Good Example Of Research Paper On Ethical Dilemma

Type of paper: Research Paper

Topic: Nursing, Patient, Ethics, Nurse, Treatment, Decision, Morality, Family

Pages: 8

Words: 2200

Published: 2020/12/09

The dilemma

This paper discusses the dilemma that is existing in a nurse-patient situation. The patient does not believe in western drugs and, therefore, has refused not to be treated with chemotherapy as ordered by the doctor. The patient' diagnosis was on breast cancer stage 1, which is a disease that if not treated well, shall lead to death. The patient discussed with her husband and they agreed to look for alternative medication since they are not willing to take a chance. The nurse was informed about the decision by the patient as she entered the room. She developed a lot of pressure because she knew well if the patient were not treated, she would die. Contradicting to this decision is that if the nurse would go ahead and use chemotherapy on the patient, the belief of the patient would not have been respected. This paper evaluates the various approaches and considerations that must be taken into action in coming up with the viable decision in this case scenario.
The conflicting principles, in this case, are two.The first one being whether the nurse was supposed to administer treatment to the patient so as to salvage her life because she has high metastatic cancer that could develop to stage IV quickly. The second conflicting factor is that if the nurse chooses to administer treatment to the patient, she will not have honored her beliefs. Therefore, the and would have violated her right of choosing the kind of treatment that they wish to undertake. The effects that come with these two conflicting factors are dire. Firstly, the effect of treating the patient anyway through chemotherapy would mean that the patient’s right to choose their medication type would have been violated. Secondly, going ahead with the treatment would imply that the belief of the patient would not have been respected. The effect arising from the decision not to treat the patient because of their treatment would be that the patient might have the cancer develop to stage IV and result in death that could have been a violation of the vows of nurses to protect the patient’s life.
The ethical perspective of the above two conflicting principles is diverse and is spelled out by a number of authors that have researched and dealt with ethics in the nursing field. To start with, Lauchman says that competence and courage are very crucial in terms of making ethical decisions. In this perspective, Lachman asserts that in order to ensure that a nurse does their work with utmost integrity, honesty, courage, and competence, they should ensure that their patients are treated by all means and avoid death. Taking this ethical perspective in place, it means that the nurse should go ahead and have the courage to treat the patient because all that matters at the end of the day is that the patient should get well at the end of the day. However, if this decision is made, it would have violated another ethical perspective that is key to making such decisions. Lauchmann also says that it is the ethical obligation of a nurse to advocate the patient’s best interests. In this perspective, the nurse should concur with the patient’s opinions and postulations about how they would be handled or how their disease would be treated. Using this ethical perspective, it means that the nurse in this case scenario should advocate the patient’s move of not undergoing chemotherapy. Nevertheless, this shall lead to advancement of the cancer to stage IV, a situation that may lead to death. Hardingham and Armstrong concur with Lauchman’s propositions concerning the ethical practices. In the making, they also propose that nurses have the obligation to ensure that their patients are treated even if it means foregoing some processes. However, they also assert that the patient’s interests are supposed to be paid attention to and be advocated by the nurse.
Various strategies could be used to solve this dilemma. The first strategy that could be used by the nurse is to bring into light, the possible outcomes of leaving the patient untreated. This wouldn’t be a violation of any ethical practice since the nurse would have taken the role of letting the patient have honest information about their condition. This would mean the nurse is giving case scenarios to the patient of the past cases that went untreated using chemotherapy and then the severe consequences that resulted from the decisions. The patient may be moved to change their mind and accept the treatment because of the fear that they would develop because of the examples of the worst case scenarios. The advantage that this strategy would have is that the nurse would not have violated the patient’s interests since the final decision would have come from the patient herself. Moreover, the chances of the patient accepting to be treated after being shown the past case scenarios would be high. No one does not fear for their lives and hence the patient would almost immediately go for the treatment. However, this strategy’s disadvantage is that the patient may develop a postulation in their mind that the nurse is blackmailing them and thence refuse further because of fear of manipulation. Moreover, the patient may traumatize and decide to sue the nurse because of an attempt to blackmail them and to scare them as well. The patient would argue that they have the right not to be given scary information about their condition and hence successfully sue the nurse. The alternative to this strategy would be the nurse revealing to the patient, the cases that have been successfully treated with chemotherapy. To ice on the cake, the nurse would contact one of the past patients who was treated this way and give testimony to the patient. This way, there is a chance that the patient may make a decision to agree to the treatment.
Another possible strategy would be the nurse talking to the patient’s husband in the privacy and then trying to convince him to get his wife to agree to undergo chemotherapy. The nurse will fully explain the consequences that would occur if his wife does not undergo chemotherapy. For the fear of his wife’s life, the husband may get to convince his wife to undergo the treatment. The advantage that this strategy would bear is that the burden of trying to get the patient to accept chemotherapy treatment would go to the husband. The nurse would then have ample time to handle the patient or other patients in waiting. Another advantage that this strategy would have is that at the end of the day, it would be a mutual agreement between the patient, her husband and the nurse, to subject the patient under chemotherapy. The demerit that would come as a result of applying this strategy would be that the trust between the patient and her husband would be put at risk. This is from the fact that the wife would feel betrayed by the fact that her husband chose the nurse’s side instead of hers. Additionally, the patient would not feel free even if they would undergo the treatment.
The above actions would have diverse outcomes. Firstly, by showing the patient past worst case scenarios would get the patient traumatized and even develop complications such as a stroke due to shock. Secondly, the patient may be annoyed to the extent of suing the hospital because of mental torture. The aftermath of this would be putting the nurse’s career as well as the doctor responsible, at risk. The possible outcome of using the husband to get the patient to accept the treatment would be such as the patient retaliating more. This is ascribed to the fact that the patient may feel cheated on and blackmailed through her husband. Moreover, as earlier on said, the patient may develop relationship issues with her husband because of him siding with the nurse.

