Ethical decision making

Ethical decision making is the application of the processes and theories of moral
philosophy to a real situation.
As a nurse, you will encounter situations where you are faced with two alternative
choices, neither of which seems a satisfactory solution.
Conflict arises when there is a need to choose between two apparently equal
courses of action, each of which would have significant consequences for the
outcome of care.
This constitutes an ethical dilemma.

CASE STUDY ONE

Consider the following scenario. You may wish to discuss it with your colleagues.
Scenario (Based on Jones 1994, p. 21.)

Your 18-year-old son, Ben, is worried about his friend Steves apparent addiction
to drugs. Until Ben became worried, no dilemma existed. The fact that he is
worried indicates that he would like to do something about it and he has two basic
choices, each with different consequences.
Choice 1: Do nothing. Consider that Steve is experimenting with aspects of life in
order to enable him to make the transition to a self-determining adult.
Alternatively, Ben may consider that it is none of his business and he has no right
to interfere.
Possible consequences:
a) Steve soon decides that it is not for him and gets on with his life.
b) Steve becomes increasingly antisocial as a result of his addiction, possibly
engaging in criminal activities to support his habit.
c) Steve dies from continual drug abuse.
Choice 2: Tell Steves parents in order that advice can be sought in time.

Possible consequences:
a) Steve is furious at the breach in friendship/confidentiality. He continues to
use drugs and the friendship is over.
b) After the initial trauma that he has been found out by his parents, Steve is

thankful that his friend sought help for him in time.

Having read this scenario you may consider that there are other options. You may
also have identified your preferred course of action. Refer back to Exercise 1.2.1
and identify how your reaction to the example was influenced by your personal
values and beliefs.

How we make decisions

We can examine a situation to determine the best course of action, using the ethical
principles below in conjunction with an ethical decision-making model.
The six ethical principles that underpin moral philosophy are:
Autonomy: This refers to a persons ability to make or exercise self-determining
choice in the context of respect for others and their right to make choices. An
example of upholding a patients autonomy is through the provision of adequate
information, allowing the patient to give informed consent.
Beneficence: This demands that above all we do good, and therefore requires a
positive action to benefit someone, for example, providing nursing care that is both
appropriate and affordable.
Non-maleficence: This demands that above all, we do no harm and therefore we
have a duty not to injure others. This is integral to the obligation of duty of care.
Justice: This is the equal distribution of benefits and harms in the context of what is
deserved. It centres on the notion of fairness. All patients deserve the same standard
and quality of care, regardless of the health care setting.
Veracity is concerned with being truthful and honest. This is fundamental to the
development of trust in the nurse/patient relationship.
Confidentiality: This is not divulging information about a person without his/her
consent thus respecting the privacy and wishes of others.

Text reading:
Refer to your text on ethical issues.

Tasmania Department of Health and Human Services and University of Tasmania Faculty of Health
Science, 2001, Medication Management for Registered Nurses, Module 1 Legal and professional
issues pp.19-20.