• Describe a fictional ethical dilemma or a dilemma you have encountered in your nursing practice.
• Identify the key stakeholders.
• Describe how the situation impacts the key stakeholders.

Ethical Dilemma in Nursing Practice: A Case Study

Introduction

Ethical dilemmas are commonplace in nursing practice, where professionals often face challenging situations requiring moral discernment and decision-making. These dilemmas can significantly impact patients, families, healthcare providers, and the broader community. This essay describes a fictional ethical dilemma encountered in a nursing practice setting, identifies the key stakeholders involved, and examines how the situation impacts them.

The Ethical Dilemma

In a busy urban hospital, Nurse Jane encountered a significant ethical dilemma involving Mr. Smith, a 65-year-old patient diagnosed with terminal cancer. Mr. Smith’s condition had deteriorated rapidly, and he was in considerable pain. Despite the medical team’s recommendation to administer a high dose of morphine to alleviate his suffering, Mr. Smith had explicitly requested minimal pain medication, fearing it would hasten his death and impair his ability to interact with his family during his final days.

Mr. Smith’s family, particularly his daughter, Mrs. Thompson, was adamant that every measure should be taken to ensure her father did not suffer unnecessarily. She pressured the healthcare team, including Nurse Jane, to override Mr. Smith’s wishes and administer the higher dose of morphine.

Key Stakeholders

The key stakeholders in this ethical dilemma include:

1. Mr. Smith: The patient whose autonomy and end-of-life wishes are at the center of the dilemma.
2. Mrs. Thompson: Mr. Smith’s daughter, who is deeply concerned about her father’s comfort and suffering.
3. Nurse Jane: The primary caregiver responsible for administering medication and advocating for the patient’s wishes.
4. The Medical Team: Comprising doctors and other nurses who are tasked with providing care while respecting patient autonomy and ethical guidelines.
5. The Hospital Administration: Responsible for ensuring that care is delivered according to ethical and legal standards.
6. The Nursing Ethics Committee: A group tasked with providing guidance on complex ethical issues in patient care.

Impact on Stakeholders

Mr. Smith

The primary concern in this dilemma is Mr. Smith’s right to autonomy and self-determination. His request for minimal pain medication reflects his desire to maintain a certain quality of life and cognitive function in his final days. Administering a higher dose of morphine against his wishes would violate his autonomy and potentially undermine his trust in the healthcare system. Moreover, it could cause psychological distress, knowing his preferences were disregarded.

Mrs. Thompson

As Mr. Smith’s daughter, Mrs. Thompson’s primary concern is her father’s well-being and comfort. Her insistence on administering a higher dose of morphine stems from a desire to alleviate his suffering. The situation puts her in a distressing position, torn between respecting her father’s wishes and wanting to see him free from pain. This dilemma can cause emotional strain and potential conflict within the family.

Nurse Jane

Nurse Jane faces a significant ethical challenge in this situation. Her professional duty includes advocating for the patient’s wishes and ensuring that care is delivered ethically. Administering morphine against Mr. Smith’s wishes would conflict with her ethical obligation to respect patient autonomy. Conversely, adhering strictly to Mr. Smith’s wishes might lead to increased suffering, challenging her commitment to providing compassionate care. This dilemma can cause moral distress and impact her professional integrity.

The Medical Team

The medical team is responsible for balancing ethical principles, such as beneficence (acting in the patient’s best interest) and autonomy. They must navigate these conflicting values while providing appropriate medical care. This dilemma can lead to ethical confusion and potential disagreements within the team regarding the best course of action.

The Hospital Administration

The hospital administration must ensure that patient care adheres to ethical and legal standards. They are tasked with upholding policies that respect patient autonomy while ensuring that all patients receive compassionate and effective care. This dilemma could lead to broader ethical policy reviews and discussions within the hospital.

The Nursing Ethics Committee

The Nursing Ethics Committee plays a crucial role in providing guidance and support for resolving such ethical dilemmas. Their input can help navigate the complex issues at hand, offering a balanced perspective that considers the ethical, legal, and emotional dimensions of the situation.

Conclusion

Ethical dilemmas in nursing practice, such as the one described, involve complex decisions that significantly impact multiple stakeholders. In this case, balancing Mr. Smith’s autonomy with the desire to alleviate his suffering requires careful ethical consideration and a compassionate approach. Addressing such dilemmas involves respecting patient wishes, supporting family members, and ensuring that healthcare providers act according to ethical principles and professional standards. The resolution of these dilemmas often necessitates collaboration, open communication, and guidance from ethics committees to ensure that all stakeholders’ concerns are addressed and respected.