Assignment 3: Ethical Issue/Dilemma

Student will be provided with an ethical issue by the lecturer. The student will be required to

critically analyzed the issue on hand and answer the following general questions. This activity

will provide students to apply specific course content discussed during the semester. Other

specific question on the case will be provided to the student for discussion aspect of the paper.

These will be provided when the topic is distributed to the groups.

Due date: No later than 5pm on the 22nd April, 2022.

Case Scenario

BB, 20-year-old, pregnant women was brought by the ambulance to the Accident and

Emergency unit in a critical condition following a road traffic accident. On assessment, she

was conscious with a good Glasgow coma scale but her blood pressure was fluctuating with

a low fetal heart rate. She presented signs and symptoms of internal bleeding and was

advised to have a blood transfusion and emergency caesarean surgery in an attempt to save

her and the fetus. She refused to accept blood or blood products and rejected the surgery

as well. Her refusal was based on a fear of blood transfusion due to her religious belief.

Applied Questions

1. Assessment: Explain the issue/problem.

a. What is the current undesirable situation?

 In the scenario presented I can see that there is a very undesirable situation

whereby a pregnant lady got into an accident. Due to this horrible situation the

doctors noticed that she had an internal hemorrhage and blood transfusion and
 caesarean surgery had to be done immediately to save both lives. She was brought

to the hospital where help was provided to her, nevertheless she refused to take it

due to the reason that her religion did not permit her to do so.

b. Who is being affected in this case?

 There are two main persons affected in this situation. The mother and the baby

because their life is at risk of death. Overall, the family members of Mrs. BB

would also be affected because no one is ready to lose a loved one, especially if a

baby is on the way.

c. What is the desired goal?

 The desired goal in this scenario is to be able to save the mother and the baby

2. Analysis: Conduct an ethical analysis.

A. What makes this an ethical dilemma?

An ethical dilemma is a situation where a nurse must decide between competing values and

know that no matter what choice they make, there are consequences. Ethical dilemmas may

conflict with the nurse's personal values or with the client’s personal values or with the Code

of Ethics for Nurses. Here we can see that the ethical dilemma presented is that the

nurse/doctors have to decide weather to save both lives or to respect the values of the patient

and find other alternatives.

B. Are there conflicting obligations, principles, values, rights, duties?

Yes there are a lot. It’s the nurses/doctors duty to help and save lives. However, the

patients have the right to decide whether they want the help or not. This is called patients
 autonomy. This is usually expressed as the right of competent adults to make informed

decisions about their own medical care. The principle underlies the requirement to seek

the consent or informed agreement of the patient before any investigation or treatment

takes place. A woman has the constitutional right to refuse unwanted medical procedures

and uphold her right to bodily integrity, self-determination, and privacy. Regardless of

the woman’s rights to individual liberty and privacy, it is important to consider that these

rights may not always be absolute. This is because when a woman is pregnant, the life of

the fetus is directly dependent on the actions and choices of the woman And here is

where the conflicting obligations, principles, rules and values emerge because it’s the

nurses’ duty to save the mother and the fetus but because Mrs. BB has certain beliefs it

makes it hard for the nurse/doctors to decide what to do.

C. How would the application of virtue ethics provide insight into BB's situation?

Virtue ethic mainly deals with something called consequentialism which makes the

goodness of outcomes of an action and the concept of moral duty central. This actually

means that if virtue ethics was to be applied in this situation it would mainly have to do

with consequentialism because they nurses and doctors would do what is morally right

for them which means transfusion of blood to save the dying mother and the baby even

though her religion does not permit it.

D. What other information is important to gather?

Some information that is important to gather in this situation is to take the blood pressure,

pulse and temperature. The nurse/doctors need to make sure that the donor blood type is a
 match for the blood type of the patient. They need to ensure that the blood supplied is the

product ordered by the doctor and is labeled with the specific name. A general survey

needs to be done to know the name, age blood type of the patient. Also information about

the fetus is important to know such as the heart rate.

3. Explore Strategies: Describe approaches to resolve the problem.

a. What are the potential strategies/approaches that emerged to address the dilemma?

A solution would be patient education so lay out how the blood with help her and advice

that it can be detrimental if not taken. And also some steps that can be considered as a

nurse are these:

Establish the facts surrounding the ethical dilemma.

Determine your legal obligations and duties.

Establish the interested participants involved.

Determine the ethical values of each participant.

Consider normative ethical theories as an aide to determine a course of action.

Consider options that would be ethically sound.

Consideration of the possible negative and positive outcomes of each possible option.

b. what are the risks and benefits that emerge from the discussions?

 After discussing this dilemma, it was concluded that there are possible risks and

benefits trying to solve this issue. If the blood transfusion is applied without the

consent form of the patient it will be considered as an unlawful act and the nurses
 or doctors may even go to court and prison for this act. Doctors have no right to

apply treatments on the patients who refuse it. As we know, the patients are well

informed by the health care providers about all the potential advantages and

disadvantages of the treatments that are proposed. The healthcare practitioners

must by law accept and respect the decisions of their patients even if it results in a

fatal outcome. A benefit would be that a child’s right to life is supreme and

therefore it must and will be considered before the religious beliefs of his or her

parents. This means that one positive outcome or benefit is that the doctors will

try everything to save the life of the fetus. But this can also result in misscarriage

or premature labor.

c. what are possible solutions/outcomes in this case?

d. how will the nurse address this dilemma?

Informed refusal may become difficult to adhere to in obstetric practice, especially in

situations in which the fetus’s life is at risk. One rare yet potentially problematic situation

of informed refusal is the case of a pregnant woman who refuses to undergo a medically

indicated cesarean delivery that would ensure the well-being of her fetus. I was speaking

with some colleges about this scenario and some argued that patient autonomy takes

precedence and the woman’s informed refusal should be respected, but others argue  that

beneficence, justice, and doing no harm to the viable fetus should ethically overrule the

refusal of a surgery. As a nurse I think I must be sure what my professional and legal

obligations are. Professional and legal obligations will likely allow me to easily decide on

a course of action to take in an ethical dilemma. In this case I would try to get in contact
 with the family members of the patient and explain to them what should be done so they

can help the patient to understand what is best for her and the fetus. I know that I’ll have

to consider several options, and each option ought to be considered critically by

determining what harm it would cause and what values the person being harmed holds. I

should consider the positives and negatives of the decision and determine the risks and

benefits associated with each option, as well as the benefits of each action, with these

values in mind. On my opinion I feel it’s my obligation to try and save both lives so I

would encourage Mrs. BB to accept the blood transfusion and take the cesarean surgery

because it would save her and her baby. If both die then I would feel bad because I know

i could have done something to help.      

e. What is the opposing arguments for this case?

As I stated before, I was speaking with some colleges about this scenario and some

argued that patient autonomy takes precedence and the woman’s informed refusal should

be respected, but others argue that beneficence, justice, and doing no harm to the viable

fetus should ethically overrule the refusal of a surgery. So these are the opposing

arguments for the action I would take as a nurse.