Decisions About Bioethical Dilemmas Of Healthcare Practice

Ethical dilemmas are more frequent in health care,the whole health team. Many nursing policies have
primarily because of the remarkable advances inan ethical component, such as those relating to
medicine and technology. Health practitioners arepatient abuse, the nurse's role in informed
now able to diagnose and treat illnesses that wereconsent, the impaired nurse, and care of the
lethal a decade ago. The growing understanding ofHIV-positive patient. Nursing staff development is
human genetics has also created new and uniqueimportant in helping nurses become effective
dilemmas. Concerns about patient choice, qualityethical advocates. Nursing practice inherently
of life, and access to health care are alsoinvolves ethical issues, so ethics education is
becoming more frequent and complex. As aparticularly important for nurses who have not
result, health care professionals face an increasinghad formal ethics training. Continuing education
number of issues for ethical decision-making.programs on ethical principles and ethical
Some research suggests that nurses do notdecision-making models are critical. Emphasis on
always have a clear understanding of their role inthe interpersonal and communication aspects of
ethical concerns. They may not know how ethicalethical involvement will empower the nurse to
decisions are made and may feel powerless whenparticipate fully as the patient's ethical advocate.
faced with ethical dilemmas (Zink, & TitusThe nurse also needs support when he or she
1996). Decision makers of healthcare practicesdisagrees with the patient's decision or cannot
find themselves in ethical dilemmas when theysupport the decisions of other health care
must choose between courses of action that areprofessionals or those of his or her employer.
based on different moral frameworks, varyingFuture ethical dilemmas are certain to involve
organizational philosophies, or conflicting duties ornurses in a variety of practice settings. Nurses
moral principles (Darr, 1997). Although in somebridge the gap between the needs of individual
cases reasonable people can be stronglypatients and the health care system. Never have
committed to different courses of action, in mostthe challenges for nursing been greater. However,
ethical dilemmas the various players can reachthe challenges bring great opportunity for nurses
consensus despite cultural or religious differencesto move to the forefront in the advocacy role
(Darr, 1997). Decisions of this nature are most(Smith, 1996). Nurses can be very valuable
times painful and much contemplation is required.advocates for bioethical practiceand as  the
Differing ethical theories do not necessarilychallenges  of making ethical decisions become
conflict, and people following diverse philosophiesgreater, nurses will be forced to perform their
may reach the same conclusions via differentadvocacy role. However, the climate of the
reasoning (Darr, 1997).  People have opinions andworkplace can create barriers for nurses trying to
these opinions are what give people a way toact ethically. Those who participate in making
express themselves. If people did not haveethical decisions may be perceived to be in conflict
differences of opinions about particular situation,with organizational expectations. For example,
there would be no ethical dilemma (Ecker, 1996).managers and co-workers may see a nurse who
More and more people have recognized theadvocates for patient rights or reports the
importance of bioethics in health care settings.unethical behavior of another health care
Ethics committees are an important resource forprofessional as lacking loyalty to the institution
patients and providers in all healthcare settings,(Oddi,  Cassidy, & Fisher, 1995). The position
including home health, long-term care, psychiatricof nurses in the health care hierarchy may create
facilities, clinics, and hospitals (Beauchamp &problems, too, as nurses often have great
Childress, 1994).  Ethics committees focus onresponsibility but little power in making decisions
education, policy development, and clinical(Oddi,  Cassidy, & Fisher, 1995). Nurses need
consultation on ethical issues. They reviewto be empowered towards making ethical decision.
decisions and develop policies and proceduresThis empowerment should be created by
about important issues such as informed consentmanagers and hospital administrators. As a result
and limitation of treatment.patients would receive better care and nurses are
Nurses and Decisions about Ethical Dilemmasmore satisfied with their jobs when they
Ethical decisions are inherent in the daily practicerecognize the ethical nature of their work,
of nurses and other healthcare practitioners anddetermine which ethical decisions are theirs to
are critical to the care being delivered to patients.make, and acknowledge their authority in making
Several notable studies have been conducted inethical decisions in practice (Smith, 1996).
recent years about nurses and ethical practice.Education about ethical responsibility and
For example, a study done by the Americandecision-making may be a part of the problem
Nurses Association found that 79 percent ofwhy nurses do not confront ethical dilemmas.
