Category: Ethical Dilemma

Introduction

In response to the message, ethical principles can be a valuable tool to consider when deciding. However, they should be one of many factors taken into account. Ethical principles provide a helpful framework for understanding the situation. Furthermore, ultimately, the individuals worldview and the specific contextual information must be thoroughly taken into account when making the final decision (Rhodes, 2020, para. 49). Moreover, it is important to understand that ethical principles can help navigate difficult decisions. In addition, they should not be the sole determinant in deciding the individuals values and the situational context is also an important consideration.

Discussion

I agree with the post that the four principles of biomedical ethics should not be the primary focus when making ethical decisions. While they are helpful in providing guidance and a framework, they are not necessarily definitive in providing a clear and direct answer to ethical dilemmas. Furthermore, each persons interpretation of the principles can be different, which can lead to disagreements. As the post suggested, the Christian biblical narrative provides a clear worldview of what is just, good, and bad. The biopsychosocial spiritual model can be used to further explore this idea.

The Christian worldview provides a unique perspective on ethical decision-making, as it holds that God is the ultimate ethical decision-maker. This view also includes the belief in the existence of a spiritual body and a physical body, and the biopsychosocial spiritual model can be used to explore this concept further. It is also noteworthy that this worldview emphasizes the importance of morality, as it gives us a straightforward way to determine what is good and evil (Addai, 2021, para. 66). This means that, when faced with ethical dilemmas, one must make the right choice, as even the most minor decision can have profound implications.

Conclusion

In comparison, secular worldviews tend to minimize or exclude Christian beliefs and values and focus more on individual autonomy when making decisions. This leads to ethical relativism, where the persons interpretation of the ethical principles may precede anothers. Although this type of thinking may provide more flexibility in decision-making, it can also lead to confusion and a lack of clarity. The individuals worldview should be considered, as well as unique situational information. This will provide a more informed and well-rounded approach to ethical decision-making.

References

Addai, E. A. (2021). Medical ethics: A physicians guide to clinical medicine. Fulton Books.

Rhodes, R. (2020). The trusted doctor: Medical ethics and professionalism. Oxford University Press.

Introduction

Forensic psychology occupies a medium place between psychology and criminal justice. Psychologists working in this sphere assess defendants ability to stand trial, evaluate credibility of witness testimonies, provide recommendations for the defendants treatment, and deal with the like issues. Like anybody working with human health and life, forensic psychologists face different ethical dilemmas the most widespread of which are do no harm, malingering, boundaries of competence, and informed consent; a more thorough consideration of these dilemmas will reveal the implications they may involve if they are ignored.

Do No Harm

This ethical dilemma is, perhaps, the most widespread for it imposes additional responsibility on the forensic psychologists whose decision influences the outcome of a particular case. According to the General Principles of the American Psychological Association Ethics Code, psychologists are expected to strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally& (Hall, 2007, p. 48). This is why the assessment process in which the forensic psychologist is involved presents an ethical dilemma for him/her personally. The primary objective of the psychologist in the course of this assessment should be objectivity and, desirably, indifference to the accused person. An objective assessment can be fulfilled only when a psychologist does not think about the assessment results and their further influence on the clients destiny. Carrying out an assessment for the cases related to capital punishment adds even more implications to this ethical dilemma. This is difficult since the credibility of the assessment results is the ethical responsibility of a psychologist, which places him/her in the unenviable position of having to take full responsibility for the life-and-death consequences of his or her assessment while simultaneously remaining deliberately ignorant of what his or her assessment may yield (Hall, 2007, p. 48). Therefore, do no harm is the first principle by which a forensic psychologist should be guided.

Malingering

Malingering is another ethical dilemma which forensic psychologists may encounter. It can be described as a response style in which the individual consciously fabricates or grossly exaggerates his or her symptoms (Bartol, 2004, p. 285). Faking mental illnesses is common among the defendants. It becomes more and more difficult for the psychologists to detect malingering in the course of a forensic evaluation because, unfortunately, sorting real pathology and mental retardation from simulated pathology and mental retardation is one of the most challenging tasks in forensic assessment (Hall, 2007, p. 56). This being the reason, every forensic evaluation should include assessment of malingering which is possible in case with every defendant. To carry out such an appraisal, forensic psychologists use a number of tests and methods which help to detect deception. Some of the most commonly used instruments and psychological tests are The Structured Interview of Reported Symptoms, the Minnesota Multiphasic Personality Inventory, the Test of Memory Malingering, the Million Clinical Multiaxial Inventory, the Rogers Criminal Responsibility Assessment Scales, etc (Bartol, 2004). Of all these methods the latter proved to be highly efficient for it allows classifying sane and insane defendants quite accurately. Nevertheless, none of them gives absolutely accurate results this is why the combination of several methods is, as a rule, used by the forensic psychologists. Thus, malingering presents one more ethical dilemma for forensic psychologists due to its being difficult to detect.

Boundaries of Competence

Professional competence is not the last issue which a forensic psychologist should be preoccupied with. One of the principles of APA Ethics Code (specified in Section 2.01(a)) does not allow a psychologist to engage in any specific form of independent assessment unless the psychologist first acquires supervised experience assessing that particular type of referral question and has received appropriate, up-to-date training in the instruments used in the course of this assessment (Hall, 2007, p. 49). If a psychologist does not have necessary training or instruments to carry out an assessment, he/she is obliged to refer the defendants case to another psychologist who might be more competent in dealing with such cases; the only exception from this rule is the absence of a more competent psychologist to consider the case (Hall, 2007). Psychologists can attain competence through education and training constantly maintaining their knowledge and developing professionally. In general, competence for a forensic psychologist in the course of the assessments includes a reasonable level of understanding of differences of age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, language, or socio-economic status (Condie, 2003, p. 20). Extra competence can be gained by the psychologists through learning to understand human differences and their influence on the assessment outcomes. This may give the psychologists a possibility to identify limitations to their forensic assessments and evaluate the influence of these limitations on the assessment results.

