ethical dilemma case study

ethical dilemma case study

Introduction

At some point in every person’s life, one will be faced with a moral dilemma that will test and question their ethical values and their loyalty to the code of conduct. In a wide variety of their practices, health care professionals are faced with ethical dilemmas often in their daily practices. This paper will discuss the moral dilemma, as demonstrated in a case study of an old school or out of touch. In so doing, it will use three ethical principles decision-making model. It will also discuss the communication element in the health care profession. Lastly, it will give the ethical principle that can be employed to solve the problem of the ethical dilemma.

The ethical dilemma in the case study

The ethical dilemma presented in this case study is a problem between the laid down procedure that guides the treatment of patients presented whith shortness of breath and the conflicting guidelines given by Dr. Lacey. Margaret Truman, the head of the Nursing Department, contact Corey Davidson, the head of the Emergency Department Division, to discuss some concerns on the professional conduct of Dr. Lacey. Margaret has played a vital role in implementing a procedural guideline, which she believed had a concrete approach in the treatment and diagnosis of patients brought to the emergency department suffering from shortness of breath (SOB).

These laid guidelines dictate that a patient brought with the problem of shortness of breath should not be prescribed Lasix as his first treatment. This should wait until a comprehensive diagnosis of heart failure is done and confirmed by chest x-ray plus some other laboratory studies. The problem arises when Dr. Lacey decides to ignore these guidelines and continues to use Lexis as his drug of choice to anyone who comes with SOB problem. Worse to it, he puts it in the first line of treating patients with SOB, a prescription that goes against the laid down guideline.

Margaret reports over the weekend they nearly lost someone’s life due to the arrogant nature of Dr. lacey to the hospital’s guideline. The patient was suffering from confusion and shortness of breathing. The nurse assisting Dr. Lacey suspected Sepsis, but without following the right diagnosis procedure, Dr. Lacey prescribed Lexis, which made his condition worse than it was. The bottom line of Margaret’s complain was the problematic situation Dr. Lacey is putting nurses assisting him. Nurses are confused about whether to follow the hospital’s policy, which is for the good of the patients. Or to obey Dr. Lacey’s prescription, whose skills and professional competence are declining as he grows old.

Ethical principal decision-making model

Moral awareness

This is the ability that makes one be able to detect and appreciate the ethical element in a decision that must be made. In fact, it is the first step that one has to make so that he or she can act ethically. Failure to have moral awareness, whether, in personal or professional life, people would not recognize the moral elements of a situation they find themselves in. This would make them behave unethically without realizing it. Moral awareness prevents people from focusing too much on pleasing the boss or producing goals that undermine the ethical dimension of a particular act.

Moral awareness is the model Margaret uses when she finds it worthy of addressing the arrogant of Dr. Lacey in complying with the hospital’s policies. She is aware that the nurse has a responsibility to offer the best treatment to his or her patients. But on the other hand, she is under the dictates of the doctor she or he is assisting. The incidence that took place over the weekend, as expressed in the case study, shows that obeying Dr. Lacey’s orders might put a nurse in a situation where they are forced to act unethically.

Moral judgment

This model involves the human ability to use intuition or arrive at a decision through logical reasoning. But the decisions involved here need to have ethical content. It is necessary for the evaluation of behavior, course of action, situations, among other things. As an intuition judgment, it involves feeling and emotions in judging whether something is right or wrong. Intuitionists argue that the goodness or badness of a thing or action is first conceived in the feeling and emotions before it can get to rationalization in mind. On the other hand, rationalists claim that we reach a moral judgment by reasoning on the bases of ethical rules. Though these two ideas present different views, they should not be understood to be conflicting with each other.

Moral judgment is the model that nurses and Margaret demonstrate in this case study. It makes the nurses feel that the professional misconduct of Dr. Lacey is conflicting with their professional code of ethics. In her claim, Margaret, tells Corey that the nurses are limited in their work, in that they cannot watch over or stop doctors from treating patients in the manner they feel right to them. Deciding to take action and report the matter to convey is an indication that she and the nurses feel that morally compelled to disobey Dr. Lacey’s prescriptions for the good of the patients.

Ethical behavior

Ethical behavior is doing the act of choosing to do the right thing and observing the professional standards even in situations where no one is around to witness. It is choosing not to compromise one’s professional ethics to please the boss or a senior colleague. This model demands one go above loyalty and obedience to doing what is right.

It is this compelling feeling to act ethically right that pushes Margaret to seek intervention from Convey so that nurses can work professionally and do the right thing. In siting the unfortunate case that happened over the weekend, she was trying to show how much nurses are committed to acting ethically but limited by the fact that they must obey the orders given by the doctors they assist. They find themselves in a situation that they have nothing they can do in the presence of Dr. Lacey.

Factors that contributed to the problem

In this case, the major factor that contributed to the rise of the issues was fear of the fear of authority. Though the nurse was aware of the required protocol in treating patients who come into the emergency department with dyspnea. Dr. lacey, a doctor with a lot of experience, is unwilling to apply the new guidelines that have been put in place by the hospital board. The doctor is used to ordering medication from nurses without consulting anyone. A nurse is viewed as a junior officer who can give directives to the doctor. The nurse who was assisting the doctor on that day suspected that the patient had Sepsis, but due to the fear of authority, she could not voice out her opinion. This fear by the nurse-led to the facility almost the patient.