Foundational virtue ethics approach

The foundational virtue Ethics approach is an approach that is used to arrive at dilemmas involving virtues such as this case scenario of a nurse and patient. The approach gives a detailed account of moral character, moral goodness, moral education and moral motivation. This approach gives a full and detailed account on how moral character is crucial. In this case, the nurse has an obligation of having a character that’s moral both professionally and normal human level interaction. Moreover, the approach describes how language is used to describe virtues and vices. Words such as ‘well’, ‘fair’, and ‘care’ are used in the nursing environment in order to show moral character and goodness. Additionally, this approach describes how moral emotions are used as moral reminders in the daily relationships of the patients. The emotions are used to describe how nurses make decisions that focus on moral character and goodness, through the development of moral motivation and education. This approach also describes how moral wisdom and judgment guide’s nurses in making decisions that are morally sound in circumstances such as this case scenario. The approach also puts emphasis on the importance of morally upright role models in the ethical decision-making process.

Virtues and vices

There are a number of virtues that apply in such a case scenario like the one at hand, in the verge of making decisions. The first virtue is honesty and integrity. Nurses are supposed to give information to their patients with utmost honesty while hiding no single piece. Moreover, integrity involves development of moral soundness that is encompassed by the right decisions by the parties involved. In making a decision, a nurse must make sure that the decision does not lead to any dishonesty or something that undermines their integrity. An application is a scenario whereby a nurse is supposed to break the news to the family of a patient that has died. The nurse is supposed to be honest and break the news as they are, not giving false hope that the patient is still alive whereas they could not be.
The second virtue that is key to the decision-making process as applies to nursing is courage. Nurses are supposed to be courageous in anything they do so that they cannot be held back by any fears. In the process, they should be able to break the news such as diagnosis of dangerous diseases such as cancer, to a patient. This way, they can uphold their integrity and professional competence.
Nurses are supposed to have the virtue of caring and compassion whereby they demonstrate how caring, compassionate and emphatic they are to their patients. In this perspective, the nurses are supposed to make their patients feel cared for and concerned about, even by people that do not know them. An application is a scenario whereby a patient is suffering from deadly diseases, and they are giving up. A nurse is supposed to show concern and help them get through the scenario. Additionally, in making a decision such as the one at hand, a nurse should be caring by listening to the patient’s interests and then make a decision that shall indeed show concern and care from the nurse.
A vice that must be avoided in the decision-making process is a lack of respect towards a patient’s privacy and confidentiality. At all times, nurses must ensure that their patients’ information is kept confidential and only the persons that a patient has passed a consent, should be given such information. For instance in the case scenario at hand, the nurse must not tell any other person except the patient’s husband concerning the cancer situation. Lest, that would be a violation of the nurses’ code of conduct.

