Moral distress occurs when a health practitioner is faced with a dilemma on moral decisions. What they believe in could be challenged by the prevailing situations. In clinical practice, cases of moral distress are common, affecting both the medical practitioner and the patient’s family. In cases where a patient is extremely sick, the family would propose mercy killing of assisted suicide. However, the law does not allow termination of the life of an adult without their consent. In scenarios where the patient can communicate in any way to those around them, they must have consented that they are ready to die (Elmore, Wright, & Paradis, 2018). Moral distress occurs in cases where personal and religious beliefs contrast the need to relieve pain or fulfill family wishes. It is especially hard in a case where the family had spent so much when medication could have been withheld long before and saved millions. On the other side, human life cannot be equated to any sum of money, as money cannot buy health (McCarthy & Gastmans, 2015). The nurse, especially if they attach high value to life, may be reluctant to assist suicide or perform a mercy killing.
I have experienced situations of moral distress in my practice several times. One instance was due to the conflict between my religion and professional conduct. As a Christian nurse in charge, I received a thirteen-year-old girl with what looked like a fever, accompanied by a swollen neck and pain when swallowing. The fever, however, did not seem to subside, so I decided to perform other tests to find out any underlying conditions. The patient was recovering, often coming down from her bed to perform a special dance with the nurse. She was in that ward for only three weeks, but they we bonded so much with the nurse. The joy did not last long as weeks later; the little girl was diagnosed with thyroid cancer.
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The parents were shocked but had great hope of her recovering. She was immediately put under medication in a special ward as her health was deteriorating fast. She could no longer come down to dance. Although she could often smile, the pain was evident in the smile. She was placed under thyroid hormone therapy for two weeks as the doctors checked her health. She did not improve and was scheduled for surgery. Unfortunately, the surgery did not yield the expected results, so she had to stay in the hospital for a month. The hospital bill and travel expenses were piling up, which worried her parents. I was still her primary caregiver, even when her family visited her less often. They went from coming twice a day to once every two days, and now thrice a week. The girl could not talk and was transferred to the Intensive Care Centre. After six weeks in the ICU, the family talked to the management and requested for euthanasia. The patient had been in pain for close to six months, and there were no signs of recovery. The family had also used their savings to pay her bills, and traveling from their upcountry residence every day was becoming hard as they were both working. At this stage, the patient was in a coma, which has lasted three weeks.
Being a staunch Christian, it was a big dilemma for me. Christians believe life comes from God, and no human has the right to take it away no matter the hopelessness. The hospital gave the parents a week to think about it, after which they came back and said they were ready for mercy killing. With their written consent, the hospital authorized the process. I was still unsure and had a side discussion with the parents on their decision. The parents were also born Christians, but non-practicing now. After explaining his journey with their girl and the bond we had formed, the parents withdrew their consent and decided to give their child another week. Unfortunately, she lived for only three days after that. This was one of the greatest moral distress cases that I had faced in my nursing practice.
The approached I took in the situation heavily relied on my religious belief and the ethical principles of non-maleficence. I perceived that terminating the patient’s life, regardless of the consent from her parents, would be contravening my religious beliefs and ethical principle. On the other hand, I went against the parent’s and the hospital’s decision of euthanasia. The patient was in terminal pain ending her life was a pragmatic decision. It would also ease the burden of the piling cost of care on the parents. As a nurse practitioner, it is imperative to evaluate both facets of the situation to make a morally, ethically, and professionally sound decision.
References
Elmore, J., Wright, D. K., & Paradis, M. (2018). Nurses’ moral experiences of assisted death: A meta-synthesis of qualitative research. Nursing ethics , 25 (8), 955-972.
McCarthy, J., & Gastmans, C. (2015). Moral distress: a review of the argument-based nursing ethics literature. Nursing ethics , 22 (1), 131-152.