Another factor that led to the rise of this issue was the arrogance state of the doctor. The doctor, due to the experience he had in the field of medicine, could not conform to the new guidelines that had been put in place by the hospital. In his defense, he had always administered Lasix to patients who came into the emergency department with breathing difficulties. The new guidelines established specifically call for delayed use of Lasix until a definitive diagnosis of heart failure can be confirmed by chest Xray and laboratory tests. The new guidance did not sit well with the doctor who stuck his old methods of treatment

Effectiveness of Communication approaches

There are two communication approaches present in the case study, informative and persuasive approaches. Informative is explicit when the nurse assisting Dr. Lacey tries to give a different opinion on the problem the patients might be suffering from. When she advises the doctor on the importance of following the hospital policy in diagnosing the problem of difficulty of breath. It is also seen when Margaret goes to report the risk posed by Dr. Lacey’s actions. In this case, she informs Corey what is going on in the emergency department, information that seems to be new to him.

Margaret demonstrates the persuasive approach during her conversation with Corey. The whole idea of this communication was to persuade Corey to take action against Dr. Lacey’s arrogant to the hospital’s policies. The use of these two approaches was effective in delivering the message as intended. Corey got to know that something was going wrong in his department, and he was ready to take the most appropriate action.

How health professionals communicated among themselves

The communication among the professionals was a one-way communication from seniors in the top to juniors at the bottom. This kind of communication did not allow for dialogue between doctors and nurses. This the reason why even in a situation where a nurse knows the doctor is risking the life of the patient, she couldn’t alter the prescription. This what prompted Margaret to tell Corey that nurses have their work, and it does not include watching over doctors.

Communication strategies applied in creating and resolving the problem

One of the communication strategies that was involved in creating the problem is the strategy of valuing oneself and his experience in communication. Though this strategy is meant to be used positively, in this case, study it was highly misused, especially by Dr. Lacey. He had overconfidence in his experience of many years as a doctor and his unrefutably knowledge in the field of medicine. Due to this, he was unable to accommodate any other view or accept guidelines laid by other people.

In solving the problem created in the emergency department, Margaret used a communication strategy of focusing on the issue instead of focusing on the person. In this way, she was able to communicate her concern effectively to Mr. Corey without being influenced by his emotions or reservations she would be having on Dr. Lacey. This is how she was able to discuss the issue rather than the person, a discussion that would have been meaningless and ineffective.

Margaret also employed the strategy of being genuine instead of being manipulative. She communicated the nurses are facing under Dr. Lacey in honesty and an open manner. She did not cook stories to make her case look strong and serious to receive a quick address. She spoke of the issues as they were, and she was able to achieve the results she intended.

On his part, Mr. Corey contributed to solving this problem by applying the strategy of empathizing instead of remaining detached. He showed concern on the issue raised and expressed readiness to act. Through employing these communication strategies, the hospital was able to resolve the problem.

Instances where communication was effective or ineffective

Ineffective communication is seen when Dr. Lacey fails to have a constructive discussion with the assisting nurse. This leads to the nurse doing what the doctor orders him. The communication was a support to inform the doctor on the hospital’s policy on how to diagnose treating shortness of breath.

On the other hand, effective communication was seen in the conversation between Margaret and Corey. This communication employed practical communication skills and strategies. In this way, the discussion was able to meet its intended intention.

The effectiveness of the approach used by the professional

The method used by Margaret to address the problem faced by nurses with the head of the department was the best action to take. The ethical issue that was raised in this case study was whether the nurse should disobey the prescription given by the doctor or she should do what is right to offer effective service to the patient.

The code of conduct prescribes that a nurse supports the doctor in his work. The only thing she can do is what the doctor prescribes. The ethical question here is, should the nurse do what is right, even if it is against the hospital’s policies? Where do her first loyalty? Is it to the doctor? Is it to the hospital’s policies? Or is it to the dictates of one’s conscience on what is right or wrong?

To have an effective service delivery, there needs to be a system that allows the nurses to follow the dictates of their conscience. Sometimes the doctors or senior staffs are not always right. Therefore, there is a need to have a space for nurses and other junior staff to exercise what is right according to the laid guidelines.

Ethical principles to solve the problem in the case study

Several ethical principals can be applied to solve a moral problem like the one in the case study. Among these principles, one is the principal of professionalism. This principle dictates that any professional should act according to the laid guideline in whichever field one is. Among these guidelines is to perform per the policies of the profession.

The second principle is loyalty. Loyalty starts with a commitment to the client or patient. It is what is right for the client that one should seek to fulfill first. Then, one can observe the policies of the institution and the protocol.

The third principle is respect, respect for both senior and junior staff. It is morally wrong to undermine a piece of advice given by a junior staff without examining its relevance. Sometimes the information might be correct and the right way to go.

Conclusion

From the above discussion, ethical dilemmas are undoubtedly common in everyday life. But whenever one decides to act, he or she should act in an ethically right manner. Observing what is morally right should be the fundamental thing that one obeys. In making decisions on how to act or respond to a particular situation, one should be guided by ethical principles and employ the right communication skills and strategies in dealing with the problem.