Making The Ethical Decision

Published Date: 02 Nov 2017

Kerridge's ethical decision making model provides 7 steps systematic approach. It helps us to identify the ethical issues and evaluate the values of identified issues (Kerridge, Lowe & Stewart 2009, p.92).

T.J is newly born with a lack of cerebral cortex. As her mother had put her for adoption, T.J is in a ward being looked after by nurses and doctors. With her medical condition, she needs to get many tests done and needs intensive care that may help to prolong her life. In this essay, we will be discussing the ethical dilemma presented in this scenario by referring to the Kerridge’s ethical decision making model.

Ethical dilemma:

It is a complicated issue because in most medical cases babies with this condition die within a week. In a medical aspect of decision making, the first considered point will be the survival rate in a similar medical condition. By referring to this point, the problem is whether nurses and doctors should constrain care for a short term quality of life and pain relief or continue intense care for the chance of prolongation of life regardless of low survival rate.

Identify facts

As mentioned earlier, T.J was born with a lack of brain part which no medical intervention developed to assist. She may pass away within a week or may live a few years longer under the constant intense care. As her parent gave her up for adoption, now she is a ward of state.

Nurses are responsible for care and doctors visit her daily. She vomits after every feeding and sometimes has a tube inserted into her stomach through the nose to reduce the amount of vomiting. She needs to have blood tests done for an electrolytes level checking and her temperature drops dramatically when she is taken out from the isolette for essential care and test. Most of all, due to insufficient cerebral cortex, her body does not function normally.

Further information required

How long could she survive under current medical support? Who is responsible for the decision whether medical care should be continued or terminated?

Fundamental ethical principles

Principles of beneficence, non-maleficence and justice are involved in this scenario. The principle of beneficence can be described as ‘active well-doing, altruism, or conduct aimed at the good and well-being of others’ (Kerridge, Lowe & Stewart 2009, p.87). Beneficence can be thought as a health profession’s obligation arising out of their role or arising out of ethical concept. In other word, beneficence can be both a morality and a principle (Kerridge, Lowe & Stewart 2009, p.87). In this case doing something good means provide continuous care to save her life from instant life threatening condition because as soon as care is stopped she may pass away. There have been a few cases where some babies survived for several years with intense care. As active well-doing can prolong her life thus, beneficence is applied.

On the other hand, Non-maleficence means ‘above all, do not harm’ (Kerridge, Lowe & Stewart 2009, p.86). Medical care may sometimes cause harm to an individual as well as other members of community, economy, relatives and environment. And it is difficult to predict its result. (Kerridge, Lowe & Stewart 2009, p.86). There is a very low chance that she can survive with current medical development status. Intense care may not prolong her life as we expect, thus if long life expectancy is not guaranteed, the principle of Non-maleficence (no pain/harm) is important while she is alive.

Justice refers to the same level of service and rights that society owes to its members (Kerridge, Lowe & Stewart 2009, p.80). Clients are entitled to have the same level of treatment free of any discrimination. (Gault 2013). Nevertheless, justice is an issue in this case in terms of distribution of resources. The client needs a high cost continuous intense care. To see the issue from an aspect of resources allocation, the question arises whether medical resources should be allocated for to support a short- term guaranteed life or not?

Ethical conflict

In this case, primary conflict occurs between beneficence and non-maleficence. We want to help and save her life by doing many tests and feeding her. But every time she is being cared, she cries to unusual pitch. Intensive care (beneficence) may extend her life but will be causing severe pain while restrain care (non-maleficence) will stop pain and allow a quality of life but her life may be terminated very soon after. For this reason, we are unsure whether our help actually cause harm (more pain) or it is benefit towards her (life prolongation).

Another ethical conflict is in between justice and non-maleficence.

It is expected that everyone has a same level of health services that suit their medical condition (Kerridges, Lowe & Stewart 2009, p.82). To meet the non-maleficence principle which means not causing harm, all medical assistance and artificial feeding should be terminated or the frequency of treatment should be restricted. However, from the moment her treatment is restricted, the client’s right to justice in terms of medical resources allocation is breached.

