Write about an ethical dilemma you faced in your practice (does not have to be about patient care, it may be a management issue or other).   Identify which principles and nursing...

Write about an ethical dilemma you faced in your practice (does not have to be about patient care, it may be a management issue or other).  

  1. Identify which principles and nursing obligations played a role in your decision making and which ethical theory do you use most often?
  2. Comment on how the scope of nursing fits into this dilemma.
  3. How would you, if deemed appropriate, bring this to the attention of the state board? What would you say?

Kearney-Nunnery, R. (2012).  Advancing Your Medical Career:  Concepts to Professional Nursing. (5th, ed.). chapter 12

Expert Answers
kipling2448 eNotes educator| Certified Educator

The practice of medicine and the administration of health care facilities provide numerous potential ethical obstacles that physicians, nurses, and others are expected to navigate knowledgeably and properly.   Ethical dilemmas that can confront nurses include conflicts of interest when personal relationships with other medical staff, especially with the attending physician, impair the nurse’s judgment at the expense of the patient’s interests; concealing medical errors, for example, administering the wrong medication, or the right medication in the wrong dose; and treating a patient improperly because of the latter’s abrasive personality, or for other inappropriate reasons.  The American Nurses Association’s Code of Ethics is specific regarding the expectation – more accurately, the requirement – that nurses will treat patients with dignity and care, and that ethical or moral boundaries will constitute an integral role in their day-to-day activities.  Section 1.4 of the Code, “The Right to Self-Determination,” is one of the more emotionally difficult of the code’s provisions with which to adhere on a daily basis.  Seemingly inarguable in its letter and intent, this section is fraught with ethical obstacles when the realities of the medical profession, especially with respect to the physicians’ obligation to do everything in his or her power to save the life of the patient.  The ANA’s expanded discuss of each provision of the code’s meaning states the following with regard to Section 1.4:

“Respect for human dignity requires the recognition of specific patient rights, particularly, the right of self-determination.  Self-determination, also known as autonomy, is the philosophical basis for informed consent in health care.  Patients have the moral and legal right to determine what will be done with their own person . . . to be assisted with weighing the benefits, burdens and available options in their treatment, including the option of no treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty; and to be given necessary support throughout the decision-making and treatment process.”

Doctors are highly-educated individuals whose academic and professional requirements dwarf those of most other professions.  By the time somebody becomes a licensed physician, especially a surgeon or specialist in particular anatomical systems (e.g., cardiovascular, neurological, etc.), he or she is imbued with a level of confidence that has been somewhat derisively labeled “the God complex.”  In other words, doctors are trained to and do, frequently, possess the power of life and death over their patients, and understandably believe they know what’s best for their patients.  This practical and psychological complex tends to blind physicians to the wishes of their patients, or to the wishes of the patients’ families.  A nurse may very well face a situation where he or she is cognizant of a serious difference between what the physician believes is right and what the nurse knows to be the preference of the patient.  A surgeon who insists that surgery is the best option for a particular patient will tend to skew the physician-patient discussion in that direction.  The nurse, however, may strongly disagree, either because he or she knows from talking to the patient that surgery is not appropriate or desired, or because the nurse knows from experience that other viable and less-invasive options exist.  A nurse is subordinate to the surgeon in a hospital’s hierarchy, and a certain amount of courage is required to confront the surgeon regarding the optimal course of treatment.

A nurse who has witnessed a serious transgression of the medical profession’s codes of ethics has an obligation to report such incidents up his or her chain of command, for instance, to the chief of nursing and/or chief hospital administrator.  Should those avenues prove unresponsive, the next step is to contact, in writing, the state medical board, which oversees the licensing of physicians for that particular state.  Taking such a step is fraught with peril as far as the nurse’s future is concerned, as reputational risk can preclude other employment opportunities in the medical profession.  A reputation as “a trouble maker” or for being disloyal can ruin a nurse’s career.  The welfare of the patient, however, is paramount, and such risks are a part of the profession of nursing.