Ethical Dilemma: Analyzing an Ethical Dilemma in a Nursing Context

This essay presents a detailed analysis of an ethical dilemma encountered in a nursing context, specifically within an intensive care unit (ICU) setting. The case study revolves around a 77-year-old patient, Mrs. Jane, suffering from advanced cancer and facing end-of-life decisions. The essay explores the conflicting wishes of the patient, her son, and her daughter, highlighting the complexities of respecting patient autonomy while considering family dynamics and the application of medical interventions. It delves into the ethical principles of beneficence, nonmaleficence, autonomy, and justice, demonstrating how they guide healthcare professionals in making difficult decisions. The analysis emphasizes the importance of communication, patient-centered care, and the challenges of balancing the patient's wishes with the perspectives of family members, especially in end-of-life scenarios, while also discussing the role of the nurses in the process. The essay concludes by acknowledging the difficulties inherent in navigating such ethical dilemmas and the need for a comprehensive approach that considers all relevant factors.

Running Head: ETHICAL DILEMMA
Ethical Dilemma
Students Name
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Ethical dilemma
Introduction
Ethical dilemmas and issues abound in the field of nursing. Nurses are normally faced
with ethical issues and dilemmas every day, every situation is unique as well as requiring the
healthcare provider to set aside their own beliefs and values to effectively and properly care for
their clients (Figar & Đorđević, 2016). Circumstances requiring healthcare providers like nurses
to make an ethical decision are dynamic and diverse; that is, the values established by the college
of the nurses of Singapore code of ethics remains the same. Thus, all the decisions anchored on
these values regardless of the circumstances and settings ensure consistent solutions (Lawson,
Beer, Rossi, Moore & Fleming, 2016). Fundamental values of life preservation as well as
alleviating human suffering are shared by professional members of the nursing and medical field.
This paper will critically analyze the concept of the ethical dilemmas as well as analyze my
personal experience of the ethical dilemmas in the ward and how I managed to prudently deal
with the situation.
Principles of Ethics
Principles of ethics are the fundamental of the study of ethics since each concept tries to
achieve to be successful (Grant, Arjoon & McGhee, 2017). Ethics are standards of wrong and
right which are professionally authorized by the healthcare professionals. While there can be
debates about what is wrong and right, principles of ethics in nursing are backed and supported
by the scholars in the healthcare field who determine how nurses are supposed to behave (Rahim,
Knights, Fyfe, Alagarajah & Baraitser, 2016). Ethics are standards and rules which govern how a

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healthcare professional should conduct himself or herself. Ethics do not provide particular
solutions; that is, they act to guide for ethical as well as moral conduct.
It should be noted that ethics do not have to deal with internal feelings or emotions.
Feelings and emotions steer individuals into undertaking things which may or may not be
morally correct. Legal requirements are normally not ethical. There are numerous instances
which have proven that laws are not ethical (Rogers, 2018). For instance, consider the laws
which were established by Adolf Hitler of Germany. Would you consider involuntary medical
empirical experiments or slavery ethical?
The two main classifications of principles of ethics as well as ethical thought are
deontology and utilitarianism (Breakey, 2018). Utilitarianism is the school of thought which hold
the view that the end justifies the means regardless of whether the means are not ethically right
(Nowak, 2017). Deontology holds that both the end and the means have to be ethical and moral.
The principles of ethics ensure that nurses have to adhere to principles of autonomy, fidelity,
veracity, nonmaleficence, justice, accountability, and beneficence. Beneficence is ethically doing
the right thing and good for the patient, justice demands that nurses must act with fairness when
offering care. Nonmaleficence is described as not harming the client; harm, in this case, can be
unintentional or intentional (Larson, Johnson & Bhayani, 2014). The principle of accountability
requires a nurse to accept responsibilities for his or her actions. Healthcare providers are
accountable for their health care as well as other professional actions. Nurses have to accept all
of the personal and professional impacts which can happen due to their actions. The principle of
fidelity requires nurses to keep their promises, that is, nurses have to be true and faithful to their
professional responsibility and promises by offering high and efficient safe and quality care in a
competent way. The principle of self-determination and autonomy state that nurses accept the

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patient as a unique individual who has the inborn right to have his or her perspectives, beliefs,
opinions, and values (Fortunato, Wasserman & Menkes, 2017). Nurses should encourage clients
to make their own decisions without coercion or any judgment from the healthcare provider. It
should be noted that the patient has a right to accept or reject the treatment process meant for him
or her (Monti, 2016). The principle of veracity requires nurses to be wholly truthful with the
clients, that is, a nurse must not give the patient incomplete information or truth to the patient
even when it can lead to the patient becoming distressed (Davidson et al. 2018)
The case
Mrs. Jane was a 77-year old woman who was brought by her son to the emergency
department after her caregiver found her in breathing distress. The emergency department
physician discovered that Mrs. Jane was minimally responsive to afebrile, verbal stimuli,
tachypneic to 31 breaths per minute, normotensive, and tachycardic to 131 bpm. Radiography
conducted on the chest showed a consolidation on the right lower lobe. It was also discovered
from the notes she came with that she had been recently admitted for weight loss due to
advanced bowel cancer as well as brain, bone, and lung metastases. In the emergency
department, Mrs. Jane respiratory functions started to deteriorate requiring a referral to the
intensive care unit (ICU). The patient was reviewed by junior registrars who recommended a
further review by the medical experts at the ICU. I was given the task the of looking after the
patient for the shift. I briefly read the patient’s history, and after learning her brief history, I
asked the doctor about what should be done with the coming admission. Are we going to
ventilate as well as intubate the patient in case she develops a respiratory failure? What were her
chances of recovery from the critical illness she was suffering from? Were there any discussions
with her next of kin like her son before planning for the admission in ICU? The doctor told me