Consider the law

Client is a newly born baby who lacks legal capacity and is unable to make the decision due to her age. The client is now a ward of state which means under the protection of the government and medical team. The medical team is responsible for looking after the client. The government authorities and the medical team are involved in decision making for treatment. From the legal perspective, there is no actual law that could be applied directly to this case (Gault 2013). However, if the medical team decides to follow the principle of non-maleficence, will it be regarded as negligence?

Making the ethical decision

Nurse’s ethical dilemmas continuously occur as long as values are in conflict with each other. Therefore it is important that nurses consider legal and ethical aspects of standards of professional behavior (Hughson, Koutoukidis & Stainton 2013, p.37). I believe that meeting the beneficence principle outweighs the non-maleficence and justice. According to Statement 4 of the Code of Professional Conduct For Nurses in Australia, nurses respect the dignity of people and uphold a competent care (Australian Nursing and Midwifery Council 2008). This is a complex situation. With or without care she will pass away in the near future. However, we should not jump to the conclusion that she is already dead. As long as she is fighting for her life our responsibility as a nurse is to provide care to support her effort regardless of any situation.

Scenario 2

The Code of Professional Conduct for Nurses in Australia (Code of Professional Conduct) set the minimum standards for nurses how to practise and behave in a professional way within and outside of occupational boundary and provide guidelines for legal and professional liability within nursing profession (Australian Nursing and Midwifery Council 2008).

In this scenario, Code of Professional Conduct statements 3,4,6,7,8 and 9 are breached.

3. Nurses practice and conduct themselves in accordance with laws relevant to the profession and practice of nursing.

Statement 3-1 is directly applied to this scenario. Nurses have responsibility to perform clinical practices within the relevant law.

Mary has a legal capacity and has the autonomy that she doesn’t want to be restrained. However, nurses restrained Mary against her autonomy, thus, they breached the law in terms of the assault.

4. Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues.

According to the statement 4-1 and 4-2, nurses protect interests of clients and take action not to compromise quality of care due to nurse’s prejudicial opinion.

Mary’s wish to stay independent wasn’t heard due to the nurse’s preconception of Mary’s falls history and health status

6. Nurses provide impartial, honest and accurate information in relation to nursing care and health care products.

Statement 6-1 and 6-2 indicate that when nurses provide a care plan it should contain accurate and honest information.

It is related to scenario because nurse advised client wrong information that wearing a belt is a new rule which nurses breach the ethical principle of veracity.

7. Nurses support the health, wellbeing and informed decision making of people requiring or received care.

Statement 7-1 indicates, nurses assist the patient to make the informed decision.

In this case, Nurses explained about risk factors however, Mary’s informed decision was not supported thoroughly because nurses started to use sit belt against Mary’s decision.

8. Nurses promote and preserve the trust and privilege inherent in the relationship between nurses and people receiving care.

By statement 8-1 and 8-2, nurses practice in a manner of respect for vulnerability and powerlessness to preserve a dignity of people and take an appropriate action to build sense of trust.

In scenario, nurse has lied to Mary because nurse may think that Mary is scared of breaching a rule due to her powerlessness. As a result mutual trust couldn’t be built up and Mary’s social and psychological wellbeing is not protected.

9. Nurses maintain and build on the community’s trust and confidence in the nursing profession.

Statement 9-1 and 9-2 suggest, nurses behave within a point of the ethics and the law in order to build and maintain a public trust as well as personal reputation.

If Mary’s issue was reveled that nurse has lied, nurse may lose her reputation and it will affect trust between nurse and other residents. Then it will eventually influence a facility’s poor reputation.

The Code of Ethics For Nurse in Australia (Code of Ethics) outline nurse’s responsibilities for fundamental human rights to carry quality nursing care and nurse’s obligation of profession (Australian Nursing and Midwifery Council 2008).

1. Nurses value quality nursing care for all people.

Nurses recognize that they are accountable for nursing care and the decision. Nurses are entitled for decision making and reporting to reduce potential risks and to support safety practice environments for patients, themselves and for all people.