those responding said they faced ethical issuesSome experts think nurses are not committed to
daily or weekly (Zink, & Titus, 1997). A highethics as a professional priority, because they are
percentage of nurses said they faced ethicalpoorly socialized about their ethical responsibilities;
dilemmas "frequently."  Other studies documenttheir education did not expose them to ethics
areas in which nursing needs to strengthen its roleenough (Oddi,  Cassidy, & Fisher, 1995).
in ethical practice. One study revealed that nursesOthers have documented a lack of ethics content
have a relatively low level of ethical sensitivity toin nursing fundamentals texts (Killeen, 1986). Some
issues other than patient autonomy. The studyresearchers say nurses would be better able to
found that approximately twenty-five (25 %)understand the ethical dimensions of the
percent of a sample of nurses failed to define orprofession and of nursing practice if as students
defined incorrectly the term ethical dilemma. Ofthey had had adequate theoretical and experiential
those who did define it correctly, only fortypreparation texts (Killeen, 1986).But what if this is
(40%) percent used a conceptual definition (Oddi,not so? What if nurses are just not empowered
 Cassidy, & Fisher, 1995). Others definedor are less inclined to act because of bureaucratic
ethical dilemmas in specific terms, such as "deathinstitutional policies that may create problems
and dying," rather than describing the conceptualafter an ethical decision? Personal characteristics
basis of the dilemma, that is, the patient'sand beliefs about ethical involvement can also
autonomy versus medical paternalism (Oddi,impair nurses' ability to act as ethical advocates.
 Cassidy, & Fisher, 1995). This raisesMany nurses have a high need to avoid conflict
concerns that nurses may lack sensitivity to theand will act to maintain rapport at all cost (Oddi,
ethical aspects of numerous practice situations Cassidy, & Fisher, 1995). 
and often use a narrow conceptualization of ethicsTo avoid conflict, nurses characterize situations
(Loewy, 1996). Another study, which assessedinvolving actual or potential ethical dilemmas as
ethical decision making in nursing, suggested thatbeing matters of differing personal opinions, and
nurses are not always aware of their role inwithdraw from ethical decision-making. Other
ethical aspects of practice. Five (5) of fifty -twonurses follow a physician-advocate model, which
(52) nurses contacted, declined to participate inpromotes the goals or ends of medical research
the study, saying that they did not make ethicalor technology. When nurses follow this model,
decisions in nursing practice (American Hospitalthey may believe that a physician's orders are
Association, 1994).always correct and see their sole responsibility as
The nurse's code of ethics was written outliningcommunicating these orders to patients (Oddi,
general behaviors that society could expect from Cassidy, & Fisher, 1995). Hence the need
nurses, regardless of their educational background,for nurses to be able to think and act
personal values, or nursing experience (Zink,independently, yet within the framework and
& Titus, 1997). Nurses, as members of thescope of healthcare practice.
profession, must be aware that the code ofNurses often rely on intuition to resolve ethical
ethics nurses contract with society and nursesconflicts, but this may not be the most effective
are therefore committed to uphold specific ethicalmethod, because they may not recognize the
behaviors. Although the code of ethics wasethical dilemma, thus not take appropriate action.
developed for the entire profession, not all nursesThey may experience moral distress when they
are aware of its requirements. A study of fiveare repeatedly exposed to unresolved conflicts
hundred and fourteen (514) nurses with varying(Oddi,  Cassidy, & Fisher, 1995). Moreover,
educational backgrounds and practice settingseven when they identify an ethical issue, not all
found that fewer than forty (40%) percent werenurses have the support needed to correct a
familiar with the code (American Hospitalquestionable situation in which the patient's welfare
Association, 1994).may be in jeopardy and nurses may not have
Both individual and organizational efforts canaccess to forums where ethical discussions are
enhance the ability of nurses to serve as ethicalencouraged. Nurses may seek to avoid the
advocates. Individual nurses can receive assistancedilemma rather than confronting it or possibly
and support in dealing with ethical issues in afacing organizational barriers needed for resolution
number of ways. Nurses need knowledge tobecause they do not have the tools to solve
participate articulately in interdisciplinary discussionsethical dilemmas effectively.
of ethics because most ethical conflicts involve