Ethical Case Study
Introduction: Overview of the Case
In the medical arena, it is important that individuals that are involved must have specialization in order to have unparalleled opportunity and capability to address the critical issues that face the world’s current health care system. The role of the nurse as a vital member of the healthcare team through collaborative professional practice must always give priority through caring its patient. The primary goal of being a nurse is to assist individuals in the achievement of an optimal level of wellness. The focus of nursing is on individuals’ specific needs based on their healthcare choices related to physiological, psychological, socio-cultural, developmental and spiritual dimensions of individual lifestyles. Nurses are working to promote health, prevent disease, and help patients cope with illness.
However, there are cases when the capabilities and responsibilities needed and called for by the patients are being challenged. In the case provided, the nurse is faced with the challenge of ethical decision making. Herein, the ethical dilemma involves an eleven year old female client who has acute lymphocytic leukemia (ALL). As mentioned, the healthcare provides have considered all avenues of treatment but this is still unsuccessful. The client’s parents have been notified of the “grim prognosis” and have requested that their daughter not be told of the prognosis. Later that evening the nurse is caring for the client and is asked if she will die. The nurse is now stuck in an ethical dilemma of respecting the parent’s rights or respecting the client’s right to know.
Primarily, this paper will analyze which decisions to make in the situation of the patient and the parents. The ethical decision making will consider the use of Situation Assessment Procedure.
Situation Assessment Procedure
The professional healthcare providers such as the nurses have the responsibility respect the rights of the patients, specifically their right to know their current situation. In the case provided, the nurse is being challenged on making decision on whether to tell the true situation of the patient or not. In the Situation Assessment Procedure, there are four steps to be considered: 1. Identify ethical issues and problems 2. Identify and analyze available alternatives 3. Select one alternative 4. Justify the selection.
Aforementioned, the ethical issue or problem for this case is about the problem of a nurse, on whether to tell the true condition of the patient in spite of the request of the parents on not telling it. The complexities of this situation lie on the notion that the parents of the patients have requested not to tell the patient. In this case, it is a major problem for the nurse who has been asked by the patients about her true condition. The parents of the child are worried and scared for their child. The parents may think that they should be the ones to tell their daughter that she isn’t going to live. Or they may think she just doesn’t need to know. The parents may be worried that their child will quit fighting or maybe they are just in plain denial about the situation. As the nurse you may overlook the parent’s desire to protect their child and think you are doing what’s best for the child. But maybe telling the child wouldn’t be in their best interest.
To be able to decide on this matter, there are some possible alternatives that the nurse may consider.
1. Hold on to the request of the parents of not telling the truth to the patient which is under the case of medical paternalism which aims on protecting the patient from emotional and physical harm.
2. Talk to the parents and other healthcare providers in the hospital involved about telling it to the child.
3. Do not tell the child the true condition but discuss some possibilities of the treatment
The next step is to choose one alternative, in this case, the alternative to be chosen is to talk to the parents about the situation and make them understand that their child has the right to know her true condition and also talk to the healthcare providers involve. In this way, you can be honest of telling the condition of the patient but you don’t have to volunteer information which the patient is not asking to avoid emotional harm.
The child obviously wants to know if she is going to die and maybe has prepared herself for that possibility. And of course each nurse will have her own way she thinks it should be handled. Maybe there is a therapeutic way to go about letting the child know instead of just saying yes you are going to die. The child has the right of autonomy (Wear, 2002), the principle of respect for the person, as well as veracity from the medical staff. In the past veracity for example was viewed as inconvenient, distressing, or even harmful to patients and families. The American Medical Association Code of Ethics in 1847 contained such a message, “The life of a sick person can be shortened not only by the acts, but also by the words or the manner of a physician. It is, therefore, a sacred duty to guard himself carefully in this respect, and to avoid all things that have a tendency to discourage the patient and to depress his spirits.
There are various reasons why this alternative was chosen. One of these reasons is because this alternative enables the parents to understand the importance of telling the truth to their children even how painful it is for them. I feel that as the nurse it is my responsibility to care for this child but at the same time doing no harm to the child. So to me this means being there as a support system but not crossing the line that defines what a parent/family is there to be. And if that means that they do not want me to tell her, I wouldn’t tell her. But I would expect them to tell her and help them find the best way possible to do that. Understanding that this may not be the best decision, I would analyze what could happen if that doesn’t work. If for some reason the child gets upset with me for not telling her one way or the other, I would be responsible for her getting upset. Also the parents might not ever tell her and it would leave me in the position to eventually tell her if her family does not. Sometimes this situation would not be the best way to go. I think it depends on each individual family and if the situation is right for that particular family.
In the nursing field, there can be seen various ethico-legal principles in which the nurses must consider so as to promote quality care for the patients and provides respect on their autonomy. In line with the ethico-legal aspects, the chosen alternative should be considered so as to adhere to the rights and interest of the patient to know.
The primary role of being a nurse is to protect the interest and rights of the patients. Hence, as a nurse he/she must be able to recognize this right, specifically the right of the child to know.
Reference
Wear, S. (2002). “Informed Consent: Patients Autonomy and Clinician Beneficence within Health Care.” Georgetown University Press: Washington, DC.
Credit:ivythesis.typepad.com
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