Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
Discussion
A moral dilemma is a decision-making problem between two moral ideas. It is an incident that geared us to question how our responses should be on our beliefs. The decision to choose between right and wrong is ethically based. Take, for instance, the story Kohlberg gave about Heinz, whose wife was sick and did not have money for the drugs and was stuck with the choice of stealing the money to save his wife or allowing her to die (Rachels & Rachels, 2019). Another instance was when my husband had to choose between to stay home with his family and be safe from the pandemic or to volunteer and work more to save lives. And he made the right choice to save lives.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
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In these situations, honesty, compassion, and courage are the most important. It would take an honest person not to steal when faced with this kind of predicament. Compassion for others is one thing that is not easy, especially this time when some people choose to serve their community instead of self, shows a lot of human compassion.
When we face life treating situation like the story of Heinz, it takes a strong will and self-disciple to be able to portray honesty, compassion, and courage. Virtues are what we practice every day (Andre & Velasquez, 1988).Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
These virtues should be expressed in our day to day life, with the people we meet, not only to people we know but to everyone. For instance, if the drug seller were compassionate with Heinz and the drugs for his sick wife, the thought of stealing would not come up. Every day of our lives, we are challenged by one situation or the other, but our courage to stand for what is right is what makes us a better person in society.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
To be able to apply Aristotle’s golden mean to this dilemma is to find a middle ground between the two extremes, which are “excess and deficiency” (Chamberlain University, 2020). In the case of my husband volunteering to work more this pandemic period, he tried as much as possible to remove the fear of exposing himself and his family to the virus by building up courage.
The dilemma involves the conflict of moral duties, which are professional versus familial duties. In this scenario, where my husband had to choose to work more to assist in reducing the cases of people dying from this virus. Thereby, making me handle all the family duties.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
Introduction: This assignment illuminates the use of ethical decision making model in taking decisions while managing patients in their best interest.
Ethical decision making is very challenging for the health care professionals while working for the benefits and the interests of the patients.
While caring for the dying or the terminally ill patients, health care providers address various issues of pain and suffering in relation to the psychological, spiritual, mental and physical complexities of the person having the terminal illness.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
The ethical decision making models act as guide to make decisions in different complex situations addressing various issues which includes ethical principles, person’s own values and beliefs, institutional policies, legal considerations and social values
Nurses can improve results of ethical decisions by:
• preferring client wishes.
• encouraging the importance of ethical issues in care of patient.
• obtaining necessary consultation on ethical concerns
• becoming involved in the development of policy on ethical issues
• advocating for safe and competent nursing care within Alberta communities
• encouraging and facilitating cooperation and collaboration between professionals and
between agencies to effect improvements within health care
• participating in the development of practice standards, issues statements and position
papers on professional issues
• working with colleagues to identify crucial ethical issues for the profession,
including:
− the implementation of evidence-based practice
− shaping the direction of health-care reform
• linking of resource allocation decisions to client outcomes
In this assignment i am going to use STORCH Model for ethical decision making.
This model was developed by Jan Storch for use in health policy decision making, but later it was adapted for use in ethical decision making.
Dr. Storch suggested the use of this circular model as a way of reminding us that it is important to return to each consideration as we move towards decision making. This model involves three major steps:Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
Information and identification
Concern
People/population
Ethical components.
Clarification and evaluation.
Ethical principles— Autonomy
Nonmaleficence
Beneficence
Justice
Social expectations and Legal requirements
Range of actions/ anticipated consequences
Professional code of ethics
One’s values’ beliefs, values of others and value conflict
3. Actions and Review.
Case study: Eighty four years old Mr. Adam, was admitted to the ICU. He has been suffering from throat malignancy for 18 months. Now his disease condition has become worsen. His life expectancy is about 3 months. He has difficulty in breathing, difficulty in swallowing and cries with pain. He is on mechanical support and has nasogastric tube in place. He lives with his 82 years old wife.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
He was a active social worker. His wife tells that he believes in living life in a productive way. He used to drive cancer patients to the rehabilitation centre voluntarily. He has two daughters who live in Ontario, but now they are here to visit their father. He requested the nurse to remove the nasogastric tube and mechanical ventilation as he does not want to live life in this way. His wife agreed to his decision as she does not want to see him suffering anymore. She want him to die peacefully and painlessly.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
According to Storch Model of ethical decision making, in this case scenario,
Information and identification: Nurse Need to gather all the information regarding Mr. Adam.
