Introduction
This executive report is prepared to give an account of the recent case of the patient Mr. Nichols, who was admitted to the intensive care unit after suffering a heart attack. The actions of the healthcare providers caused dissatisfaction among the patient’s relatives, who also failed to find a common ground in deciding upon the best treatment option for the patient.
Thereof, the case raised three ethical dilemmas across distinct dimensions of the health care setting, including organizational, formal process, and end-of-life planning. All of them demanded a thorough examination of the conflicting sides to choose the most appropriate course of action. In the decision-making process, I followed the principles of prioritizing the patient’s interests and safeguarding the hospital’s interests against potential legal consequences.
The Organizational Dilemma
The organizational dilemma arose from competing obligations between securing the organization’s well-being and pursuing the interests of the patient, Mr. Nichols. In the given situation, the patient’s DNR and DNI orders were not followed, and he received treatment from our healthcare providers. These actions contradict the principles of patient-centered care, which hold that respect for autonomy is the highest ethical imperative.
According to Wiesen et al. (2021), autonomy is the “patient’s right to self-determination and to make personal medical decisions” (p. 517). At the same time, the medical workers had to align with the hospital’s standards of conduct, which regard human life as the highest priority. Therefore, they were guided by the goal of not compromising the hospital’s reputation by harming the patient. The above-mentioned internal factors and ethical principles were considered while resolving the dilemma.
In my decision-making, I also considered additional external factors that contributed to the problem. The key issue is that the substitute decision-makers represented Mr. Nichol’s interests. They failed to provide advance health care directives, a document that proves a representative was legally appointed to make “health care decisions on a person’s behalf” (Pope, 2023). Otherwise, the hospital could face lawsuits, resulting in nurses experiencing significant emotional distress from causing harm to the patient (Hansson & Fröding, 2020).
Taking all this evidence and regulatory forces into account, I concluded that saving Mr. Nichols was a necessary measure to strike a balance between protecting the patient and fulfilling the core obligations of medical workers, given limited access to information. In this process, I was guided by the ethical principle of non-maleficence, which requires healthcare providers to weigh beneficence and non-maleficence in any situation (Haahr et al., 2019). My integrity helped me stay unbiased and consider the interests of all parties: the family members, the patient, and the hospital. Consequently, I arrived at a solution that I believe meets the highest ethical standards of care.
The Formal Process Dilemma
The second dilemma concerns the existing inconsistencies in the formal process for fulfilling obligations to the patient under limited information, as I discussed earlier in this report. In the given case, Mr. Nichols, the patient’s daughter, expressed dissatisfaction with the actions of a nurse who, in her view, acted unethically. Therefore, Mr. Nichols could accuse the nurse of negligence and breach of her legal duty (Wiesen et al., 2021).
However, the question arises as to the extent to which the nurse may be regarded as responsible for decisions affecting the patient’s safety. According to the hospital’s internal policies, formulated in accordance with the World Health Organization’s Code of Ethics, nurses should act within the scope of their authority (“World Health Organization”, 2023). Therefore, the nurse who communicated with the patient’s daughter could not provide assistance that would alter the case’s outcome.
Subsequently, to resolve this ethical dilemma, I considered the organizational policy that warns health care providers against making decisions beyond their expertise. The rationale for this policy was grounded in the ethical principle of not causing harm and of avoiding malpractice when a person performs duties beyond one’s professional skill (Wiesen et al., 2021). External factors, such as the threat of litigation and the potential jeopardization of medical ethics standards, strengthen the importance of this policy. To arrive at a conclusion that aligns with professional conduct, I grounded my decision in my integrity and in the principles of justice and the defined responsibilities of medical workers.
The End-of-Life Planning Dilemma
The last dilemma to be discussed touches upon the ethical and legal implications of an end-of-life decision. This is a complex issue that required me to thoroughly examine the hospital’s internal organizational policies and external and regulatory factors to support my decision to discharge Mr. Nichols. The internal policy of our facility is rooted in a patient-centered approach to healthcare that prioritizes “maintaining and respecting the individual’s dignity and integrity” (Haahr et al., 2019).
From this standpoint, the hospital must fulfill the patient’s will and respect his right to autonomy. To comply with external procedural regulations, the hospital obtained informed consent from the patient after he regained consciousness. Therefore, the decision has no legal, ethical, internal, or external obstacles.
In the decision-making process regarding this dilemma, I had to adhere to standards of conduct that prioritize the patient’s benefit. Even though the need to discharge the patient posed a moral dilemma due to the sensitivity of the issue, I rejected subjective reasoning. I approached the case objectively.
Moreover, the examination of all facts and procedures proved that there were no information gaps or conditions that could influence Mr. Nichol’s reasoning. He and his legally appointed substitute decision-maker expressed similar intentions, which I used to resolve the situation. Thus, my integrity prompted me to act in accordance with the available evidence and to consider the patient’s well-being.
Conclusion
The case of Mr. Nichols presented complex ethical dilemmas that demanded an in-depth understanding of medical ethical standards and legal regulations to inform decision-making. Therefore, to resolve the issues, I gathered as much detail as possible about the situation and reviewed the existing policies pertinent to the DNR and DNI orders and the end-of-life decision. While working through the dilemmas, I proceeded from the highest ethical imperative: pursuing beneficence and non-maleficence for patients, employees, and the hospital. Adherence to integrity and personal beliefs helped me remain confident in my strategies of dealing with the situation.
References
Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2019). Nurses experiences of ethical dilemmas: A Review. Nursing Ethics, 27(1), 258–272.
Hansson, S. O., & Fröding, B. (2020). Ethical conflicts in patient-centered care. Clinical Ethics.
Pope, M. T. (2023). Overview of Legal and Ethical Issues in Health Care. MSD Manual.
Wiesen, J., Donatelli, C., Smith, M. L., Hyle, L., & Mireles-Cabodevila, E. (2021). Medical, ethical, and legal aspects of end-of-life dilemmas in the Intensive Care Unit. Cleveland Clinic Journal of Medicine, 88(9), 516–527.
World Health Organization. (2023). WHO Code of Ethics.