Throughout the history of nursing as a profession, it has always been regarded as a profession of duty and service coupled with the attributes of selflessness and self-sacrifice. As that, the primary goal and responsibility of nurses is to work for the well-being and good of the patient. These goals and responsibilities are intertwined in the complexity of nursing practice and care that encompasses significant ethical dimensions (Page, 2012). Since the Nightingale era, the importance of ethics has been an integral aspect of nursing practice. Nightingale highlighted some attributable actions that every nurse ought to have such as listening and caring for the needs of their patients and maintaining the confidentiality of the details of their patient’s treatment. These actions that she described are what are today considered ethical actions and which have since been expanded and formalized as the nursing codes of ethics (Page, 2012).
The nurses’ code of ethics serves to guide the required competencies and explicit obligations required of nurses when caring for their patients. Owing to the level of high accountability required in the nursing profession, nursing practice is constantly regarded as a moral endeavor. This paper analyzes a case scenario of an ethical dilemma where Mr. Newcomb, a patient on the final stages of his life asks the nurse to lie to his wife so that he can see his mistress one last time. In addition, I will analyze the application and implication of four principles of healthcare- autonomy, beneficence, non-maleficence, and justice- regarding this scenario. The principle of healthcare proposed by Beauchamp and Childress provide a framework for handling ethical dilemmas in clinical settings and estimating the effectiveness of the ethical solutions provided in response.
Delegate your assignment to our experts and they will do the rest.
The Patient-Nurse Relationship
First and foremost, before analyzing how to handle the encircling ethical dilemma, it is important to consider and pay specific attention to the development of nurse-patient relationships and the implication of these relationships have on the occurrence and handling of ethical dilemmas. Nurse-patient relationships have been the center of interest since the publishing of Hildegard Peplau’s Interpersonal Relationships in Nursing Practice in 1952 which emphasized the role of interaction in nursing practice (Mariani, 2012). Also, that the human-human relationship between nurses and their patients is the epitome of nursing practice paradigms everywhere. Peplau’s theory of nursing has continued to guide nursing practice to date. Similarly, according to Mariani, nurse-patient relationships reiterate the essence of nursing practice and the level of nurse-patient engagement it requires. Nursing is an engaging profession, and it includes understanding, considering and meeting the needs of another in the process of caregiving. Thus, interaction and engagement denote the human aspect of nursing and caregiving. Therefore, through these interactions, it is inevitable to avoid forming personal and close relationships with patients and vice versa (Mariani, 2012). Considering the hypothetical case scenario, over the one year that I have been Mr. Newcomb’s nurse I have resonated with him on a personal level and developed a relationship with him and his family proving the normality of nurse-patient relationships.
Handling Ethical Problems
Nurses encounter numerous instances when they are confronted with an ethical problem that consequently requires ethical decision making. Thus, it is an interrelated process influenced by several factors both on a personal and contextual level (McLennnon et al., 2013). On a personal level, various factors apply and influence how an individual perceives ethical decision making, such as values, belief systems, and convictions, moral sensitivity among others. For example, moral sensitivity is a personal notion that describes the personal ability to identify personal moral values when dealing with an ethical situation and recognizing one’s role and responsibility in handling the situation. It requires significant self-awareness of one’s moral values. The process of ethical decision is also contextually embedded since the relationship between the nurse and patient is contextual perceived as it varies from patient to patient. Some of the contextual factors to be considered include nurses’ experience with the patient; rules like the nurses’ code of ethics; workplace opinions and expectations; etc. Situations of ethical conflict can be complex and difficult to handle especially in deciding the course of action to take. Moral distress within the nursing profession has been a topic of interest widely replete with numerous medical and nursing literature given the ethical nature of medical professions ( Milligan & Winch, 2015) . Moral distress refers situations when one finds it difficult to decide the right course of action due to institutional constraints, despite knowing the right thing to do ( Milligan & Winch, 2015) .
