Ethical decision making
Category : Nursing Ethics
Ethical decision making
Ethical decision making is the application of the processes and theories of moral philosophy to a ‘real’ situation.
As a nurse, you will encounter situations where you are faced with two alternative choices, neither of which seems a satisfactory solution.
Conflict arises when there is a need to choose between two apparently equal courses of action, each of which would have significant consequences for the outcome of care.
This constitutes an ethical dilemma.
Having read this scenario you may consider that there are other options. You may also have identified your preferred course of action. Refer back to Exercise 1.2.1 and identify how your reaction to the example was influenced by your personal values and beliefs.
CASE STUDY ONE
Consider the following scenario. You may wish to discuss it with your colleagues.
Scenario(Based on Jones 1994, p. 21.)
Your 18-year-old son, Ben, is worried about his friend Steve’s apparent addiction to drugs. Until Ben became worried, no dilemma existed. The fact that he is worried indicates that he would like to do something about it and he has two basic choices, each with different consequences.
Choice 1: Do nothing. Consider that Steve is experimenting with aspects of life in order to enable him to make the transition to a self-determining adult. Alternatively, Ben may consider that it is none of his business and he has no right to interfere.
a) Steve soon decides that it is not for him and gets on with his life.
b) Steve becomes increasingly antisocial as a result of his addiction, possibly engaging in criminal activities to support his habit.
c) Steve dies from continual drug abuse.
Choice 2: Tell Steve’s parents in order that advice can be sought in time.
a) Steve is furious at the breach in friendship/confidentiality. He continues to use drugs and the friendship is over.
b) After the initial trauma that he has been found out by his parents, Steve is thankful that his friend sought help for him in time.
How we make decisions
We can examine a situation to determine the best course of action, using the ethical principles below in conjunction with an ethical decision-making model.
The six ethical principles that underpin moral philosophy are:
Autonomy: This refers to a person’s ability to make or exercise self-determining choice in the context of respect for others and their right to make choices. An example of upholding a patient’s autonomy is through the provision of adequate information, allowing the patient to give informed consent.
Beneficence: This demands that above all we do good, and therefore requires a positive action to benefit someone, for example, providing nursing care that is both appropriate and affordable.
Non-maleficence: This demands that above all, we do no harm and therefore we have a duty not to injure others. This is integral to the obligation of ‘duty of care’.
Justice: This is the equal distribution of benefits and harms in the context of what is deserved. It centres on the notion of fairness. All patients deserve the same standard and quality of care, regardless of the health care setting.
Veracity is concerned with being truthful and honest. This is fundamental to the development of trust in the nurse/patient relationship.
Confidentiality: This is not divulging information about a person without his/her consent thus respecting the privacy and wishes of others.
Refer to your text on ethical issues.
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