Introduction
An ethical dilemma includes a responsible person and two or more morally correct courses of action. It is a situation where those actions cannot be followed simultaneously, resulting in different outcomes and placing the person in a difficult position. The right decision can be made by choosing one course of action, but not choosing the other would be wrong. Ethical dilemmas involve assessing personal values, beliefs, and ideas about right and wrong.
Ethical Dilemma
A patient from the Appalachian region receiving care at the facility wishes to discontinue treatment for stage 4 bone cancer, while his family insists he continue. The family has repeatedly verbally abused the nursing staff for respecting the patient’s decision. As a result, the attending administrator convenes the ethics committee.
Ethical Decisions’ Frameworks
To resolve the ethical dilemma, the problem must be considered as broadly as possible and from different angles. All solution options must be thoroughly examined, and for most ethical decisions, there are three basic frameworks: consequentialism, virtue ethics, and deontology (Morrison, 2019). The duty framework will be applied in this case and is described in the following section.
The consequentialist framework is about making a decision based on the preference for the consequences that each of the proposed options implies. The condition and opinions of people directly or indirectly affected by the decision must also be taken into consideration. However, this framework is not pragmatic enough, as it is sometimes impossible to consider all factors and predict all the consequences of a particular decision (Matthews, 2018). It is challenging to apply this method in the situation in question because stage-four bone cancer is a severe disease, but it is still treatable.
Second, the virtue framework focuses on the individuality of the people interested in one option. Their good and bad traits are considered, and their motivation correlates with them. The negative behavior of the patient’s relatives toward healthcare personnel, as described in the case study, is insufficient to make a decision. People whose close relatives are seriously ill are under constant stress (Morrison, 2019). There are not enough details about the situation; their reaction could have been motivated by concern for the patient’s health during the conflict.
Ethical Committee Assembly and Action
The duty framework, which is planned for use in the case study, focuses on the duties of the individuals making the decision. It depends on the dues and obligations of everyone involved (Morrison, 2019). This method is the most impersonal and unemotional, which is appropriate in situations involving an emotional issue, such as a voluntary refusal of necessary treatment.
Before the ethics committee meeting, it is necessary to review all the data and collect all possible information. It includes communication with the patients and their relatives. Sometimes the issue can be resolved in a simple dialogue without creating an ethical dilemma for the hospital staff and the treating physicians (Morrison, 2019). After the patient and his relatives have justified their points of view, it is necessary to ensure they have also spoken to each other.
The situation description initially lacks facts, such as the patient’s physical and mental state, age, and operability. Therefore, the ethical dilemma assumes that the patient is elderly but operable and in a good mental state. Ethnic group affiliation may also be taken into consideration.
Although there are many stereotypes about Appalachian people in general, there are still communities where the basic interaction principles between people are based on religiosity and collectivism (Purnell & Fenkl, 2019). In this case, religiosity does not prohibit the patient’s relatives from trusting the treatment. At the same time, collectivism and spirituality prevent them from letting him make an individual decision.
The diversity of its members must be considered when forming an ethics committee. According to the initial issue, in this case, the committee should include the attending physician and nurses, the institution’s administration, a lawyer, a psychiatrist, and a sociologist with knowledge of the specific ethnic group’s characteristics. Medical personnel had direct contact with the patient and his relatives; their opinion is also relevant.
A lawyer can explain the situation from a legal perspective, and a sociologist can help the committee understand the intricacies of the specific relationships among Appalachian people. The psychiatrist should be the specialist who interviewed the patient and can provide certain conclusions based on that. Such specialists will be better equipped to understand all aspects of the issue. In conducting the work of an ethics committee, there are six main steps (Matthews, 2018):
- Recognize the origin of the problem.
- Identify the ethical question.
- Consider related principles and methods.
- Determine the possible outcomes and options.
- Recommend a decision.
- Anticipate the conflict.
Furthermore, it should not be overlooked that the ethical committee is intended to act more as advisers and teachers, rather than as decision-makers. Patients, their relatives, physicians, nurses, and other interested parties should not be obliged to accept the committee’s recommendations. If a dissent occurs, parties should explain their motives when they decide not to follow the committee’s recommendations in a particular case.
Conclusion
Based on the analysis, the committee’s outcome would be to recommend that the patient’s request be satisfied. The mentally healthy person has every right to refuse treatment. If, after the consultation, he has explained his position and does not change his mind, his wish should be granted. His relatives should also be given adequate feedback to explain that every person has the right to decide for themself. Perhaps having the therapist work simultaneously with the patient and his family will help resolve their misunderstanding and move forward. Ultimately, the patient’s decision will be respectfully accepted, or treatment will resume voluntarily.
References
Matthews, P. (2018). Ethical questions in healthcare chaplaincy: Learning to make informed decisions. Jessica Kingsley Publishers.
Morrison, E. E. (2019). Ethics in health administration: A practical approach for decision makers (4th edition). Jones & Bartlett Learning.
Purnell, L. D., & Fenkl, E. A. (2019). People of Appalachian heritage. In Handbook for Culturally Competent Care (73-82). Springer.