To start with, it should be stated that nursing world is filled with dilemmas and uncertainties. Frequently, health care employees do not know how to deal with certain cases because of the necessity to violate one of the ethical principles. For years, health care scientists have been trying to develop certain decision-taking models, which could assist medical employees in taking the right decisions. The examples of the decision-making frameworks include Thompson and Thompson’s bioethical decision-making model, Thompson, Melia, and Boyd’s practical model for moral decision-making, and Husted’s formal ethical decision-making model. Each of these models includes a certain way that could be applied in case of ethical dilemma occurrence. In order to understand the applicability of the decision-making framework, one model will be chosen and used for the concrete case analysis.
The case study discusses the problem of a six-year-old child who has been diagnosed with meningitis. The problem lies in the fact that parents of this kid are divorced, and the child lives with a mother who is not his biological relative. The mother denies the treatment offered by doctors due to her religious reasons. The biological father lives separately, but he insists on treatment and demands additional consultation provided by a different physician. The ethical dilemma in this case lies in the fact of the doctor’s inability to administer the medications. The medical treatment is impossible without the consent of the parents, and they provide different answers towards it. This fact confuses doctors, as they do not now whose side to take and hesitate regarding further actions. In such cases, it is essential to remind who the central figure of health care is. The central individual is a patient. For that reason, his or her well-being should be considered first.
While discussing the decision model that might suit to this case, Thompson, Melia, and Boyd’s practical model for moral decision-making should be taken into account. Researchers Pera and Tonder (2005) state that this model presupposes connecting the practical and moral decision-making and using them as one whole. It suggests taking the same decisions in the moral case as in usual practice. In practice, the nurse assesses the physical state of the individual and takes concrete actions in order to assist him or her. The same thing should be conducted in the moral case. The health care employees should act in a way that is better for the child. Researchers Brooker and Waugh (2013) state:
Intellectual virtues relate to skill in decision-making and problem-solving, while moral virtues are character traits that are prerequisites for an individual to be reliable, effective and efficient in action. The keystone that links and binds intellectual and moral virtues together is prudence, also referred as practical wisdom. (p. 149)
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In this case, situational ethics is of great importance. First, doctors have to confirm the diagnosis, as it will determine the course of action. In case of the diagnosis confirmation, doctors have to start the treatment process. Meningitis is a serious disorder, and delays might have detrimental consequences – the child might die. Despite the treatment opposition expressed by the mother, health care employees have support from the father. He is also a close relative, and his consent to the treatment is of great significance. Thompson, Melia, and Boyd’s model presupposes taking into account the specifics of the situation and not relying on the ethical theories. In present case, such a decision seems to be sound. Considerations of the proper ethics might take too much time and deprive the child of the chance to survive. As health care employees, the doctors have to think first and foremost about the well-being of the kid and about the ways to save the life.
Indulgence in the ethical analysis might turn out to be rather dangerous. In general, the issue of ethics is rather subjective, as different scientists and researchers view it from their perspective. While researching different traits and shades of meaning, the adverse effects might happen to the patients. Campbell (2005) emphasizes such issue as “privatization” of ethics due to the fact that every individual perceives it using the issues of personal taste and preference. A practical approach to moral decisions is necessary in the health care sphere because moral decisions are tightly linked to physical consequences.
The practical viewpoint towards current moral problem will assist doctors in taking the right decision. Being the health care workers presupposes acquiring the ability to build a plan of actions that could be applied. The ethical principles of beneficence and non-maleficence should be taken into account. They emphasize taking those actions that might bring good to the patient. Moreover, the principle of non-maleficence suggests avoiding the actions that could exacerbate the situation. In this particular case, doing nothing means hurting the patient. In case of meningitis, even a minute can play the groundbreaking role. The timely administered treatment may drastically alter the final result and the whole course of the treatment.
In order to explain the family the whole seriousness of the situation, the following dialogue could be used:
“Doctor: Dear Mr. and Mrs. …, I want to be honest with you. The situation is critical. Currently, administering of the necessary medications and starting the treatment is one of the essential things. I know that you, Mrs. … oppose this decision, but try to understand that meningitis is a serious disorder. It is not just flu or chickenpox. It can take the life of your child.
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Mrs.: I believe in God and His power, and I am sure that my child will feel better without your poisonous medications.
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