This assignment addresses the implications relating to an ethical dilemma encountered in practice using an appropriate model of reflection. The assignment will highlight ethical theories and four guiding ethical principles, such as autonomy, beneficence, paternalism and non-malificence. The two main principles that will be discussed in depth will be autonomy and beneficence and how they impact on practice. I will use Bortons (1970) reflective model, which was taken from Jasper (2003).
An incident, which occurred on practice placement, involved a patient’s decision to withdraw from active treatment. It is hoped that by exploring the incident in depth, a greater understanding of moral and ethical principles will be gained. All names that will be used within the text are pseudonyms. This is to ensure confidentiality, as stated by the Nursing and Midwifery Council (NMC 2004).
Health care professionals have a legal and moral obligation to care. They have to respect the patient’s decision even though they themselves find it difficult (Butts and Rich 2005). Decisions are not unproblematic. They have to be rationalised, as there are many dividing thoughts, which must be acknowledged.
The dilemma occurred whilst on practice placement with District Nurses (DN) in the community. It involved a 72-year-old female whom we shall refer to as Clare, who made a utilitarian decision to forego active treatment. It was an autonomous decision and the DN and I had to respect her choice but we were concerned with the practicalities associated with her judgment. Attempting to relieve pain and suffering is a primary responsibility for the nurse (Butts and Rich 2005).
Clare was extremely weak and she was not able to take the stairs. She was sleeping on the sofa in the living room. Our main concern was to make the as comfortable as possible and reduce the risk of developing pressure areas. Clare would be at quite a significant risk due to her lack of mobility so precautions would have to be put into place.
A dilemma, according to Thompson, Melia and Boyd (2004) derives from the Greek word, di-lemma, which highlights a specific state in which a choice has to be made between undesirable alternatives. It can involve a clash of principles to which there are no rules.
By refining the dilemma into a problem, which all health care professionals deal with on a daily basis to make moral decisions, we can solve or pacify the situation to our advantage (Tadd 1998).
Clare’s past medical history included recurring gastrointestinal problems. She had seen her General Practitioner (GP) with associated problems although he suggested that these were nothing serious, and gave her medication to ease her symptoms. Consequently, Clare was very disheartened and felt disillusioned with the service provided.
Upon admission to hospital for exploratory surgery following a traumatic episode of gastric pain, investigations revealed abnormalities. Two...