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Older Patient Care and Related Ethical Challenges Essay (Article)

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Updated: Nov 15th, 2020


Nurses have to face various ethical dilemmas every day of their clinical practice. One of the major dilemmas is related to the principle of respect for patient autonomy as nurses try to provide the most effective care while patients may have their needs and perspectives concerning the treatment offered or provided (Cole, Wellard, & Mummery, 2014). The ethical dilemma is often associated with mental and palliative care as the populations involved are specifically vulnerable. However, the balance between the nurse control and patient autonomy is an ethical issue in acute care as well (Bull & Sorlie, 2014).

For example, the use of the respirator when addressing an acute condition in a patient suffering from a chronic lung disease. The relationship between the nurse and the patient should be developed with the focus on the patient health outcomes and the provision of the most appropriate care. This paper examines the way the ethical dilemma is addressed in the American society and includes some personal considerations on the matter.

Defining the Ethical Dilemma

First, it is necessary to identify what the ethical dilemma is and its effects on nursing. Brodtkorb, Skisland, Slettebo, and Skaar (2014) refer to the ethical dilemma as the availability of “two or more possible solutions between which are difficult to choose” (p. 7). One of the illustrations of such dilemmas is the situation when a patient refuses to undergo some procedures.

For instance, in mental or palliative care, patients are often affected by delirium or can have chronic mental disorders that affect their ability to make important decisions (Hem, Gjerberg, Husum, & Pedersen, 2016). In many countries including the United States, coercion is legally and morally accepted in such cases, which leads to a considerable restriction of patient autonomy. Thus, nurses have to decide whether they exercise their control and make their patients follow the necessary guidelines or they respect their patients’ right to choose even if this decision can lead to negative health outcomes.

Main Moral Issues

The moral issues involved in the case in question are closely related to the domain of the relationships between the patient and the nurse (Baykara, Demir, & Yaman, 2014). The patient should trust in the nurse’s expertise to be able to make a well-thought decision. In many cases, patients lack trust in nurses, as well as the entire system, which makes them less cooperative. Nurses also experience moral stress as they are often unsure in their own decisions. The respect for autonomy is often in conflict with the most beneficial treatment, and nurses often hesitate as they try to take into account patients’ desires (Tuominen, Leino-Kilpi, & Suhonen, 2014). The lack of confidence is increased due to nursing professionals’ own moral principles and religious beliefs.

Bioethical Principles Involved

Principle of Respect for Autonomy

The ethical dilemma in question is mainly associated with such principles as respect for autonomy and beneficence. When the patient refuses to use a respirator, the nurse has to respect the patients’ choice and their autonomy. The patient may have certain fears, beliefs, and other reasons to avoid certain procedures (Rasoal, Kihlgren, James, & Svantesson, 2016). Thus, choosing between life-threatening pain and a life-threatening chronic condition is the right of the patient.

Principle of Beneficence

At the same time, the nurse should make sure that the patient makes a choice based on detailed information concerning the available options (Choi, 2015). One of the major priorities of the nurse is the most positive health outcomes for the patient. If the nurse believes (or better knows) that the use of a respirator is beneficial for the patient, this healthcare professional should find the most effective arguments to persuade the patient.

Personal Morality

I understand that my decision can lead to immediate and highly adverse effects for a patient in an acute care unit. It has been acknowledged that one of the major challenges associated with maintaining the balance between nurse control and patient autonomy is the persuasion of the patient (Bull & Sorlie, 2014). I believe that I have an obligation to assume the role of an expert and persuade the patient to accept the procedures necessary to improve their condition.

Nevertheless, I also understand that patients may have doubts and fears, as well as certain perspectives, making them refuse the care, which brings me to the need to assume the roles of an expert and advocate. In some cases that do not involve life-threatening conditions, I am ready to respect the patient choice. However, I also believe that the human life is the most precious thing that can often be undervalued by patients in pain. I have met many people who were ready to die at some points of their lives but were grateful they remained alive.

The Morality of the Society

My moral values are consistent with the morality of the society I am currently living. In the western world, people respect individuals’ autonomy and their right to make decisions. However, the human life and the well-being of a human being are the major priorities (Choi, 2015). Importantly, the majority of western people also believe in technology and science, which makes them trust in the benefits of various clinical procedures.

It is necessary to note that these values are promoted through educational establishments as well as personal experiences, family, and community. At that, education plays a central role and students may start sharing particular values after the graduation from their educational establishments. I firmly believe that my studies, as well as my living in this country, made me adopt the western view of medicine, patients’ autonomy, and healthcare professionals’ role.


In conclusion, it is necessary to note that when the patient refuses to undergo certain procedures (for example, use a respirator), the nurse faces a difficult ethical dilemma. The nursing professionals should find the balance between patient autonomy and medical staff’s control and between beneficence and respect for autonomy. In many cases, western nurses tend to choose the latter option.

First, they have the knowledge, skills, and experience that help them identify the most appropriate options for the patients. Being knowledgeable makes nurses responsible for persuading the patient through the provision of detailed information on possible benefits and threats. Clearly, in acute care setting, the process of persuasion can be stressful as it is associated with limited time, patients’ pain and even delirium, life-threatening conditions.

Therefore, the nurse has to have a particular set of values and ethical norms to follow. There is no time to choose between different ethical approaches. I have adopted the western view of the overall healthcare systems as well as patient autonomy and nurse’s authority. Nurses often understand what is better for the patient, but they often lack the skills necessary to act in acute care setting. Nursing education is the platform for the development of these skills.


Baykara, Z., Demir, S., & Yaman, S. (2014). The effect of ethics training on students recognizing ethical violations and developing moral sensitivity. Nursing Ethics, 22(6), 661-675.

Brodtkorb, K., Skisland, A., Slettebo, A., & Skaar, R. (2014). Ethical challenges in care for older patients who resist help. Nursing Ethics, 22(6), 631-641.

Bull, E., & Sorlie, V. (2014). Ethical challenges when intensive care unit patients refuse nursing care: A narrative approach. Nursing Ethics, 23(2), 214-222.

Choi, P. (2015). Patient advocacy: The role of the nurse. Nursing Standard, 29(41), 52-58.

Cole, C., Wellard, S., & Mummery, J. (2014). Problematising autonomy and advocacy in nursing. Nursing Ethics, 21(5), 576-582.

Hem, M., Gjerberg, E., Husum, T., & Pedersen, R. (2016). . Nursing Ethics. Web.

Rasoal, D., Kihlgren, A., James, I., & Svantesson, M. (2016). What healthcare teams find ethically difficult. Nursing Ethics, 23(8), 825-837.

Tuominen, L., Leino-Kilpi, H., & Suhonen, R. (2014). Older peoples experiences of their free will in nursing homes. Nursing Ethics, 23(1), 22-35.

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