Applying Ethical Frameworks in Practice



ApplyingEthical Frameworks in Practice

ApplyingEthical Frameworks in Practice


Thereare numerous ethical dilemmas that are encountered in the health caresector. While some ethical dilemmas are easy to deal with, others arecomplex and demand fine analytical skills to come up with the mostappropriate decision. An ethical dilemma involves a situation wherean individual, mainly a caregiver or a family member of the patienthas to make a choice between competing options. In some cases, thecompeting options are accepting depending on individual’s valuesand ethical principles that come into play. In the above case, thechild is diagnosed with a life threatening condition. However, beforethe treatment on the minor can begin, the hospital has to seek thepermission from the guardian or parent. In the particular case, thebiological parents are divorced and therefore, the step mother hasprimary custody since the biological father lives in another state.Although he seeks independent consultation with another physician,the father agrees that treatment should commence. However, the stepmother who is a Christian scientist insists that her religious beliefdoes not allow medical intervention. The ethical dilemma is whetherthe physician and the nurse should treat the child according to thefather’s advice or follow the step mother direction not to treatthe child. Whether the hospital decides to treat the child or not,they will go against the will of either the father or the stepmother. The ethical dilemma is a choice between autonomy andbeneficence.

Uustalsethical decision model

Thereare numerous ethical dilemmas that nurses are faced with in the dailylives. Therefore, decision making is an aspect of daily life, as anurse and in the general social life. We need to make decision whenwe speak or act in all situations. While some decision are basic andminor, others involve critical ethical dilemmas where the decisionsare life changing (Jonsen, 2010). The decision made by a nurse maymake the different between life and death to a patient. However, themost important aspect of the decision making process is the ethicalconsiderations that come into play. In an ethical dilemma, the nurseshould make use of all the information available to him in order tomake the most appropriate decision. Failure to take intoconsideration some of the basic information may result into anunethical decision (Daviset al, 2010).There are several tools that a nurse can use to systematically andcritically analyze the available information in order to arrive at anethical conclusion. One of the tools is the Uustals ethical decisionmodel.

Uustal(1993) developed a nine steps decision making model that can be usedby nurses to analyze a situation and make an ethical decision. In thefirst step of the decision making process, the nurse need to identifythe problem in the situation. This includes the people as well as theissues involved in the dilemma and how they are involved. In thesecond step, the nurse should be able to state the values that guidehim or her and the ethical position in relation to the ethicaldilemma. The issues analyzed in this step includes whether thepersonal values and ethical position is congruent to the ethicaldilemma. The third step involves considering other factors in theethical dilemma and developing an alternative solution. In the forthstep, all the alternatives are analyzed and categorized depending onwhether they are consistence with the ethical position and personalvalues. The fifth step involves a prediction of all the possibleoutcomes of the alternatives that are more acceptable. This includesshort term and long term physical, social, psychological andspiritual impacts of each alternative. In the sixth step, the nursewill be required to list the alternative from the most appropriate tothe least appropriate alternative. The seven eight and ninth stepinvolves developing an action plan, implementation and evaluation ofthe action respectively. In the evaluation of the action, the nurseshould be able to whether the action was right and ethical dependingon the outcome and response (Uustal,1993).

Resolvingthe dilemma using the Uustals ethical decision model


Theproblem in the ethical dilemma is whether the hospital is shouldtreat the child or not. The physician and the nurses in the hospitalare involved in the ethical dilemma. On the other hand, the stepmother, who is opposed to treatment for religious reason and thefather who support treatment are also involved in the case.


Inmaking the decision, I will be guided by personal values as well asmedical and nursing ethics. According to my personal values, I have aresponsibility as a nurse to preserve life and alleviate suffering tothe best of my ability. On the other hand, I will be guided by theprinciple of autonomy and beneficence in making the decision.Patients have the right to self determination. In this case, thechild may not be able to make decisions, but his parents have theright to make decision on behalf of the child. Additionally, theprinciple of beneficence requires that medical workers should alwaystake actions that promote the wellbeing of their patients. Nottreating the child is against my personal value s as a nurse buteither decision violates the principle of autonomy or beneficence.


Inthis case, the hospital is required to balance between the desires ofthe step mother which are based on religious beliefs, the desire ofthe father to have the child treatment but also be examined byanother patient, and the responsibility of the hospital to take careof the child welfare.


Thefirst alternative is to treat the child. This is congruent to mypersonal values but violates the principle of autonomy. The secondalternative is not to treat the child, which violates my personalvalues and the principle of beneficence.


Inthe first alternative, the suffering or death of the child will bealleviated. However, the step mother will be spiritually hurt becausethis goes against her religious belief. In the second alternative thespiritual desires of the step mother will be satisfied at the expenseof the child suffering or life. Additionally, since the father’sdesire was to have the child treated, he will be unhappy in case ofcomplications.


Alternative1: Treat the child.

Alternative2: Not to threat the child.


Sincethe most appropriate alternative is to treat the child, the hospitalneeds to seek authority from the father. The informed consent of thefather, which may involve a second opinion from another physician,will be essential in solving the ethical dilemma. Help from achildren welfare department can also be necessary.


Treatmentcan be done with the authority of the father. However, caution isnecessary to avoid unnecessary confrontation with the step mother.For example, the hospital can retain the child until the arrival ofthe father.


Althoughthe decision to treat the child is against the desires of the stepmother, it is the right thing to do. This is because it preserves thelife of the child and is supported by the father.

Dialoguewith the family/parents

Asmedical practitioners,we have a responsibility to preserve life aswell as educate patient and their family about their health status.You son is seriously sick and require urgent medical attention. We asmedical practitioners respect you religious belief and values. Weappreciate the fact that we can have different views on any issuethat affects us. However, in out case, the life of the young boy isat stake. Failure to take appropriate medical action will result intosuffering and probably death. As parents, are you happy when thechild is suffering? Do you want the child to live? We are not sayingthat you should discard your religious values, but you need to savethe life of the child. You need to make a decision that will make thechild happy in the future. The principles that guide the medicalprofession will not allow use to release the child without treatment.Kindly allow us to proceed with the treatment.


Davis,A. J. et al (2010). Ethicaldilemmas &amp nursing practice,Boston: Pearson.

JonsenA. Siegler M. &amp Winslade W. (2010). Ethics. New York:McGraw-Hill Medical.

Uustal.D. B. (1993).&nbspClinicalethics &amp values: Issues and insights.East Greenwich, RI: Educational Resources in Healthcare.