Informed Consent

Obtaining informed consent is critically important for forensic psychologists since APA Ethics Code specifically mentions this issue in the professional guidelines. The informed consent should be necessarily obtained because forensic work often involves serious issues, such as losing children or guardianship, disclosing information which may jeopardize other individuals life or freedom, etc. Generally, informed consent consists of describing the procedures and the processes as they are likely to happen and obtaining the clients legal consent to proceed (Huss, 2003, p. 65). The ethical dilemma with respect to this issue consists in the presence of certain coercion on a person from who the consent is demanded due to the procedure being mandated by a legal authority (for instance, a person may be reluctant to give a consent, but since the case has legal value, he/she may agree to do this due to the fear of facing serious consequences in the opposite case). Anyways, the consent is expected to be voluntary with the person who gives it being aware of the essence of the assessment (or another procedure he/she is agreeing to), as well as this person should be mentally capable of realizing what exactly he/she is giving consent to.

Conclusion

Therefore, forensic psychologists face numerous ethical dilemmas in their work because they are responsible for human life, health, and freedom. One of such dilemmas is do no harm, or a situation in which a psychologist has to bear responsibility for the outcome of the assessment. Another dilemma is malingering which is difficult to detect and which may mislead a psychologist, thus changing the forensic evaluation results. Apart from these, forensic psychologists should be professionally competent and should avoid considering cases for which they lack special training. Finally, before carrying out any assessments, forensic psychologists should obtain consent from the defendant or another individual with this consent being given voluntarily.

Reference List

Bartol, A.M. (2004). Introduction to Forensic Psychology. London: SAGE.

Condie, L.O. (2003). Parenting Evaluations for the Court: Care and Protection Matters. London: Springer.

Hall, H.V. (2007). Forensic Psychology and Neuropsychology for Criminal and Civil Cases. London: CRC Press.

Huss, M.T. (2008). Forensic Psychology: Research, Clinical Practice, and Applications. New York: Wiley-Blackwell.

Introduction

This case study shows an example of a young woman, Janet, who survived an accident in which her husband died. Although Janet survived the accident, the doctor found that she had suffered a severe head injury, and the prognosis for the woman was poor. Moreover, the patient has been pregnant for about nine weeks. Before Janet dies, she writes advance directives to doctors and demands that they never try to take any medication to prolong her life when she is overwhelmed by her condition. She is later transferred to a hospice, receiving palliative care, with her other life support removed. Although doctors keep Janet alive due to her pregnancy, her parents refuse to comply, saying their daughter does not want a life extension.

Discussion

There are some ethical and legal dilemmas in this case. According to Park (2012), the first step in making decisions in difficult situations is identifying the moral issue. In Janets case, a decision must be made as soon as possible because, according to doctors forecasts, the womans condition will worsen, but the child will continue to develop. In this case, health workers main problem is deciding whose interests are more important in this situation  the mother or the fetus (Siwatch et al., 2020). On the one hand, in advance directives, Janet indicated that she did not want to be medically supported. However, on the other hand, these instructions were written before the patient knew of her pregnancy.

After identifying the problem, doctors need to collect all the necessary information to help make the right decision. This information includes but is not limited to, patient information and family members as caregivers or surrogates (Park, 2012, p. 151). Because Janet cannot make decisions in her condition, healthcare decisions are left to her agents. Her primary agent was her husband, who died in an accident. A womans parents are her secondary agents who must make decisions regarding the continuation of their daughters treatment.

Ethical considerations, in this case, are heightened due to the presence of legal issues. First, doctors told Janets parents that the prognosis for their daughter was not good a month after the accident. It means that, for a month in the hospital, doctors provided Janet with assistance, which she refused in advance directives. Second, physicians are required by law to maintain a womans condition until the child is born (Siwatch et al., 2020). However, the doctors did not initially carry out a complete diagnosis of the patients condition, and Janets pregnancy was revealed only a month after she was admitted to the hospital. That indicates violations of the standards of medical care by doctors.

Another problem is that in the event of the final death of the mothers brain, negative consequences for the child are possible. Dodaro et al. (2021) note that most children during pregnancy in a vegetative state are born prematurely and have severe health problems. In such a case, violation of the patients advance directives and non-compliance with the treatment decisions of surrogates will not have sufficient grounds. Furthermore, the doctor, referring to the State of Kansas law, noted that decisions made by the patient before pregnancy have no effect during pregnancy. Since the fetus cannot make decisions on its own, its interests must be above the interests of the mother.

In addition, transferring a patient to a hospice raises ethical questions. Hospices are not considered for life support but only for the provision of palliative care to people in critical conditions to improve their quality of life. However, in her instructions to doctors, Janet indicated that in the case of a persistent vegetative state with a poor prognosis, she did not want any medical assistance, including nutrition and hydration. Consequently, the transfer of a woman to a hospice violates her desires since this assistance will be provided until the moment of final brain death. However, this decision must be made by Janets parents as her surrogates.

After collecting all the information, it is necessary to consider all possible solutions that apply to a given situation. The answer to this situation requires the involvement of doctors, legal counsel, an ethical committee, and social workers (Siwatch et al., 2020). The first option is to follow Janets advance directives and take her off life support. The second alternative is to transfer the patient to a hospice under the decision of the patients parents, who are her agents. The third option puts the fetuss interests above the mothers interests, so the patients life must be supported until the childs birth. Each of these alternatives has ethical and legal advantages. For example, option 1 is entirely in line with the patients wishes and has an ethical justification. The second alternative considers Janets parents treatment decision, who are her official representatives, and has a legal argument. The third option has ethical and legal justification but may harm the patient.

To select the optimal alternative, it is necessary to collect additional information. For example, it is required to assess how the hospital where Janet is currently located can support her life until the childs birth. Therefore, counseling must include some data on the prognosis if somatic support is considered as an option (Dodaro et al., 2021, p.465). In addition, social workers must determine who will be chosen as the childs guardian. Considering that Janets parents have made the decision not to continue their daughters treatment, there is a possibility that they will not want to take the child into their care.

