Module 5 Discussion Ethical Dilemma

Sample Answer

An ethical dilemma in nursing refers to a situation where a nurse must decide between competing values whereby there are consequences no matter what choice one makes. When working in the ED, a 16-year-old female patient was accompanied by his parents after she felt dizzy and fell.

She reported that she has been having constant headaches, feeling dizzy, getting easily tired, and having shortness of breath in the past month. The patient reported she was 5-6 months pregnant but was not sure because she had not gone for an ultrasound and had not been attending her antenatal checkups. She attributed the symptoms to the pregnancy.

The patient stated that she only attended the first antenatal check-up when she realized she was pregnant. She was too scared to inform her parent since she feared their reaction and anger, and they only learned she was pregnant two weeks ago. The patient never took the Iron and Ferrous supplements because she did not want the parent to suspect she was pregnant. The patient had mild distress, tachycardia, and pale ++ on physical exam. The attending physician ordered a Full hemoglobin test which revealed a Hemoglobin level of 6.5 g/dl and hematocrit of 28.2%.

The physician informed the patient and her parents that she would require an immediate blood transfusion to increase her Hb and reduce the risk of maternal and fetal complications. The parents were against the blood transfusion and stated they were Jehovah Witnesses, and receiving a blood transfusion goes against their religious beliefs. The parents declined to consent to their daughter having a blood transfusion even if her life and the fetus depended upon one.

In this situation, it was difficult for the ED team to remain objective with the patient, considering she was in a life-threatening situation. An ethical dilemma occurred when the patient’s parents contradicted what was medically necessary to promote health and sustain the life of the patient and the fetus. Ethical values that collided included respect for patient autonomy and beneficence/ nonmaleficence.

The patient’s guardian had the right to refuse treatment interventions for their child since she was a minor. However, failing to provide the appropriate treatment intervention, which was blood transfusion, was against the providers’ moral duty to promote the best patient outcome and prevent harm (Giannetta et al., 2021).

Furthermore, failing to transfuse blood puts the mother and fetus at risk. Even though it is normal to want to implement life-saving interventions, the nurse must learn to draw a line between providing accurate information and pushing their opinions or beliefs (Lechasseur et al., 2018).

The ED team consulted an obstetrician and a perinatologist to evaluate anemia in the pregnant patient as soon as possible. The obstetrician and perinatologist confirmed that the patient had severe anemia during pregnancy, and the best course of action was to admit her and transfuse packed red blood cells. As the ED nurse, I educated the patient and her parents that anemia increases the risk of preterm delivery, low birth weight, and postpartum maternal infections. I documented the health education provided and the guardians’ response, including their reason for declining treatment.

We consulted a legal officer who informed us that a 16-year-old is a non-minor and should be considered capable of understanding the information provided by a physician and making the appropriate decisions for her life. The parents were informed that the patient had the right to make decisions regarding her health care without her parents’ or the state’s consent. The patient was scared of losing her life or that of her baby, and she accepted the transfusion.

References

• Giannetta, N., Villa, G., Pennestrì, F., Sala, R., Mordacci, R., & Manara, D. F. (2021). Ethical Problems and Moral Distress in Primary Care A Scoping Review. International journal of environmental research and public health, 18(14), 7565. https //doi.org/10.3390/ijerph18147565
• Lechasseur, K., Caux, C., Dollé, S., & Legault, A. (2018). Ethical competence an integrative review. Nursing Ethics, 25(6), 694-706. https //doi.org/10.1177/0969733016667773