Clinical problems affecting children and other patients who are not able to make their own decisions causes increasing ethical dilemma in clinical practices (Attard-Montalto, 2001). Though patient-centered care places more emphasis on patient interests, beliefs, values and preferences to eliminate bias in personal, cultural and religious perspectives, it is important to consider the impact and cost of treatment, and the availability of healthcare resources to enable practitioners to provide rational and consistently objective approach to management of patient issue (Attard-Montalto, 2001). The role of a pediatric nurse is to come up with ways to reduce physical and psychological distress associated with treatment of children and their families (Watwood, 2016). Performing these roles has enabled the healthcare sector to reduce children mortality, and address different ethical, social, financial, and educational issues affecting patients.
The ethical dilemma results from the case of a mother who expressed her wish that her child with Down syndrome should not be resuscitated at birth. In addition, the mother is not willing to consider the surgical repair of an atrioventricular (AV) canal defect. Therefore, knowing that children born with Down syndrome can pursue their goals in life, the nursing team need to consider compete AV canal defect in children as a moral obligatory, while factoring in the mother’s decision as an immediate advocate to her child’s care.
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Ethical Principles
The case requires an application of ethically-acceptable practices to solve the ethical problem, while appropriately adjusting it to provide quality care. Some ethical principles support the mother’s ability to make decisions regarding care for her child. On the other hand, it is the duty of a pediatric nurse to ensure that the patient receives recommended care that would improve patient experience and outcome.
The principle of respect beneficence ensures that medical practitioners provide care without harming the patient (Attard-Montalto, 2014). The principle allows for highly risky medical therapies that are meant to rescue the patient provided that there is a realistic chance of a reasonable benefit. This is supported by the principle of respect of limitation of medical care , where practitioners should provide care tailored towards individual needs, including complications and disabilities (Attard-Montalto, 2014).
The principle of respect of individual’s autonomy requires that patients should play an active and independent role in making decisions that affect their treatment (Attard-Montalto, 2014). This is supported by the principle of respect of the individual competence . In this case, the patient’s level of understanding allows him/her to make rational decisions based in the ethical issues associated with a particular clinical situation (Attard-Montalto, 2014). Children do not have the ability to make rational decisions as they cannot get truly consented.
While the principle of respect beneficence and respect of limitation of medical care may guide clinicians to discard mother’s decision and proceed to offer surgical repair of an atrioventricular (AV) canal defect, the principle of respect of individual’s autonomy and respect for individual competence mandate the mother to make decisions on behalf of her child. Therefore, nurses will breach these principles if they fail to consider the mother’s decision on the child’s treatment.
ANA Code of Ethics Provisions
The ANA Code of Ethics provides the ethical duties and obligations for any individual in the nursing profession. It an expression of the nurse’s roles and commitment to serve the community through their distinguished concern towards the welfare of the vulnerable, injured, sick, and the social justice, through alleviating suffering, preventing illness, protecting, promoting and restoring health in individual, family, group, and community care.
The appropriate provisions for the case are; provision 2, which indicates that the primary commitment of a nurse is to the patient, whether the patient is an individual, family, group, community, or population (American Nurses Association, 2015); provision 3, which indicates that the nurse promotes, advocates for, and protect the rights, health, and safety of the patient (American Nurses Association, 2015); and provision 4, which indicates that the nurse has accountability, responsibility, and authority for nursing practice, and can take actions that are consistent with the obligation to promote care and provide optimal care (American Nurses Association, 2015).
Provision 2 indicates that the nurse has the moral responsibility to ensure that the patient receives quality care. In the case, the nursing team understands that is their obligation to offer surgical repair of an atrioventricular (AV) canal defect to improve the quality of life of the patient. Provision 3 requires nurses to ensure that patient safety is considered in care. In addition, it advocates for patient rights, and for the case, the mother has the responsibility to make the decisions on behalf of the child. Therefore, the provision requires that they should consider the mother’s decisions as a way of protecting patient’s rights. Provision 4 gives the nurses authority to conduct a nursing practice provided that they promote care and provide optimal care. Therefore, the nurses can apply this provision to offer the surgery since it is the best option to safeguard the future life of the child.
Outcomes and Plan
If the nursing team offer surgical repair of an atrioventricular (AV) canal defect, they will improve the quality of life of the child. However, there is a possible breach of the ethical principles, and this may lead to potential problems, including litigation. Therefore, the complexity of this dilemma requires that nurses use potentially helpful resources to support ethical thinking and develop possible solutions to the problem. The available resources include; 2015 ANA Code of Ethics for Nurses with Interpretive Statements, ANA Position Statements on Ethics and Human Rights, Online Journal of Health Ethics, and International Council of Nurses. These resources enable nurses to review different ways of resolving ethical dilemmas. They provide research and legal information on ethical matters, and allow nurses to participate in the review, and revision of different ethical engagements in clinical setting.
To solve the ethical dilemma, the nursing team should engage the mother and explain to her to long-term implications of not offering the surgical repair of an atrioventricular (AV) canal defect. The nurses will outline the efficacy of the surgery, and the potential risks, and explain to the mother that the surgery is the best option to provide the greatest benefit to the child.
References
American Nurses Association. (2015). Code of Ethics for Nurses With Interpretive Statements.
https://www.nursingworld.org/coe-view-only
Attard-Montalto, S. (2001). Ethical Issues in Paediatric Practice-Part I: General Principles.
Images in paediatric cardiology , 3 (4), 1.
Attard-Montalto, S. (2014). Ethical principles in paediatric practice. The Journal of the Malta
College of Family Doctors, 3(1), 5-11.
Watwood, C. L. (2016). Mapping the literature of pediatric nursing: update and implications for
library services. Journal of the Medical Library Association: JMLA , 104 (4), 278.
Reflection
The case gives an opportunity to explore different aspects of ethical principles and the code of ethics in medical practices. Ethical dilemma is becoming an increasingly common problem in treating children and people with complications that do not allow them to make their own decisions. I believe that the nursing sector should join hands with different health agencies to outline a clear plan of solving diverse ethical dilemmas, such that the decisions of the patient advocates are respected, while ensuring that the patient receives quality care. These solutions should be centered on social, cultural, and religious factors, considering that these factors have a significant influence on the patient beliefs, practices, preferences and values.
