5 Types of Ethics Dilemma Encountered in Healthcare : Discover


Ethics are part of the working code in healthcare. Healthcare has become one of the most fragile environments for snap decision-making. At the heart of it all are nurses who are tasked with relaying information, negotiating, and discussing health decisions with patients. To govern all this, the nursing community has long been reliant on ethics and principles for guidance. 

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What are ethics?

In a normal world, ethics would be defined as a code of conduct for the practice of one’s responsibility. In the nursing world, though, ethics are more than just responsibilities. To some plausible extent, ethics can become impediments to one’s duties – a hard nut to crack. For this reason, 4 ethical principles embody the practice of healthcare administration.

Ethical Principles of Healthcare

They are just four, the core ones;

  1. Autonomy

The principle of autonomy requires that healthcare is administered based on the patient’s preference, decision, and wishes. Anciently, the autonomy on patient care rested with the physician in charge. The situation has evolved, and at the current age no hospital staff is allowed to not just make decisions on behalf of the patient, but also influencing the patient to these decisions.

Autonomy comes with so many legal intrigues, such that the provider is expected to be adept with all legalities around healthcare administration. A point in case is the qualification of consent, which changes a lot from jurisdiction to jurisdiction. At an age below 18 or 16 in some countries, the patient does not consent to any decisions, and in their place the guardian holds that autonomy.

However, emancipation has grown into the society, placing nurses at an even tighter spot. Briefly, emancipation comes in the forms of (i) Underage marriage (ii) Expulsion by parents/guardians (iii) A court order (iv) Underage parenthood, and (v) Unequivocal responsibility on the minor. Emancipation is one of the dynamic laws across different jurisdictions, and nurses should be keen to follow the rule of the situational land.

  1. Beneficence

This principle requires healthcare providers to be kind to the patient, and relieve them from any pain, injuries, or terminal consequences. Beneficence as a principle provides that healthcare should be administered in the best interests of the patient. Unlike autonomy which is a strict law, beneficence is more like a caregiver’s moral responsibility to give the patient the best care, and have the patient’s well-being at heart.

  1. Non-maleficence

Professional caregivers are expected to “not do harm” on the patient in many ways but most commonly, as a result of the caregiver’s negligence. Non-maleficence is the exact antithesis of beneficence, where the nurse acts to not just do good, but instead “not do any bad”. 

The principle of non-maleficence demands that caregivers deliberately fetch all information on an active patient, be on the active watch, and respond to the slightest of cues from the patient or their behavior. Ethical dilemmas surround this principle, where an act of heroism for one patient may be commission of malice to another. And here is where the principle of justice and equitability comes in.

  1. Justice

The principle of justice states that all patients are equal, and that healthcare should be administered equitably across patients. Justice requires that healthcare be administered without any discrimination in the lines of financial ability, class, race, color, nationality, age, or gender. Nurses as human beings and also suffer the temptation of administering care on considerable bias such as financial ability.

Justice is administration of care equally to all patient, to all according to need, effort, and contribution. Healthcare is a service industry and people may forget that the primary objective is to make money, otherwise the service will not be sustained. However, a contested debate has ensued around providing care on a public platform. 

Other auxiliary principles in healthcare ethics are fidelity and veracity. Fidelity requires caregivers to respect their relationship with the patient, and to show loyalty to the patient even when it stands to compromise seamless healthcare administration. A nurse should only make promises to a patient when they are sure they can keep them.

Veracity is truthfulness, requiring caregivers to relay all the information to patients and in due time. One common dilemma with this principle is withholding of information from the patient under instruction from loved ones, in the plight that the information might further distress the patient. Nurses should make all relevant communication to the loved ones, explain all rules before rejecting that request as patients have a right to information on their health, regardless of the prevailing circumstances.

Issues in Healthcare Ethics: Situational Dilemmas

  1. Religious and Cultural Beliefs in Healthcare

Ethics is a vast dimension that cannot be limited to the four or six principles provided by industry scholars. Some ethical values are rooted in cultural and religious beliefs on contentious issues such as pro-life/pro-choice, blood transfusion, and so much more. To the farther extent, some patients will be selective on the gender of attendants they want, also based on their beliefs.

Nurses too have beliefs, but the rule of the thumb here is professionalism comes before your beliefs, otherwise you’ll have to sit the case out if you feel compromised. When it comes to a patient’s beliefs, present them with all available information on the consequences and prevailing circumstances before sticking to the principle of autonomy, allowing them to make the final call.

  1. Resource Limitations

Healthcare resources are generally scanty, unless the patients want un-affordable care. Moreover, a pandemic might prevail, paving for a resource crisis in the industry. This happened at the summit of the COVID-19 pandemic not long ago, when infections were unmanageably high, offsetting the available clinical resources. Caregivers were forced to make unpopular decisions like reassigning oxygen ventilators from lost causes to patients with a hope of recovery. During this time, hospitals erected boards to consider such cases, and recommend the decisions. Under no circumstances should residents make these decisions on their own, without keeping tabs with higher authorities.

  1. Right to Information

Disclosing very negative news to a patient may not serve any substantial purpose in aiding healthcare administration especially if the patience is sponsored and under guidance from relatives. However, disclosing the news means more distress to the patient, and may even worsen their condition. Be that as it may, every consenting adult has a right to information on their body regardless of prevailing circumstances. Its only that nurses should consider relaying only the required information and in a way that does help with the situation. Beneficence comes into play, as the mental well-being matters just as their physical health.

These issues are a blanket for the many unique compromising situations faced by nurses in their daily routines. It is however important that the nurse prioritizes the principles of ethics, the general practice code of conduct, and the house policies for the facility they work in. Dilemmas are not to be avoided but rather to be negotiated. A problem shared with the right people is just as solved. 

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