Essay on Ethics and Ethical Decision-Making Frameworks

Nurses are always faced with ethical dilemmas as a matter of routine. In most cases, a wrong decision can lead to a detrimental result, and at times it can lead to death (Alba, 2016). At the same time, well-defined decisions can improve medical care and can lead to patient satisfaction. To avoid consequential medical errors and improve patient outcomes, nurses must adhere to ethical principles and encourage the use of medical decision-making frameworks (Atkins, De Lacey, Ripperger & Britton, 2011). Abdul’s case is an excellent example of the many cases medical personnel encounter in their daily practice. A nurse who adheres to the ethical decision-making framework should understand that Abdul is a minor, and in most instances, professionals dealing with patients under the age of full legal responsibility must seek medical consent from parents or guardians. There are several steps to ethical decision making; however, this paper, with the help of Abdul’s case, analyses the first three steps. In this paper, I discuss how I would respond to Abdul’s situation while considering steps one to three of the ethical decision-making model.

Ethics and Ethical Decision Making

Ethics are standards of behaviour that establish how people should act when they find themselves in challenging situations (McDonald & Then, 2019). It is important to note that there is a close similarity between ethics and personal feelings; however, ethics is not the same as feelings. According to Schwartz (2015), our personal feelings provide us with ethical choices that guide us towards doing what is right. Individuals with highly developed feelings feel bad when they engage in the wrong act, but some enjoy doing something wrong. In like manner, there is a distinction between ethics and following the law, although law and ethics are very much similar (Pope, 2016). A well-established legal system incorporates many ethical standards; however, it is also worth noting that the law can deviate from ethical (Pope, 2016). For instance, the age of medical consent in Australia is set at 18, and parents generally consent to the treatment of patients less than 18. This is the law, and the ethical thing to do as a medical practitioner working with minors would be to seek informed consent from patients.

Moreover, attaining ethical decisions in the medical context requires a trained sensitivity to ethical issues. Notably, the nurses must have a practised method for exploring ethical aspects of a situation (Lechasseur, Caux, Dollé & Legault, 2016). The nurses must be able to understand their choices, and they must weigh every consideration. A well-designed decision-making framework is essential. Significantly, when this framework is repeated and practised regularly, it becomes familiar that nurses work through it automatically without consulting the specific steps (Cashin et al., 2017). The ethical decision-making framework includes five steps, and each includes different considerations and guiding questions that help nurses through the ethical decision-making process (Pollard, 2015). Nevertheless, I will utilize the first three steps in Abdul’s situation.

Step 1: Assessment

Assessment is the first step in the ethical decision-making framework (Pollard, 2015). It is also an essential component of the nursing practice and vital in planning and providing patient and family-centred care. The Nursing and Midwifery Board of Australia (NMBA) requires nurses to conduct a comprehensive and systematic nursing assessment and respond effectively to unexpected changing situations when dealing with patients (Nursing and Midwifery Board of Australia, 2020). To be successful in the assessment step, nurses should identify what they need to make ethical decisions. In this case, I should understand that Abdul, just like any other patient, has the right to make his own decisions. In other words, I should apply the principle of autonomy. As a nurse, I should respect my patients’ autonomy, which means I should respect the decisions made by others concerning their own lives (Nibbelink & Brewer, 2018).

Nevertheless, and despite my intention to respect Abdul’s decision, there remains a challenge. Abdul is under 18, which means that I would have to consult with his parents before choosing. Also, Abdul’s parents are against the new treatment as they consider it to be dangerous. However, Abdul is determined and is willing to proceed with the new treatment, which can be attained regardless of the parents’ views. According to Youth Law Australia, an organization that aims to address human rights for children and young people in Australia, medical personnel can proceed with treatment without parental consent as long as the minor understands the nature and the consequences of the treatment (Youth Law Australia, 2020). Abdul seems to understand the nature and the consequences of the treatment. For instance, he states, “…I know the risks, I want to do this; it is my best chance of a cure.” Importantly, this statement may be used to judge whether Abdul is mature enough; it may be useful in deciding whether he understands the treatment, the risks, and the ability to appreciate the treatment’s broader consequences.

