The ethical dilemma is a situation that is common in many places of work including the nurse’s career. These dilemmas are always hard to solve since technically they weigh equally in the eyes of the professional nurses in question (White, 2001). Nursing as a career like any other has diverse ethical dilemmas. This paper aims at describing an ethical dilemma in relation to declaration of brain death by the nurse and refusal of this fact by the patient’s family. The work will entail the definition of ethical dilemma; main moral issues that arose in the scenario given; description of two bioethical principles and giving a view of how they relate to this scenario; explain my personal morality and how it relates to the dilemma of declaration of brain death and finally the conclusion.
Ethical Dilemma and How it Affects Nursing
According to Ong & Yee (2012), ethical dilemma is a situation that needs one to choose one from among two or more morally acceptable options or between equally unacceptable courses of action, whereby one of the choices prevents the selection of the other. Increase in economic stress, advances in medicine, rise in self determination of patients and differing values between patients, their family and health workers, especially nurses are among the many factors that contribute to the frequency and complexity of issues that are ethical in the healthcare. Example of these ethical dilemmas includes truth-telling and disagreement over the management plans. This therefore needs the nurses to be in a good stead so as to be aware of these issues and adopt a suitable approach towards dealing with such dilemmas. In addition, the health care facilities management should have a responsibility to ensure that systems are in place to minimize the occurrence of dilemmas and to ensure that in case it happens, staffs, including nurses, are supported on how to get through the process of resolving dilemmas and conflicts that may arise afterwards.
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An ethical dilemma can also be a situation or state in which one must select between two or more adoptions that are equally unacceptable, where this is “Conflict between two or more nursing ethical principles and each solution may contain unpleasant outcomes for one or more involved parties”; and in my case the parties are the bereaved family and the management staff (Miwa et al, 2012).
The effect of a brain death and the family refusal scenario may be of great emotional impact of the nurses. Some might even end up losing it all, according the historical findings, but it always appropriate to note that these effects will differ from one nurse to another. The grade to which one feels a dilemma will always differ from each nurse and also differs in terms of the nurses educational background, how much clinical experienced is the nurse and also one’s nursing moral (Miwa et al, 2012). The dilemma consequences are always frustrating and upsetting nurses and more so when one does not have adequate experience dealing with the matter. The suffering that the nurses go through is known as the moral distress (Epstein & Delgado 2010). This is meant to happen since the nurses know the ethically correct action to take in reference to the brain death but feels powerless to take the action. This might lead to some nurses leaving their jobs, or even the profession altogether.
Main Moral Issues Raised
In a situation of ethical dilemma in the declaration of brain death and refusal on the part of the family, the main moral issues include the fact that the family is legally authorized to make decisions in relations to the patient even though they do not have the medical knowhow they desire an action; not declaring the patient brain death thus the patient will still be assumed to be alive and thus treated. On the other hand, the nurse who has the clinical knowledge opposes the idea and is about a desire for action that the patient should be declared clinically and legally dead so that other follow up procedures could be taken (Epstein & Delgado 2010).
This means that there are two courses of action, both of which can be justified ethically and neither of which is of lesser weight. If the desires of the family are followed, the patient will be in the hospital assumed alive and treated like any other patient. One may ask how beneficial is this to the family and what are the costs of this action? On the other hand, if the desire of the staff is followed, the patient will be declared dead and there is the likely hood of the family feeling abandoned and opinion, neglected thus angry thus would lead to other repercussions like court battles a situation that one would like to avoid due to the costs that come with it (Epstein & Delgado 2010).
According to Crisham (1985), the bioethical principal has evolved over the years with some elements added and others removed until now we have only four broad bioethical principles: beneficence, non-maleficence, justice and autonomy. In this case will discuss autonomy and beneficence. This does not mean they override all other moral considerations, but they are the perfect match for this kind of ethical dilemma.
Ethics entails the respect for autonomy. This is the principle of permission. In minimal terms, autonomy requires to decide for the as an individual and free from the control of others and with sufficient level of understanding that you will provide a meaningful choice. Autonomous persons should be capable to deliberate a course of action and develop an action plan then implement it. This principle comes with its share of problems, especially when the person is incompetent for our scenario the bereaved family. The issues, therefore, rise since the family is to give informed consent to the declaration of the patient’s brain death. The principle holds that there is a need for competence, disclosure, voluntariness and comprehension when it comes to the informed consent making the declaration even more difficult for our car (Gordon et al, 2011).