Analysis of the scenario
Truth and honesty are integral values inculcated within the nursing curriculum as part of fundamental principles and core values of nursing practice. Thus, it is a requirement of the nurses’ code of ethics to speak the truth when dealing with patients and their families. These values are especially integral in ethical conflict situations. As a nurse, I value the essence of nursing ethics and the need to uphold them in handling the patients I interact and engage with on a daily basis. Thus, in handling the situation, I recognize that the ethical requirements of my profession do not permit lying to a patient or their family. Thus, I would decline Mr. Newcomb’s request to lie to his wife so that he can see his mistress one last time. Also, my decision is influenced by my individual moral imperative motivated by my belief system regarding telling the truth and my conviction on the institution of marriage. I believe that telling lies is wrong and the institution of marriage is sacred and should be respected. Most times, as trained nursing professionals, we know how to analyze and rationalize a situation according to the training we have received. For example, in this case it is easy to rationalize that Mr. Newcomb’s request violates the fidelity and truthfulness requirements of our profession warranting that I decline such a request. However, sometimes nursing training does not teach how to moral distress situation that affect someone on a personal level to the core of their being and which is not essentially related to medical practice. Mr. Newcomb’s request presents a moral distress situation about an issue not related to medical practice- the issue of cheating, which seems to be the societally accepted norm. Given the close relationship that I developed with Mr. Newcomb and his wife, Mrs. Newcomb on her daily visits to the hospital, Mr. Newcomb’s request will present a moral dilemma and distress on my part. My course of action is to decline Mr. Newcomb’s request to lie to his wife without trying to stop him from pursuing his intention of seeing his mistress.
Application of the Principles of Beneficence, Non-maleficence, Autonomy, and Justice to the scenario
The Principle of Beneficence and Non-maleficence
According to Beauchamp and Childress, the principle of Beneficence requires that medical practitioners and more specifically nurses ought to act in the best interests of their patients ( Beauchamp and Childress, 2001). This includes promoting good for the patient in every endeavor by preventing and removing harm that may cause the progression of a disease, pain, suffering, death, etc. Instead, a nurse should work to promote good health and well-being of their patients. This principle is not limited to the administration of medical treatment only; it includes acts like ensuring the patient is comfortable, such as asking if they need an extra pillow or water. Mr. Newcomb’s request to meet his mistress one last time can be of the utmost importance to him considering he stopped treatment and is in the final stages of his life. Such requests are characteristic of patients y-under palliative care in the final stages of their lives as most patients at this stage often want to spend the final stages of their lives with family, friends and loved ones. In most situations, upon the request of the patient, nurses and medical practitioners are required to contact these loved ones on behalf of their patients. However, Mr. Newcomb’s request proposes an ethical challenge because it involves lying to his wife, who has constantly been by his side during his treatment. Mr. Newcomb seeing his mistress may be in his best interest, but the process violates ethical codes of nursing practice. Despite declining his request to lie to his wife, I did not take any action that would prevent him from seeing his mistress. Thus, I still considered the importance of his interest to see his mistress according to the beneficence principle.
The principle of non-maleficence, on the other hand, assures the duty of a medical practitioner against causing harm or hurt to a patient and is inter-related to the principle of beneficence (Beauchamp and Childress, 2001). Similarly, by not informing Mr. Newcomb against seeing his mistress, I upheld the principle of non-maleficence of not causing him any harm. This is because I may not understand the dynamics of Mr. Newcomb and his mistress’ relationship and the impact that their meeting can have on the well-being of Mr. Newcomb on his final stages of life.
Autonomy
The principle of autonomy emphasizes the need for upholding the rights and obligations of a patient. It is an agreement for medical practitioners to always accord a patient the right to the self-determine course of action or decisions regarding their treatment options or anything affecting their health through independent decision making ( Beauchamp and Childress, 2001) . Also, in providing autonomy to the patient, this principle requires that medical practitioners remain truthful but devoid of imparting controlling influences that will violate a patient’s autonomy. In this situation, I decide to remain truthful by informing Mr. Newcomb that his request violates the ethical code of my practice and my personal moral imperative. However, I accord him autonomy by respecting his decision to pursue a meeting with his mistress probably through an alternative way. This principle also advocates confidentiality which requires that I do not discuss Mr. Newcomb’s request with Mrs. Newcomb.
Justice
From its literal meaning, justice advocates for fairness and equality in the administration treatment options to a patient. Often, this principle is limited in scope to the provision of healthcare resources and the criticality of healthcare practitioners ensuring equitable distribution of these resources to all patients ( Beauchamp and Childress, 2001) . However, it can also mean the accordance of due action by upholding someone’s right which in this case scenario implies according Mr. Newcomb the free will to pursue a meeting with his mistress.
