Ethical Dilemma of Patient Care Delivery

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Table of Contents

Description and Precipitating Factors of the Dilemma
Barriers to Resolution of the Dilemmas
Personal Bias and their Impact on the Evaluation of the Dilemma
Ethical Principles Relevant to the Dilemmas
Useful Theories and Models to Evaluate and Propose Solutions to the Dilemmas
Theories and Models for Evaluation and Resolution of the Dilemma
Concepts from the Models
Analyzing the Dilemma
Proposed Resolution to the Dilemma
References

Description and Precipitating Factors of the Dilemma

A patient with a drug addiction problem is admitted in the hospital with extensive trauma. The patient requires an additional dosage of analgesics to adequately suppress the pain. However, the administration of more pain depressants is likely to escalate the addiction problem while the denial of the medication will aggravate the patient’s suffering. The nurse has to make a decision on whether to administer an additional dosage of analgesics, potentially worsening the addiction, or deny the dosage and impede patient’s suffering and prolong their suffering.

In the given dilemma, the precipitating factors are the patient’s extensive trauma and the underlying addiction problem. Administering adequate analgesics and mitigating the possibility of escalating the addiction are competing priorities often encountered by nurses attending to patients with substance abuse problems and requiring pain management (Carvalho et al., 2018). Therefore, the nurses have to choose between providing adequate pain depressants, which will increase their suffering, or administer the analgesics and risk worsening the addiction.

Barriers to Resolution of the Dilemmas

In the dilemma, the nurse’s decision-making is challenged by the competing principles of the ethical code and professional commitment of alleviating patient suffering. According to Pesut et al. (2021), mitigating the suffering of patients is the primary objective of those providing care. Al Kalaldeh et al. (2017) and Rathnayake et al. (2021) corroborate this perspective and argue that healthcare professionals fundamentally focus on relieving and easing the psychological and physical distress of their clients. For instance, if the nurse opts to administer additional analgesics to the patient with extensive trauma and addiction problem, the latter will be potentially aggravated by the pain depressants.

Personal Bias and their Impact on the Evaluation of the Dilemma

The personal bias of striving to deliver solutions for others and pursuing the best interests of patients influence the subsequent course of action. This implies that nurses do not exclusively rely in evidence-based practices in their clinical decision-making (Barlow et al., 2018). In the given scenario, the implicit desire of relieving the immediate physical and psychological pain of a patient influence the administration of additional analgesics. Once those needs are addressed, the possibility of worsening addiction would be addressed later after the patient has been stabilized. This implies that the personal predispositions of alleviating patient suffering directly impact the treatment decisions when a practitioner is faced with mutually exclusive or conflicting options (Gerald & Hurst, 2017; Gopal et al., 2021). Therefore, healthcare workers apply moral reasoning based on their personal values and beliefs to navigate through complex situations to deliver care to their patients.

Ethical Principles Relevant to the Dilemmas

Beneficence and autonomy are the two prominent ethical principles relevant to the dilemma. The ethical code of conduct obligates nurses to exclusively undertake actions that benefit and promote the overall wellbeing of a patient and uphold their right to self-determination. Beneficence implies that despite the complexity of a situation, the nurse’s foundational commitment is to the betterment of the patient’s health (Varkey, 2020; Stone, 2018)). For instance, failing to administer adequate analgesics in the hope of avoiding potential escalation of the addiction problem would mean prolonging the psychological and physical distress of the patient due to the extensive trauma.

Regarding autonomy, healthcare practitioners are obligated to respect patient’s decisions, views, and choices on any aspect of treatment being administered. Hence, nurses should support and encourage patient’s right to make their resolutions without any external influence, persuasion, or control (Blease et al., 2020). The principle of autonomy recognizes patient’s capacity for self-determination, particularly those clients whose competence is not compromised (Varkey, 2020). Notably, such independence empowers patients, which is a critical precursor for positive outcomes (Ubel et al., 2018). As a result, nurses should respect the patient’s decisions on such issues as what shall done with their bodies or what treatment to be administered. Considering the competing tenets in the given dilemma, beneficence takes precedence over patient autonomy.

