Ethical Dilemma in Nursing Practice
Nursing professionals have to deal with various people on a daily basis. Their job significantly involves ethically problematic situations when the right choice of treating a patient is not so easy to make. Obviously, when stakeholders with the opposite interests are involved in the matter, there may be no single right solution to an ethical dilemma. Nurse’s duty is to resolve the problem with the least harm caused to the patient and other parties. It is especially difficult to do when a controversial religious belief denies medical intrusion in the healing process. In many cases, it prevented patients or his or her relatives to accept medical help that subsequently led to mortal consequences (Hendrick, 2000). Therefore, the aim of the paper is to solve an ethical dilemma connected with such beliefs by using Uustal’s decision-making model.
A correctly used decision-making model ensures that the medical professional can find the most reasonable solution to an ethical dilemma with a minimum negative effect on its stakeholders. An approach proposed by Uustal (1993) is quite helpful in making the right decision since it does not only give directions to the nursing process but also includes the clarification of values of all stakeholders involved. The model contains nine steps. First, it is necessary to identify an ethical dilemma in the case under analysis. A child suffers from meningitis and needs urgent medical treatment. Physician’s primary duty is to save child’s life, but the ethical dilemma is that while the father insists on medical intervention, the mother refuses it because of her religion.
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Secondly, Uustal’s model suggests that the physician should consider his or her own personal values and look for the best solution that is consistent with the latter. If the practitioner does not practice the same religion, the ultimate goal is to save child’s life with the help of professional medical intervention. To resolve the dilemma at this step, I will ask myself whether I will feel guilty taking no actions and let the situation be as it is because of so many other patients waiting for help. Hendrick (200) emphasizes that,“the guiding principle is thattreatmentmust be in the child’sbest interests” (p. 48).
Thirdly, the model requires considering all factors associated with the dilemma. The physician faces the situation when child’s mom is a Christian scientist refusing any medical intervention into the healing process. An important factor to consider is that she is not a biological mother and received primary custody after the divorce with the biological father residing in a different state and insisting on medical help.
Fourthly, it is crucial to analyze the situation and draw different alternatives with possible outcomes to see which are consistent (or not) with physician’s values. One of the scenarios is to let things go as they are, but the kid risks to die. Another alternative is to persuade the mother to change her mind and allow medical treatment. One more option can be to talk to child’s father as a person who supports the latter and ask him to convince his ex-wife to proceed with intervention to rescue the child. The father should know better how religiously fanatic the woman is, whether she can be supportive or not, whether she denies all types of medical care or accepts taking some medicines, or whether she can allow any medical treatment since she is not a biological mother of the kid. “Sometimes common ground may be reached between the family’s religious or cultural believes and the healthcare team’s recommendations; communication and education are the keys in this situation” (Kyle, 2008, p. 51).
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The fifth step helps to predict all outcomes of the chosen alternatives. In the first case, the child may die, and the second and third solutions, if successful, can lead to survival. The sixth step prioritizes possible consequences. Physician’s primary call is to save patient’s life, so it is necessary to convince the mother to allow treatment.
Seventhly, it is required to develop a plan to reach the best possible outcome. The physician should talk honestly to the mother about possible consequences of child’s negligence, if the father fails to persuade his ex to proceed with treatment. It would be good to find the right tune with the mom to make her feel comfortable while speaking about religious topics and her feelings. It is advisable to be a good listener and show her compassion with respect to her religious views. The physician should also remind about possible legal consequences she can have in case of refusing to permit intervention. It is necessary to remind that she is not a biological mother and may not face such religious outcomes as those legal if she lets the child die. If she finally refuses to cooperate, the physician has the right to appeal to court to have legal permission for medical treatment. According to the Uustal’s model, the last two steps are plan implementation and evaluation. If the adopted plan has been not successful, the alternatives may be reviewed and a new strategy can be taken.
In conclusion, it is hard to diminish the value of the Uustal’s model. It gives detailed guidance for a medical practitioner how to deal with ethical dilemmas not omitting such an important factor as personal values and believes. One of its possible limitations can be is that it requires the most professional judgment with no subjectivism in the decision-making process (Uustal, 1993). Thus, to reach objectivism, more unbiased professionals may be needed.