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Ethical dilemmas in the healthcare and nursing field have been on the rise, with recent developments in technology creating new concerns. These are dilemmas that arise as a result from breaking certain moral principles as defined in the nursing practice, conducting certain operations that go against the set standards in the healthcare system. Ethical dilemmas happen when moral acts raise questions that cannot be answered with simple explanations, rule or authoritative approach for the acts (Beauchamp & Childress, 2001). This article talks about an ethical issue that is involved in the use of informatics and how to analyse and evaluate it with the various decision-making approaches as explained in McGonigle and Mastrian’s Ethical Applications of Informatics (Mastrian, McGonigle, 2009).
Conflicting values in ethical dilemma
Conflicting values in ethical dilemmas are defined as the different and incompatible beliefs of different individuals towards certain viewpoints, expectations and principles. Different theoretical approaches have been used in the healthcare system. These include the use principlism, causist approach, virtue ethics, care ethics and consensus-based approach (McGonigle, 2009). Principlism became a decision making approach when it arose as societies became experiencing difference in beliefs and values and the principles became expansive enough to incorporate all individuals regardless of beliefs and background. Causist approach involves decision making that establishes concrete methods of examining dilemmas, through sound and logical analysis that is structured in and orderly.
Virtue ethics focuses on the use of virtuous human character to make decisions and choices. It emphasizes that most virtues can be taught to individuals as the ethicists believed that what can be known can be taught (Scott, 2002). Care ethics is defined as the way an individual responds to another’s needs and how they can provide care, prevent harm and maintain their relationships. According to Benjamin and Curtis, care ethics is the “critical reflection and inquiry in ethics that involves the complex interplay of a variety of human faculties” (Benjamin and Curtis, 1992). Lastly, consensus-based approach deals with bioethical approaches that involve numerous methods, used to emphasize the various ethical factors, including the circumstances involved, character, interpersonal needs, principles and personal meaning (Martin, 1999). In informatics, an ethical dilemma can be evaluated and solved using the ethical model for decision-making, by offering solutions for the dilemma and alternatives.
Possible alternatives in analysis ethical issue of informatics
For instance, a patient approaches the nurse and is diagnosed with acute appendicitis. Though in a very critical stage, the patient declines to relay parent’s contacts to ensure that family or relatives are informed. Since the nurse has no other form of contact, she tactfully gets her way into the patient’s phone and retrieves the required contacts, and informs the parents of the patient’s condition. This is a violation of the patient’s privacy, as it denies her the ability to make and retain her own decisions. It also goes against the hospital policy that protects the privacy and security of client information (Mastrian, McGonigle, 2009).
The possible alternatives in this situation would include; (1) The nurse would have politely advised the client the importance of informing her parents about her condition; (2) The nurse would have referred the patient to a higher authority for better advice of the matter.
Hypothesis of the ethical dilemma
The approach needed for this situation was the care ethics, which involves responding to the needs of other individuals to ensure they receive care, prevent harm to both themselves and concerned parties and maintain relationships. In this scenario, the nurse has clearly violated the hospital rights that is designed to protect the privacy of hospital records. Using the client’s phone to relay information, without her consent, also goes against the principles of virtuous behaviour. However, the nurse had every right to contact the parents and inform them of the situation. She also understood that doing that jeopardizes her work as a nurse, as she violates the hospital policy. She also understands that the patient’s health is in crisis and needs immediate attention with the best possible medical care – which is immediate surgery – therefore informs the parents.
She therefore balances all the possible approaches of the patients, the parents and her job in the situation. Even though there was a long-term solution for the situation, which would possibly involve change in hospital policy, it is safe to assume she handled the dilemma accurately at the particular time.
Investigation, comparison and evaluation of alternatives
Talk about the importance of communication with the patient
No hospital policy violated.
Patient’s rights considered
Critical condition of patient is time-sensitive
Rules that protect hospital records violated
Best: Patient gets immediate permission and support from parents.
Worst: Patient’s health deteriorates as parents may take time to get to the hospital to issue go-ahead.
Patient’s right considered.
Parents’ relationship with patient improved through communication.
Refer patient to higher authority
No hospital policy violated.
Patient’s rights safeguarded
There might not be a higher authority not busy at the moment of crisis
Best: Higher authority may access and contact patient’s parents legally.
Worst: May not be possible to get one at short notice.
Patient rights and care would come first.
The best alternative that the nurse would have used as an immediate solution was to talk to the patient and understand her reasons for declining to relay her condition to her parents. The best long term solution for the nurse would be to consult the hospital administration to change the policies that give barriers against accessing hospital records to nurses, in the event of a future occurrence.
Act on chosen alternative
The nurse should convince the patient to release the information needed before attention as the critical care needed, the surgery, would require the immediate consent of the parents. She should address the challenges that would arise in case the patient withholds such information from the hospital for treatment.
Ethical dilemma and outcomes of decision
The best alternative for the ethical dilemma, was accessing the information immediately from the patient. However, the nurse was unable to have the same as the patient voluntarily declined to give the information as needed. Since she was in a critical condition, and immediate care was needed, the nurse’s access to her phone to retrieve contact information, was the best immediate solution for the dilemma. However, a long term solution is needed in case of future occurrences, and the nurse should approach the administration to be able to gain access to the hospital records, in case of need for communication to relatives or immediate family. This was the hospital policy remains not violated, the patient’s privacy is safe-guarded and the critical care needed by the patient is evaluated as soon as possible.
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. Oxford
University Press, USA.
Benjamin, M., & Curtis, J. (1992). Ethics in nursing (3rd ed.). New York, NY: Oxford
Mastrian, K., McGonigle, D., & Farcus, N. (2009). Ethical Applications of Informatics.
Martin, P. A. (1999). Bioethics and the whole: pluralism, consensus, and the transmutation of
bioethical methods into gold. The Journal of Law, Medicine & Ethics, 27(4), 316-327.
McGonigle, D. (2000). The ethical model for ethical decision making. Inside Case
Management, 7 (8), 1–5
Scott, A. (2002). Plato’s Meno. http://www.angelfire.com/md2/timewarp/plato.html
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