In this case, compliance with the healthcare decision made by Janets parents is optimal. The rationale for this alternative is based on the fundamental ethical principles of healthcare (Park, 2012). First, healthcare professionals must respect patients values and decisions and follow advanced directives where available. Even though Janet refused any medical care, the hospice will provide decent living conditions for her. The ethical rationale for moving a patient to a hospice is that the role of healthcare providers is to benefit the patient. In addition, the patients parents, who are both healthcare professionals and understand the severity of their daughters condition, made this decision.

Moreover, healthcare providers must eliminate or reduce all patient harm; therefore, considering the risks for the fetus and mother is worth considering. There is a possibility of death for the child associated with the death of the mothers brain (Dodaro et al., 2021). Using the mother as an incubator for the fetus has no ethical justification. Furthermore, there is no guarantee that Janets parents will want to become the childs guardians, so the medical prolongation of the patients life until delivery also raises an ethical dilemma related to the social protection of the child.

Conclusion

Thus, in Janets case, transferring the patient to the hospice will be a compromise solution for all parties. In the advanced directives, the patient refused medical prolongation of life. Moreover, as her agents, the womans parents decided to transport their daughter to a hospice for palliative care. Moreover, from a legal point of view, serious violations were committed by doctors who could establish the patients condition and detect pregnancy a month after the accident. The case study does not indicate whether the clinic can support Janets vital functions necessary for the development of the fetus. In addition, social questions arise regarding the childs fate due to the lack of official guardians.

References

Dodaro, M. G., Seidenari, A., Marino, I. R., Berghella, V., & Bellussi, F. (2021). Brain death in pregnancy: a systematic review focusing on perinatal outcomes. American Journal of Obstetrics and Gynecology, 224(5), 445-469. Web.

Park, E. J. (2012). An integrated ethical decision-making model for nurses. Nursing ethics, 19(1), 139-159. Web.

Siwatch, S., Rohilla, M., Singh, A., Ahuja, C., Jain, K., & Jain, V. (2020). Pregnancy in a Persistent Vegetative State: A Management Dilemma. Case Report, Literature Review and Ethical Concerns. The Journal of Obstetrics and Gynecology of India, 70(4), 310-313. Web.

The behavior of ethical analysis is of high academic relevance to any professional practice because it addresses several issues related to operational effectiveness at once. Exploring ethical dilemmas within a clinical organization has high relevance to all stakeholders, including medical staff, clients, and district administration. Consequently, how successfully a particular professional code of ethics issue is addressed determines how smoothly and highly effective the companys subsequent clinical operations will be. This essay discusses in detail one of the most pressing problems of the current agenda, namely patient confidentiality as an object of health care delivery. It is true that physicians often violate ethical principles by disclosing private patient data. The purpose of this essay is to provide critical analysis of this problem, realized through discussion and examination of authoritative sources.

Of primary importance within the issue under discussion is the clarification of the ethical dilemma that is being investigated. To begin with, it should be noted that the patient is the key actor in any clinical process since any manifestation of health services has a patient-centered orientation. At the same time, this relationship is always strictly individual: qualified clinicians clearly understand that the exact instructions may affect different patients differently. This understanding is justified by the atypicality of human bodies, the presence of chronic and concomitant diseases, and genetic differences, after all. On the other hand, the multiplicity and heterogeneity of clinical cases often become the foundation for discussions of the case. In an effort to explain in more detail the nature of a particular patients pathophysiological condition, physicians or nurses may share this information with colleagues, their family members, or members of the patients family. Moreover, in many developing regions, the concept of medical confidentiality is not yet fully legally and morally established. To put it another way, it is not uncommon for incompetent physicians to disclose a complicated diagnosis  for instance, cancer  first to the family, that they more sensitively pass it on to the patient. In addition, many of the patients parents or partners may not always accept that some of the medical information cannot be divulged to them, despite their family or loving intimacy with the patient. All of this adds up to a serious moral problem. The ethical dilemma, in this case, determines the morality of such discussions realized without the patients consent. The critical issue is to determine whether it is permissible to disclose confidential patient data  including test results, prognoses, and diagnoses  without the individuals consent.

Admittedly, this issue is an important one that falls under the responsibility of the health care administrator. As the leader of a clinical organization, the administrator is hardly eager to violate the code of ethics. The consequences of such a violation can significantly diminish the reputation of the institution, as well as a result in losses if the patient decides to take legal action (How much, 2021). However, poor management effectiveness, lack of corporate training programs for health care workers, and insufficient sanctions are catalysts for the ethical dilemma. More specifically, even in spite of organizational leadership strategies, unscrupulous institutional employees may surreptitiously disclose data and share work-related incidents with their family members. Technically, these acts are difficult to trace, but the very act of disclosure should be considered a violation of the professional code of ethics. The adverse effects of such a crime usually lie in economic and organizational issues.

From an economic point of view, disclosure of confidential patient data can lead to financial imbalance. As a general rule, if no external or internal factors cause dislocation, the economic systems of clinical organizations are in a state of stability. A financial management system built up over many years of operation allows clinics to intelligently allocate revenues to pay salaries, utilities, medications, and equipment upgrades. Saved money can always be sent to a reserve fund, which will be used if necessary. However, the ethical dilemma under discussion could significantly upset this balance since a breach of patient clinical confidentiality could result in a lawsuit. In fact, U.S. jurisdiction  namely, Federal Law  fully protects any written, oral, or digital patient health information from disclosure. In addition, the U.S. has a 1996 act, HIPAA, which governs the protection of such data in more detail (OCR, 2020). If this law is violated, the patient is entitled to recover damages from the clinic, including fines for moral, emotional, and reputational interference. For example, under HIPAA regulations, the maximum fine for disclosing a patients personal information is $1.5 million (How much, 2021). Another type of sanction  which is often combined with a fine  can be imprisonment. In either case, it is clear that both fines and criminal prosecutions are states that put significant pressure on a clinics financial balance sheet. The need to pay for an employee or to have him or her fired would increase costs and, as a consequence, impair the operational efficiency of the institution.

