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Ethical dilemmas occur when health care providers have various conflicting choices from which to choose. To make a better decision, they need to employ clinical decision-making models. This paper will look at a dilemma case of a pediatric patient, discuss the rational theory, and provide a dialogue that a nurse can use convincing parents to allow the child to be treated.
In this case, the ethical dilemma is a conflict of choices between decisions of the father and the mother. Both of them are parents and are expected to have the interest of their child at heart. Additionally, they are informed about his diagnosis. Again, both of them understand that the child is in an emergency situation and needs urgent care. However, the father, a biological parent, wants his son to get treatment, but the stepmother declines care due to religious reasons. The physician who diagnosed the child understands that failure to treat him is life threatening and might lead to poor prognosis. He must make a choice but with consent from parents who have conflicting decisions. This situation is a dilemma because choosing to follow the decision of one parent will certainly lead to transgressing the decision of another.
Considering that the mother is not a biological one, the physician might follow the orders from the father. However, it is noted that the stepmother is the primary custodian and takes all the responsibility of caring for the child. Furthermore, in the Hippocratic Oath, physicians swear to uphold various ethical standards respecting patients being one of them. Arguably, respecting decisions of patients is paramount in upholding medical ethics (Rahmani, Ghahramanian, & Alahbakhshian, 2010). Recognizing those ethical principles and deciding who to follow in caring for the child is a dilemma that requires proper decision-making.
Rational Decision-Making Model
In clinical decision-making, there are many decision-making models, but the rational one is the most appropriate for this case. The acronym ‘DECIDE’ summarizes this model in the best way possible. It stands for Defining the problem, Establishing the criteria, Consider all the alternatives, Develop and implement a plan of action, as well as Evaluating and monitoring the solution and examining feedback when necessary (Guo, 2008). This model starts from identification of a problem to solve and explanation why it requires a solution. There are various challenges in the health care settings that need a solution such as in the case. Next is to identify criteria to be used to solve the problem. Here, what to be achieved is put into consideration. Consideration of alternatives is the next step that looks at possible choices that meet the criteria. Next is to identify the best option from the range of various alternatives in the previous step. It comes from experience or intuition. The next step is to implement the plan put in place. The resources to be used are also put into consideration. Finally, evaluation and monitoring of the solution is the last step.
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This model is efficient because nurses have an evidence-based decision on which to base their choices (Marwala, 2013). Similarly, in the health care setting, nurses have access to various resources and personnel to enable them to have various alternatives on which they can act.
How to Resolve the Dilemma Using the Rational Model
In this case, using the rational model in solving the dilemma would require me to be careful and to uphold my ethics as I do it. First, I would identify the problem. On these terms, it is easy to determine because of conflict of interest between the father and the mother. It seems the family has difficulties in communication and unified decision-making. Also, there appears to be something wrong with the father who does not probably have confidence in the intended care providers of the child and seeks consultation from an independent physician. After identifying the problem, I would strive to single out what criteria that I would use to let the mother know about the importance of treating the child and assure the father of our competence in discharging the mandate.
The criteria would involve choosing variables that would determine the outcome of my decision. From my knowledge as a nurse, I would organize myself with information regarding the care of the child that is understandable to the family. Also, there is a physician fully equipped with the pathophysiology and treatment of meningitis. Additionally, the child is in a health care facility that would ensure proper care. From the criteria and alternatives chosen, I would select the best option that may provide the mother with the appropriate information about the importance of treating the child and assuring the father that the child would receive the best care.
Explaining My Decision to the Family
Explanation to the family: “I see both of you have conflicts regarding the care of this child. You need to understand that meningitis is a serious condition that can severely deteriorate your son’s health. To the mother, I would say, “I respect your decision that we should not attend to the child. However, this condition is life-threatening to your son’s brain, and if not acted upon, your child might lose hearing, will have problems with seeing, and will develop learning disabilities. You have the right to decline treatment, but you should also know that if the health of this child deteriorates, the responsibility lies on your shoulder. To the father, I would say,” Thank you for understanding that treatment needs to be given. We have a team of specialized doctors and nurses to address the concerns of your child, and you do not need to panic. We will make sure that we treat him towards recovery to avoid any problems that your child might develop if not treated. To both the mother and the father, I would say, “This child is sick and needs both of you, and you need to be united in the efforts to ensure better care for your child.