Ethical Decision Making

Emma Lumerto, Mira Ojaranta

The patient
Patient

is very demanding
The way the patient talks to the nurses is very
demeaning
Taking care of her has become such a burden; no
nurse voluntarily wants to take care of her.
Patient has decided herself how her condition
(wounds) must be taken care of.
The care is not medically appropriate to her specific
needs.
She wont let the nurses do their job.
Her condition has worsened since she came to the
ward.

She

thinks she is very ill and needs all the

assistance she can get.
She enjoys making it hard for anyone to take care
of her and making the nurses around her feel
inadequate.
The problem is no proper medication can be given
to her because she has declined to talk to any
psychiatric personnel.
The ward wants a mental examination done to the
patient so they can start the proper treatment
without her consent, or at least transfer her to a
different ward (psychiatric) where they might be
more adequate in her treatment. She has declined
it.

Main questions
What

happens when her condition declines rapidly and might

die? The nurses are accountable.
Treatment is not the right, her wounds will not heal. This is
why she is mainly in the hospital.
Taking care of her has overwhelmed the staff and she cannot
be moved around different wards.
She is a laitostunut patient. She will not be able to go home
and take herself. Negligence if the ward sends her home
without additional care.
Is it ethical that home care refuses her?
Is it ethical to respect the patients autonomy at the expense
of her health care etc?
How can the nurses let the patient decide on care that the
nurse is ultimately accountable for?
She most likely suffers from a mental illness but it cannot be
evaluated or medicated without the patients consent.

Accountability
vs.
Autonomy!

Main concepts
Main concepts:
Accountability Nurses are responsible of all care they provide
or do not.
Autonomy The patient has the right to decide on their care.
Benevolence Do good to others.
Nonmalevolence Do no harm.
Principles of health care:
Right to good care- the nurse is obliged to provide good care.
Right of self-determination- the patient has the right to take
part in their care.
Cooperation and mutual appreciation and respect it is
important that the nurse and the patient work together and
compromise where necessary. The nurse has a duty to show
respect to the patient and it is desirable that the patient would
show respect back. It is a partnership.

Seedhouses Ethical Grid

Gray level:

Green level:

Wishes

Most beneficial outcome for

individual
Most beneficial outcome for a
particular group
Most beneficial outcome for
society

of others
The risk
Resources available
Effectiveness and
efficiency of action
Disputed evidence and
facts

Red level:

Blue level:

Do most positive
good
Minimise harm

Serve needs first

Respect
autonomy

The solution?
The

difference between a
problem and a dilemma is that a
problem has a potential solution.
A dilemma does not; there is only
a choice between two (or more)
equally difficult, bad or
impossible alternatives.
(Tschudin, V. 2003 p123)

The solution?
Cooperation

and compromise
Educating the patient (nurse
fulfills their duty to the best of
their ability)
Nurse has the right to give best
possible care. Ability to provide
care should not be compromised.
Patient has the right to refuse
care.

References:
http://www.un.org/en/documents/udhr/

accessed 12.11.-14

Tschudin,

Verena. Ethics in nursing : the caring relationship /

Verena Tschudin. Oxford : Butterworth Heinemann, 2003. ISBN
0-7506-5265-9.

The

ICN code of ethics. International council of nurses. 2006

Ministry

of social affairs and health. Rights of patient. Brochure

of the ministry of social affairs and health 2005 (English)

http://

www.stm.fi/c/document_library/get_file?folderId=39503&nam
e=DLFE-6816.pdf
Accessed: 12.11.2014