Ethical Decision MakingIntroductionJust as nursing applies a systematic process for evaluating the condition of a givenpopulation to determine an appropriate intervention,

Ethical Decision MakingIntroductionJust as nursing applies a systematic process for evaluating the condition of a givenpopulation to determine an appropriate intervention, health care providers must alsoutilize a systematic process to assess the nature of an ethical dilemma to determine areasonable solution.Ethical decisions are reasoned choices based on:The dilemma itself.The principles in conflict.The people involved.The outcome of the proposed action.The ethical reasoning process selected.Ethical Decision MakingIt is helpful to use a decision-making model for ethical dilemmas in order to guide one’sdecision making from an objective, cognitive perspective, rather than a purely affectiveor emotional perspective. Uustal (1993) proposed the following steps to guide one’sethical decision making. Uustal’s model not only follows the nursing process, but alsoincludes values clarification when applying an ethical decision-making model.Step 1: Identify the problem. Ask:Who are people involved in the dilemma?How are they related or interrelated?What is involved in the situation?After answering the above questions, identify the ethical dilemma and make a concisestatement of the problem. Then, state the conflict in values.Step 2: State your values and ethical position related to the problem.How does the issue fit with your personal values?Are they congruent or incongruent?Step 3: Take into consideration factors that relate to the situation and generatealternatives for resolving the dilemma.Step 4: Examine and categorize the alternatives. Identify those that are consistent andinconsistent with your personal values.If the most appropriate alternative is inconsistent with your personal values, anotherprovider may be needed to facilitate resolution. This eliminates bias and preserves yourown ethical integrity.Step 5: Predict all possible outcomes for those acceptable alternatives.Consider physical, psychological, social, and spiritual consequences, both short-termand long-term.What might happen if you follow Alternative A?What might happen if you follow Alternative B?Step 6: Prioritize acceptable alternatives. List them in order from the most acceptable tothe least acceptable.Step 7: Develop a plan of action utilizing the list of acceptable alternatives. Determinewhat you are going to do about this dilemma.Step 8: Implement the plan.Step 9: Evaluate the action taken. Ask yourself the following questions:Did I do the right thing?Were my actions ethical?Characteristics of Ethical DilemmasFollowing is a review of the characteristics of ethical dilemmas:The choice is between equally undesirable alternatives.Real choice exists between possible courses of action.The people involved in the dilemma place a significantly different value judgment onpossible actions or on the consequences of actions. That is why there is a conflict. Ifeveryone involved agreed, there would be no ethical dilemma.Data alone will not help resolve the dilemma. One always wants more data, but it isnot available.Answers to the ethical dilemma come from a variety of disciplines (e.g., psychology,sociology, theology).Actions taken in an ethical dilemma will result in unfavorable outcomes and/orconstitute a breach of one’s duty to another person. Although the action taken maymeet the needs of one person or party, it may result at the expense of another.The choices made in an ethical dilemma have far-reaching effects on our perceptionof human beings and definition of personhood, our relationships, and people insociety as a whole.Any ethical decision involves the allocation and expenditure of resources which arefinite. If there were an infinite amount of resources to share with everyone in need,there would be no dilemma in deciding who gets the scarce resource.Ethical dilemmas are not solvable, but rather resolvable. A solution would mean thatthe problem is fixed. A resolution means that a decision has been made to determinea course of action in the situation.When one is faced with an ethical dilemma, there are specific ethical questions toaddress:What ought to be done in this case?Who should be involved in the decision making process?Who has the right to make the final decision? Why?For whom should the decision be made: for oneself, someone for whom you areacting as a proxy, or others?What criteria should be used in a dilemma? Psychological condition only?Physiological status, economic concerns, legal factors, social and familyperspectives, or spiritual considerations?What degree of consent should be obtained from the client?What harm or benefits will result from the decision and resulting actions?Does the ability to intervene justify the intent to do so? Just because it is possible,does it make it right?Ethics CommitteesAs a response to the growing number of ethical questions stemming from scientificadvancement, President George Bush established a President’s Council on Bioethics inJanuary of 2002. A significant step to approaching ethical dilemmas was made when thecouncil mandated the creation of ethics committees in acute care settings. Thesecommittees are comprised of members from different disciplines in and outside of healthcare as well as laypersons from the community. Committees often include an ethicist(educated in ethical consultation), a lawyer, a quality improvement manager, aphysician, a nurse, a clergyman or other spiritual director, and an individual from thecommunity at large.In the coming together of differing experiences, educational backgrounds and uniqueperspectives, the committee as a whole can produce a well-balanced discussion ofalternatives. In addition, these committees can provide recommendations intended toadvocate for patient’s rights and promote shared decision making, even in the face ofthe most challenging of ethical dilemmas. While the alternatives and recommendationsoffered by an ethics committee do not have the weight of law, they make a significantinfluence on decision making at the bedside and have the power to influence a judge orjury during any deliberation involving patient rights.ConclusionAs long as the delivery of health care involves human life, changing technology, andfinite resources, health care professionals will face ethical dilemmas on a daily basis.Often times, life-changing decisions must be made quickly. Because of the long-termand life-altering effects of many actions, it is important that ethical dilemmas be resolvedin accordance with ethical principles and theories. Just as health care professionalspractice CPR in order to be able to perform it efficiently in a real situation, it is importantthat health care professionals practice ethical decision making in a classroom setting sothat they are in tune with their own values and are better prepared to make ethicaldecisions when they occur in the clinical setting.ReferencesUustal. D. B. (1993). Clinical ethics & values: Issues and insights. East Greenwich, RI:Educational Resources in Healthcare.

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