After identifying the situation’s needs, it is paramount that nurses seeking to attain an ethical decision gather as much information as possible, including relevant factors. Gathering information as a nurse is critical and essential to patient care (Blumenthal-Barby & Krieger, 2014). I would use two different modes in the information gathering task: the focusing and scanning modes. I would use informational gathering activities that require skilled performance and little cognitive effort in the scanning mode. This mode is often helpful when the information is routine, and no decision is required (Blumenthal-Barby & Krieger, 2014). I would use the information gathered in this case to decide whether Abdul needs care or not. On the other hand, the focusing mode requires skills and complex cognitive effort (Blumenthal-Barby & Krieger, 2014). I would use the information gathered at the focusing mode to clarify, interpret, and decide related to Abdul’s case.

Step 2: Review and Reflect

Reviewing and reflecting on the situation is the second step in the ethical decision-making framework. In this step, nurses must identify all the available alternatives and examine the different options that could be implemented (Melin-Johansson, Palmqvist & Rönnberg, 2017). As a nurse, I would consider the actions that lead to the most good in this step. In other words, I would employ the utilitarian approach in Abdul’s case. Scholars also agree that an ethical action must promote the most good and produce the greatest balance of good over harm (Fok, Payne & Corey, 2014). In this case, the action that promotes the utmost good would be proceeding with treatment. According to Felzmann (2017), this is known as the consequentialist approach as the consequences determine the morality of the action. Treating Abdul could disappoint the parents; however, the net outcome would maximize the benefit. In addition to applying the utilitarian approach, I would consider societal values and societal expectations of care. Nurses should understand that miscalculation in care provision affects how the public views the organizational services (Ling, Yu & Guo, 2017). If I proceed with treatment and the outcome of the treatment becomes consequential, the public would view the hospital as a lenient institution or an institution that encourages failure.

Furthermore, it is critical to understand that reflection benefits patients and professionals (Johansen & O’Brien, 2015). To be effective in this case, I would describe, analyze, and evaluate different practice experiences to help me find sense in Abdul’s situation. Also, to achieve the best outcomes, I would try not to focus on adverse incidents as they would affect my morale towards care. More significantly, I would be mindful of the things I reflect on and focus on positive experiences and events. While reflecting, I would intensely consider the risk of harm if I choose to proceed with Abdul’s treatment and the risks if I decide not to continue with the treatment. The value of reflection in attaining suitable patient care cannot be underestimated (Johansen & O’Brien, 2015). It can help nurses make sense of their practice by encouraging them to look back at numerous instances in their practice; they can understand what went well and what went wrong through reflection. I will be able to navigate through this challenge by reflecting on my past practice.

The review and reflection step also requires one to consider the constraints experienced in taking actions consistent with ethical duties and obligation (Friesen-Storms, Bours, van der Weijden & Beurskens, 2015). Some of the constraints and limitations a nurse faces in the decision-making process include lack of knowledge of the available ethical standards, fear of criticism, and financial incentives. The medical environment is advancing fast, and nurses must remain committed to development in the profession. This includes understanding the continually changing ethical codes and standards. Before deciding to treat Abdul, I would first seek to understand if the available ethical codes have changed or if they have been updated. At the same time, to avoid criticism, I would focus on finding a sustainable solution for Abdul and his parents. If the outcomes are not as expected, I would stand up and accept the responsibility for my actions, which may help maintain my credibility. I also believe that people will only respect me if I do not overreact to criticism or deflect the blame.

