Discussion of Ethical Dilemma in Nursing

Introduction

Individuals in the nursing profession often face difficult decisions that concern the health and wellbeing of their patients. Many of those choices and judgments also present an ethical problem to the nursing practitioners who have to follow the hospital protocols and guidelines and ensure that their clients’ wishes are respected. This paper will discuss a potential ethical quandary that nurses may encounter that needs to be resolved with care for the patient and their family and significant others.

Definition of the Dilemma

The proposed ethical dilemma concerns a patient in the late stages of motor neuron disease (MND) who expressed a desire to discontinue treatments and start palliative care. The client is a married man with two children under the age of 10. His wife was appointed by a proxy as his healthcare agent two years ago when he was first diagnosed with MND. Recently, he began showing signs of cognitive impairment and progressive muscular weakness in his chest. Although the patient shared his desire to stop the treatment, his wife refuses. She argues it is important for the children to get as much time as possible with their father, while the patient does not want his children to see him during the last stages of the disease. There are few possible choices nurses can make in this case, including trying to persuade the spouse to respect her husband’s desire and delegating the issue to the hospital’s ethics committee. In addition, the nurse can insist on requesting a psychological evaluation of the patient to allow him to sign an advance healthcare directive in the form of a living will.

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Significance of the Topic

The proposed ethical dilemma is of great significance to the nursing practice. According to Oliver (2019), the prognosis for patients with MND is 2-3 years of life on average, and palliative care can start early for such individuals. However, the cessation of treatment can be viewed as the primary cause of death by the patients’ families and significant others (Oliver, 2019). Therefore, it is essential to ensure that the client and their family discuss palliative care and end-of-life treatment beforehand to avoid their wishes not being fulfilled. Patients also need to be advised on different types of advanced healthcare directives that will help ensure their autonomy.

Framework Model Used for Decision Making

In the proposed scenario, the patient is ready to cease treatment while his legal healthcare agent, his wife, aims to prolong his life for as long as possible. Therefore, a shared decision-making framework should be utilized to allow the family to arrive at the judgment that will be most beneficial for all the stakeholders. The shared decision-making framework that helps evaluate the individual’s condition and physiological reserve and accounts for their values at this stage of life should be implemented by the nurse (Kalsi et al., 2019). The patient’s condition is not reversible, and although his physiological reserve is optimal, due to his young age and absence of other chronic conditions, the MND diagnosis is terminal. The nurse should also recognize that the client desires to spare his children seeing him intubated. It is crucial to the patient to spend as much time as possible with his children and avoid them seeing him vulnerable.

Thus, the framework leads to the conclusion that the client must stop treatment and consider palliative care. As his legal healthcare agent, the patient’s wife should be approached to allow cessation of treatment and sign a do-not-resuscitate order. A grief counselor can be employed to address the topic and mediate the discussion between the client, the nurse, and the wife. If the spouse declines the offer, the nurse should pursue the matter with the hospital’s ethics committee and seek legal aid for the patient to secure a new advanced healthcare directive.

Ethical Principles Used to Guide the Decision

When deciding to attempt to overrule the existing advanced directive that appointed the spouse as the healthcare agent, several ethical principles should be considered. Autonomy is the primary principle that should guide the decision made by the nurse. It states that every patient has the right “to self-determination and decision-making” (Gaines, 2020). In this case, the client is aware of his condition and should be allowed to choose what makes him most comfortable. The principle of beneficence, or acting for the welfare of others, also guides the decision (Gaines, 2020). Finally, the principle of nonmaleficence and not harming the patient should be observed when making the judgment (Gaines, 2020). It should be noted that although the decision to stop treatment and start palliative care can be damaging to the client’s family, the nurse’s primary responsibility is to the patient.

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Relationship of the Dilemma Decision with Family and Significant Others

The decision to secure a new advanced healthcare directive will significantly impact the patient’s family and, potentially, his relationship with his wife and children. It is expected that the spouse will react negatively to the decision as she expressed her wishes to continue her husband’s treatment for as long as possible. Therefore, it is recommended to provide her with psychological help that will help her through the process of grieving her husband and the loss of control over his life through a healthcare proxy.

Conclusion

In summary, nurses may face a variety of challenging ethical dilemmas in their practice. In the proposed scenario, the principles of autonomy, beneficence, and nonmaleficence should be observed when deciding to assist the client in securing a new advanced healthcare directive. It is imperative to ensure that the patient’s wishes are adhered to by his medical team and that he receives the care he needs.

References

Gaines, K. (2020). What is the nursing code of ethics? Web.

Kalsi, D., Ward, J., Lee, R., Wee, B., Fulford, K. W., & Handa, A. (2019). Recognizing the dying patient, when less could be more: A diagnostic framework for shared decision-making at the end of life. Journal of Patient Experience, 7(4), 621–628. Web.

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Oliver, D. J. (2019). Palliative care in motor neurone disease: Where are we now? Palliative Care: Research and Treatment, 12, 1–14. Web.

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