Useful Theories and Models to Evaluate and Propose Solutions to the Dilemmas

The Kantian theory and the American Association of Critical-Care Nurses’ (AACN) synergy model are useful conceptual frameworks which can significantly promote the nurses’ ability to resolve the dilemmas. The AACN Synergy model underscores the need for healthcare practitioners to consider the needs and specific characteristics of patients as the basis of choosing the applicable treatment modality. The former imposes a deeper sense of responsibility and duty of care on nurses to their patients while the latter focuses on the practitioner’s essence of optimizing client’s outcomes and meeting their needs.

Theories and Models for Evaluation and Resolution of the Dilemma

Utilitarianism theory and the AACN Synergy model are useful theoretical frameworks that can guide a practitioner in resolving the dilemma. The former is a teleological perspective characterized by such features as consequentialism and welfarism. The AACN Synergy model discourages practitioners from rigid practice and promotes the adoption of dynamic thinking when helping patients. This model advances the argument that contemporary medicine is characterized by unique problems, making absolute principlism inapplicable.

Concepts from the Models

The utilitarianism model encompasses the concepts of welfarism, maximization, and consequentialism. The idea of welfarism is relevant to the given dilemma as it reinforces the avoidance of pain and suffering, which is integral in the management of extensive trauma. Similarly, consequentialism rejects absolute commitment to moral duties and encourages practitioners to make decisions that yield less suffering to the patient (Scott, 2017). Maximization persuades decision-makers to choose the option that generates the highest benefit. Notably, this is a relevant consideration in the given scenario since pain management is affects multiple aspects of patient outcomes.

The AACN Synergy model integrates such concepts as patient autonomy, participation in care and decision-making, and practitioner’s attitudes. These underlying tenets are useful reference points that allows a nurse to weigh the available options (Kaplow & Reed, 2008). For instance, although autonomy is an essential treatment component, the nurse evaluates how it impacts the outcomes. Similarly, patient participation in the decision-making is integral as it affects multiple aspects of treatment, including satisfaction levels and realization of positive outcomes. A professional and empathic attitude is also relevant in the given dilemma as it comprises inclinations, emotions, and feelings towards their patient. For instance, the care provider’s intention of alleviating pain would be executed in moderation to significantly reduce any potential of eliciting the addiction problem.

Analyzing the Dilemma

From a utilitarian perspective, healthcare practitioners’ decisions and actions should be driven by the desire to achieve and maximize positive patient outcomes. The theory imposes an obligation to nurses to continually explore and implement options that promote the welfare of individuals and populations. Consequently, this theory’s philosophical underpinning reflects such nursing principles of nonmaleficence and beneficence. In this regard, caregivers and practitioners should undertake decisions that do not inflict harm on their patients and their decisions should be driven exclusively by the desire to promote welfare. For instance, in the given dilemma, failing to administer additional analgesics would amount to a deliberate choice of inflicting harm on the patient since the action would prolong suffering and jeopardize recovery (Crisp, 2017). Since unrelieved pain suppresses recovery, increases the likelihood of complications, and adversely affects patient’s attitude to medication, it amounts to an omission that worsens the client’s overall status. Form a utilitarian perspective, the nurse would apply their ethical knowledge and shift their focus on addressing the current pressing need of alleviating the psychological and physical pain.

