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Introduction

Ethical dilemma are situations in which there is a choice to be made between two options, neither of which resolves the issues in an ethically acceptable manner. Advances in medicine, increasing economic stress, rise of patient self-determination as well as differing values between healthcare workers and patients are among the many factors contributing to frequency and complexity of ethical issues in healthcare (Hollis and et. al., 2015).. The present report is based on ethical dilemma in health and social care where a case study is presented to highlight how service providers take decisions and deals with ethical issues. For this purpose, some theories and approaches are described which entails how decisions related to patient’s care have taken in ethical manner.

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Case Scenario

Patient A was a 56 years old father of five children with a history of lung cancer of last stage. Since last hospitalization, patient A conditions worsened due to cancer and was not maintaining oxygen saturation (Brown, Ryan and Harris, 2014). Therefore, such person was continuously getting oxygen as well. It has seen that the patient had become stubborn and denied treatments such as insertion of a urinary catheter and insertion of nasogastric tube. Patient’s family members and doctors were well aware of prognosis but hidden from the patient. After one month of hospital stay, sick person wanted to discharge from the hospital and wanted to stay at hus house in last days of his life. That patient also complaints about not getting better in spite of giving all treatment.

Ethical Dilemma

Ethics is the study of practical reasoning. Nurses face ethical dilemmas on a daily basis. Ethical behaviour is determined by many factors; what one person considers ethical may be vastly different from a person approaching a situation with a different point of view (Bowling, 2014). Ethical problems which arise in hospitals are affected by all members of health care team including nurses. The essay includes the dilemma which a nurse faced during clinical practice Nurses face difficulties in making decision due to some ethical approaches during their work at hospitals. According to ethical standard, a nurse action must be defendable in an ethical issue. The choice of action depends on the advantages and disadvantages of issue, so such decision depends accordingly. The matter of refusal of treatment between health care team and patient A put family in a hard situation. They encouraged patient A to agree the treatment which provides by hospital, on the other hand, they also requested to respect own autonomous wishes. The medical team disclosed terminal diagnosis and informed this to family. Afterwards family members asked the consultant to keep this truth away from patient A. The consultant agreed to keep this as a secret (Bryman, 2016).

In this scenario the ethical dilemma is identified and discussed how to deal with those situations by applying the theories. The issues which are identified in this case scenario are: whether as a nurse, by respecting the family’s wish should keep the truth from a terminally ill patient or should disclose that truth to patient. The approaches which a researcher applied in this essay are principalism, importance of general principles such as respect for autonomy, beneficence and non-maleficence. The other theory is consequentialism which is an ethical theory that judges whether something is right by its consequences. In this theory most people would agree that lying is wrong. But if telling a lie would help save a person’s life, consequentialism says it’s the right thing to do. Consequentialism is sometimes criticized because it can be difficult, or even impossible, to know that the result of an action will be ahead of time.

Autonomy

Autonomy means having the authority to make independent decisions and the freedom to act in accordance with one’s professional knowledge base. Many patients are unable to make a decision due to their illness. All patients whether autonomous or not should be treated equally with their dignity (Manners, 2017). Respecting a patient’s autonomy includes responding the patient’s sufferings with care and empathy. Hence the patient is not in a condition to disclose the diagnosis, the patient party can disclose the truth. In this scenario patient A has full rights to be informed about his diagnosis and prognosis. Informing about poor prognosis may cause psychological harm to him. Therefore, in this situation, by withholding truth about his disease condition may enhance patient care and prevent harm. On the other hand, by informing truth and providing accurate information may disregard family’s feelings.

Justice

This terms refers to an important aspect in ethical dilemma which states that every person is has right to get equally treated by others. Justice in general manner means being fair with all persons and respect their human rights. It states that human beings should get what they deserve as well as have right to get information. Dignity of a person doesn’t matter where they are working or living and to which background (racial, gender, sex orientation, caste, nationalism etc.) they belong. In context with present scenario, if information about disease i.e. poor prognosis will be kept secretive from Patient A then it will prove injustice. While, if it will be told to patient then it may impact negatively on mind and cause psychological harm as well. Therefore, to keep secret the information regarding poor prognosis from patient A seems to be better solution. As telling lie for survival of a person and keeps him away from psychological disorder refers to do justice.