Aspects of the accessibility of medical services may also suffer as a result of this ethical dilemma. On the one hand, an attempt to disseminate sensitive information about a patient to family members may be well-intentioned. In this case, health care providers may be guided by the idea that relatives will find a better approach to the patient, which will ultimately increase trust in the clinic and increase the availability of healthcare services. However, on the other hand, the disclosure of personal data would be a significant blow to the organization, which would affect its reputation and could even lead to a temporary suspension of professional activities for the duration of the judicial investigation. Then, those who wish to obtain medical care will not be able to turn to this organization, which will complicate the availability of its services. In turn, the decrease in the reputation and trust of clients may be accompanied by a deterioration in the quality of clinical care provided. A reduction in the client base will entail a reduction in funding and, as a result, a decrease in the quality of services.

It is not difficult to determine that aspects of strategic planning will also be threatened. Typically, a health care administrator will have a formalized plan for the months ahead that will guide the organization toward commercial and professional development. However, a breach of the ethical dilemma could entail a halt in operations and a shrinking of the client base. It is understandable that prospective patients will refuse the services of a clinic that cannot enforce the fundamental legal principles of HIPAA and Federal law. Then the whole plan for development will be frozen because of the rapidly changing agenda.

This problem can also be considered from another angle. As it is known, strategic planning ensures the viability of the company in a competitive market. This is mainly realized through the correspondence between normative organizational indicators and accurate data that can be measured. Thus, if a clinic repeatedly violates the ethical framework, it leads to a disconnect between the professional code and the reality of the institution. This contributes to an increased distance between employees and, as a result, a reduction in the sustainability of the facility.

One additional consequence of a breach of the code of ethics, lying in the plane of organizational change, is a decline in risk management. The initial risk assessment and, as a consequence, the orientation of strategic planning may not be designed for acts of violation of professional ethics. In other words, the risk assessment carried out will prove to be untenable because it will not take into account internal crimes. On the other hand, violation of the rule of non-disclosure of confidential data is, as has already been emphasized, a severe legal problem. If a clinical organization is repeatedly spotted in such episodes, it will terminate the clinics active license. At the same time, it will become a reason to suspend the professional activities of the company.

In conclusion, it should be emphasized that strict adherence to the code of ethics is an essential professional obligation for any medical professional. Nevertheless, scenarios in which employees disclose confidential patient information  even in good faith  cannot be completely ruled out. In such cases, the clinical institution is exposed to severe economic, reputational, organizational, and legal risks, as has been shown in this paper. Addressing such ethical concerns is possible by supporting training programs, instilling corporate values in employees, and encouraging adherence to the code.

References

How much do HIPAA violations cost? (2021). True Vault.

OCR. (2020). Your rights under HIPAA. HHS.

Definition of Ethical Nursing Practice

An Ethical Nursing Practice is a decision-making challenge between two potential normative choices, neither of which is undoubtedly desirable to a nurse. Typically, nurses encounter the problem in almost every aspect of their personal, social, and professional life. Consequently, due to their complexity, it is rather difficult for most people to find the right solution to the challenge (Sari et al, 2018). Thus, the paper aims at exploring the meaning, framework, as well as solution to a dilemma in the field of nursing.

The Basis or Framework for Definition

The above framework of the Ethical Nursing Practice is based on the power to follow and to uphold moral values, ethical standards, and policies. At all costs, a person or an expert facing the issue must accurately scan the environment and only choose the right option out of the alternatives (Sari et al, 2018). As a result of the above framework, the nurses must work to operate within the prescribed definition.

The Difference between Legal and Ethical Nursing Practice

Ethical standards are based on the professions principles, values, and poli.

References

De Vries, K., & Plaskota, M. (2017). Ethical dilemmas faced by hospice nurses when administering palliative sedation to patients with terminal cancer. Palliative &Supportive Care, 15(2), 148-157. Web.

Sari, D., Baysal, E., Celik, G. G., & Eser, I. (2018). Ethimcal decision making levels of nursing students. Pakistan Journal of Medical Sciences, 34(3), 724-729. Web.

It is critical for administrators in the public health sector to acquaint themselves with the ethical principles that govern the public sector as well as the complexities that surround them. Interest in the legal, ethical, and social aspects of public health is contemporarily at its highest point and is likely to continue growing in the future. According to the medical and public health communities, there is a difference between blacks and whites in terms of disease prevalence. In a study that was carried out in the U.S., about 35- 40% of blacks tested positive for syphilis in Macon County, Alabama. The public health sector felt that it had to study the cause of syphilis in blacks and compare it against a study of the same disease in whites. The study of syphilis in whites was done for several years. It was completed by the PHS in 1928 in Mississippi and the results showed that only 25% of the sample, who were all whites, tested positive for syphilis. The PHS planned to continue the study of syphilis in blacks and provide treatment as well.

Focus on the TSUS by the political as well as public attention led to regulatory changes regarding research conduct. African-Americans were outraged when they became aware of the TSUSs conduct. The TSUS served to magnify and reinforce the mistrust that many African-Americans had towards the government, the services offered, and those who were in power and supported the act (Parker, 2003). The widespread and the magnified mistrust had to be confronted by the researchers to fulfill the regulatory requirements that were brought about by the Tuskegee as well as other scandals in the research. Enrollment in research study groups for the minority became more difficult because of the mistrust, which was prevalent and collaboration between the researchers and the community was elusive. Members of the minority groups failed to maximally benefit from the advances of the researches as they were conducted without the relevant peoples participation. The mistrust spawned due to earlier injustices. And the legacy of mistrust among the community with minority members played a great role in African-Americans disinclination to take part in any research.

Greater understanding of the process as well as the purpose of the research allayed many participation fears. Education not only in the school but also in the community as whole seeks to tell more about research as its purposes and procedures. For many activities of the human, trust comes out as a very important and a necessary precondition.