Finally, I would reflect on the legislation, policies, and standards that apply to this instance. I would seek to understand the legal implication of my actions. In most cases, nurses are held to ethical principles in the International Council of Nurses Codes of Ethics. The ICN codes of ethics require nurses to provide care that respects human rights, care sensitive to human values, beliefs, and customs (ICN, 2020). To achieve this, I would ensure I provide Abdul with all the necessary information regarding his treatment. I would also work hard to protect Abdul’s health confidential information and only use the information he gives me to improve care. The ICN codes of ethics also recommend that nurses provide patients with sufficient information to permit informed consent (ICN, 2020). This aspect falls under the ethical principle of veracity. According to Samuel and Zaïane (2018), veracity is being truthful with patients. A nurse who adheres to this principle does not withhold critical information from patients even if the information may result in distress. I would be sure to inform Abdul about the side effects that may come with the treatment. Nurses are also required to establish standards of care that enhance safety and quality care. This code of ethics may fall under the nonmaleficence principle of ethics, which requires medical professionals not to harm. To attain this, I would ensure that I do not avoid or neglect Abdul while in the process of care.

Step 3: Maximize Good

Maximizing good is the third step in the ethical decision-making framework. This step helps nurses understand their obligation when deciding on ethical actions (Ramos et al., 2015). This step requires nurses to consider relevant legislation and professional standards that apply to nurse care. It is also essential to identify and include nursing resources that support my decision in this step. However, to maximize the good, I would ensure I follow several decision-making tips.

First, I would use my past experiences for learning. As a nurse, I learned to record my decisions and mainly how I attained them. This is critical as these records help me manage future dilemmas, including this one. I would seek a past case in which I was involved in the decision making process and solve Abdul’s situation. Secondly, I would be sure to entertain doubts as they would help me make more informed decisions. Embracing the unknown and believing that I might be making a mistake is the first step in maximizing the good (Ramos et al., 2015). However, this does not mean decision paralysis; it means that nurses should test each decision against multiple scenarios. I should be able to ask questions in order to attain absolute certainty. Importantly, I would reflect on how my decision might play out by considering things that might frustrate it.

In addition to learning from experience and embracing doubts, I would conduct a cost-benefit analysis. Conducting a cost-benefit analysis would ensure that I weigh the pros and cons of every decision in the situation (Riahi, Thomson & Duxbury, 2016). I would analyze the outcome of engaging Abdul in the new treatment without parents’ informed consent. Also, I would weigh the decision to deny Abdul his right to treatment because of the lack of informed consent. This will allow me to see the things that I miss when I consider one decision over another.

Furthermore, to simplify the cost-benefit, I would limit myself to fewer options. It is important to note that it can be challenging to make informed decisions when many alternatives are presented (Riahi, Thomson & Duxbury, 2016). Having many choices can lead to regret as people often consider the missed possibilities and worry whether they have made the right decision to choose one alternative. Therefore, narrowing my options will ensure that I attain greater peace of mind. After considering all these tips, I would seek feedback on the process from the people involved. The people involved in this case include Abdul’s parents and the doctors who will mostly be included in the treatment. Abdul’s parents do not want their child to undergo the treatment; however, it is essential to inform them regarding their child’s decision. They should be informed regarding all aspects of the treatment, considering that they will be deeply involved in the treatment and care. At the same time, I should inform the doctors regarding the patient’s decision so as they can effectively prepare.

Conclusion

Abdul’s case presents a challenging atmosphere. More importantly, a slight misstep and a wrong decision could be consequential and lead to unwarranted lawsuits. Therefore, to reach a suitable conclusion, there is a need to adhere to an ethical decision-making framework. The decision making framework included several steps, but this case has only utilized the first three steps. Assessment is the first step, and here I have identified the aspects of ethical decisions. The principle of autonomy, which recognizes an individual’s right to make a decision, could be beneficial in the assessment step. As a nurse, I must respect the independence of my patients. I have also recognized the importance of seeking informed consent from the parents. Review and reflection is the second step, and in this case, I have noted the importance of experience and analyzing other related subjects in the decision-making process. To be effective in reflection and review, I would describe, analyze, and evaluate different backgrounds in a way that helps me find sense in Abdul’s situation. The third step in ethical decision making is maximizing on good. Here, I have noted beneficial tips that will allow me to make an informed decision in Abdul’s instance. Embracing doubts and borrowing from the past are beneficial tips that may help me in ethical decision making. All in all, and by closely adhering to the three decision making steps, I confidently state that agreeing to Abdul’s treatment would be the best decision as it would promote the utmost good.

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