Navigating Ethical Dilemmas in Modern Healthcare: Challenges and Solutions
Discover how healthcare professionals navigate complex ethical dilemmas in nursing and midwifery. Learn about real-world challenges and practical solutions in today’s clinical settings.
A dilemma is a tough situation. It’s hard to decide when values clash or there’s no clear right or wrong answer.
An ethical dilemma is a situation in nursing and midwifery where there are two or more choices. Each choice has effects, making decisions very difficult.
In this article, we will cover:
Definition of ethical dilemma
An ethical dilemma is a situation in nursing and midwifery with two or more choices. Each choice has its effects, making decisions very difficult.
Nursing has a code of ethics that guides nurses in their practice and decision-making.
Ethics is a system that helps us identify and understand what is good or bad, right or wrong.
The best philosophy helps nurses make decisions in complex situations.
That idea is:
1. Socrates focuses on knowledge. 2. Plato focuses on happiness. 3. Aristotle focuses on virtue. 4. Immanuel Kant focuses on duty. 5. Jeremy b. focuses on the utility.
Socrates believed in the pursuit of truth through questioning and reflection. In nursing, this involves critical thinking. It also requires using evidence-based practice to make smart decisions. A nurse using Socratic thought focuses on understanding everything about the situation. This includes medical facts, patient values, and legal limits. Then, they can decide how to act.
For Plato, true happiness comes from living a virtuous life. In nursing, this involves working toward the holistic well-being of patients. A nurse may look at what actions will best support the patient's well-being. It's about promoting long-term health, not short-term comfort.
Aristotle emphasized developing moral character and virtues like compassion, courage, and wisdom. A virtuous nurse would ask, “What would a good nurse do?” and act in a way that reflects moral integrity, such as advocating for a patient even when it is difficult.
Kant’s philosophy focuses on moral rules and the importance of human dignity. This respect is key, no matter what the outcomes may be. A Kantian nurse sticks to professional codes and ethical duties. This includes patient confidentiality and honesty. They do this even if breaking these rules seems easier or better at the time.
Bentham said the right action is the one that brings the most happiness to the most people. A utilitarian nurse focuses on actions that help the most people. They may focus on saving more lives with limited resources. This can mean that one patient might not receive all the help they need.
Nurses take a holistic approach to health. We focus on mental, spiritual, social, psychological, and physical aspects. This aligns with WHO guidelines. Health means achieving complete well-being in body, mind, and social life. It’s more than just not being sick or weak.
A code of ethics is a set of laws and rules that guide nurses in their practice. It outlines their responsibilities and defines what is right and good for patients.
Nurses have core duties and important principles of nursing ethics. The ICN and ANA outline these.
Four fundamental responsibilities of nurses are: 1. To promote health, 2. To prevent illness, 3. To restore health, 4. To alleviate suffering.
The four main principles of nursing ethics are: 1. Autonomy 2. Beneficence 3. Non-maleficence 4. Justice.
In the ethical dilemma, nurses use this code of ethics to guide their actions.
Let's take an example of a case of an ethical dilemma and look at how we can make a decision.
Real Case in Nurses' Everyday Life
In one of Africa's busiest cities, a man named Patrick worked as a nurse in a public health clinic. Everyone who knew Patrick respected and liked him because he was a man of high moral standards. He lived and showed values like caring, generosity, and compassion. He also embodied humility, integrity, loyalty, and moderation. He was patient, persevering, reliable, respectful, responsible, tolerant, kind, and understanding. The clinic where Patrick worked provided free and anonymous testing. It also offered confidential counseling and advice for HIV patients. In a counseling session, Patrick found out that a patient with HIV hadn't told his sex partner. He also did not use protection. Patrick noticed that the patient did not plan to change that attitude. In some countries, a patient's actions can be serious crimes. These behaviors are punishable by law.
Questions are: 1. Assume you were Patrick; what would be your reaction in such a situation and why?
2. Between what two elements does the above case raise a dilemma on the side of Patrick and his health clinic?
If I were Patrick, I would respond with caution while maintaining a strong stance. I would balance patient confidentiality with the need to prevent harm to others.
Steps I would take:
Keep the counseling session going. Explore the patient’s thoughts. Use empathy, education, and persuasion to encourage change.
Emphasize safe sex practices. It's crucial for protecting everyone’s health. Exposing others to HIV with awareness can lead to serious legal and ethical issues. So, always prioritize safety to prevent harm.
Review clinic policies. Follow ethical codes. Also, check legal frameworks from nursing boards or local health authorities.
If the patient remains unwilling to inform partners and poses a clear risk to others, I would:
Talk to senior staff or an ethics committee if you see any confidentiality issues. Also, discuss exceptions under public health law.
In places where it is allowed, report the case to public health. You can do this without sharing your identity. They may have the power to act.
Why:
As a nurse, I have a duty to maintain confidentiality, which builds trust in the healthcare system.
I must also protect others from harm. This is crucial, especially if someone is putting lives at risk.
The principle of non-maleficence, or "do no harm," might allow breaking confidentiality. This is true if it can stop significant harm to others.
From a Kantian view, it is essential to protect the patient’s dignity and rights. Yet, we must also respect the rights of the partner(s).
A utilitarian would argue that warning or protecting many potential victims is the best choice.
2. Between what two elements does the above case raise a dilemma for Patrick and his health clinic?
The ethical dilemma arises between:
1. Patient Confidentiality
A core principle in healthcare, especially in HIV/AIDS care, is essential.
Patients need to feel safe to disclose sensitive information.
Breaching confidentiality may damage trust and discourage others from seeking care.
Versus
2. Duty to Protect Public Health and Prevent Harm
The nurse and clinic must protect others from harm that they can predict and avoid.
Letting an HIV-positive person take risks can cause new infections and legal issues.
The International Council of Nurses (ICN) Code of Ethics has four key principles: 1. Nurses and people, 2. Nurses and practice, 3. Nurses and professionalism, 4. Nurses and co-workers.