Another variable in the research about syphilis was the legacy of race. The thread in the TSUS legacy deserved specific attention. Scientific justifications for the TSUS were brought about by the assumptions about race as well as racial differences (Thomas, 2002). That showed that all the men who had registered did so because they were blacks and thus the research problem was syphilis in the blacks. Another legacy of the research was the debate about the TSUS itself. The authors sought to show the original study design of syphilis was appropriate both scientifically and ethically. It became clear that even after the advent of penicillin, it was not wrong in any way for the TSUS enrollees to be denied the drug for the research to go on. These arguments focus on examining untreated syphilis cases. There are skills that are fundamental in the PHS. Before a research study is conducted, the researchers should be capable of identifying the underlying ethical issues. Additionally, they should posses the ethical decision making skills necessary both as individuals as well as for the agencies they are affiliated to. A greater component of ethical decision making entails weighing the benefits to the affected. Researchers should also be aware of the best means of prevention, which run deep into understanding the determinants of health.

The public health sector and agencies cannot work well without the trust of the public. They should build and maintain the public trust. As an administrator I would use the media to address the causes of the disease in question as well as the health requirements in an attempt to prevent adverse health outcomes. I would strive to achieve the health of the community in such a way that all the rights of the individuals in the community are respected. Additionally, I would advocate the community members empowerment so as to make sure that the basic conditions and resources that are necessary for their health are accessible to all.

Humans are naturally interdependent and characteristically social. They look to each other for companionships and friendship and also rely on one another for their survival and safety. A critical indicator of a healthy community is, therefore, positive collaboration among the institutions within the community as well as positive relationships among its members (Thomas, 2004). Thus, the policies of public health, their priorities, and the programs to be undertaken should be developed and evaluated in a way that will ensure an input opportunity from the members of the community is availed.

References

Parker, L. S. (2003). The legacy of the Tuskegee syphilis study. Ethics and Public Health: Model Curriculum, 37-58.

Thomas, J. (2002). Principles of the ethical practice of public health. Public Health Leadership Society, 1-16.

Thomas, J. (2004). Skills for the ethical practice of public health. Public Health Leadership Society, 5-14.

Introduction

Life is full of ethical dilemmas and almost every day people have to make tough decisions to face their careers, professions, or callings. Whether one is a parent, clergy, spouse, or someone in a professional career like nursing, s/he has to make certain decisions to contain emerging circumstances. My decisions hinge on the values that I hold in life, as a nurse. So what are the values?

Values

Values are a set of beliefs or ideals that are meaningful to a persons life. They underscore ones nature and the kind of judgment s/he makes in life. Thus, every person possesses a set of personal values whether they recognize them or not (Guido, 2009). In essence, these values are the motivational forces behind every success in any professional or vocational life. Moreover, values release fresh energy that propels one into achievements and a morally upright life (Tonnow-Rasmussen, 2011)

My values

• Sacrifice and concern for others:  Perhaps the most important value in the nursing profession is a concern for others. As much as we may be overwhelmed with our ambitions and burdens, having more concern for others reenergizes us in our everyday life. It reveals genuine love and cares for others. A nurse has to sacrifice his or her time, especially during odd working hours for the good of the patients. At times, a nurse foregoes family comforts to attend to the patients. The presence of love is the best miracle and medicine that a patient may require at any time in a hospital setting (OBrien, 2011).
• Appreciation:  As a nurse, my life and profession are very dear to me. Regardless of any circumstances, I always take a moment to say thank you. I know that if I do not appreciate my life coupled with what I do, there is no way I can serve others wholeheartedly. The positive attitude must resonate from within before I can extend it out to others (Guido, 2009). Patients need someone to assure them that even though they are at their worst moments, they will overcome their present condition, and the best person to give this hope and confidence is a nurse. Consequently, I appreciate every single moment that I have, to appreciate others.
• Commitment and devotion:  Nursing is a very sensitive profession and without commitment, one may not be of much help to the patients. Therefore, the loyalty I have towards my profession keeps me motivated when I am unable to perform a certain task or overcome disappointments. Devotion is an equally important value in honoring my professional promises.
• Compassion, caring, and tolerance:  These are very important values in the nursing profession. Tolerance reveals ones patience, respect, and civility. Caring for patients too gives them hope, which makes them realize that still there are remnants of caring people who value patients lives. Compassion is another important quality that I cherish in my profession as a nurse, as without compassion, a nurse cannot perform optimally (OBrien, 2011).

How personal values influence our professional decision-making

Personal values are very important tools in our professional decision-making. They determine our objectives and outcomes in life. Rational decisions are a true reflection of the core values in life. When we know our values, we simply need to refer to the factors we considered in the previous decision to make another decision.

Further, apart from informing and influencing the sort of decision that we make, personal values also clarify the fundamental principles of our profession coupled with what we stand for. They relate our decisions to our purpose in life. Values will thus tell one that this particular decision is a priority, while the alternative is not. In addition, they will prompt us to shift our lives in definite directions. Therefore, personal values are the guiding principles in professional decision-making (OBrien, 2011).

Personal values are also effective ideals in making ethical decisions. Professionally, nurses are required to make ethical decisions in their work. Those who have good personal values always make choices based on respect for human rights, equality, and justice. Such nurses are willing to let go of their self-interests to follow their professional principles (Burkhardt, 2008). A rationally constructed decision takes into consideration the outcomes, benefits, usefulness, and impacts of such a decision. Personal values thus provide the best references in solving professional decision dilemmas.

Ethical dilemmas in a nursing profession

As aforementioned, nursing is an extremely delicate and tricky profession. Almost every move is a test for ones patience and philosophy in life. Many times, nurses find themselves in two unpleasant situations. Whether they like it or not, they have to make some choices. The worst end is that, whatever decision they make, it manifests itself in their own lives and those of their patients (Icheku, 2011).

