Ethical Dilemma in Nursing

Institutional Affiliation
Ethical Dilemma in Nursing
Nurses are faced by various ethical dilemmas everyday in their
workplaces. An ethical dilemma is an issue that lacks any satisfactory
solution. The implication of an ethical decision making is founded on
the fact that diverse ethical options concerning similar ethical dilemma
can be formulated (Bandman & Bandman, 2002). This results in neither
option being wrong or right. Nurses are guided by the nursing principles
in their daily functioning, and their ethical decisions are based on
such principles, together with their beliefs, values, and experiences.
In the United States, some of the hospitals are religious foundations,
and notwithstanding this, they are given government funding (Medicaid
and Medicare payments). However, some of them formulate policies in
order to abide by their religious beliefs and policies (Sloan
&VandeCreek, 2000). For instance, some religious based hospitals have
set up policies that impede their doctors and nurses from offering
certain treatment to their patients, including contraception (Stulberg
et al. 2010). This is the case in the faith based hospital in this case
where nurses are caught in an ethical dilemma between religion and
healthcare.
Purpose of the Paper
This paper investigates the complexities and issues in decision making
that has ethical consequences. As a nurse, am caught in an ethical
dilemma between religion and healthcare. The paper discusses this issue
comprehensively and offers alternative options to resolve the same.
Description of the Ethical Situation
Religion and healthcare is one of the major ethical dilemmas that nurses
are faced with (Stulberg et al. 2010). As a nurse in a faith based
hospital that has strong catholic beliefs, am faced with this ethical
dilemma. As per the hospital policy, nurses are not permitted to talk
about oral contraceptives with patients of child producing age. Besides,
they are not allowed to converse about any kind of abortifacient, give
or discuss birth control or tubal ligation, or fill patients’
prescriptions in case they are taking it as a home prescription.
In the hospital environment, I have come across various patients who
take oral contraceptives for different reasons. Nurses are necessitated
to acquire a correct copy of prescription list from home on a universal
medical-surgical floor. Once a nurse fills in a patient’s medical
record with oral contraceptive, it is difficult for them to be given the
same whilst in the hospital. Nevertheless, excluding it violates
hospital policy of obtaining right and precise information. To be
precise, while in the clinical setting, I encountered a patient who
listed oral contraceptive in her admission medication record. It was
clear to me that if I prescribed it in the medical record she could not
obtain it while in the hospital. On the other hand, omitting the same
meant violating the policy of the hospital which states that patients
need to be provided with accurate and precise information. This is the
dilemma I have faced whilst in the faith based hospital, and in order to
cope with it, have made an exception every time a patient talks about
oral contraceptives. Evidently, a woman has a right to choose whether to
use oral contraceptives or not, and her general practitioner might see
this to be medically important. A nurse has no power of preventing this
from taking place based on a formulated policy, rather than a
patient’s personality. The new Obama care movement requires hospitals
that depend on Medicare payment to offer such services for them to go on
receiving money from the government. This means that such hospitals
need to edit their policies to include the same.
Significance of the Topic
This topic is of paramount importance in that it is essential to know
the extent to which religion influences the provision of healthcare. In
the hospital setting, patients are asked regarding their religious
preference, as well as their beliefs and values as this is vital in the
provision of care. However, it seems such information is of no use as
patients are not cared for based on the same. The faith based hospital
imposes the Catholic views and beliefs concerning oral contraceptives
and the beginning of life to the patients. It is apparent that everyone
has the freedom of religion, and not every patient who visits the
hospital is a Catholic. Becoming a patient in the hospital automatically
turns one into a catholic until they are discharged. Forcing such
beliefs on the patients goes against or violates their rights.
By studying this topic, hospitals, nurses, and general practitioners
would know where to draw the line in matters related to religion and
healthcare. The ethical dilemma that nurses find themselves in with
reference to the issue would be solved. Besides, hospitals would learn
how formulating policies that are open to all religious beliefs and
values is paramount.
