It is not a secret that nurses, just as many other medical professionals, regularly meet some ethical issues. On the one hand, they work with people, which can result in interpersonal conflicts and relevant situations. On the other hand, death-or-life cases are common in the healthcare system, and it is necessary to know how to deal with them correctly. The most famous examples of ethical dilemmas include end-of-life issues, patient privacy concerns, conflicts with patients or their relatives, organizational constraints, and many others. There exists the Nursing Code of Ethics that contains comprehensive information on how to handle various ethical issues; that is why it should be an indispensable book for many nurses. It means that each of the cases above requires from a nurse to evaluate a situation correctly, choose a suitable decision-making theory, and apply it step-by-step.
Introducing an Ethical Dilemma
As has been stated, there are many examples of ethical dilemmas that are faced by nurses, and it is impossible to say which of them are more complicated than the others. All nurses should be able to handle each of them successfully. In this case, they should have an appropriate level of expertise and experience. In the modern healthcare system, it is a typical case when providers should care for patients who require particular attention concerning their religion (Scharman, Burger, Shatzel, Kim, & DeLoughery, 2017). Thus, ethical dilemmas involving religious and medical affairs are common for nurses, which, however, does not mean that they are easy to meet.
Considering the fact that the U.S. is a multinational and multicultural state, there are many representatives of different religions among patients. In some cases, these religions, including alternative ones, can ban the use of some medical practices. Quite often, the prohibition refers to those procedures that can be detrimental for saving patients’ lives. For example, Jehovah’s Witnesses have a firm belief that it is a great sin for them to receive blood transfusions (Scharman et al., 2017). Besides, Scharman et al. (2017) state that many representatives of this religious group endanger their lives because of this conviction. Even though such patients should sign an official refusal to permit transfusion of blood, these situations can create specific issues for nurses. On the one hand, all medical professionals should respect patients’ autonomy and their right to make decisions without any pressure. On the other hand, nurses should do their best to provide the patients and their family with exhaustive information to try to make them change that decision. In this case, it can be reasonable to apply to the logical side of the issue, but religious beliefs often win.
Choosing an Ethical Theory
In modern nursing, there are a few ethical theories that can be helpful to resolve the dilemma. Each of them implies its own peculiarities and recommendations for use. Among the existing variants, natural law theory and deontology seem to be the most suitable ones. Thus, the first approach relies on the course of nature, meaning that everything is predetermined in the world. It denotes that any action or decision is right because it will inevitably result in the predestined consequences. On the contrary, deontology represents a different approach to the dilemma. According to this ethical theory, nurses’ decisions are determined by their duties and obligations (Amer, 2019). In this case, nurses should pay attention to what they ought to do without considering possible outcomes of this situation. As for the dilemma under consideration, the deontology theory stipulates that the voluntarily signed official refusal to receive blood transfusion should be the principal element in a decision-making process.
A few significant factors influence and explain the choice above. Firstly, nurses should respect the patients’ autonomy, and the selected ethical theory reflects this condition. That is why medical professionals are not allowed to force patients or their relatives to change their decisions. Secondly, this theory relieves nurses from responsibility for treatment outcomes. In other words, if the patient dies, the nurse should not be accused of this. The fact is that the deontology theory pays specific attention to mortality, considering it as a natural end, rather than someone’s guilt (Amer, 2019). According to the information above, one can note that the ethical theory applied depends on the circumstances and events involved. It denotes that every separate situation should be correctly analyzed to choose the necessary approach.
Applying a Decision-Making Model
Any dilemma requires a suitable decision-making model to be used, and the case under consideration is not an exception. The choice of a particular variant depends on a specific situation. In this case, a rational model seems to be the most helpful because of a few factors. According to Djulbegovic, Elqayam, and Dale (2018), rationality aims at achieving those outcomes that will be the most optimal for both nurses and patients. In other words, the model is said to be a compromise that satisfies the desires of both parties. That is why the given model is said to be useful in many cases when nurses are not sure what decision to take.
The rational decision-making model is said to consist of four particular steps that can help resolve the dilemma. Identifying a problem is the first and most natural step to be taken. In the given case, the issue is that the patient refuses to receive blood transfusion because of their religious belief even despite the fact that this refusal can lead to their death. The second step is represented by developing alternative solutions to the issue. As for the given case, there are two probable variants. It is possible either to make the patient change their mind to agree to the medical procedure or to consider the patient’s autonomy and right for self-determination. The third step is to choose a single variant from the two mentioned above. Even though the first strategy seems to be more humane, the nurse should follow the second scenario because it meets the ethical principles of the nursing profession. Implementing the decision is the final step of the given model. However, the nurse should provide the patient with exhaustive information on possible dangers of their refusal irrespective of their final decision.
Relevance for the Profession of Nursing
It is difficult to overestimate the relevance of the dilemma under consideration for nurses and the whole healthcare system. As Scharman et al. (2017) prove, the U.S. medical industry is forced to deal with a high number of religious patients, who require specific attention. As soon as nurses have significant meaning for care delivery and patient outcomes, these medical professionals regularly meet appropriate ethical dilemmas. For nurses to cope with these issues successfully, they should ideally know the main principles that govern their profession. Thus, it refers to the Code of Ethics that contains helpful information on how to handle this or that issue. As for the present example with the Jehovah’s witness and blood transfusion, nurses should know that the patient’s right for self-determination has primacy over other things. If the patient officially refuses from the medical procedure, the nurse should not try to make this patient change their mind forcefully. However, it is still necessary to explain the possible consequences of their refusal to the patient and their family.
Conclusion
According to their official instructions, nurses are regularly forced to deal with some ethical dilemmas. At present, there are many of them, and religious beliefs that can result in medical issues should attract precise attention of these health professionals. It often happens that a patient needs a blood transfusion to stay alive, but they refuse from it because of a religious commitment. In this case, nurses should apply a useful ethical theory. The deontology theory seems to be the most suitable in this situation because it makes the nurses follow their duties without considering external factors. Furthermore, a four-step rational decision-making theory can provide the nurses with the advice of what to do in this case. The steps are identifying a problem, developing alternative solutions, choosing among them, and implementing the suitable variant. They represent particular significance, and it is necessary to take each of them attentively. Thus, the ethical theory and the decision-making model above can provide nurses with essential information on how to handle the ethical dilemma under consideration.
References
- Amer, A. B. (2019). Understanding the ethical theories in medical practice. Open Journal of Nursing, 9(2), 188-193.
- Djulbegovic, B., Elqayam, S., & Dale, W. (2018). Rational decision making in medicine: Implications for overuse and underuse. Journal of Evaluation in Clinical Practice, 24(3), 655-665.
- Scharman, C. D., Burger, D., Shatzel, J. J., Kim, E., & DeLoughery, T. G. (2017). Treatment of individuals who cannot receive blood products for religious or other beliefs. American Journal of Hematology, 92(12), 1370-1381.