Non Maleficence

Non-maleficence, is the negative side of the beneficence like the two sides of the same coin. The notion of not informing truth in this scenario relates to the principles of non-maleficence. Telling about poor prognosis may cause psychological harm to the patient (Carter, Laurie and Dixon-Woods, 2015). Therefore, in this situation, action of nurse by withholding truth about his diagnosis may enhance patient care and prevent harm. On the contrary, the principle of veracity focuses on telling truth and providing full and accurate information to patient. Therefore, if nurse abiding this principle advocates truth telling, can may disregards patients and family’s feelings.  This entails nurse to be experienced enough in weighing the benefits versus harm that is being provided to the patient. Hence nurse must reflect the situation and do analysis before reaching the final decision (Rubin and Babbie, 2016).

Beneficence

The principle of beneficence states that the nurse should promote good and prevent harm. This means that the patient’s autonomy should be respected. In patient A case, beneficence is not considered by his nurse by hiding the poor prognosis of cancer from him. Informing about patient’s diagnosis and prognosis may let patient to complete his unfinished tasks of his life and spending some time with his children and family members. Moreover, it may help in gaining peaceful mind and reduce his worries, therefore knowing his poor condition could have benefited him in many ways (Hunter, 2016). Thus diagnosis and poor prognosis should not be concealed as per family’s preference.

Consequentialism

According to this approach, it has ascertained that morality of any action or decision cannot be determined only as consequence. It is also considered as one of the crucial ethical theories in terms of influential and controversial. Researchers generally use consequentialism theory to identify what normally people think about what is right or wrong for them. Therefore, it helps in judging whether decision taken by a person is right or not by determining its consequences. As per views of Dinnie (2015), the concept of consequantialist states that if any wrong action is taken for welfare of a person or society then it will be a right decision. In context with present case study, it is seen that doctors and family members of Patient A take steps to hide information of poor prognosis from him. Since telling lie is not considered as ethical action but if it is taken for survival of a person who is suffering from a incurable disease then it will be right action to do (Lewis, 2015).  

Advantage: Action taken to keep secret the information of disease from patient reduces harm. Along with this positive and negative consequences can be obtained that justify unethical decisions. Therefore, if keeping patient A unaware from own disease and type of treatment given then it will increase the chance of survival. But second consequence of an action states whether in last days of a person telling lie is good or not. Therefore, according to ethical theory of utilitarian approach, in this condition of right or wrong decision, if keeping information secret from a person shows symptoms of mental and physical health recovery, then it is a good and right decision. Henceforth, if a goal behind certain wrong steps is morally important then kind of methods or decisions will be acceptable.

Disadvantage: Consequentialism sometime seems as criticized in terms of difficulties, harm and injustice (Dinnie, 2015). As every human being has right to get information about own health and consequences therefore, keeping them away from incurable disease refers as injustice. This theory forces researchers or physicians to predict all certain consequences behind an action. It judges decisions in terms of pain of pleasure which would obtain from certain course of action. Therefore, it seems to be questionable whether it is fair judgement that decisions of family members are most important than the patient. Thus, consequentialism approach fails to create universal truth as every decision has different consequences. So, it is unanswerable here whether to keep secret or expose the information of poor prognosis to patient.

Compare Principalism And Consequentialism

According to Cherry and Jacob (2016), it has evaluated that consequential theory helps in making impartial or favourable decisions. To keep patient A away from information of incurable disease, decrease the chance of mental disability and enhance chance of survival as well. As per based on condition that prolonged lungs cancer lead patients towards death yet it is vital to keep this secret from him. While principles theory refers as practical approach which deals with moral dilemmas in medical ethics. Principlism includes multiple principles and applied in those conditions where two or more than two obligations are made but only one has to be satisfied. Therefore, it states that the autonomy of person should be respected and can be expressed as a principle of respect for autonomy. Thus, it includes both kind of positive and negative obligation. Here, negative obligation about autonomous action is not be subjected for controlling the constraints. While positive obligation states that disclosing information to patient is ethical action rather than to hide. In this regard, respect autonomy of patients, any decision cannot be taken without willingness of his own decision. As per beneficence principle, keeping information hide from patient and disclose in front of family members enhance benefit and reduce harm to the patient itself (Cherry and Jacob, 2016). Therefore, it balances the benefits against risk. Similarly, the principle of maleficence seems to create no harm i.e. keeping secret the information about prolonged cancer increase chance of survival then in that condition it is acceptable method. But in practicable manner, expose information seems to be more good as in that condition patient will cooperate doctors for better treatment.