Examples of ethical dilemmas in a nursing profession

Quality of life versus quantity of life

Quality of life responds to the question of a good life. How nurses define good differs from one person to another, but the ethical benchmark is that they have to do good and cause no harm. On the other hand, the quantity of life is based on the idea that it is better to prolong life even if it means compromising the quality of the same life. love life. the dilemma comes in when a nurse has to choose between prolonging a patients those of their pateThe ethical dilemma comes in when a nurse has to choose between prolonging a patients life by compromising the quality of life and letting the patients life end by ignoring the impacts on the affected people (Guido, 2009).

Pro-choice versus pro-life

This dilemma appeals to the personal values of a nurse directly. No matter the circumstances, the decision made directly impacts the nurse personally. Take, for instance, choosing between doing abortion for a patient who has been gang-raped and letting the baby live, or conducting an abortion to save the life of a mother and taking the risk of losing both in the process of saving the baby (Ellis & Hartley, 2003).

Freedom versus control

This ethical dilemma pertains to the rights of the patient. It responds to the question of whether nurses can prevent patients from making choices that harm their lives. For instance, if a patient chooses to stop taking medicine while the nurse knows well that this move would automatically lead to losing the patient, can the nurse force the patient to take the medicine.

Truth-telling versus deception

This ethical dilemma also appeals to the rights of the patient and the personal values of the nurse. Suppose the nurse knows the patient will not survive or needs a treatment that will paralyze some parts of the body and has explained this issue to the family and the familys position is that the patient should not know his medical condition. Is the nurse bound by nursing ethical codes to reveal the truth to the patient or should the nurse respect the familys decision? (Ellis & Hartley, 2003).

A nursing experience when I was faced with an ethical dilemma

My worst experience in the nursing profession happened in 2008. We had a thirty-year-old man in the intensive care unit for over a year because his family was not ready to lose him. Months before his condition worsened, the patient had instructed the hospital to end his life if there were no possibility of him surviving. When it became clear that he could not survive, I attempted to respect his wish and preserve the quality of his life. The family, however, protested and threatened to sue the management if we kept the patients directive. For a year I took care of this man, I saw him a wreath in pain, but that is all I did. In the end, we lost him. I have not forgiven myself for letting him a wreath in pain. I still have a feeling that I could have disobeyed the familys threats and let the patient die in peace.

The ethical Decision-Making model that I applied

I applied the Five Steps of Principled Reasoning by Josephson Institute of Ethics.

1. Clarity  I first clarified the situation at hand together with what I must decide on. There were three options available viz. one, end the life of the patient, two, respect the wish of the family, and three, wait for miracles to happen.
2. Evaluate  Given that it was already clear that the patient could not survive, the best option was to respect the directive by the patient to end his life and preserve the quality of his life. I could explore the second option if the family maintained their threat. The third option was not professional. I automatically ruled it out, though I was aware that miracles happen.
3. Decide  My decision, based on my personal values and the wish of the patient, was to end his life. However, because of external threats, I submitted to the demands of the family.
4. Implement  I did not implement my decision. Instead, I followed the family instructions.
5. Monitor and modify  After the death of the patient, I realized that I made a terrible mistake by bending to the familys demand. It was obvious that the patient would die, and thus leaving him to wreath in pain, in my understanding was not ethical.

Conclusion

Nursing is a very delicate profession. Almost every day nurses have to deal ethical dilemmas, which require prompt decisions. Whether they want or not, they have to make certain decisions that will influence their lives and those of the patients directly. As a nurse, I draw my strength from my personal values. They shape my priorities in life and define how I react to new situations. They also indicate to me whether I am living a moral life, professional life, or something contrary to my principles. When faced with tough ethical dilemmas, I simply refer to them through the ethical decision-making models.

References

Burkhardt, A., & Nathaniel, K. (2008). Ethics & issues in contemporary nursing (3^rd ed.). New York, NY: Thompson Delmar.

Ellis, J., & Hartley, L. (2003). Nursing in Todays World. New York, NY: Lippincott Williams & Wilkins.

Guido, W. (2009). Legal & ethical issues in nursing (5^th ed.). Massachusetts, MA: Pearson.

Icheku, V. (2011). Understanding Ethics and Ethical Decision-Making. Indiana, IN: Xlibris Corporation.

OBrien, M. (2011). Servant leadership in nursing: Spirituality and practice in contemporary healthcare. Sudbury, MA: Jones and Bartlett.

Tonnow-Rasmussen, T. (2011). Personal Value. New York, NY: Oxford University Press.

Abstract

Cassandra, a 17-year-old girl, is not legally permitted to make her own medical decisions because of her age. Her mother sides with her decision not to undertake a chemotherapy treatment. The DCF gains custody of Cassandra and decides to compel her to undergo chemotherapy treatment, posing an ethical dilemma of who is entitled to the final decision.

Summary of Facts of the Case

Cassandra C. is a 17-year-old girl in Connecticut diagnosed with cancer. The chemotherapy revealed that she had an 80 percent chance to recover. She underwent one chemotherapy process, after which she did go back after determining that the treatment was harmful. The Department of Children and Families (DCF) then seized her and compelled her to go through the treatment. The debatable issue is on whether or not Cassandra is entitled to making liberal medical decisions as a 17-year-old, one year shy of the legal age of deciding on her medical issues.

The IP Team and their Roles

The IP team members that dealt with Cassandras case included an oncologist, pediatrician, registered nurse, social worker, and psychiatrist. The oncologist recommended the chemotherapy treatment and administered it to Cassandra. The registered nurse offered supportive care and treated Cassandras symptoms as well as monitored her results. The social worker and psychiatrist offer psychosocial evaluations and treatment to the patients (Lang & Paquette, 2018). They help the patient and family to counter the experience of managing cancer. As a pediatrician, I recommended that Cassandra receives chemotherapy treatment to survive it.

Additional Information

Cassandra can be recognized as a mature minor, but legally until she is 18, she cannot make her own medical decisions. The healthcare team denied her wishes to escape the medical protocol because they defended her best interests. Cassandra has a higher chance of survival if she undergoes chemotherapy treatment as acknowledged by the States Superior Court and the DCF.

