Running head: ETHICAL DECISION MAKING 1

Ethical Decision Making

Emily A. Ramsland

Grand Canyon University: NSG-436

11 August 2019
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Ethical Decision Making

Caring for children at the end of their life can be difficult for a variety of reasons. Health

care team members who care for children at the end of their life must consistently be reminded

of ethically correct standards and ultimately, they are always expected to do what is best for the

patient. For the purpose of this assignment, my thesis is: This paper will provide an analysis of a

nursing ethical dilemma describing the expected moral and ethical standards, additionally, an

exploration of providing safe client care with a proposed solution to the dilemma will be

included.

Analysis of Ethical Dilemma

End-of-life care for pediatric patients often is challenging for a variety of reasons

including moral obligation, ethical standards, and often unaccepted circumstances. Ethical

dilemmas occur most often when there is a disagreement between the healthcare team and the

family regarding the care that the child ought to be given. The personal values and moral norms

will be challenged for every individual involved. The nurse has a unique role in the care of the

dying child as they copious amount of time with both the family and the patient and can assist

them in the decision-making processes for their child. The nurse may also choose to consult with

the bioethics committee, risk management, palliative care consultants, and home hospice

organizations (Harrington & Hollye, 2005).

Each patient presents with specific needs and different presenting features all of which

are leading to death. The student nurse believes that each dying child should be given the respect

of treating them like a unique individual, not simply another number. Therefore, each case must

be carefully taken into consideration and a collaborative meeting between patients, families, and
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the healthcare team are vital in providing the most dignified death for each specific patient

(Harrington & Hollye, 2005).

Ethical and Moral Standards

Morality is described as having a protective nature for the life of others and yourself,

whereas ethics is the difference between right and wrong (McNamara, 2012). The principle of

ethics involved with pediatric end-of-life care includes respect, autonomy, beneficence, and

nonmaleficence. Respect for human dignity and proving unique care to each patient is a crucial

aspect of nursing that must be implemented for every patient. Autonomy is the right to self-

determination and for the patient to make decisions that are not affected by others. One

controversy in pediatric healthcare is at what point children can practice autonomy, some will

suggest them must be a legal adult, others are more lenient in suggesting that as long as they

understand the circumstances. Beneficence refers to doing what is best for the patient and their

well-being. Nonmaleficence is doing no harm to patients, including causing no unnecessary pain

physically or psychologically. When nurses and other health care team members are confronted

with an ethical dilemma, each ethical principle must be addressed to ensure the patient is

receiving what is best for them. In addition, most pediatric patients will have family that is

actively involved in their care and it is always best for the family to be involved in the decision-

making process for the dying child (Harrington & Hollye, 2005).

Providing Safe Client Care

When caring for a pediatric patient at the end-of-life, the nurse must consider the legal

obligation of the nurse to provide safe and dignified care to all patients. According to the Code of

Ethics for Nurses with Interpretive Statements, in provision 1 it states that, “the nurse should

provide interventions to relieve pain and other symptoms in the dying process consistent with
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palliative care standards and may not act with the sole intent of ending a patient’s life” (ANA

Center for Ethics and Human Rights, pp. 4, 2016). The nurse must respect the self-determination

of each patient and act carefully not to hasten the death of anyone. Nurses are also responsible

for providing physical comfort, psychological attention, interpersonal consideration and spiritual

anticipation for each patient. Nurses can be guided in proving safe patient care through the

American Nurses Association as well as the Code of Ethics for Nurses. These two references can

help the nurse depict his/her legal role as well as who else can become involved with difficult

situations (ANA Center for Ethics and Human Rights, pp. 4, 2016).

Ethical Decision

The “Character-Based Decision-Making Model” can assist in the ethical decision-making

process. This model involved three steps. The first step is that all decisions must take into

account and reflect a concern for the interests and well-being of all affected individuals. The

second step is realizing that ethical values and principles always take precedence over nonethical

ones. The third step is that it is ethically proper to violate an ethical principle only when it is

clearly necessary to advance another true ethical principle, which, according to the decision-

makers conscience, will produce the greatest balance of good in the long run (Josephson Institute

of Ethics, 2014). This model can be used to resolve the ethical dilemma of end-of-life care for

the pediatric patient. By following this model, nurses and all other health care team members can

ensure that they are providing ethically sound, competent care to their patient without applying

their own bias to the situation (Josephson Institute of Ethics, 2014).

Solution

A solution to the ethical dilemma is for each hospital to host monthly ethical decision-

making classes. Nurses and other healthcare team members involved with end-of-life care will be
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able to attend and gain a greater understanding of ethics, the rights of patients, and how to handle

different kinds of situations. This will equip nurses and the health care team to make appropriate

and well-educated decisions with the patient’s best interest at hand.

Conclusion

Pediatric end-of-life-care is one of the most difficult and morally straining careers in

health care. Nurses and all involved team members must consider what is best for the child and

the family and advocate for the rights of the patient. Through monthly ethical education classes,

all health care team members can feel fully equipped to handle any circumstance that they are

confronted with. This paper provided an analysis of a nursing ethical dilemma which described

the expected moral and ethical standards, additionally, it explored providing safe client care with

a proposed solution to the dilemma.

References

ANA Center for Ethics and Human Rights. (2016). Nurses’ roles and responsibilities in providing care

and support at the end of life. American Nurses Association. Retrieved from

https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/endoflife-

positionstatement.pdf

Harrington, J. & Hollye. (2005). Ethics in pediatric end-of-life care: A nursing perspective. Journal of

Pediatric Nursing, 20(5), 360–369. https://doiorg.lopes.idm.oclc.org/10.1016/j.pedn.2005.04.016

Josephson Institute of Ethics. (2014). Making ethical decisions: Model. UC San Diego. Retrieved from

https://blink.ucsd.edu/finance/accountability/ethics/model.html

McNamara, C. (2012). What are values, morals, and ethics? Blog: Business Ethics, Culture and

Performance. Retrieved from https://managementhelp.org/blogs/business-

ethics/2012/01/02/what-are-values-morals-and-ethics/