Major Issue
The main issue as seen in this case is that, the faith based hospital
has formulated a policy that averts pharmacists from administering oral
contraceptives to patients. Besides, it prevents nurses from talking
about oral contraceptives with patients of child producing age. They are
also not allowed to converse about any kind of abortifacient, give or
discuss birth control or tubal ligation, or fill patients’
prescriptions in case they are taking it as a home prescription. These
acts are believed to go against the values and beliefs laid down by the
Catholic Church. Non-Catholic patients are the most impacted by the
hospital policy. Their religious beliefs and values allow them to use
orals contraceptives. Women of child bearing age who visit the hospital
are not permitted to use oral contraceptives from home. The hospital
pharmacy does not store oral contraceptives, and this is not ethical
based on the fact that women have a right to choose. In addition, this
can potentially give rise to unplanned pregnancies once one is
discharged from the hospital after birth. It is true that some women
take oral contraceptives with an aim of preventing chronic medical
conditions including endometriosis, rather than avoiding bearing
children. In conjunction with oral contraceptives, the Catholic based
hospital does not offer tubal litigation to women, in spite of the fact
that it has been warranted medically for the safety and health of
mothers.
As a nurse, we are trained that patients are individuals with their own
rights. However, this becomes increasingly complex when medicine and
religion interlink. Every religion has its own values and beliefs as far
as the provision of care is concerned. In the hospital setting, patients
are only treated given that what the Catholic Church acknowledges is
taken into consideration, a factor that deprives individuals of their
rights.
Alternative Options to Resolve the Dilemma
The dilemma pertaining to religion and healthcare can be resolved using
various options. As aforementioned, the implication of an ethical
decision making is founded on the fact that diverse ethical options
concerning similar ethical dilemma can be formulated. This results in
neither option being wrong or right. In this case, two major options are
considered, which includes:
Editing the hospital policy in order to reflect a more open perspective
that covers all religions.
Giving patients the opportunity to take the oral contraceptive from home
supply.
Discussion of Ethical Principles Related to Each Option
Autonomy
Autonomy is the capacity for freewill. However respect of an autonomous
agent is not the same as being autonomous. Acknowledging a person’s
right to decide and make their choices and conduct themselves based on
their beliefs and values is considered as respect. On the same vein,
respect entails not only desisting from meddling with other people’s
choices, but also availing the necessary opportunities and conditions
for exercising their independence. It also entails refraining from
coercing others in their decision making, respecting privacy, being
honest and protecting confidentiality (Scension Health, 2013).
In health care setting, an individual’s autonomy is exercised through
getting consent. Respect of autonomy however, does not mean mandatory
cooperation with the other person’s actions. Within the Catholic
framework, respect of individual autonomy is also limited to the extent
that it must adhere to the accepted principle of justice, common good,
respect for people and stewardship. A health care facility is a moral
community that can be succinctly regarded as an autonomous agent. With
that in mind, Catholic health care facilities should by no means be
required to aid in any action that damages and negates its values,
institutional conscience and professional integrity. Such institutions
should not be seen as moving against the current, especially in regards
to family planning. Though in few selected cases, sometimes such health
care institution may be called upon to weigh its actions and principle
against contraceptives as this may be a major setback not only to the
nation but also tat the family level. Giving patients opportunity to
take oral contraceptive from home supply will not only ensure respect of
autonomy is maintained but will also accord people an opportunity to
exercise their autonomy, the basic premise upon which the principle of
autonomy is founded.
Justice
Distributive justice is one type of justice, which is at the heart of
Catholic tradition, and it is intertwined to the principle of human
rights and dignity (Scension Health, 2013). Distributive justice is
considered as to the society obligation to individual members in
relation to individual’s contribution, responsibility and need. In the
realm of health care, distributive justice means that each member in the
society has access to fundamental health care (Scension Health, 2013).
For everyone to live a full life respect for their human right is
paramount, and access of health care is a part of that. By denying
individuals opportunity to access contraceptives due to religion dogma
compromises their health care and consequently their human right.
Editing the hospitals policy in order to reflect a more open perspective
for all religions would play a huge role in ensuring distributive
justice is ensured.
Beneficence
The principle of beneficence means doing well and avoiding evil and is
the foundation of particular moral norms though this varies depending on
the degree of hoe one defines ‘goodness’ (Scension Health, 2013). It
is considered as a middle principle due to the fact that it is partly
dependent on how individual’s perceives the whole idea of goodness.
Therefore, it is not a definite moral rule and cannot self sufficiently
give us clear actions that amount to doing good and avoiding evil.
From the Catholic tradition some of the norms that stem from the
principle of beneficence are not aimed at ensuring justice for all,
respect for patient’s religious beliefs, goodwill, act of charity and
more importantly valuing the system in harmony with the principle of
religious freedom. It also encompasses appreciating the complexities of
life ad making sound judgment for our own good and others. It is under
this premise that affording others opportunity to access contraceptive
from home supply is pegged. It will not only allow easy access to
healthcare, but will also go along the way in respecting decisions and
actions of others individuals for the common good of all.
