Introduction
In the modern, intricate healthcare environment, nurses and other professionals encounter challenging situations that demand critical thinking and decision-making skills. Ethical dilemmas involving two competing values and rights are nowadays standard in healthcare. Therefore, applying Guido’s MORAL model in challenging times can help nurses and other care providers in complex scenarios solve ethical dilemmas. Moreover, anchoring decisions in bioethical principles such as beneficence, autonomy, justice, and non-maleficence can also serve as a basis for resolving conflicts among patients, nurses, and physicians.
Objectives
Drawing on Guido’s provided textbook, this essay examines the application of Guido’s MORAL model to resolve the case “When Care Appears Medically Inappropriate,” which concerns a dilemma between nurses and physicians (Guido, 2020, p. 48). The nurses had contradicting opinions regarding the physician’s order to transfer Mrs. R to an advanced facility for continued life support care, considering it inappropriate care.
Moreover, this paper will address the ethical questions about Mrs. Helga Wanglie from the case “You Be the Ethicist,” grounding its arguments in bioethical principles to resolve the disputes in the case (Guido, 2020, p. 41). Finally, examining the Helga scenario from healthcare policy perspectives is essential, as it will reveal the role of organizational policies in advocating for patients’ rights and preferences.
Guido’s MORAL Model: When Care Appears Medically Inappropriate
Guido’s MORAL model is an appropriate framework for understanding and resolving the conflicting differences this case presents. According to Guido (2020), the MORAL framework is an ethical decision-making process with five steps that begin with a comprehensive understanding of the moral dilemma and end with the evaluation of the chosen course of action. These steps include massaging the dilemma (M), outlining the options (O), resolving the dilemma (R), acting with the chosen option (A), and looking back to evaluate the effectiveness of the entire process (L) (Guido, 2020).
First, in this case, the nurses must assess the situation and understand the matters at stake. They are in a challenging moment, having sworn to render appropriate care to all patients, regardless of their condition. On the other hand, they are expected to follow the physician’s instructions. Regarding the available options, they can either follow or refuse the directives of Dr. G, which they consider medically inappropriate.
The next step of Guido’s MORAL model will require the nurses to find their way out of this problematic state. They may need to channel their concerns about the directives to the primary physician. Nurses need to discuss the proposed treatment plan with Dr. G to assess its importance and suitability. If, in any case, the nurses still consider this treatment wrong and unsuitable, they must refuse the order and pursue the legal protocols and procedures outlined by the institutions for solving ethical issues.
After rejecting the requested treatment, the nurses must document the chosen action, the moral conflict, and its impact on the patient’s well-being in the patient’s record. Finally, the nurses need to review the actions taken to resolve the conflicting ethical issues regarding Mrs. R’s treatment. It is the responsibility of care providers and the organization to examine the dilemma presented in this case and develop strategies or policies to prevent such situations from happening in the future.
Responding to the physician’s call for advanced support may take several courses. For example, the nurses could openly and honestly discuss their concerns with Dr. G. Moreover, they can hold a comprehensive meeting with family members, ethicists, and an ethics committee to determine the patient’s best interests. Regarding the nurses’ distress, they may have experienced moral distress under pressure to maintain ethical commitments or to follow the physician’s directives. Thus, individual nurses need to periodically participate in ethics committees, formulate ethical policies and procedures, and seek support from colleagues and management to protect themselves from distress, as seen in this case.
You Be the Ethicist
The ‘You Be the Ethicist’ case on page 41 of Guido’s textbook, Legal and Ethical Issues in Nursing (7th ed.), revolves around Mrs. Helga Wanglie’s decision to continue receiving end-of-life care and the power that her family advocates have over her rights to live. Therefore, the compelling rights in this case are the right to live, the patient’s family’s authority to make treatment decisions, the physician’s decision-making regarding the treatment plan, and family members’ right to stay informed.
As Houska and Loučka (2019) noted, patient autonomy should be the primary factor in deciding whether the right is superior. As such, the family’s wishes and rights should guide the outcome of this case. Pozgar (2020) further states that organizational policies may also have influenced the outcome of this case. The study revealed that healthcare organizations have rules and procedures for addressing ethical issues, especially end-of-life concerns, to ensure that patients receive appropriate care.
Supposing Mrs. Wanglie had continued receiving end-of-life treatment, I would have applied ethical principles to resolve the conflicting issues. First, patient autonomy and her family’s decision must be considered. However, beneficence may revoke the family decision since it involves comparing the course of action that serves the best interest between stopping or continuing support (Childress & Beauchamp, 2021; Guido, 2020). Moreover, the non-maleficence principle is also essential when deciding this case. Continued proposed care subjected the patient to torture and suffering and thus was not necessary.
Furthermore, veracity, which entails opening up and telling the truth, may also resolve this case. I would need to tell her husband about her helpless condition. Finally, considering the principle of justice, it would be best to continue with life-supporting treatment until the husband is informed of the importance of withdrawing the plan.
Perspective of Healthcare Policy
There are several steps I would need to take to evaluate whether the healthcare policy for end-of-life care is necessary or requires improvement. The first step would be to assess and identify gaps in current policies and detail what should be done to make them appropriate. As Xu et al. (2022) noted, defining the process, objective, and inclusion criteria is also crucial in developing the policy. Assessing potential solutions, barriers, and ethical arguments, and defining the levels at which the observed conflicts in rights can be resolved, are part of policy formulation.
Finally, identifying the necessary resources and personnel to develop the policy is crucial. According to Guido (2020), Malone’s ten framework questions outlined in Chapter 4 provide valuable insights by offering a strategy for examining the ethical, legal, and social implications of a policy. Based on these questions, practitioners and organizations assess the need for end-of-life care policies, as well as the potential solutions and barriers to their adoption.
Process Proposal for Organization to Address the Identified Issue
- Title: Addressing end-of-life issues in the organization about patient, family, and institutional crises.
- Problem Statement: The lack of organizational policies, guidelines, and procedures that help address end-of-life issues.
- Rationale and Justification: The purpose of the proposal is to outline possible procedures, guidelines, and policies to enhance the organization’s end-of-life process.
Conclusion
Considering the intricate nature of the healthcare landscape in terms of ethical dilemmas, this essay has analyzed the application of Guido’s MORAL framework, ethical principles, and the role of institutional policies in settling morally challenging issues. The cases used are You Be the Ethicist and When Care Appears Medically Inappropriate, both of which emphasize patient autonomy in making ethical decisions. Moreover, it has also been discovered that institutional policies may impact a patient’s healthcare plan.
References
Childress, J. F., & Beauchamp, T. L. (2021). Common morality principles in biomedical ethics: Responses to critics. Cambridge Quarterly of Healthcare Ethics, 31(2), 1–13.
Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson.
Houska, A., & Loučka, M. (2019). Patients’ autonomy at the end of life: A critical review. Journal of Pain and Symptom Management, 57(4), 835–845.
Pozgar, G. D. (2020). Legal and ethical issues for health professionals (5th ed.). Jones & Bartlett Learning.
Xu, D., Luo, D., Chen, J., Zeng, J., Cheng, X., Li, J., Pei, J., & Hu, F. (2022). Nurses’ perceptions of barriers and supportive behaviors in end-of-life care in the intensive care unit: A cross-sectional study. BMC Palliative Care, 21(1).