Nursing Ethical Dilemma

Nursing Ethical Dilemma

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Introduction

The American Counselling Association has set up a number of ethical guidance models to help physicians and counsellors in decision making when handling patients or offering medical advice to them in an ethical way (Ernst, 2009). Therefore, there are principles that guide medical practitioners when making ethical decisions on questions that require ethical approach so as not to hurt or misguide their patients. The article uses a case study to show how ethical decision making models can be used in a dilemma that calls for ethical decision making in medical practice (Williams, 1993).

Ethical Dilemma

Considering that we are dealing with a minor here whose parents are the only ones who can make decisions for him, the dilemma then comes from both the parents. As for the mother, who is not the biological parent of the child, she believes that her child cannot be treated as it is against her religious beliefs (Williams, 1993). On the other hand, the father, who is the biological parent, wants his son to be taken to the hospital and a treatment procedure for meningitis to be initiated immediately. Therefore, the dilemma is on how to convince the mother to allow a treatment procedure for her son to be initiated without causing a conflict with her husband. Moreover, the fundamental good health and medication rights of the child was at risk as one of the parents would not give consent for her treatment to take place (Ernst, 2009).

Decision Making Model

Resolving the Dilemma

1. Problem identification
2. Application of ACA Ethical Codes
3. Nature of dilemma determined
4. Generation of course of actions which are viable
5. Assessment of the consequences of the selected course of Actions
6. Evaluation of the final selected course of Action
7. Implementation of the course of action

Therefore, the model that fits best to solve the dilemma is that of first identifying the problem at hand. In this case, the dilemma is that of the mother refusing her child to be treated of meningitis on religious basis while on the other hand the biological father demands for the treatment to commence. In addition, the health of the child should be of at most importance and an immediate action should be taken but there is the impediment from the parental concept for treatment to take place (Shelly, 1980).

Secondly, ensure that the American Counsellor’s Association (ACA) code of ethics is applied in the decision making process (Williams, 1993). In this case, it would be wise for the counsellor to make the parents understand that they have the independence of autonomy, whereby they have the right to make free willed decisions on behalf of the child. Moreover, since the consenting parent is far away, and he is the biological parent, he has a better chance to make the final rational decision. However, it would be wise to try and advise the mother to change her mind (“Solving” Ethical Problems, 2014).

Moreover, it would be ethical to apply the non-maleficense concept whereby it would be advisable to tell the parents that the decisions that they are making should not harm their child in any way. In this case, by the fact the mother was refusing her son to be treated, it means that she was causing harm to her child by endangering his health (White, 1992). On the other hand, while giving the advice, it would be ethical for the counsellor to practice beneficence in that the welfare of the client should be of at most importance (Shelly, 1980). In this case, the interest of the father is his son’s health while that of the mother is maintenance of religious beliefs hence endangering the son’s health. In this case, advising the father to obtain a court order demanding for his son to be treated would be an excellent choice (Williams, 1993).

Thirdly, the nature of the dilemma should be determined. The mother is the primary custodian of the son but she is depriving him of his right to health-access. Therefore, the nature of the case is that of child’s rights is being neglect on the basis of religious beliefs that the mother has (“Solving” Ethical Problems, 2014). Therefore, the concept of nonmaleficence applies here as the health of the child is being put at harm by her mother. Therefore, if the advice for her mother to allow the treatment does not work, then the counsellor should turn on concept of the father as under legal grounds, he has an upper hand in deciding that the son undergoes (Williams, 1993).

Fourthly, a reasonable course of action which is has the potential of implementation should be generated. The first course of action is to advise the mother to change her mind and allow her son to be treated, secondly, if she doesn’t agree, the father can now file a law suit demanding for the permission to have his son treated (Ernst, 2009). It is under the government policies for everybody to have the right to healthcare and in this case the mother was depriving the son of that right. Moreover, it would not be legal for the father to give a direct consent for his son’s treatment as he was not the primary custodian of the child and furthermore he was far away (White, 1992).