Ethical Dilemmas

Cassandras case presents an ethical dilemma that originates from a variance between two significant ethical principles: respect for autonomy and beneficence. Respecting autonomy is honoring ones right to self-determination, for instance, refusing the medical process. The beneficence principle gives practitioners and hospitals the right to prioritize the benefits of caring for patients and limit harms (Turnham et al., 2020; Sisk et al., 2017). Cassandra is legally a minor, implying that the parent makes healthcare decisions on her behalf. In this case, Cassandras mother supports her daughters rejection of treatment.

Personal Moral Position

Connecticut Childrens Medical Center is acting ethically and morally right in administering chemotherapy to Cassandra. The center is prioritizing chemotherapys advantage on Cassandra and suppressing her position which could be harmful. It is legally right to respect Cassandras autonomy, but if the physicians and the hospital recognize that the chemotherapy process will do her better than harm, then the autonomous right should be rightly overlooked.

Ethical Position of Pediatrician

Pediatricians have a moral obligation to act for the best interest of others (or beneficence). In this case, preventing the harm of Cassandra circumventing chemotherapy treatment would be a pediatricians priority since it is in the patients best interest. Pediatricians are also bound to respect the patients autonomy to accept or refuse treatment. According to Sisk et al. (2017), beneficence opposes the principle of autonomy, but in Cassandras case, she was still a minor and rightly received treatment without her permission. Another code of ethics is that pediatricians also respect parental authority whereby parents could make decisions for their children, but not at the expense of their lives. Parental authority is not absolute, and in Cassandras case, the parents rights were overruled in favor of the childs best interests.

Divergent Moral or Ethical Positions in the IP group

Ethically, the parent (the mother in this case) felt that there should be exceptions to age-based requirements, and the minor is granted equal rights like adults. The IP teams pursuit was intended for protecting Cassandra rather than harming her, specifically, preventing her death.

The Final Decision

The government should make the final decision to protect people from making careless decisions that would be harmful to them. The DCF was delegated the right by the Superior Court to decide on behalf of Cassandra, other than her mother, who perhaps did not see the overall good.

References

Turnham, H., Binik, A., & Wilkinson, D. (2020). Minority report: can minor parents refuse treatment for their child? Journal of Medical Ethics, 46(6). Web.

Lang, A., & Paquette, E. T. (2018). Involving minors in medical decision making: understanding ethical issues in assent and refusal of care by minors. In Seminars in neurology, 38(5), 533-538. Thieme Medical Publishers.

Sisk, B. A., DuBois, J., Kodish, E., Wolfe, J., & Feudtner, C. (2017). Navigating decisional discord: the pediatricians role when child and parents disagree. Pediatrics, 139(6).

The ethical dilemma that Mr. Markham is currently facing is the necessity to choose between the two undesirable options. These are: whether to report the board of directors of the pension funds the real numbers regarding their value of liabilities, which are two times higher than the official numbers, or to just silently move on with his job, violating the CFA Code of Ethics and Standards of Professional Conduct. Mr. Markham also has other alternatives, but he prefers not to say them aloud. This paper aims to analyze the ethical dilemma Mr. Markham faces and propose optimal alternatives developed in the context of the relevant laws, codes, standards, and regulations.

Mr. Markham is the CFA of the Investment Consulting Associates (ICA) firm. ICA is giving investment advice to pension funds, and Mr. Markhams job is to develop comprehensive investment advice. The firm is usually hired by the pension funds who want to hear only good news about their assets. The main reason for such desire is that pension funds want to present seemingly favorable conditions for their investors, who are current and future pensioners. The second reason is that if the actual information about the value of pension funds liabilities became known to the broad public, politicians would stop supporting the pension funds, and they would have to close up. Moreover, if Mr. Markham reports the real statistics to the boards of directors of the pension funds, who are the primary clients of ICA, they will likely fire the firm, and his CEO will fire Mr. Markham himself. Mr. Markham spoke about the actual statistics with his colleagues and management, but they would not want to listen, insisting that Mr. Markham should do his job.

Interestingly, although he is not an accountant and is not responsible for calculating the actuaries for the pension funds, part of Mr. Markhams job is providing sound investment advice, which can only be developed considering the real circumstances of the company seeking investment. Moreover, the CFA Code of Ethics and Standards of Professional Conduct clearly states that as a professional CFA, Mr. Markham should not make any wrongdoing, given that he is aware of it. Therefore, Mr. Markham found himself in a complex situation, in which, to obey the Code of Ethics he should refuse from the obvious wrongdoing, and to save his job, he must be involved in presenting investment advice that is based on misleading information.

Noteworthy, some firms hire HR professionals who specialize in ethical dilemmas. Usually, they ask employees who face ethical dilemmas several important questions. These are: Is the action legal? Is it the right thing to do? Who will be impacted? Does the decision fit with the organizations mission? How will I feel after I make this decision? How will my decision look to readers of the local newspaper? In the light of the ethical dilemma details presented above, Mr. Markham has several alternatives to the two unfavorable options of making the wrongdoing and losing his job.

Interestingly, investment advisors report annually to the CFA Code of Ethics and Standards of Professional Conduct on compliance with ethical standards and have a recorded disciplinary history. This history is stored on such portals as the Investment Advisor Public Disclosure website, FINRAs Broker Check website, and the North American Securities Administrators Associations Check out Your Broker website (Fontinelle, 2019). Considering that providing investment advice based on misleading information is a violation of the Investment Advisers Act of 1940, Mr. Markham violates not only ethical standards.

By participating in the illegal activities of the ICA, he breaks the law and risks his future career (Kagan, 2019). Therefore, in the presented situation, Mr. Markham has only two alternatives  a silent resignation or a resignation accompanied by a report about the companys wrongdoings. Otherwise, he risks facing the legal consequences of providing false financial information and permanently losing his reputation and the ability to provide investment advisory services in the future.