Literature Search strategy:

Before drawing any valid conclusion or justify any decision, I have gathered proper data on the concept of principalism and consequentialism theories. For this purpose, I have used secondary source methods that are books, journals and some websites of internet where different professionals have given their view point on the same. Along with this, I have made proper plan about how to collect information and further analyse it to draw conclusion. Through this research, it has analysed that both theories are useful for making decisions and justify in medical terms of conditions.

My Decision

As per comparison with consequentialism and principalism, as a researcher I prefer to principlaism theory, because according to current scenario, patient A has refused to take medical treatment or stay at hospital. Therefore, if doctors or family members will make him aware about his own prolonged cancer then it increase chance of getting cooperation of patient for treatment procedure. It includes chemotherapy, insertion of a urinary catheter and nasogastric tube etc. which patient A is refused to take. Along with this, after getting such kind of information, such people would like to spend more time with family, friends and other relatives in last days. It proves justice with them as they can spend last days more happily and fulfil own desires as well. Therefore, without getting emotional, it is ethical duty of nurses and doctors to disclose information to patients about disease and kind of treatment. Thus, actions taken as per prinicpalism theory are beneficial in terms of dealing with morale conflicts. It provides all certain statements related to desirable values viz. avoidance of harm, respect of autonomy, justice and more.

Conclusion

It has been concluded from the above report that doctors and nurses have play a very difficult role and face many ethical challenges while taking care of their patients. In order to deal with the issues where doctors have to take major decisions related to survival of patients and care, they used to apply various theories. It includes prinicpalism, consequentialsim and more ethical dilemma. In this context, every theory has ascertained some principles and concepts for care of person. Therefore, to keep in consideration such principles and accountable of action, nurses should be defensible in terms of moral and ethical standard. They should consider what is right and wrong for patients and before taking any choice of actions, it is responsibility of them to evaluate the pros and cons of each course of action. By understanding the concept of theories of prinicpalism, consequentialsim, it becomes easy for service provides in health and care sector to face ethical dilemmas. It seems to be useful to evaluate all consequences before taking any action related to patient’s care and goof for their professional practice as well. By analysing all facts both in terms of practical and ethical manner, nurses can take better actions. Along with this, using concept of such theories, they can handle morale conflicts more effectively.

References

  • Cherry, B. and Jacob, S.R., 2016. Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.
  • Dinnie, K., 2015. Nation branding: Concepts, issues, practice. Routledge.
  • Lewis, S., 2015. Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), pp.473-475.
  • Manners, R.A., 2017. Professional dominance: The social structure of medical care. Routledge.
  • Hunter, D.J., 2016. Desperately seeking solutions: rationing Health Care. Routledge.
  • Bowling, A., 2014. Research methods in health: investigating health and health services. McGraw-Hill Education (UK).
  • Rubin, A. and Babbie, E.R., 2016. Empowerment series: Research methods for social work. Cengage Learning.
  • Carter, P., Laurie, G.T. and Dixon-Woods, M., 2015. The social licence for research: why care. data ran into trouble. Journal of medical ethics, pp.medethics-2014.
  • Bryman, A., 2016. Social research methods. Oxford university press.
  • Hollis, C. and et. al., 2015. Technological innovations in mental healthcare: harnessing the digital revolution. The British Journal of Psychiatry. 206(4). pp.263-265.
  • Brown, J., Ryan, C. and Harris, A., 2014. How doctors view and use social media: a national survey. Journal of medical Internet research. 16(12).

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