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Miss Shurouq Qadous
A situation in which an individual feels compelled to make a choice between two or more actions that he or she can reasonably and morally justify, or when evidence or an arguments are inconclusive, is called an ethical dilemma (Beauchamp&Childress,2001;McConnell,2002).
One action must be chosen because performing both actions would be impossible.
Dilemmas may arise from conflicts between midwives and other health care professionals, health care organizational administrators, or patients and family members.
Ethical Dilemmas are usually described in terms of right or wrong, duty or obligation, rights or responsibilities, and good or bad. Ethical dilemmas are commonly identified by the question,” What should be done?”
Nurses / midwives confound ethical dilemmas with tragic circumstances. A tragic circumstance is one when nothing can be done to alleviate the situation. In this case a good choice or solution may be lacking . The sadness of the situation may make the nurse / midwife wish that there was something that could be done, but there are often no further options for treatment.
For example, several years ago a 10 – year – old boy with leukemia was being considered for a bone marrow transplant. Just as a donor was found , he developed an infection that would not respond to the most potent antibiotics, and donation was no longer a possibility. He died within a few days.
Most moral dilemmas in nursing / midwifery can be identified according to the following classifications:
Growing awareness of ethical problems has occurred largely because of (a) social and technological changes and (b) midwifes conflicting loyalties and obligations.
Before organ transplantation , death did not require a legal definition that might still permit viable tissues to be removed and given to other living persons. A advances in the ability to decode and control the growth of tissues through gene manipulation present new potential ethical dilemmas related to cloning organisms and altering the course of hereditary disease and biological characteristics. Today, with treatment that can prolong and enhance biologic life, these questions arise: should we do what we know we can?
Midwifes experience conflicts among their loyalties and obligations to clients, families, primary care providers, employing institutions. Client needs may conflict with institutional policies, primary care provider preferences, needs of the client’s family, or even laws of the state. However, it is not always easy to determine which action best serves the client’s needs.
For instance, the nurse may be aware that marijuana has been shown to be effective for a condition a client has that has not responded to mainstream therapies. Although legal issues are involved, the nurse must determine if, ethically, the client should be made aware of a potentially effective alternative.
Another example employee strikes.
Responsible ethical reasoning is rational and systematic. It should be based on ethical principles and codes rather than on emotions, intuition, fixed policies, or precedent (حدث سابق((that is, an earlier similar occurrence).
Two decision – making models shown to be effective for a condition a client has that has not responded to mainstream therapies. Although legal issues are involved, the nurse must determine if, ethically, the client should be made aware of a potentially effective alternative.
1- Thompson and Thompson (1985)
2- Cassells and Redman (1989) shown to be effective for a condition a client has that has not responded to mainstream therapies. Although legal issues are involved, the nurse must determine if, ethically, the client should be made aware of a potentially effective alternative.
A good decision is one that is in the client’s best interest and at the same time preserves the integrity of all involved. Midwives have ethical obligations to their clients, to the agency that employs them, and to primary care providers. Therefore, midwives must weigh competing factors when making ethical decisions.
The midwife may feel torn between obligations to the client, the family, and the employer. What is in the client’s best interest may be contrary to the midwife personal belief system. In settings in which ethical issues arise frequently, nurses, midwives should establish support systems such as team conferences and use of counseling professionals to allow expression of their feelings.
Process for resolving ethical problems: established guidelines, procedures, and rules to resolve anticipated, routine, expected types of moral dilemmas
Ethical decision making is a skill that can be learned, based on understanding of underlying ethical principles, ethical theories or systems, a decision making model, and the ICM of Ethics.
Mrs. L, a 67- year – old women, is hospitalized with multiple fractures and lacerations caused by an automobile accident. Her husband, who was killed in the accident, was taken to the same hospital. Mrs.L,who had been driving the automobile, constantly questions her primary nurse about her husband. The surgeon has told the nurse not to tell Mrs.L about the death of her husband, however, the surgeon does not give the nurse any reason for these instructions. The nurse expresses concern to the charge nurse, who says the surgeon’s orders must be followed – that the surgeon will decide when Mrs.L should be told. However, the nurse is not comfortable with this and wonders what should be done.