Quietly leaving looks like the safest option, but, as for whistleblowing, Mr. Markham has to be sure that he will be protected by law. Mr. Markham also must keep in mind that since his firms main occupation is providing investment advice, if he reports the wrongdoing to the SEC Commission, the ICA employees will likely face legal consequences (General Information on the Regulation of Investment Advisers, 2011). Therefore, it is up to Mr. Markham whether to report or not on the wrongdoings.

Since the case study is based on actual events, ICA was not the only company providing misleading investment advice for pension funds. Noteworthy, Kenton & Cheng (2020) say that there are still problems the pension funds face as pay liabilities have risen sharply in some states, resulting in higher pension guarantees. Kenton & Cheng (2020) note that according to a 2019 study by The Pew Charitable Trusts, overall, US states have funded 69% of their liabilities for retirement benefits; New Jersey, Kentucky, and Illinois financed only 40% of the commitments.

Interestingly, since June 2020, the Employee Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue Code began regulating the activity of investment advisers (Improving Investment Advice for Workers & Retirees, n.d.). Therefore, if I were Mr. Markham, I would not risk my carrier by providing misleading information. It is unlikely that I would officially report on the ICA wrongdoings. Still, I would maybe seek ways to anonymously inform the public and my close friends of the potential dangers of pension funds cheating their investors.

Thus, the ethical dilemma of Mr. Markham was analyzed, and optimal alternatives were proposed. Given that Mr. Markham is an investment adviser, his activity and job duties are subject to the Investment Advisers Act of 1940. Moreover, since June 2020, his actions are regulated by the ERISA and the Internal Revenue Code. Therefore, the only reasonable alternative for Mr. Markham is to resign, because in another case, he will be forced to break the law, which will ruin his career.

References

Fontinelle, E. (2019). Ethical standards you should expect from financial advisors. Web.

Improving investment advice for workers and retirees. (n.d.). Web.

Kagan, J. (2019). Investment Advisers Act of 1940. Web.

Kenton, W., & Cheng, M. (2020). Actuarial valuation. Web.

Introduction

An ethical dilemma refers to a complex situation characterized by a conflict in principles on which an individual or a community judges a behaviour or an action as right or wrong. When two moral principles that are used for making a decision conflict, a person is faced with the difficulty of either choosing one of the principles on which they can base their judgment. The complexity of the situation rests on the fact by choosing one principle; the person will be transgressing on another equally important principle at the same time. This essay will explore how the process of ethical decision making can be used to handle the case of an employee who is underperforming hence causing undue burden to other workers.

Description of the Ethical decision-making framework

Burch, n.d, p.160, explains that the Resolved strategy encourages decision-makers to do the following when trying to resolve an ethical dilemma; they need at first to review the details of the case so that it becomes possible to state the main ethical problem or conflict. The next step involves preparing a list of possible solutions to the conflict and stating the most important and probable outcomes of each of the proposed solutions.

In addition to the above, the decision-makers are also required to describe the likely impact of these possible solutions on the lives of individuals involved in the conflict. After this, there is a need by the decision-makers to explain the values upheld and violated by each of the probable solutions. Finally, the decision-makers should critically evaluate the proposed solutions, proceed to make a decision and justify it. It is equally important for decision-makers to know that at times they may need to defend their decision/s against objections.

Case resolution

Based on the Resolved strategy model, the main conflict in the case being evaluated in this paper involves a junior employee who is underperforming and as a result, inconveniences the boss through a heavy workload. Besides this, the employee also comes to work late and this is not pleasing to the employees boss. The boss reports that the employee has been absent from work at times when their presence was of great importance. Similarly, the employee has been noted to have developed a casual attitude towards their work. The outcome of all this has been a reduction in performance on the employees part and this is what has created a conflict between the boss and the employee.

Performance issues in an organization can be dealt with as they occur by providing constructive feedback, employee training or coaching, counselling and using the companys code of conduct or performance standards as a guide to resolving ethical conflict related to poor performance.

According to Carroll, 1996, p.152, all these possible solutions present a challenge in making ethical decisions. Counselling for underperforming employees is thought to be beneficial because it allows the employee to share any personal problems they could be facing. These can be problems at the workplace or those the employee faces with the family back at home. Employee training and coaching on the other hand are important in enhancing the competence of the employee in case the employee faces difficulties in carrying a particular task (Carter&McMahon, 2005, p.131).

Carter and McMahon, 2005, p.131, continue to explain that code of conduct and performance standards do not provide straight answers to ethical dilemmas frequently encountered in organizational settings. According to them, provisions within these documents can be used to remind the employee of their responsibility to the employer and be used as a basis to provide coaching. This in turn can lead to an improvement in the performance of an employee.

Considering that the employee has occasionally been absent from work and does not take the work seriously, the manager should approach the employee and share the pressing concerns regarding the employee performance.

The manager should also ensure that the employee is put under close supervision and there is progress reviewed to check if there is any improvement or not. If the problems persist, the manager should recommend that the employee undergoes some counselling and continue to work under probation. If no impressive results are forthcoming, the manager should issue the employee a written warning letter and continue following up on the matter. In case the employee does not show any positive change, the manager can consider discharging the employee temporarily or permanently (Grote, 2006, p.124).

Making an ethical decision is not easy. This is because resolving a case like this takes time to review all the relevant provisions contained in the employees employment contract, provisions of government legislation regarding employee welfare like the National Labor relation Act, performance standards and ethical code of conduct of the company and make relations that are specific to the case. The last choice of discharging an employee from gainful employment can harm the employees life by rendering the employee incapable of providing for their families and themselves.

Reference List

Burch, J. (n.d). No Easy Answers. Analytic teaching, 22( 2):160-161..

Carroll, M. (1996). Workplace counseling: a systematic approach to employee care. London: Sage.

Carter, M. A., & McMahon, F. A. (2005). Improving employee performance through workplace coaching: a practical guide to performance management. London: Kogan publishers.

Grote, R. C. (2006). Discipline without punishment: the proven strategy that turns problem employees into superior performers. New York: AMACOM Div American Mgmt Assn.