Nonmaleficence
This principle is considered as the outcome of the principle of
beneficence, and it means ‘first, do no harm’ (Scension Health,
2013). As such, it is considered as a middle principle and shares the
same features with beneficence. This principle is sometimes interpreted
to mean that if one cannot do well without harming others, then they
should act at all. Under the context of a health care, allowing others
to access contraceptive from home supply in a scenario where the life of
a ‘mother’ is a danger if conception happens can be perceived as
doing good since it averts death. Contraceptives meant to prevent
pregnancy may be construed being contrary to the beliefs of the
Catholics but giving patients a chance to access the same from home
supply is not.
Veracity
Medical practitioners have a duty of telling the truth to their
patients. Violation of the principle of veracity results in loss of
respect and trustworthiness from the patients (Scension Health, 2013).
The hospital policy requires nurses to offer right and precise
information. In this case, the nurse should be allowed to prescribe oral
contraceptive to patients, and this can only be achieved if the hospital
policy is edited to include people from all religious background.
Confidentiality
The notion of confidentiality requires practitioners to keep patients
secrets. The requirement of concealing information occurs from the fact
that revealing such information would cause harm to the patient, or the
profession (Scension Health, 2013). Information such as the use of oral
contraceptive by the patient to prevent chronic disease is paramount and
should not be concealed. In this case, the patient should be allowed to
use oral contraceptive from home supply in order to safeguard their
health and welfare.
Fidelity
The principle necessitates justice, loyalty, support, honesty, and
commitment to the patient (Scension Health, 2013). Nurses are supposed
to keep their promises and do what is required of them. In this case, by
giving patients the opportunity to take the oral contraceptive from home
supply would show the devotion of the nurses and the profession itself.
The ANA Code of Ethics Provisions and Sub-provisions Related to Each
Option
The American Nurses Association`s (ANA) Code for Nurses with
Interpretive Statements explains the values, goals, as well as ethical
principles which direct the nursing profession (American Nurses
Association, 2001). According to the ANA, Code for Nurses is not
negotiable, and nurses have a duty of upholding and adhering to the code
of ethics. Through this framework, nurses are able to formulate ethical
decisions while fulfilling their professional duties.
Provision 1 of the Code of Ethics requires nurses to practice with
respect and compassion for the intrinsic dignity, uniqueness and worth
of a person, unobstructed by concerns of economic or social status,
nature of health issue, or personal attributes (American Nurses
Association, 2001). Respect for human dignity is one of the subdivisions
which require human rights, dignity and worth of a person to be
respected. The other subdivision is the right to self- determination. In
this case, self-determination is also referred to as autonomy, and it
requires patients to be given a chance to voice in the provision o care,
offered complete and accurate information regarding treatment, and be
given a chance to plan for their care (American Nurses Association,
2001). Giving patients’ opportunity to take oral contraceptive from
home supply will not only ensure human rights and respect of autonomy is
maintained but will also accord people an opportunity to exercise their
autonomy, the basic premise upon which the principle of autonomy is
founded.
Provision 2 states that the main dedication of a nurse is to the
patient, regardless of whether he is an individual, a community, a
family or a group (American Nurses Association, 2001). Primacy of the
patient’s interests is one of the subdivisions. Nurses have a basic
dedication to the distinctiveness of an individual patient, and as a
result, provision of care should reflect such uniqueness. In order to
address the interests of the patient, it is critical considering their
relationships and family. In this case, by editing the hospital policy
in order to reflect a more open perspective that covers all religions
will assist in meeting the interest of every person despite of their
religion.
Provision 8 requires nurses to work together with other practitioners as
well as the public in promoting health needs. Health needs and concerns
is one of the sub-provisions which states that a nursing profession is
dedicated to promoting welfare, health as well as safety for all persons
(American Nurses Association, 2001). In this case, by giving patients
the opportunity to take the oral contraceptive from home supply would be
of great significant as they would guarantee their safety and health.
