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Applying Ethical Frameworks in Practice

Ethical dilemmas are situations that nurses frequently encounter in their profession. It can involve two or more different courses of action that can’t both be acted on, placing the agent in an uncertain position (Purtilo & Doherty, 2011). Ethical dilemmas place the agent with two different courses of action that leading to two very different outcomes. Ethical dilemmas include one’s own personal values, beliefs and sense of right and wrong. When a nurse is faced with this sort of dilemma, they will need to examine their own beliefs and values.
The ethical dilemma being presented in the paper is a six year old who a minor. The physician must legally get consent from the child’s legal guardian to proceed with medical care. The person who has primary custody of the child is not the child’s biological mother and is citing her religious beliefs to denying treatment. However, the biological father lives in another state and wants to seek treatment. It is the custodial mother’s right to deny treatment, and the biological father’s right to want to seek treatment, hence both choices that can end in two very different outcomes. When a difficult case like this arises and a decision must be made quickly, it is vital that a decision that is the most ethical and the best approach to solving the ethical situation at hand.
The decision making model that will be used and discussed in the paper to solve this ethical dilemma process that includes six steps and is discussed by Purtilo and Doherty (2011) in “Ethical Dimensions in the Health Professions.” This process allows one to take the situation apart, organize it in a calm-headed way while still being aware that emotions are high and how these feelings play a part in addressing the situation at hand (Purtilo & Doherty, 2011).
The first step requires gathering all the important data such as the clinical indications of treating verses withholding treatment. It also involves finding out more about the parent's relationship and if they discussed the situation. Identifying any possible communication barriers would be helpful while assessing the legal ramifications pertaining to this situation. The custodial mother has legal custody of the child and has the same rights in decision making that the biological father has even though he lives out of state. Obtaining a copy of the custodial papers to determine both parents' legal rights in making decisions for the child would be important at this time. Only one parent is required to sign for medical consent . Based on the child’s sign and symptoms of a high fever, seizures, and vomiting, there is a high likelihood it’s bacterial meningitis (CDC, 2014). The treatment for this includes IV antibiotics, seizure treatment, and IV fluids (CDC, 2014). Bacterial meningitis can be deadly and must be treated quickly. Withholding treatment can lead to serious lifelong complications such as hearing loss, brain damage, and learning disabilities (CDC, 2014).
Step two of the process identifies the ethical problem and moral distress. The ethical issue at hand is that the child is only six years old and cannot legally make his own decisions regarding his medical treatment. The moral distress would be withholding treatment resulting in further complications and possible even death. Due to her religious beliefs, the mother can withhold treatment as does the father for wanting medical treatment for his son.
The third step utilizes ethical theories and principles. An example of an ethical theory is Utilitarianism. Utilitarianism utilizes what is best is in the best interest for most people while emphasizing the consequences and outcomes of the action (ANA, 2014). In this case, the child would benefit from treating the meningitis.
The fourth step involves determining practical alternatives. By not initiating treatment could cause the child to endure lifelong disabilities and even death. The other alternative is to initiate treatment immediately due to the child’s signs and symptoms pointing to bacterial meningitis.
Step five is choosing which action will be taken. After careful review, it is critical that the healthcare team should implement treatment. Starting IV antibiotics, IV fluids, and anti-seizure medication is necessary for this child to receive a positive outcome.
The sixth step evaluates the outcome of the chosen action. It’s important to be understanding towards both parents and seek to find common ground. Being that this young child is unable to make his own decisions about his medical care, it was the nurses obligation to use the decision making model to give the best possible outcome for this child. The nurse had an ethical obligation to do what is right when faced with adversity, and that was being a advocate for this patient.
Family Dialogue
I would like you both to know that the decision that was reached was made with the utmost respect for your child and your family. We know that this is an emotional situation for everyone, and that both of you have strong feelings about which course of treatment should have been taken. We honor that and want you both to know we incorporated that into our decision. After thoughtful reflection and examination of the situation using an ethical decision making model, the decision has been made that it is in your child's best interest to receive immediate treatment for his meningitis. If it were to go untreated your son could very likely suffer life long disabilities such as hearing loss, brain damage, or even death. We will be starting him on fluids through an IV because he is dehydrated, antibiotics through his IV because this is a bacterial infection and antibiotics will help get rid of the infection he has and lastly, seizure medication. Please know this decision wasn’t made out of disregard pertaining to your personal beliefs. We very much respect them and would like to arrange for someone from your church to visit with you and your son.

References:
American Nurses Association (ANA). (2014) Short Definitions of Ethical Principles and Theories Familiar words, what do they mean? Retrieved fromhttp://www. nursingworld.org/MainMenuCategories/EthicsStandards/ Resources/Ethics-Definitions.pdf
Center for Disease Control. (2014). Bacterial Meningitis. Retrieved from http://www.cdc.gov/meningitis/bacterial.html
Purtilo, R. & Doherty, R. (2011). Ethical Dimensions in the Health Professions, 5th Edition. W.B. Saunders Company. St. Louis, Missouri.

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