Nurse can arrange a family conference including his wife and the daughters also the family physician can be involved. She should listen to the views and concerns of all the family members related to the request of the patient.
Nurse should consider the medical condition of the patient, Mr. Adam is terminally ill and now as his condition has become worsen he has become totally dependent on life support system. He has severe pain which he cannot tolerate.
His life expectancy is very short and the prognosis is really poor.
Mr. Adam is suffering from throat cancer and is on the last stage but his decision making capacity can be intact, so nurse should assess the reason for his decision. Nurse should assess if there is depression, as it may effect the decision of the patient.
Mr. Adam is staying alone with his wife, so the financial resources may be limited to bear his stay in hospital.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
He was an active social worker. Mr. Adam used to drive cancer patients to the rehabilitation centre. He may have strong social connections and a positive quality of life.
Mr. Adam believes in active living of life not in this dependent manner and he spends his life living for others and helping others in their time of need. He had very positive attitude towards life. He believes in life worth living rather living.
Nurse should assess the expectations of his family regarding the condition of the patient. Mr. Adam’s wife and daughter should be asked about their expectations for Mr. Adam’s health status and prognosis. His daughters live far away from him so they may not have as much familiar with his condition as Mrs. Adam do.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
Nurse can consult the doctor regarding the condition of the patient and also about the outcome of the decision.
Identify the surrogate decision makers for Mr. Adam.
According to the second step:
Clarification and evaluation: nurse should assess the different values associated with Mr. Adam.
Mr. Adam’s personal values regarding life are worth living life. He believes in living life in a productive and positive way.
Nurse should assess the cultural values of the patient, what role cultural values play in his life. What his culture says about life and death.
Nurse should also keep in view the religious values of the patient. What role does his religion play in his life? If the religion allows for hastening the death process.
Professional values play an important role in ethical decision making. Nurse should consider the professional values associated with the removal of life support system.
Nurse should assess the values of the family members regarding the decision of hastening death of their family member.
Mr. Adam’s wife is in favor of his decision to remove life support as she does not want to see him suffering. She wants him to die peacefully and painlessly.
Consider the ethical principles.
Principle of Autonomy: According to this principle patient has the right to decide for himself, here in this case Mr. Adam is autonomous and deciding removal of life support system. He tells the nurse that he does not want to live life like this.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
Nurse should respect his autonomy towards the life and should consider his decision and wish while taking actions.
Principle of non maleficence: According to this principle nurse should do no harm to the patient. In the above case scenario,
patient want to stop the life support and continuing the treatment may go against the principle as it is against his wish.
Principle of beneficence: According to this principle, nurse should do good for the patient. Here patient is asking for stopping life support system but it does not provide any benefit towards his condition at the same time it works in favor of his wish to die.
Principle of justice: According to this principle, all persons should be equally provided with health care services. In this case patient is provided with required health care needs.
Consider the social expectations and legal requirements:
Nurse should look for any similar history in the hospital. Identify any previous similar case in the institution, so that she/he can look for the policies and steps that can be taken.
Nurse should check the hospital policies regarding the hastening of death of the patient. She should assess that what steps can be taken according to the policies.
Nurse should ask for any legal documentation of client’s decision making authorities. She can ask for any legal will or advance directives.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
While considering the different aspects of model nurse should assess that what possible range of actions can de done.
Considering the information provided, Mr. Adam is a strong social human being, he spent life doing productive, now as he is chronically sick and dependent which for him is not worth living. He is old and the life expectancy is poor also it gives him severe pain. His wife want him die peacefully. And also the financial sources may be limited to continue life support.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
The ethical principles gives him the right to decide for himself.
According to Canadian Nurses association code of ethics for registered nurses, there are seven primary nursing values:
1. Providing safe, compassionate, competent and ethical care
2. Promoting health and well-being
3. Promoting and respecting informed decision-making
4. Preserving dignity
5. Maintaining privacy and confidentiality
6. Promoting justice
7. Being accountable
( CNA code of ethics for registered nurse)
Nurse should consider the professional code of ethics while making decision for the patient that whether she is going according to provided professional guidelines.