Moreover, the consequences for the chosen course of action should be determined and how they will affect the parties involved in the dilemma. One of the major consequences for the mother refusing to give the consent from her son’s treatment is that she may be jailed for it. Secondly, if the husband files a law suit, it may lead to domestic wrangles with his religious wife and probably a divorce. The court may also charge the wife with negligence on her son’s health. However, if the wife maintains on her religious beliefs against the treatment, it would be necessary to obtain a court order for the treatment of the child (“Solving” Ethical Problems, 2014).

After the course of action is selected, it should be evaluated to determine if it is ethically viable and any considerations needed to be stipulated. The best option for the husband to take is applying for an urgent court order requesting for the court to authorise the treatment of his son. He should further use the case to request the custody of his son to avoid such future endeavours against his son’s health. Moreover, the wife was not the biological mother of the boy and this could have been a reason why she did not care about his health. On the other hand, she was a religious fanatic who never believed in medical treatment and this endangered the boy’s life (Shelly, 1980).

Finally, the selected ethical course of action should be implemented. In order to implement the course of action, the father should call or hire a lawyer to apply for a court order requesting an argent treatment of his son. In addition, he should also file for the son’s custody to shift from the wife to the biological father on the basis of neglect and irrational religious beliefs that endangered the child’s life (Shelly, 1980). However, he should not sue his wife for the negligence as it would not be wise to have her jailed. The move would be wise as the government advocates for the children’s rights on good health and access to health services. Therefore, the court order for the treatment is likely to be issued with an immediate effect (Ernst, 2009).

The Dialogue

Counsellor: Good evening, I am a Physician counsellor from West Wood Consultancy. I have come here to convey my decision and advice in regards to your son’s health.

Counsellor: I have thought it through, suing your wife on the issue of child neglect would be unethical to you; therefore, I have another option.

Father: Which one is it, what do I do?

Counsellor: Taking into consideration the non-maleficense principle, I saw that the child’s health should come first above anything else. Therefore, making an urgent court order requesting for the child’s treatment to be initiated without her mother’s consent will be very advisable.

Father: How do I go about this?

Counsellor: Since it is a legal approach, as you are not the primary custodian of the boy, but you are the biological father, it would be wise for you to hire or use your lawyer. The lawyer will file the order and explain its urgency.

Father: What if the court denies the request.

Counsellor: it would be unlikely as the court will take into consideration the rights of the child in terms of health and the negligence the mother is posing to the child.

Father: What will be the most likely consequences?

Counsellor: The boy’s treatment will start immediately after the order, and legally, you will not have breached any law. However, if you sue her, she may be jailed on the terms of child negligence.

Father: Can I get my son’s primary custody?

Counsellor: you can use the chance to file an appeal for your son’s primary custody on the basis of neglect by the mother. You will have strong grounds on the matter. However, I may warn you, your personal relationship with your wife may be ruined; but considering the harm that her religion is posing to your child, go for it.

Father: Thank very much.

Counsellor: You are welcome. I have therefore deemed it right for you to file a court order requesting for your son’s immediate treatment. This would be the best decision as your wife has refused fully to cooperate. However, if you talk it over and she agrees, there is would be no need for a court order. Thank you.

Conclusion

Application of ethical models in decision making is very important as it enables counsellors to make give the most practical and ethical approaches to a given dilemma. However, the decision should come from the client as the counsellor’s work is supposed to be guidance and stipulation of possible consequences (White, 1992).

References

Ernst, E. (2009). Advice Offered by Practitioners of Complementary/ Alternative Medicine: An Important Ethical Issue. Evaluation & the Health Professions, 32(4), 335-342. doi:10.1177/0163278709346812

Shelly, J. A. (1980). Dilemma: A nurse’s guide for making ethical decisions. Downers Grove, IL: InterVarsity Press.

“Solving” Ethical Problems. (2014). Textbook of Healthcare Ethics, 267-299. doi:10.1007/0-306-46801-8_12

Williams, R. M. (1993). Health policy and quality: An ethical dilemma. The Journal of Emergency Medicine, 11(3), 345-349. doi:10.1016/0736-4679(93)90062-c

White, G. B. (1992). Ethical dilemmas in contemporary nursing practice. Washington, DC: American Nurses Pub.