In relation to the ethical dilemma therefore, there is a need for informed consent from the parents for the declaration to take effect. And the fact that the family denies the declaration simply means they do not consent to it thus rendering it null and void (Gordon et al, 2011).
This principle requires that we contribute to the welfare of others as an ‘embodiment of the Golden Rule’ (Gordon et al, 2011). This principle can be divided into two: utility and positive beneficence. The positive beneficence principle requires that there is provision of benefits from the moral staff while the utility principle requires that the nurses weigh the benefits and deficits as a means of producing the best result. There is therefore need for a risk benefit analysis.
In the scenario of brain death declaration and refusal from family, I will be preventing the ethical losses on part of the health facility by declaring that the patient is brain dead while I will be like issuing a loose statement to the patient’s family. The utility principle, therefore, requires me to weigh the risk associated with the declaration and come up with a sound decision (Gordon et al, 2011).
Naturally, I am an empathetic person with great compassion, thus pride myself being a nurse. I always try to put myself in the patients and family shoes and try to understand the situation that they are in. I made great sacrifices on behalf of my career as a nurse and just to see that my role as a nurse is felt in the health facility. I am open and ready to lean in all the environments. I also enjoy socializing and comparing notes with my colleagues to ensure that the product of my decisions is holistic and meet the threshold that is set. My compassion has enabled me to appear friendly for both the patients and their family and friends. I always believe that am suppose to be dedicated to my place of work through hard work and ensuring flexibility whenever need be (White, 2001). The majority of these qualities is what I would call that makes part of me as a nurse if not all and therefore a situation that brings a collision between these qualities and the my occupation as a nurse does not only cause great confusion but perplexes.
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The scenario of declaring the brain death and refusal of the family is therefore a hard nut to crack on my part. One side of the puzzle is, given the fact that I have been appearing to be the ‘friend’ of the patients and their family members and friends, and such a declaration will make me lose one of the morality that I intend to keep. Compassion is the morality that keeps me going in my career as a nurse (White, 2001). Empathy makes me understand the situation of the family and the pain that they are going through thus making the declaration even harder. On the other hand, a declaration is my duty in place of work. I have to declare that the child is brain dead to ensure me being a benefit to the facility. Failure of which will be like a denial to do an activity which is actually the same reason why I am a nurse. This might lead to results such as being sucked.
The declaration of brain death and refusal by the family is therefore an ethical dilemma. This is from the fact that it brings forward the controversy between the two bioethical principles: autonomy and beneficence. It is hard to determine whether to do what one is expected to do in the career or do what one views is right while all this does not solve the solution at hand; this is the scenario that comes with this ethical dilemma. The values of compassion and empathy makes enable one to understand the situation better and feel for the family even more and may end up forgetting his or her role as a nurse. In this case, the declaration of a brain death would be still a great ethical dilemma on part of the nurses if the family is against the declaration.
Beauchamp, T.L. (2011). Making Principlism Practical,Bioethics, 25(6), 301-303.
Crisham, P. (1985).Moral: How Can I Do What’s Right? Nursing Management, 16 (3), 42A- 42N.
Epstein, E.G., Delgado, S., (Sept 30, 2010) Understanding and Addressing Moral Distress. OJIN: The Online Journal of Issues in Nursing, 15(3), Manuscript 1.
Gordon, J.S., Rauprich, O. & Vollmann, J. (2011). Applying the Four-Principle Approach. Bioethics, 25(6), 293-300.
Ham, K. (2004). Principled Thinking: A Comparison of Nursing Students and Experienced Nurses. Journal of Continuing Education in Nursing, 35(2), 66-73.
Miwa, Y., Shizue, M., & Masako A. (2012). Ethical Dilemma Factor in Regarding Physical Restraints to Elderly of Female Nurses with the Living Together Experience. International Journal of Clinical Medicine, 3, 328-334.
Ong, W. Y., Yee, C. M. , Lee, A. (2012). Ethical Dilemmas in the Care of Cancer Patients near the end of Life. Singapore Medical Journal, 53 (1), 11-6.
White, G. (2001). Issues Update: The Code of Ethics for Nurses. The American Journal of Nursing, 101(10), 73-75.
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