In this case nurse should follow the professional code of ethics while caring
And deciding for Mr. Adam.
Nurse can consider her own values and beliefs regarding life and death in empathizing and understanding the needs of the patient and family.
Nurse should understand the values and beliefs of the persons involved in the decision making for the patient. How the stopping of life support system effect the family members? What they believe about death process?Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
Mr, Adam’s wife believes in his peaceful death.
Nurse should assess if there is any conflict between the values of patient, family members , profession, culture, religion.
Action and review: in this case scenario action must be decided according to the various perspectives proposed by the model.
Nurse can check what she can provide to the patient, whether the request to hasten dying is made under depression or really in relevant means to patient.
If it is due to depression, what nurse can do to promote and facilitate calm and peace to mind of patient.
How she can provide compassionate care and peaceful death to the patient.
If patient really wants to die, nurse should t check what she can do while regulating the hospital policies.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
All the perspectives given by the model should be reviewed before taking any actions.
Conclusion: In the nutshell, I can say that Storch Model is the best suited model to the above case scenario as it covers all the issues and perspectives related to the decision. The ethical decision making skill can achieved by reading literature and with the practice experience. These decisions play important role in the lives of patients and nurses as well. There is need of ethical relationship between patient and nurse. There should be better understanding of nurses own values, beliefs, patient and his values and beliefs, professional values , institutional policies.
Introduction
Decision making in an ethical dilemma circumstances could be difficult at time as one is prone to use similar past experience as a yardstick to analyse the circumstances. McGhee and Perrin (2008), define ethical dilemma as a situation that gives rise to conflicting moral claims resulting in disagreements about choices of action. Therefore using a framework as a tool to guide one through the ethical dilemma would aid in arriving a client-centred decision. This paper aims to look into Ranjit’s decision to die in his own home instead in a hospital as requested by his children using the model for ethical decision making by Kerridge, Lowe and McPhee (2005).
Clearly state the problem
Ranjit, a 77 year old man diagnosed with Parkinson’s disease lost his motor functions. He prefers to be cared and die at home however his children are concerned about not being able to meet his needs as they do not possess with necessary skills to handle his disease if he deteriorate.
Ethical Problem
Ranjit may have Parkinson’s disease however it does not limit his freedom to make his own decision. Therefore the ethical issue is raised in contradiction of his autonomy.
Social Problem
No one is able to care for Ranjit when his condition required more attention, therefore a caregiver is required if Ranjit wish is passed through.
Legal Problem
Ranjit is of a legal age in the eye of the law; he is capable to make sound decision for himself. His diagnosis may lead others to make baseless assumption about his capability to make a decision.
Get the facts
Parkinson’s disease is defined as chronic neurodegenerative disorder, which is related to loss of dopaminergic neurons in the substantia nigra. Symptoms such as tremor, brandykinesia and rigidity present in early stage and later stage non-motor features including autonomic dysfunction, falls, and sleep disturbances as loss in non-dopaminergic areas (Ministry of Health, 2007). According to Hoehn and Yahr (1967), Parkinson is classified into five stages, from stage one tremor over one limb to stage five confinements to bed. The prevalence rate in Singapore was found to be 0.3% for the population aged 50 and above (MOH, 2007). People with Parkinson do not only experience distress with their own movement, but the increasing motor deficit also diminishes their ability to express, communicate and interact with others (Doyle Lyons, Tickle-Degnen, Henry, & Cohn, 2004). Disability is seen more prominent as the disease progresses, caregiver may experience strain, burnout or financial burdened (Tan 2013). Therefore communication is critical for patient and caregiver to discuss openly about the disease, understanding their frustrations will help them to live with the disease (Chiong-Rivero et al., 2011).
Although with pharmacotherapy can improve the quality of life ancillary approach in managing disease cannot be overlooked. Utilisation of rehabilitation services for Parkinson patients will go a long way to keep them active within the community to prevent isolation and depression. Occupational therapy can be involved in teaching client and care givers in coping with activities of daily living. Physiotherapist can be involved in gait training and strengthening muscles to prevent falls. Caregivers can consider sending Ranjit to various alternative services such as Agency Integrated Care (AIC), day care centre or respite care.
