Tonya and Lydia are two senior nursing students assigned to

Tonya and Lydia are two senior nursing students assigned to work in the intensive care unit with a critically ill patient. The patient, Mr. Dunn, is an 87-year-old retired ironworker. He lives alone in an old two-story frame house. Mr. Dunn is diabetic. He is nearly blind and has moderately advanced prostate cancer and Alzheimer\'s disease. Mr. Dunn was admitted to the intensive care unit after he was discovered unconscious in his home by a neighbor. At that time he was ketoacidotic and had a very severe necrotic wound on his left leg. The surgeon plans to amputate Mr. Dunn\'s left leg but has been unable to get consent from either Mr. Dunn or his next of kin, a niece who lives out of town.

Tonya is proud of her efficiency as a nursing student. She makes rapid decisions. Tonya insists that Mr. Dunn must have the amputation. She boldly suggests to the physician that he have a surrogate appointed for Mr. Dunn so that the surgery can proceed. The course is clear to her. Lydia, on the other hand, is not certain of the correct course of action. She talks to Mr. Dunn and his niece about his condition. She wonders if the amputation is the best solution to his problem. She thinks about what his quality of life will be after the surgery. She worries about his ability to care for himself and about his state of mind should he be forced to live in a nursing home. She thinks about what she would want for her own father if he were in the same situation. Lydia falls asleep at night pondering these thoughts. She does not know how to go about solving the problem. Tonya is impatient with Lydia. She sees no benefit to the time and energy spent worrying about this problem when the solution is apparent to her. She dislikes wasting her time talking to Lydia about these concerns.

Think about It: Facing Ethical Dilemmas

What alerts you to the presence of an ethical dilemma?

How do you feel when confronted with difficult ethical decisions?

To what degree do you think nurses should become involved in making decisions such as the one described in the situation presented previously?

With which qualities of each nurse do you identify?

Solution

Ethical dilemma evolves from the concept of ethics, which proposes good and no harm. So a resolution to a problem lies in doing good and no harm. Professional ethics are a significant part of a nursing profession and ethical dilemma is a situation when confronted with has a no perfect all good resolution. It is the nurses conquest to provide care and assure good quality of life to the patient,

Given situation have the following challenges for the nurse:

Pro-choice vs pro-life: Mr. Dunn has a choice of amputation but with the meager family support and given physical and psychological condition, a preparation for amputation should be difficult.

Freedom vs Control: Does Mr. Dunn have the freedom to choice and even if he is given the choice is he in a position, without any kin to make a decision.

Empirical knowledge vs personal belief: Lydia believes that post-operative care and mental support to Mr. Dunn would be difficult. It appears easier to amputate his leg, but they have to holistically deal with this case as he was in an abandoned state and has to brought to acceptance that he may lose his leg, which may handicap him and he should be provided enough psychological orientation for the same.

This situation presents an ethical dilemma for the nurses. Classes on nursing ethics present the basics of nursing ethics, but what is empirical knowledge and gauging the beliefs of the patient, a particular choice of decision may just have a thin margin between ethical and unethical. When confronted with an ethical situation, I feel it\'s imperative to empathize with the patient, yes follow the basic principles of ethics but also keep the family informed, what is comfortable to the patient may not always be the best choice. I may choose amputation in Mr. Dunn\'s case as he is also keto acidotic so it is important to protect his vital organs and prevent further damage. So I would arrive at a decision gauging all possibilities and to what is the best for him.

Since a nurse is the one who nurses the patient, she will be aware of the circumstances of the patient. She will have an understanding of the background, and what other complications may arise. Although the physician has the authority in decision of the therapeutic or surgical course, a nurse can be involved in giving opinion based on the study of the patient and his circumstances. Given case presents a situation where Mr. Dunn is almost blind, has Alzheimer\'s, is 87 years old and has advanced prostate cancer, all these make the situation quite complex. As per the presentation of the case, the doctor has suggested amputation. A nurse like Lydia understands that surgery may save him, from further necrotic damage, but his age, mental condition and being severely diabetic with ketoacidosis and prostate cancer, gives a bleak chance of good quality of life. A nurse in the given case should have a discussion with the patient or the kin, and give valid inputs to the physician which will help making the right ethical decision.

I identify with the presence of mind for the quick decision-making capacity of Tonya. But I in the larger purview agree with Lydia, in reference to the given case of Mr. Dunn, it demands deliberation a conscious one and given the complication the way Lydia identifies with Mr. Dunn, is required to provide the best solution which is ethical as well as safe for the patient. Lydia possess compassion, care and empathizes with the family which is phenomenal and is expected of an ideal nurse.