Today’s health care environment gives nurses many reasons to be conflicted.

 

Today’s health care environment gives nurses many reasons to be conflicted. Genetic testing, abortion, and end of life care are just some of the areas in which nurses may face ethical dilemmas. Consider how you feel about the following issues:

Respecting the wishes of a suffering client that he is permitted to die with dignity,
Respecting the health surrogate’s wishes regarding termination of life support,
Or even observing another nurse take two tablets of oxycodone as ordered but keeping one for herself.
Then give an example of an ethical dilemma you may have confronted in your own clinical experience or workplace. How did you come to the decision you made? What feelings did you experience while coming to that choice? (If you have not yet faced an ethical dilemma, research one and comment on it, answering the same questions.)

Sample Solution

1. Respecting a Patient’s Wish for Dignity in Death:

This scenario touches upon the sensitive issue of assisted dying. A healthcare professional faces a deeply personal choice: adhering to the patient’s right to autonomy and their desire for a dignified death, or upholding the legal and ethical limitations surrounding assisted dying. This could evoke mixed emotions, including empathy for the patient’s suffering, respect for their autonomy, and perhaps uncertainty about the legal and ethical implications. Navigating this dilemma would require careful consideration of the patient’s medical condition, wishes communicated through advance directives, and local laws and professional guidelines. Open communication with the patient, family, and other healthcare professionals is crucial for arriving at a decision that honors the patient’s agency while complying with ethical and legal boundaries.

2. Respecting a Surrogate’s Wish to Terminate Life Support:

Here, the nurse grapples with the moral conflict between respecting the surrogate’s decision based on the patient’s presumed wishes and the potential violation of the sanctity of life. Feelings of apprehension, responsibility, and the desire to provide the best possible care could arise. Exploring the patient’s medical history, considering the quality of life, and understanding the reasoning behind the surrogate’s decision are essential. Consulting with other healthcare professionals, seeking ethical guidance, and ensuring transparent communication with all involved individuals can help alleviate some of the emotional burden and guide towards a thoughtful decision aligned with ethical principles and respect for all parties.

3. Witnessing Misappropriation of Medications:

Observing another nurse’s potential drug diversion presents a significant ethical conflict. The desire to uphold patient safety and professional integrity clashes with the fear of retaliation or personal repercussions. Feelings of anxiety, moral obligation, and uncertainty about how to proceed are understandable. Reporting the observed behavior through established channels, such as hospital ethics committees or regulatory bodies, while ensuring patient safety and confidentiality, is crucial. Seeking support from colleagues or mentors could also be helpful in navigating this challenging situation.

Personal Experience or Research Example:

Since I can’t possess personal experiences, I can offer an example of a researched ethical dilemma faced by nurses:

Scenario: A nurse witnesses a doctor repeatedly making inappropriate comments and advances towards a young female patient. Feelings of discomfort, concern for the patient’s safety, and uncertainty about their professional responsibility could arise. This dilemma involves balancing patient advocacy with respect for the doctor’s position and fear of jeopardizing their own career.

Decision-Making Process:

The nurse could:

  • Approach the patient directly: Gently inquire about their well-being and express concern, offering support and resources.
  • Document the witnessed behavior: Keep a detailed record of the incidents, dates, and witnesses.
  • Report the doctor’s behavior: Follow the hospital’s established whistleblowing procedures or contact external regulatory bodies.
  • Seek support: Consult with trusted colleagues, mentors, or legal counsel for guidance.

These actions prioritize patient safety while respecting established channels and protecting oneself from potential retaliation.

Emotions:

Navigating such a dilemma could evoke strong emotions like fear, anger, and anxiety. It’s essential to acknowledge and manage these emotions, seeking support from confidantes or mental health professionals if needed.

Conclusion:

Ethical dilemmas are challenging realities for nurses who navigate complex situations requiring careful decision-making. By understanding the principles of autonomy, beneficence, justice, and non-maleficence, seeking guidance from professional resources, and maintaining open communication, nurses can approach these challenges with integrity and compassion. Remember, prioritizing patient safety, seeking support, and acting ethically are crucial aspects of upholding your professional obligations.

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