. Sarah should utilize available resources within the hospital for support and guidance from colleagues or ethics committees.

Conclusion

Ethical dilemmas in healthcare require careful consideration of principles and potential consequences. By prioritizing non-maleficence, beneficence, and respecting patient autonomy whenever possible, healthcare professionals can navigate difficult situations and promote patient well-being.

Note: This paper provides a framework for a 3-5 page exploration of the ethical dilemma. You can further expand on each section by including:

• Specific examples and case studies related to self-harm and adolescent mental health.
• Detailed discussions of the ethical principles and their application in this scenario.
• Exploration of cultural considerations that might influence the approach.
• References to relevant professional codes of ethics for nurses or healthcare providers.

By delving deeper into these aspects, you can create a comprehensive and informative paper on a real-world ethical dilemma faced by healthcare professionals