Ethical dilemma

Ethical dilemma

Ethical dilemma is also known as moral dilemma and it refers to a situation where an individual is faced with two choices and neither of the choices provides a solution to the situation in an ethically acceptable way. In such situations, personal and societal ethical guidelines provide no satisfactory outcomes for the person making choices (Ascension health 2013, para. 3). This reading explores an ethical dilemma scenario that is exhibited between physicians and the patient’s rights to end of life.

In the scenario, the ethical dilemma concerns making the right decision pertaining to end of life. There is ethical dilemma of personal autonomy of patient with the societal norms that is associated with the interventions of a physician to cause harm instead of relieving harm. Medical professional are required to uphold to ethical standards when executing their tasks. This requirement is found in Hippocratic Oath. However, individuals have the personal autonomy and the right to make decisions regarding their end of life decisions. An ethical dilemma therefore arises when physicians are requested by the patients to assist in committing suicide; they face a dilemma in respecting the wishes of the patients and the right to personal autonomy.

The opinion and view of Dr. Kevorkian about end of life whereby patients right to end of life should be upheld is an illustration of ethical dilemma that confronts advance practice nurse. The nurses have the moral obligation of ensuring that they enhance the quality of life of their patients. The ethical question that arises from this is the circumstance under which such decisions are to be arrived at in order to avoid abuse. The patients’ right to common rule and right to control must be upheld but at the same time with a lot of care. One of the concerns that were to be guarded carefully to ensure that ethical dilemma was handled well was to ensure that the patient is above 18 years and that is suffering from terminal illness (Martin, 2013, p. 26). The integrity of the physician should be investigated to determine or verify the fact that the physician is committed to protecting life. Furthermore, physicians are required to explain the consequences of the decisions to the patient in a coherent manner. The patient must be mentally intact and capable of making informed decisions.

In this dilemma, one decision is undertaken at last. The decision, which is normally taken, is to end the life of a patient in seeking to fulfill the personal autonomy and the rights of the person. This is an ethical dilemma because, it deprives a person his life and yet if the person would have been given an opportunity or a second chance would have recovered from the illnesses (Gabriele, 2011, p. 88). The physicians are also acting unethical by carrying out physician-assisted suicide and yet they are compelled to always work towards saving the lives of the patients. Even though, the patient has the right to make informed consent to end his or her life, such a decision should be scrutinized and efforts put in place to ensure that the patient is not subjected to early end of life.

Advance practice nursing are guided by various ethical principles and values in their service delivery and specifically when making decisions based on ending of life/assisted suicide. These principles include beneficence, non-maleficence, dignity, justice, truthfulness and honesty. Autonomy means that the patient has the right to make decisions that pertains to his/her life end of life decision and has the right therefore to refuse treatment as well as the right to informed consent. In the doctor Kevorkian argument, non maleficence is the duty of the physicians not to inflict harm or pain to the patients, beneficence requires physicians to always carry themselves or practice in a away that benefits the patient while the principle of justice requires that all patients are granted equal opportunities to access to healthcare without any intimidation or discrimination. It is evident that doctor Kevorkian violates some of these principles when carrying out assisted suicide. The principle of justice is violated in this case. A patient has the legal right to access to healthcare and has the right to be treated and relieved of his/her pain. Committing assisted suicide; is therefore unethical and a violation of this principle. Beneficence principle is yet another value that is violated as it is the duty of a physician to provide interventions to prevent harm. Palliative care can be provided in substitute of assisted suicide to relieve the terminally ill of the patient using sedating drugs that are able to relieve the intolerable pain. Furthermore, the principle of non maleficence was also violated. It is the duty of physicians not to inflict harm or evil to his/her patients. Engaging in assisted suicide is killing and this is instilling harm to the patients. It is also unethical practice that should be denounced.