The Effects of Each Option on Affected Parties/Individual Involved in
the Situation
In addition to solving the ethical dilemma, the options would be of
great benefit to the affected parties. For instance, by editing the
hospital policy in order to reflect a more open perspective that covers
all religions, both the nursing staff and the patient would benefit. The
nurses would be able to talk about oral contraceptives with patients of
child producing age. Besides, they would converse about any kind of
abortifacient, give or discuss birth control with patients, and offer
tubal ligation, in addition to filling patients’ prescriptions in case
they are taking it as a home prescription. The hospitals pharmacist
would be able to administer oral contraceptives to women as the same
would be stocked in the pharmacy. On the other hand, patients,
especially those who take oral contraceptives with an aim of preventing
chronic medical conditions including endometriosis would benefit
greatly. Furthermore, women would be able to prevented unplanned
pregnancies once they are discharged from hospitals. The fact that the
hospital would start offering tubal litigation to women, would be of
importance towards the safety and health of mothers.
The other option which involves giving patients the opportunity to take
the oral contraceptive from home supply would be of great significant to
the patients. This is based on the fact that in addition to respecting
their rights, they are able to continue with their medication either for
preventing child bearing or chronic diseases. Both options are paramount
to the family of the patients as they are assured that the best care is
offered to their patients. The hospital would also enable them receive
money help from the government as the new Obama care movement requires
hospitals that depend on Medicare payment to offer such services.
Contextual/Situational Issues and Legal Premises Related to the Options
Editing the hospital policy in order to reflect a more open perspective
that covers all religions and giving patients the opportunity to take
the oral contraceptive from home supply will enable patients to use oral
contraceptives in the hospital environment, thus safeguard their health
and prevent unplanned child bearing. Nurses would also have the autonomy
of giving and discussing birth control with patients, and prescribing
the same. However, allowing such options in the Catholic based hospital
would go against the values as well as beliefs of the Catholic Church.
It is however apparent that, patients have a right of choosing proper
care and nurses has an obligation of providing the same as stated in the
Code of Ethics. Failure to prescribe oral contraceptives to patients and
denying them the same may promote a major legal issue in case harm is
caused to the patient. In a nutshell, the hospital necessitates
implementing the best option to see to it that proper care is provided
to all individuals in spite of their religious background.
The Best Option to Resolve the Dilemma
As aforesaid, the implication of an ethical decision making is derived
from the fact that varied ethical options relating to a similar ethical
dilemma can be formulated. As a result, neither of the chosen options is
right or wrong. However, selecting the best option to solve the dilemma
is paramount. In this case, the best option is to edit the hospital
policy in order to reflect a more open perspective that covers all
religions. The underlying principle behind the selection of this option
is the fact that, it has more pros as compared to the second best
option. For instance, the option will not only allow access of oral
contraceptives in the hospital, but will also assist in respecting
decisions and actions of other individuals for the common good of all.
It also upholds human rights in addition to allowing the nursing staff
to prescribe oral contraceptives to patients thus breaking the dilemma.
Summary and Conclusion
Religion and healthcare is one of the major ethical dilemmas that nurses
are faced with. In this case, the faith based hospital has a policy that
does not allow nurses to give or discuss birth control with the
patients, offer tubal ligation or prescribe oral contraceptives. Nurses
are caught in a dilemma of prescribing oral contraceptives as the
hospital does not allow them and omitting the same means violating the
policy of the hospital which states that patients need to be provided
with accurate and precise information. The Code of Ethics requires
nurses to offer proper care to patients in order to safeguard their
health and welfare. By editing the hospital policy in order to reflect a
more open perspective that covers all religions, and giving patients the
opportunity to take the oral contraceptive from home supply, the
hospital can meet the needs of all people notwithstanding their
religion.
References
American Nurses Association (ANA). (2001). Code of Ethics for Nurses
with Interpretive Statements. Retrieved April 28, 2013 from:
http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsf
orNurses/Code-of-Ethics.pdf
Bandman, E. & Bandman, B. (2002). Nursing ethics through the life span.
(4th ed.). Upper Saddle River, NJ: Prentice Hall.
Scension Health. (2013). Key Ethical Principles. Retrieved April 28,
2013 from:
http://www.ascensionhealth.org/index.php?option=com_content&view=article
&id=47&Itemid=171
Sloan, R. &VandeCreek, L. (2000). Religion and Medicine: Why Faith
Should Not Be Mixed With Science MedScape General Medicine 2 (3).
Retrieved April 28, 2013 from:
http://www.medscape.com/viewarticle/408068
Stulberg, D., Lawrence, R., Shattuck, J., & Curlin, F. (2010). Religious
Hospitals and Primary Care Physicians: Conflicts over Policies for
Patient Care. Journal of General Internal Medicine.
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