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that his consultant took the decision. Therefore, we were supposed to wait when the patient
arrives in the unit.
After spending 24 hours at the ICU, the patient’s condition worsened swiftly, and a
decision was made to engage the family of what had to be done in case of cardiac arrest. Family
members need to be integrated into the discussion concerning end-life issues which ensures that
all parties in the treatment understand the situation. The son was informed about the condition of
his mother, and he revealed that the mother had previously stated that she did not want any
heroic strategies in the event of cardiac arrest. The conversation with the son led to a decision to
start a not-for-resuscitation order which was meant to deliberately stop live-saving measures
when the cardiac or respiratory function of the patient immediately stops. The following day her
daughter arrived. In my discussion with the daughter, she stated that did not have a close
relationship with the mother as she was staying in another city and had not been in
communication with her for the past four years. However, she still insisted on everything to be
documented. At this point I was not sure whether the daughter was aware of her mother’s
condition before being admitted, that is, her mother having bowel cancer and her chances of
survival were very dim. I suggested that she meets with other staff members.
In this case study, a medical ethical dilemma has been identified. The request for care by
the patient’s daughter conflicts with the patient’s previous directive. This placed us in a difficult
situation of either satisfying the request of the daughter or honoring her mother’s directive. The
doctor was forced to call the son of the patient, family lawyer and healthcare proxy of the
patient. The son was reached by phone, and he was informed about the planned course of
treatment, and he agreed with the team from the ICU. The son stated that the patient would not
assent to any form of aggressive measures and agrees to comfort care for his mother. The son

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promised to talk to his sister about her concerns. The initial step in analyzing the ethical dilemma
in this case study is to characterize the circumstance in terms of the fundamental principles of
ethics which apply as well as the possible linked concepts of ethics which can be involved
(Ronneberg, Peters-Beumer, Marks & Factor, 2015; Demir, Sançar, Yazgan, Özcan & Duyan,
2017). To effectively comprehend the process of decision making in this case study, you must
consider the principles of nonmaleficence, beneficence, autonomy, and justice (Neoh, 2017). The
principles can guide the nurses the doctors to execute the healthcare to the patient. The
consultation team held a meeting and agreed that the patient was dying. They agreed that even if
more treatment options were provided, the expected outcome was death. Thus, a prudent critical
care treatment should come up with a meaningful situation between the objective of life
preservation as well as a peaceful death (Curcio, 2017).
Autonomy; the ethical dilemma we were presented with was whether to respect Mrs.
Jane’s autonomy or give in to the demands of her daughter. The consultant was concerned with
offering additional care which did not go with the wishes of the patient. In this case, I held the
view that respecting the autonomy of the patient overrides the principle of beneficence as the
treatment option Mrs. Jane is the treatment which has to be followed. Therefore, we continued
with the comfort care involving regular suctioning, oxygen as well as pain relief for the breathing
problems. Nevertheless, we had to do this without the daughter’s cooperation.
Beneficence; this ethical principle directed the doctor to act in the interest of the patient.
As the healthcare provider tasked with looking after Mrs. Jane, I had the intention to give her
care which was in her best interest. Offering her comfort freeing her from pain is an example of
beneficence during the end-of-life dilemma. It should be noted that stress of dying and illness
have the potential of creating tension which makes communication barriers even if there was a

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directive in advance (Baldassarri, Lee, Latham, & D’Onofrio, 2018). In the meeting with the
daughter and the son, the consultant initiates a conversation concerning the significance of
comfort in dying patients. We had to consider the degree of Mrs. Jane Illness and her quality of
life.
Non-maleficence; this ethical principle influenced the team's decision not to resuscitate
Mrs. Jane. It is key to note that undertaking a complete cardiopulmonary resuscitation
approaches to a client who is critically ill might result in grievous effects as well as contributes
to ineffective care at the end-stage of the condition (Hidayat, Iqbal, Nasir, Mohamad & Taib,
2015; Venkat & Kim, 2016).
Justice; this principle states that all individuals should be treated with dignity and fairly
as well as use the available resources equitably. I observed that this principle was not executed
right at the onset of the incident. This has led to conflict situations in this case scenario. When a
client is placed in ICU, the utilization of technologies usually has the effect of unrealistic
expectations by the family members of what can be achieved by the care of the end-of-life
(Huang et al. 2018). In this case, the principle of autonomy did not empower the right of the
patient at the onset which leads to a breach of the principle of justice. Nevertheless, the doctor
also had a right to utilize autonomy to exercise ethical belief in handling a request for ineffective
care.
Conclusion
Most of the situations that result in an ethical dilemma are very hard to navigate (Avella,
2017). Usually, there are many clinical facts to put into consideration. Furthermore, the
preference, concerns of the patient as well as the values of the family have to be considered.

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Some of the factors in this scenario were out of my control yet I had to apply the principles of
ethics.
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