The five-step decision-making process

In making a decision, there are five key steps that are involved. The first step is recognizing the problem at hand. In this case, the nurse would recognize that the problem at hand is whether they should violate the patient’s right to choose their preferred treatment or whether they should go ahead and treat the patient anyway. After exposing the problem, searching and gathering information follows. In this case, the nurse would ask for recommendations from such people as fellow nurses, doctors and any other person that could give reliable advice. Thirdly, coming up with alternatives is the step that follows. In this step, the nurse would look at the possible alternative solutions to handling the problem at hand and then evaluating viability of each. The next step after evaluation of alternatives is the selection of the solution. This step involves looking at the weights of the alternatives and selecting the alternative that has the most advantages. Lastly, the selected solution is evaluated to check whether it meets the expected requirements or not. For instance in this case scenario, the nurse must check whether the decision they made conforms to professional ethics, and if not, they should reevaluate the alternatives till they find the best solution.
The code of ethics that has been spelled out by Vicki Lachman that explains the four obligations and six virtues is the code of ethics that could be helpful in the making of decisions. The four obligations include the following:

Respectforing the privacy and confidentiality of patients

Honest communication about patient diagnosis, prognosis, and treatment.
Advocating the interests of the patients.
Carrying out processes that are ethically valid
The following are the six virtues that are involved in the code of ethics:
Integrity and honesty
Compassion and caring
Professional Competence.
I chose the above code because the code has almost all the requirements that are needed to arrive at the right decision of the case scenario at hand.
The human becoming theory describes life quality from individuals’ perspectives as in the nursing practice goal. Becoming is used to describe the patterns with which human beings relate their value priorities and the human living health. The theory differentiates nursing from the rest of the disciplines and research methodologies as well. This theory assists in the making of informed decisions that are in line with the nursing codes of ethics. As in this case scenario, the nurse would make a decision depending on their view of the importance of human life.
Finally, my opinion on what the nurse is supposed to do in the case is that the nurse should go ahead and administer treatment to the patient. I draw my opinion from a variety of dimensions. First, I have considered the nurses code of ethics that requires nurses to protect the health and welfare of their patients at all times. Secondly, it is a legal requirement that nurses and doctors ensure that the patients are treated, and all necessary efforts are made to ensure that the patient does not die. Considering Christian values, the Bible requires that we protect the human life because it is a gift, and regardless of its ‘quality’, we should respect and protect it. These words are drawn from 2nd Corinthians 5:15. Additionally, personal values such as compassion, love and caring cannot allow a nurse to let a patient die just because they do not approve of the type of treatment they receive. Therefore, it is the moral right of the nurse to protect the patient’s life by going ahead with the treatment even if the patient does not acknowledge it.


In conclusion, I can assert that a number of challenges face the nursing profession. These challenges put the nurses in a position that they have to make decisions that are sensitive, and if not chosen right, they will risk their jobs and lives of patients. Various codes of ethics are used to govern how the nurses make decisions. One of these ethics is the Lauchman code that spells out the four obligations and six virtues that are expected of the nurses in whatever they do. In the case scenario whereby the nurse had to choose between respecting the patient’s wishes or disrespecting it and going ahead to administer treatment. Considering the nurse code of ethics, personal values, Christian values and legal requirements, it is only rightful that the nurse goes ahead and administers treatment to the cancer patient. This is in the best of interests, to save the patient’s life regardless of violating their right.

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