In this case, Mary has a history of falls, unsteady on her feet and has not been using provided walking frame. In the circumstances, nurses were concerned that if Mary falls again, she may unable to walk again. Therefore, nurses decided preventing Mary from fall is priority.

5. Nurses value informed decision making.

Nurses value the people’s participation in making informed decision however, in some cases nurses are entitled to decision making within their professional role and relevant information.

Mary’s informed decision was supported at the beginning by being provided with a walking frame. However, as Mary has not been following an alternative care plan, the risks remains. Thus, nurses make the decision to prevent Mary from fall.

6. Nurses value a culture of safety in nursing and health care.

Nurses contribute to development of safe environment in health care to prevent event of people at risk of harm by monitoring, identifying risk factors and risk management.

In this scenario nurses monitored and identified risks and decided to take action to prevent event of fall that is because otherwise, if Mary falls again she will may be having a permanent disability,

With considering of the Code of Professional Conduct and the Code of Ethics, there are ethical conflicts presenting in this scenario. Professional conduct statement 6, 7 conflict with value statement 1,5. While conduct 6 and 7 state, nurses are accountable to provide honest and accurate information and respect patient’s informed decision making, value statement 1 and 5 says that nurses are entitled to make an own decision to protect the patients from significant harm.

And code of conduct statement 4 contrast with code of ethics statement 6. Even though Mary wants to remain independent in her movement, nurses are entitled to apply care plan against Mary’s wish if they think that is safety obstruction.

If I was a nurse looking after Mary, I would refer to the code of ethics statement because I consider keeping Mary in a safe condition is more important for her long-term satisfaction.

The Code Professional conduct and the Code of ethics do not provide all solutions but address the concept what nurses are expected to do. So it is important that nurses are aware and familiar with statements and are able to apply them to situations and take an appropriate action.

Scenario 3

Nurses are expected to get into the nursing profession with skills and knowledge for providing good quality of care. To doing that, nurses have to maintain an objective distance with the clients. If nurses come across the line, power imbalance presence then it may possibly put patients into exposure of mistreatment or abuse. ‘Professional boundaries in nursing are defined as limits which protect the space between the professional’s power and client’s vulnerability.’ (Australian Nursing and Midwifery Council 2010

An Enrolled Nurse(EN) working in a chemotherapy unit has fallen in love with her old boy friend. As their relationship developed, she was aware of their relationship and told him that she will be reporting to manager about their relationships. He persuaded her not to tell if she wants him to get better. She wants to help him and decides not to tell.

In this scenario, EN breached the professional boundaries in terms of Dual relationships and boundaries. According to the Nurse’s guide to Professional boundaries, Dual relationships and Boundaries, nursing care is maximized when nurses are not engaged in dual relationships. In order to avoid boundary crossing, nurses should understand about dual relationships and be aware of the consequences. If nurses cross boundary unintentionally, they should return to established boundaries and evaluate potential harm and seek support from senior manager (Australian Nursing and Midwifery Council 2010).

I think that is because once professional relationships are broken, people within personal relationship could be demanding and may ask for additional care and services which may be out of nurse’s availability. This may influence health care setting therefore, people in a same care unit may ask same level of care. And I also believe that if nurses meet an emergency situation within personal relationship, nurses cannot analyze a situation realistically.

If I was a nurse in this scenario, I would definitely report to the manager and seek a resolution. As mentioned earlier, dual relationships within therapeutic care obstruct professional conduction. Considering a special care, chemotherapy unit, I may be facing a difficult moment that I possibly cannot perform professionally. Thus, I think that in this case, EN has not been able to conduct the Professional Boundaries throughout this case should report to the unit manager and seek a solution.

Nurse’s duty is providing good standard of care and the safety of people. In order to meet high quality of care delivering, nurses should be well-informed with nurse’s legal and ethical requirements. If nurses are unaware of how to determine situation, they should seek support and consultation from senior member or relative organization. (Word count of 2,509)