Ethical Dilemma in Oncology - Research Paper Example

Ethical Dilemma Introduction Ethical dilemma is a situation where a nurse has to decide whether to go by the moral rules in order to make a crucial decision or to go by the code of ethics for nurses. This is a difficult situation bearing in mind that there is someone’s life that is at stake. The decision the nurse makes will determine whether the patient lives or not (Perrin & McGhee 2008). Scenario Patient was a 28yr old married female presenting for a primary c/s due to spots noted to be found on patient liver during pregnancy. The patient was told that these "spots" were benign and not to worry. Upon delivery patient became unstable and was transferred to ICU. Second CT and testing performed and the patient was found to have a rare form of untreatable cancer (Hepatocellular Carcinomas) and 3 months to live. Doctors were not being truthful to the patient regarding her diagnosis and kept telling her that she had "nothing to worry about" I knew the true diagnosis and had to decide whether or not to tell the patient the truth. This situation requires a moral judgment as it was the moral obligation of the doctors to make the disease known to the patient. Cancer is the disease in this scenario, and it is well known that cancer cells replicate in seconds and the earlier the treatment, the better for the patient. It was a moral action for the doctors to make the disease known to the patient right from the time it was diagnosed as this would prepare the patient psychologically on what to expect and to understand how serious her condition was. Moral values and principles conflict One of the most challenging ethical dilemmas that health care professionals like doctors and nurses working in oncology settings experience is whether, when, how and how much to tell cancer patients about their diagnosis and prognosis that is cancer. This scenario poses an ethical dilemma as there are conflicting moral claims. The doctors were required to make a decision between tow alternatives; to let the diagnosis known to the dying patient or just keep quite and try to give her medication without her knowledge. It is an ethical issue for nurses to provide information about a given illness, counseling and emotional support for patients who are terminally ill. Every adult with a sound mind has the full rights to know his or her medical status in order to determine what should be done with her body regarding the necessary treatment. In this case, the doctors were not truthful to the patient regarding her diagnosis and kept assuring her that everything was fine. However, the 28 year old married female is considered an adult of adult years and should have been informed of her terminal illness. Care is a moral and ethical obligation of doctors and nurses, and in this case, care seems to have been compromised (Timby, 2009). In this case, the moral value is in conflict with the ethical responsibilities of nurses and doctors in that the nurse should tell the patient the truth in regard to her health. This is because it is morally right. The ethics of care seems to be under conflict in the given scenario (Perrin & McGhee, 2008). For example, it is assumed that the doctors made an ethical decision if the doctors did not have the diagnosis well known to the cancer patient is because of the ethics of care they upheld as this would not hurt the patient. However, ethics of care should have been applied by letting the patient know of her condition. Though this would be hurting to the patient, the nurses would then provide the required guidance and counseling to the patient as part of care. Autonomy is ones freedom to make very independent choices. It is important for all healthcare professionals to respect their patient’s rights to make free decisions after they have been provided with the necessary information regarding her health (Perrin & McGhee, 2008). This case portrays the conflict of principles. The doctors should have exercises autonomy as an ethical principle, let the diagnosis known to the patient just as soon as it had been done, advise, counsel and treat the patient immediately if possible or let the patient make her own decision concerning her condition. Beneficence is another ethical principle which was under conflict in this case. The primary objective or goal of healthcare is for the good of all patients. For example, failure to let the diagnosis known to the patient may be termed as an act of doing good as it would prevent adverse reactions from the patient (Porche, 2009).. However, the act of doing well is where the patient is approached in a holistic manner and made fully aware of her condition otherwise it would be termed as non maleficence. Non maleficence is where healthcare providers do harm to their patients. Telling the patient her medical situation may be unintentional harm to her. Failure to tell the patient of her situation is doing harm to her as she would continue experiencing pain with little or no knowledge about the cause. All healthcare practitioners should practice truthfulness. That is, they should tell the truth regarding the patient’s condition. For healthcare professionals the challenge and the dilemma of whether to tell the truth or not becomes clear when having to break the bad news, especially if it is about a terminal disease. Since the condition was determined during the primary c/s, the doctors should have been truthful to the patient about her condition as at that time. The healthcare providers should have