This dilemma leads to mixed reactions with some states passing the Physician assisted suicide laws while other making it illegal. However, those that legalized it like Oregon required that some principles be upheld in an effect the person autonomy and rights to end of life are to be executed. These laws, therefore, helped in sustaining the life of a person. Some of the laws requires that a patient be 18 years and above and suffering from the terminal illness. The doctor or physicians integrity should also be scrutinized to establish whether he/she is committed to life. The physician must also explain the consequences to the patients to allow the patient to make informed decision (Ben, 2002, para. 1). The patient should also be mentally intact and the request should be made in a prescribed form and witnessed by two people. These laws therefore, helped to ensure that; end of life was done in a professional way and to ensure that patients are not subjected to end of life without valid reason. Even though, the patient has the right and personal autonomy over their life, the physicians have on the other hand an obligation of ensuring that they save life and by upholding to the ethics of their work.

The appropriate code of ethics that is applicable for APN/DNP is that of American nurses association (ANA) codes of ethics. The codes of ethics requires that health professionals to uphold to the highest standards in providing healthcare to patients. Nurses have the responsibility of remaining committed to the patient’s health (American Nurses Association. 2013, para. 4). Therefore, nurses are required at all time to endeavor to provide quality health care to their patients. The ANA code of conducts refutes assistance suicide among the APN on grounds that it violates the ethical standards of non-maleficence and nursing practices. It is ethical tradition of nurses to always endeavor to ensure that the patients are well taken care of. Therefore, in providing their services APN should always ensure that there is justice. They should provide equal access to health care for patients. They are also required to have integrity in providing services to the patients. Integrity requires that nurses remain honest on their service delivery. They should also be beneficence to be able to do well and not harm their patients. These principles are part of the American code of conducts that nurses should adhere to minimize the problem of ethical dilemma in their duty of making decisions concerning end of life.

Therefore, one of the codes of ethics that is applicable to APD /DNP is non- maleficence, which requires that, nurses dot to inflict any harm or evil to the patient in course of their service delivery. The work and duty of the nurse is to ensure that the wellbeing of the patients is enhanced through provision of better quality medical services. Therefore, killing or assisting suicide is not an option for APD. This ethical consideration impacts on ethical dilemma because; it denies the patient his right to personal autonomy and right to end of life decision (Aita & Richer, 2005, p. 119).

An example of an advance practice situation that violates ethical principle of beneficence is where a nurse does not endeavor to support the well-being of the patient. It is the duty of the nurse to ensure that the patient is not exposed to harm (Sorta-Bilajac, 2011, p. 41). In a situation where a nurse is not concerned about the health status of his patient shows lack of responsibility and is violation of ethics. Another example to demonstrate failure to uphold to ethical standards is where a nurse prescribes unnecessary treatment to the patient intentionally (College of Physicians and surgeons 2012, para. 1). This act is geared at harming the patient which is not moral correct.

In conclusion

Ethical dilemma is one of the problems that face medical practitioners in line with service delivery. This problem can only be solved if the medical practitioners adhered to ethical standards and endeavor to promote well being of their patients rather than end of life. Even though, the patient have their personal autonomy to accept or reject treatment, it is important to ensure that assisted suicide is done after exploiting all the available options. Medical practitioners can be of great assistance and influence to the lives of patients if they work with diligently towards enhancing quality of health services.

References

Aita, M., & Richer, M. (2005). Essentials of research ethics for healthcare professionals, Nursing & Health Sciences, 7(2): 119-125

American Nurses Association. (2013). Codes of ethics for nurses. Retrieved from: http://www.nursingworld.org/codeofethics

Ascension health. (2013). Key ethical principles. Retrieved from: http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=47&It emid=171

Ben, B. (2002). Ethics, Values and principles. Retrieved from: http://www.massagetoday.com/mpacms/mt/article.php?id=10521

College of Physicians and surgeons. (2012). Servicing the public by guiding the medical profession. Retrieved form: http://www.cpsa.ab.ca/resources/ethics_101/Ethics_101_Archives.aspx

Gabriele, E. (2011). Ethics Leadership in Research, Healthcare and Organizational Systems: Commentary and Critical Reflections, Journal of Research Administration, 42(1):88-102.

Martin, W. (2013). Beyond the Hippocratic Oath: Developing Codes of Conduct in Healthcare Organizations, OD Practitioner, 45(2):26-30.

Sorta-Bilajac, I. (2011). How Nurses and physicians face ethical dilemmas — the Croatian experience, Nursing Ethics, 18(3): 341-355.