An ethical dilemma requires making a choice between two equally unfavourable alternatives. The basis of a dilemma can be a conflict between any combination of an individual’s obligations and rights, and those of another. This is due to the different circumstances that present varying challenges in End Of Life (EOL) circumstances. In this study, an ethical issue that can be encountered by a nurse practitioner is being discussed in the light of deontological ethical theory. This is a case of a mother whose baby has gone through unsuccessful heart surgery. She requested doctors to be by the baby’s side as her little son faced his last moments. The dilemma faced by the nurse was whether or not to allow the mother into the Operating Room (OR) which was against hospital rules. Consequently, an ethical issue arises, which is adequately addressed, for clear understanding. This is also reviewed in consideration of the American Nurses Association (ANA, 2009) code of ethics, and the International Council of Nurses (ICN) guidelines (ICN, 2009).
Decisions concerning the treatment of dying patients present different options for their healthcare. These often lead to ethical dilemmas, some of which are quite complicated in end-of-life (EOL) care circumstances. According to Aiken (2009), even the nurses find themselves, at times not well prepared to resolve these dilemmas and issues. That might be due to the modern major technological advancements in healthcare systems that make it quite challenging to handle various situations effectively. The situation gets even more complicated with a legal system that is unprepared and cannot handle effectively ethical conflicts. It happens until the legal system develops precedence of decisions made in such ethical dilemmas that can be cited later under the common law. In comparison, however, the ethical system is more inclusive, exceeding the legal system in its coverage. In healthcare, both law and ethics overlap in common practice. When faced with difficult situations that require making such hard choices, the decision made has to be well defended, always in the light of the patient’s concerns and rights (Drug Policy Research Center, 2009). It leads to the fact that all EOL choices in medical grounds have their effects out of their complex psychosocial components having a resounding effect on the patient or the guardian of a baby patient (Urlich et al. 2010. pp. 20-22). A debate can be generated concerning restrictions against maximizing moral good while interfering with moral standards. This, as championed by deontological moral theory, allowing for self-interpretation, can at times lead to moral dilemmas.
The case of a mother, whose baby has unsuccessfully undergone heart surgery and could not, therefore, be switched off from the heart-lung machine, can be a point of focus, as an example. The mother wanted to go into the Operating Room and be with her child to the point of his death since it was very clear the baby was facing death. The mother felt that this was the best she deserved. This put the nurse into a dilemma since the hospital’s rules were rigidly prohibitive to allowing the mother into the operating room suite; yet she felt, ethically, it ought to have been the best option. After the baby had died, the parents were given a chance to see him. They also had a chance of seeing their baby’s body for the second time, but still restated their sorrow about not being with the baby when he died. Therefore, this prompted the nurse to think about the way of dealing with such cases in the future. In the interactions that ensued, the baby’s mother disclosed to the medical professionals why she had insisted on being with her baby at the time of his death. The result of it was the formulation of the policy as a way of rectifying and dealing fairly with other such situations in the future.
In this case, there were conflicting alternatives that could not be assumed. This presented a moral problem, with a difficult choice between two actions based on an ethical principle (Hamilton, 2009). The nurse had to decide whether to honour the principle of autonomy by informing the parents about the available options and making them understand beneficence and justice, where she should have believed and attended on time to their demands and concerns. This would have been simply trying to maximize the good, which is against the deontological moral theory. Therefore, the nurse decided to be non-consequential, to be completely absolute. However, a question of whether it is always justifiable to take such absolute stances arises. According to the American Nurses Association (ANA) code of ethics, the nurse’s initial commitment is to the client be it an “individual, family, group, or community” (ANA, 2011). In addition, the client’s rights, safety and health should be protected, promoted and advocated for by the medical professionals. (American Nurses Association, 2001).
To sum up the above mentioned, it should be mentioned that patients, physicians, and caregivers face a lot of dilemmas in regard to life situations. Ethical dilemmas need a thorough consideration, putting weight into all facts and consultation with everyone. The major decision-makers in the field should also be highly involved and their position gave important consideration. In addition, the code of ethics that sets standards of ethical behaviour and makes the goals and values of the nursing profession explicit should be adhered to. This should provide guidance and responsible nursing, which reflect the high professionalism of nurses.
Aiken, T. (2009). Legal, Ethical, and Political Issues in Nursing. 2nd ed. New York: F. A. Davis Company.
American Nurses Association (ANA). 2001. Code of Ethics for Nurses with Interpretive Statements. Washington DC: American Nurses Association.