Ethical concerns and dilemmas are common in healthcare settings on a daily basis. Nursing practice is very much an interpersonal profession such that these ethical issues are prevalent that most often nurses do not even realize they are making an ethical decision by the minute sometimes. Making ethical decisions is not an easy fete, and yet it is expected to come naturally within the nursing profession. This natural instinct requires recognition of self-awareness, what is required and a framework that guides the making of these ethical decisions. Theoretical perspectives especially, provide normative frameworks and foundation that guide a particular belief, right, and values. Thus, it is important to consider the application of ethical theories in guiding nursing practice. I will analyze ethical theories that I found applicable in helping me come to an ethical decision concerning the case scenario.
First, it is important to consider the theory of Ethical Relativism, which emphasize that institutions of morality are relative and unique according to individual and context. The theory proposes that morality varies from one individual to another and that there are no definitions of absolute truth when it comes to issues of morality ( Monteverde, 2014) . This is true for the majority of ethical dilemmas I have encountered. One person’s interpretation of what is morally right or wrong may not be the same as that of someone else’s. The variation in interpretation is brought about by differences in culture and contexts. For example, a different nurse may probably handle the ethical dilemma from Mr. Newcomb’s request differently than I handled it. In handling the decision to lie, nursing practice requires that nurses restrain from lying. However, the moral distress that I experienced due to the repercussions that the mistress’ visit will have on Mrs. Newcomb may not necessarily be felt by every other nurse in the same dilemma because it is a personal construct and depends on personal beliefs and convictions. Thus, it is true according to this theory; it is true to deduce that there are no prescribed ‘truths’ concerning morality.
Deontology is another ethical theory that perceives the morality of an action based on obligation or duty to predetermined rules or laws. The theory is non-consequential. Thus it does not take into consideration whether the consequence of an action was good or bad. It analyzes the morality of an action depending on whether rules of action were followed ( Monteverde, 2014) . In many ways, nursing practice follows a deontological approach in handling certain ethical dilemmas as denoted in the nurses’ code of ethics. For example, the principles of beneficence, non-maleficence, autonomy, and justice are regarded as guidelines of action that should always be followed in nursing practice. However, there are times when the ethical dilemmas encountered are out of the ordinary with no specific guidelines on how to handle them. For example, in this cases scenario, deciding against lying is easy as it is a normal requirement of nursing practice. However, Mr. Newcomb’s request to see his mistress is a non-traditional request which requires critical evaluation. It is easy to think that it is no big deal because she just like any other visitor and that Mr. Newcomb is entitled to receiving any visitor he wishes. However, it is important to consider the ethical underpinning of his request because it is intertwined with ethical violations of nursing practice.
Most often, the ethics of nursing practice are embedded in feminist theory which is much like ethical relativism in that it does evaluate the morality of actions through the eventuality that these actions are universal acts- just like in utilitarianism- which judges morality based on the maximum good that an action brings to the maximum number of people. Feminist theory advocates for specific and critical analysis of individual contexts and applying attributes such as empathy, compassion, sympathy, and care in coming to a moral conclusion ( Monteverde, 2014) . This is the most applicable theory that I resonated with in coming to my conclusion concerning Mr. Newcomb’s request. It advocates for consideration on how an action affects a patient, their family and you as the individual making the decision.
References
Beauchamp, T. L, Childress, J. F. (2001) Principles of biomedical ethics. (5thedn).
New York: Oxford University Press
Mariani, B. (2012). The effect of mentoring on career satisfaction of registered nurses and intent to stay in the nursing profession. Nursing research and practice , 2012 .
McLennon, S. M., Uhrich, M., Lasiter, S., Chamness, A. R., & Helft, P. R. (2013). Oncology nurses’ narratives about ethical dilemmas and prognosis-related communication in advanced cancer patients. Cancer nursing , 36 (2), 114-121.
Milligan, E., & Winch, S. (2015). Practical ethics in clinical care. Psychosocial Dimensions of Medicine , 276 .
Monteverde, S. (2014). Undergraduate healthcare ethics education, moral resilience, and the role of ethical theories. Nursing ethics , 21 (4), 385-401.
Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision making?. BMC medical ethics , 13 (1), 10.