Consider the four principles
Autonomy
Autonomy is defined as the freedom and ability to exercise one’s choice and the ability to decide for oneself. The principle in autonomy is to respect a person’s decision, privacy and confidentiality and receive full disclosure (Staunton and Chiarella, 2008, p. 31; Butt and Rich, 2008, p. 42). His children are against Ranjit decision to be cared and die at home, despite his disease his right to choose should not be stripped off. As healthcare provider it is important to respect and promote client’s autonomy (Singapore Nursing Board (SNB) Code of Ethics and Professional Conduct, 1999, p.4).
Beneficence
Beneficence is described as taking action to help other; the desire to do good (Butt and Rich, 2008). The nurse would advocate client’s interest accordance to SNB Code of Ethics and Professional Conduct (1999, p.8) value statement 7, to promote client’s best interest by ensuring desires are acknowledge and considered by the healthcare team. The team shall consider Ranjit’s decision to be cared at home as it is deemed good for him.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.
Non- Maleficence
Non- maleficence is defined as “above all, do no harm’ (Staunton and Chiarella, 2008). (ANMC) Code of Professional Conduct (2008) conduct statement 4 stated nurses to ensure the safety and quality of care are not compromised. If Ranjit’s decision was granted, a caregiver should be nominated to prevent harm at home such as fall.
Justice
Justice is based on the concept of fairness (Hendrick, 2000, p. 121). This suggests that one shall be treated fairly and be given equal chance to make decision.
Statement 2.3 under Australian Nursing & Midwifery Council (ANMC) National Competency Standards for Registered nurses (2006), to demonstrate respect for client’s legal right in relation to health care.
Identify Ethical Conflicts
Beneficence versus Autonomy
The first conflict to be addressed her is whether Ranjit should be cared at home or die in hospital. No doubt hospital is well equipped with equipment and healthcare team to provide a care plan for him till he die but however Ranjit has the right to refuse admission, treatment or care from the hospital. Therefore his primary treating doctor should provide a full disclosure on the disease process, risk and potential problems to allow him to make an autonomous choice.
Beneficence versus Non Maleficence
The second conflict here is his children perceived hospital is the best place for him as they do not have the necessary skills to look after him. However what seem to be best may not be as it place Ranjit at risk for acquiring infection or develop depression to his wish rebuked.
Non Maleficence ethical principle here is involved if Ranjit’s decision is approved by his children. Due to the lack of care at home, he may be faced with potential issues such as falls, pressure sores and chest infection.
Consider the law
Consent
Mr Ranjit has the mental capacity to take consent as evidenced by his active commitments with various activities. His consent may be deemed valid if he is able to understand and retain information and communicate his decision as stated in Mental Capacity Act (2008).
Right to refuse treatment
As the children wanted him to be institutionalised, Ranjit can refuse admission to a hospital or a nursing home.
Advance directives
An advance medical directive (AMD) an Act to provide for, and give legal effect to, advance directives to medical practitioners against artificial prolongation of the dying process and for matters connected therewith (Advance Medical Directive Act, 1996). Mr Ranjit may consider AMD to safeguard his wishes, case he became unconscious or terminally ill.
Making the ethical decision
Ranjit’s decision to be cared at home should be granted as he is competent to make his own decision and what is deem best for his interest. Family conference involving patient’s treating doctor, patient and his family may be helpful in this circumstance to hear from individual’s perspective to reach a conclusion that may benefit all. However the ultimate decision is still on Ranjit thus his children should respect his decision and look for alternative revenue to provide care for their father.
Document the decision
In accordance to statement 6.3 of ANMC National Competency Standards for the Registered Nurse (2006), Documentation must be written clearly and concise to provide accurate assessments. Therefore it is important for nurses and doctors to document all discussion shared as evidence to prevent unnecessary miscommunication.
Evaluate the decision
Ranjit’s care plan will need to be evaluated when there is a change in his condition or needs (ANMC National Competency Standards for the Registered Nurse statement 8.2, 2006). As Ranjit is able to make an autonomous decision to be cared at home, his children can employ a caregiver to be home to look after the father, the care plan will need to be evaluated every three months to better support and meet his needs.Discussion-week7:A Moral Dilemma is a Decision-Making Essay.