Additionally, the failure to address the patient’s pain would violate the principle of beneficence in that it discourages practitioners from implementing actions that do not promote the patient’s welfare. More specifically, the refusal to administer sufficient pain management dosage would inherently aggravate patient’s suffering and even lead to poor outcomes. Conversely, the aggravation of the addiction problem was an outcome whose occurrence was not guaranteed. Hence, denial of adequate pain depressants would be deemed as harmful since the action endangers the patient due to the risks associated with inadequate pain management. In this regard, additional pain depressants would ultimately improve the patient’s overall wellbeing and mitigate the possibility of complications. Notably, the denial of such medications was not guaranteed to yield any benefits for the patient. Besides, since the patient was collaboratively engaging with the nurse and participating in the decision-making, the implementation of the joint resolution and consideration would have been the best course of action for the practitioner.

Moreover, there were no ascertainable positive outcomes that would be realized if the practitioner were to withhold the additional dosage. By comprehensively weighing these two eventualities through the utilitarian and AACN Synergy models, the nurse would be obligated to pursue actions which advance patient’s welfare and minimize harm. The philosophical underpinning of the two approaches would require a nurse to exclusively undertake the decisions which promote the patient’s wellbeing of easing their physical and psychological distress by providing additional analgesics (Crisp, 2017). This is because a patient in excessive pain would need the immediate administration of analgesics while a subsequent treatment modality for their addiction problem would be developed once the disorder arises. Kaplow and Reed (2008) argue that adopting an approach tailored to suit a client’s needs improves their satisfaction and promotes positive outcomes. Therefore, the AACN Synergy model obligates a practitioner to explore all options to improve the wellbeing of a patient, including administering a novel treatment modality.

Proposed Resolution to the Dilemma

The philosophical underpinnings of utilitarianism and AACN Synergy models provides a useful reference framework to help healthcare practitioners to navigate complex practice occurrences. A comprehensive assessment of their abstractions would persuade a nurse to provide an additional dosage of pain depressants since this decision would have mitigated adverse outcomes, promoted patient’s wellbeing, and enhanced the realization of positive outcomes. Conversely, the failure to administer adequate analgesics would endanger the patient’s health by impeding their recovery and increasing the risk of complications.

References

Al Kalaldeh, M., Shosha, G., Saiah, N., & Salameh, O. (2017). Dimensions of phenomenology in exploring patient’s suffering in long-life illnesses. Journal of Patient Experience, 5(1), 43-49.

Barlow, N. A., Hargreaves, J., & Gillibrand, W. P. (2018). Nurses’ contributions to the resolution of ethical dilemmas in practice. Nursing ethics, 25(2), 230–242.

Blease, C., Walker, J., Torous, J., & O’Neill, S. (2020). Sharing clinical notes in psychotherapy: A new tool to strengthen patient autonomy. Frontiers in Psychiatry, 11, 1-4.

Crisp, J. (2017). Right or Duty: A Kantian Argument for Universal Healthcare. Online Journal of Health Ethics, 13(1), 1-5.

FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1), 1-18.

Kaplov, R., & Reed, K. D. (2008). The AACN Synergy Model for patient care: A nursing model as a force of magnetism. Nursing Economics, 26(1), 17-25.

Pesut, B., Wright, D., Thorne, S., Hall, M., Puurveen, G., Storch, J., & Huggins, M. (2021). What’s suffering got to do with it? A qualitative study of suffering in the context of Medical Assistance in Dying (MAID). BMC Palliative Care, 20(1), 1-15.

Rathnayake, S., Dasanayake, D., Maithreepala, S. D., Ekanayake, R., & Basnayake, P. L. (2021) Nurses’ perspectives of taking care of patients with Coronavirus disease 2019: A phenomenological study. PLoS ONE 16(9), 1-17.

Scott, P. A. (2017). Key concepts and issues in nursing ethics (1st ed.). Springer.

Stone E. G. (2018). Evidence-based medicine and bioethics: Implications for health care organizations, clinicians, and patients. The Permanente Journal, 22, 18-030.

Ubel, P. A., Scherr, K. A., & Fagerlin, A. (2018). Autonomy: What’s shared decision making have to do with it? The American Journal of Bioethics, 18(2), W11–W12.

Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30, 17-28.

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