Nurses face ethical dilemmas on a daily basis regardless of where they practice. No matter where nurses function in their varied roles, they are faced with ethical decisions that can impact them and their patients. There is no “right” solution to an ethical dilemma. So what is an ethical dilemma? It is a problem without a satisfactory resolution.
The significance of ethical decision-making lays in the fact that very different ethical choices regarding the same ethical dilemma can be made resulting in neither choice being a “right or wrong” decision.Ethics involve doing “good” and causing no harmThere are many ethical issues nurses can encounter in the workplace. These include: * quality versus quantity of life: Quantity may address how long a person lives or perhaps how many people will be affected by the decision. Quality pertains to how “good” a life a person may have and this varies depending on how a person defines “good”. So how does the nurse support a patient deciding between a therapy that will prolong life but the quality of life will be compromised? The person may live longer, but will likely experience significant side effects from the therapy. What should the nurse’s position be?* pro-choice versus pro-life * freedom versus control, * truth telling versus deception, * fair distribution of resources,www.
nursetogether.comDefinitions Moral philosophy ‘Moral philosophy is the attempt to achieve a systematic understanding of the nature of morality and what it requires of us - in Socrates’ words, of “how we ought to live,” and why’. Morality * Morality is usually construed as meaning what is right and wrong. * ‘The term morality refers to social conventions about right and wrong human conduct that are so widely shared that they form a stable (although usually incomplete) communal consensus, whereas ethics is a general term referring to both morality and ethical theory’.
‘Ethics is a generic term for various ways of understanding and examining the moral life’ The Four Principles Beauchamp and Childress’ Four Principles approach is one of the most widely used frameworks and offers a broad consideration of medical ethics issues generally, not just for use in a clinical setting. The Four Principles provide a general guide and leave considerable room for judgement in specific cases.Respect for autonomy: respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices. Beneficence (doing good): balancing benefits of treatment against the risks and costs; the healthcare professional should act in a way that benefits the patient. Non maleficence (not doing harm) Avoiding causing harm; the healthcare professional should not harm the patient. Most treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of the treatment.
Justice: Respect for justice takes several forms: * Distribution of a fair share of benefits * Legal justice - doing what the law says * Rights based justice, which deals in the language, and perhaps the rhetoric, of claimed human rights, and hence goes beyond, though it includes, legal rights. These principles are prima facie – that is, each to be followed unless it conflicts with one or more of the others - and non-hierarchical i.e. one is not ranked higher than another.
In recent years however, respect for patient autonomy has assumed great significance in the context of patient choice, underpinned by the requirement to provide the patient with sufficient information to put him / her in a position to choose. The ‘Four Principles’ are intended as an aid to balance judgement, not a substitute for it. We would like to thank Don Hill, Co-ordinator of Postgraduate Education, The Ethox Centre, University of Oxford for his assistance in producing this section.
