Ethical dilemmas: a case study

Although the governing of medical conduct has always existed, medical ethics has become an issue to be addressed in the 1990s. The purpose of this article is to address the dilemma of reinserting a feeding tube in a patient whose wishes are unclear and whose family and physicians are in conflict. By presenting a case study, the author encourages the reader to resolve this dilemma on a personal level.     

Ethical dilemmas

Dilemma is the name we reserve for some of the hardest cases and issues in ethics. Ethical dilemmas arise from fundamental conflicts among ethical beliefs, duties, principles, and theories. This article discusses some of the morally disturbing dilemmas in nursing practice.     

Ethical dilemmas in curriculum planning

This paper delivers a discussion regarding the ethical dilemmas currently facing curriculum planners when designing nurse training programmes. The paper acknowledges the ideal of curriculum planning in nurse education and sets against it the worsening picture of nurse staffing levels facing many hospitals at present. It attempts to consider the esteem needs of the students and the legal requirements for care in relation to this dilemma. Whilst appearing to take a rather pessimistic view, the paper reflects the realities of the staffing problems currently being faced by some Liverpool hospitals.     

Ethical dilemmas in trauma nursing

For someone seeking to understand the ethical dimensions of trauma nursing, it quickly becomes apparent that there is a uniquely complex set of issues to be examined in this context. Many of these issues are made more difficult by the fact that the provider/patient relationship that undergirds the moral dimension of patient care in other contexts is necessarily truncated or absent in the trauma unit. This article seeks to explore some of these issues and the moral ambivalence they create.     

Ethical dilemmas in driver reeducation

This article illustrates ethical dilemmas faced by therapists who provide driver reeducation. The dilemmas discussed are (a) accepting a wide range of referral sources and client disabilities versus the inability to know enough to anticipate all driver performance errors, (b) the client's safety versus the client's right to independence, (c) financial constraints versus advantages of technology, and (d) the reporting of poor driving risk versus client confidentiality. A method for determining one's pattern of resolving ethical dilemmas is discussed.     

Ethical dilemmas in antibiotic treatment

Patients with moderate to severe infections are given less than maximum empirical antibiotic treatment in order to reduce the rise in resistance. This practice involves two ethical dilemmas: whether the danger to a present patient should be increased (even if by a small degree) to benefit future, unidentified patients; and whether this should be done without the consent of the patient, disregarding the patient's autonomy. We argue that future patients have a right to come to no harm. Future patients being unidentified, practitioners of medicine have a duty to protect their rights and weigh them against the rights of the present patient. A decision on the collective (guidelines, decision support systems) is a convenient way to do that. Using a temporal discount rate to show that the life of present patients has pre-eminence, to some degree, over future patients does not solve the immediacy of the plight facing a present, identified patient with a very severe infection. We think there are good grounds to take into less account considerations of future resistance for such a patient, or in a formal analysis, to make the ratio of benefits to the present versus future patients dependent on the severity of disease of the present patient. None of these solve the problem of patients' autonomy. We see no other way but to argue that the right of future patients to come to less harm outweighs the right of the present patient to share in decisions on antibiotic treatment.     

Ethical dilemmas in pain management.

The purpose of this study was to survey the membership of the American Pain Society and the American Academy of Pain Medicine to determine their beliefs about ethical dilemmas in pain management practice. Respondents rated ethical dilemmas for their importance as well as their own competence in dealing with these ethical issues. The survey also included an open-ended question that asked respondents to describe clinical situations in which they had encountered ethical dilemmas. A total of 1,105 surveys were analyzed, with physicians (N = 612), nurses (N = 189), and psychologists (N = 166) representing the professions with the greatest response. Management of pain at the end of life, general undertreatment of pain, and undertreatment of pain in the elderly were the most frequently encountered dilemmas. Qualitative data were analyzed to identify ethical issues in the case examples provided by the respondents. Major themes included inappropriate pain management, barriers to care, interactions and conflicts with others, regulatory/legal issues, euthanasia, assisted suicide, and research issues. We conclude that ethical dilemmas are common in pain management practice and that resolution of these dilemmas requires commitment by individual professionals as well as health systems.     

护生临床实习伦理困境的质性研究

目的 深入了解实习护生在临床实习过程中面临伦理困境的主观体验.方法 运用现象学研究法,采用目的抽样法对13例实习护生深入访谈以获取资料.结果 通过阅读、分析、反思、分类、归纳,提炼出以下3大主题:(1)操作规范性的伦理冲突;(2)自身能力不足的伦理冲突;(3)价值观差异的伦理冲突.对第1个主题的分析获得病人要求与规范操作之间的伦理冲突、临床实际工作与规范行为的伦理冲突2个次要概念;对第3个主题的分析获得保护性医疗与病人知情权的伦理冲突和安乐死的伦理冲突2个次要概念.结论 学校及临床带教老师应为实习护生提供多方面的、持续的应对伦理冲突的教育,促进实习护生伦理素质的不断提高.     

Ethical dilemmas associated with small samples

This paper describes the ethical dilemmas which the authors encountered when conducting qualitative research with samples consisting of a small number of participants. Ethical conflicts are explored in terms of the principles of autonomy, non-maleficience, and beneficience with examples from the authors' research experiences. Although there are no definitive resolutions to these conflicts, the paper may increase awareness of the special concerns which require further study and debate.     

Ethical dilemmas in perioperative nursing practice

Ethical dilemmas in perioperative nursing practice occur during all phases and in every practice setting. Awareness of commonly experienced dilemmas and understanding of a model available to analyze and resolve these dilemmas can benefit patients and perioperative nurses. Patients will benefit from nurse advocates who recognize and act to resolve actual and potential ethical dilemmas. Nurses will benefit when they are empowered with the knowledge and ethical skills to enhance patient autonomy, to protect dignity and confidentiality, and human rights. Perioperative nurses should reflect on previous dilemmas and use them to assist with resolution of similar dilemmas. They should be knowledgeable of personal, departmental, institutional, and professional resources available when faced with ethical dilemmas. The ANA code for Nurses and the AORN Statements of Competency in Perioperative Nursing are two resources available to perioperative nurses. In the increasingly complex, technologically laden surgical environment, patients who are sicker and living longer will require services of highly skilled and educated professionals. They are vulnerable in the surgical setting and need surgical teams to act on their behalf. Perioperative nurses with ethical skill are an asset to patients and other members of the surgical team when they seek to resolve ethical dilemmas in knowledgeable and systematic ways.