told the truth to the client to avoiding misleading her. Truthfulness also brings about the value of life of patients with medical conditions. According to Shives (2008), value of life was examined after the diagnosis of cancer. Truthfulness conflicts with the standard of the best interest as principles of healthcare (Timby, 2009). The female patient became unstable after delivery and had to be transferred to the ICU. As at this point, she was unable to make her own decisions. Now that the healthcare providers had not told her of her condition, the best of the best interest was applied. In this case, the practitioners made a decision on her behalf as she was unable to make any informed decision. Moreover, the news about her terminal illness would alter radically and negatively the patient’s scrutiny of his or her own health. Ethical analysis Utilitarianism is the moral and ethical framework in this scenario. Utilitarianism is an ethical theory which is consequence based which judges any action that does a lot of good and less harm to a huge number of people as morally right. This theory is quite applicable in this case as any action taken by the medical practitioners for the good of the patient will be termed as being morally right. This scenario poses a situation of ethical dilemma. This situation occurs when one has to make a decision between equally favorable alternatives. In this case, the healthcare providers were in an ethical dilemma on whether to tell the patient of her serious condition just after she had been through a c/s operation or to withhold her medical status for the purposes of her health. Even though, the providers had their moral and ethical obligation regarding this scenario, they chose to take sides to prevent further harm from the ailing patient. This situation calls for ethical decision making (Porche, 2009). The main aim of ethical decision making is for the medical practitioners to determine wrong and rights from a situation which does not have clear demarcations. Therefore, the healthcare practitioners should have first analyzed the medical condition of the patient just after her primary c/s. After a thorough analysis is done, the ethical dilemma should be stated. Choice of the next course of action should then be considered to determine how to make the patient informed of her medical situation. The advantages and disadvantages of each of the choices should then be analyzed after which a decision is reached. The final decision reached should be for the goodness of the ailing patient (Perrin & McGhee, 2008). The decision arrived at by the health professionals should take into consideration the consequences, if any, that it may have on the patients’ value of life. The appropriate action to this scenario would have to let the patient know of her condition just at the time when the spots were spotted. Though this would pose a state of denial and mental torture, it would have been better for the patient to know her condition in order to make an informed decision considering the fact that she had only 3 months to live. This would be acting for the best interest of the patient. The patient had just delivered and yet she had three more months to live. Letting her condition known to her would have been the better option while putting in mind the young child. This would then be followed by guidance and counseling to the patient for her to accept her condition (Perrin & McGhee, 2008). Action: Strategies to prevent such scenarios To prevent further scenarios in future, medical practitioners should apply the doctors and nurses code of conduct, ethical responsibilities and code of ethics for nurses and moral obligations in all medical situations. It is important for all healthcare providers to be truthful to their patients regarding their medical conditions as this would help in the cure. To avoid similar cases in the future, the healthcare providers should let the condition known to the patients family members if at all the patient is not in the best shape and condition to be informed (Shives, 2008). Different organizations have put considerable measures to deal with patients with terminal diseases in order to avoid cases like in this scenario. These organizations have put in place advocate, support and education measures to deal with these patients. The support teams usually offer counsel and support to patients. They also have services like referrals to specialists dealing with pain and they also talk to the patient’s families about the wishes about health care wishes. The organizations also talk to the patient and family members about pain management and the ways of handling pain. Sometimes, the organizations talk to people who are terminally ill on the different ways in which they can hasten their death to avoid too much pain and suffering. All in all, people should choose the manner and time of death when the pain is prolonged for those with terminal illness. All this is done with the purposes of effective care for the dying patient. References Perrin, K. O., & McGhee, J. (2008). Ethics and conflict. Sudbury, Mass: Jones and Bartlett. Brunner, L. S., & Smeltzer, S. C. O. C. (2010). Brunner & Suddarth's textbook of medical-surgical nursing. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Timby, B. K. (2009). Fundamental nursing skills and concepts. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Shives, L. R. (2008). Basic concepts of psychiatric-mental health nursing. Philadelphia: Wolters Kluwer / Lippincott Williams & Wilkins. Read More