Running header: ETHICAL DECISION MAKING 1

Ethical Decision Making

Grand Canyon University: NSG-436

Trang Nguyen

August 11, 2019

ETHICAL DECISION MAKING 2

Ethical dilemmas are a constant barrier that health care professionals face just about

every day. The specialty of pediatrics has been a field that I have always had a fond interest in

and plan to pursue. I find that the biggest problems can arise from children having decisions

made for them by parents or guardians without their full understanding and knowledge. The

ethical dilemma I will be discussing about focuses on the topic of autonomy and gender

dysphoria. The scenario is of a 16-year-old transgender male who want to get a sex reassignment

surgery to transition from male to female. The dilemma is that his parents do not want him to

continue with the course of treatment and surgery and since he is a minor, he must oblige. I will

be further discussing my justification, the ethical standard and model that can be applied, safe

client care, and solution.

Analysis and Justification

Gender dysphoria is a term used to describe an immense level of distress an individual

experience when the gender assigned at birth conflicts with how they feel internally and the

gender they associate with. Autonomy is described as “The client’s right of self-determination

and freedom of decision making” (Huber, 2018). It is one of the four principles that form the

very foundation of ethical decision making. It can be extremely complicated to abide by the

concept of autonomy when you have a child under 18 because legally, they are not old enough to

make decisions for themselves and require a parental approval. In this case, the ethical dilemma

surrounds the child autonomy and the parent’s disagreement to continue the course of care

regarding their child’s gender reassignment surgery. If I were a nurse taking care of a pediatric

client as such, my primary objectives would be to see how I can advocate for my client to get the

necessary surgeries. Though the patient is only a minor, I believe that he deserves a say in his

course of treatment because that is his right to autonomy. Gender dysphoria can create a
ETHICAL DECISION MAKING 3

significant impact on the mental state and social functioning of an individual. A recent study

presented data on the improvement of quality of life following male-to-female sex reassignment

surgery (Weinforth, Fakin, Giovanoli, & Garcia Nunez, 2019). If the client is not able to get the

surgery, alongside other procedures, his mental health will worsen from the level it currently sits.

Eliminating a child’s autonomy when it comes to their own body is an ethical injustice

Appropriate Ethical and Moral Standards

The most appropriate ethical and moral standard that can be applied to this case would be

autonomy. There are important considerations when it comes to guiding a client’s autonomy,

especially one who is not of the legal age of 18. As nurses, we must help our clients understand

the impact of their choices and the consequences that can arise from their decisions. In addition,

we must use our clinical judgment to analyze if the patient is competent of making such

decisions for themselves (Forester-Miller & Davis, (2016). Since it is the parents declining the

surgery, I believe that a great approach would be to understanding their reason why. Often, there

is a lack of knowledge and preconceived notions surrounding gender dysphoria and the LGBTQ

community in general. The application of fidelity grants these parents our duties as nurses to

provide them loyalty and faithfulness. Creating a trusting relationship and honoring the

commitment of their decision is the most appropriate ethical action.

Safe Client Care

As a health care professional taking care of a transgendered patient, it is important to care

for the patient holistically. Going through this journey of gender reassignment can take such a

heavy toll on one’s mental state. Before a nurse leader can make any navigations to the standard

of care, they must assess their own thoughts and beliefs first. Gender reassignment surgeries and

the hormone treatments that come it are nothing less than overwhelming, especially when it your
ETHICAL DECISION MAKING 4

child going through it. Extensive education for not only the patient, but parents as well, is vital

because the lack of knowledge could very well be the reason why they are hesitant about

proceeding with surgery. This is a time filled with much stress and anxiety for our patient and so

his mental health would be my main priority. Since he is considered a pediatric patient, I would

use the assistance of Child Life to further help me provide the best care and to ease his fears.

Ethical Decision Model

The ethical decision model I deem the most fit to resolve the dilemma would be the

PLUS Ethical Decision Making Model. The PLUS model consists of seven step geared towards

ethical decision making. The first step is to define the problem and identify the desired outcome.

Second, look for resources that can be of use to help you in the decision-making process. These

resources can include doctors, case management, social work, and so forth in the case of our 16-

year-old transgendered patient. Third, identify the possible alternatives. Fourth, take time to

closely analyze those identified alternatives, Fifth, make the decision complete with a clear

understanding of the problem and a clear list of rationales for the chosen solution. Sixth,

implement the proposed solution and lastly, it is important to evaluate the outcome (ECI, 2019).

Possible Solution and Leadership Influence

The one solution to resolving this dilemma is if the parents to come to a unanimous

agreement to allow the surgery. To do so, I believe that it is in the best interest of the health care

team to educate them on the benefits and improvement to quality of life for their child. As a

nurse leader, I would recruit fellow doctors, psychologists, social workers, and case managers for

a meeting to ensure them that their child’s best interest is in mind. By doing so, this could

possible persuade them to allow their child to go through with the surgery. My leadership style
ETHICAL DECISION MAKING 5

influenced the decision-making process by directing my care towards the entire family, not just

the client.

Conclusion

Autonomy is the core of ethical decision making guidelines and every patient has a right

to it. The topic of gender dysphoria can pose as an ethical dilemma to many, especially now with

gender reassignment surgeries on the rise. I think it is in the best interest of the patient, even if

they are a minor, that medical professionals try their hardest to advocate for the decisions the

patients choose. This was an extremely complicated scenario because the parents were the ones

declining the surgery for their child. I do believe that the possible solution would be a medical

pofessional discussing this matter with the parents of the minor. That way an educated and

informed decision can be reached and the best outcome for the patient can be obtained.
ETHICAL DECISION MAKING 6

References

Forester-Miller, H., & Davis, T. E. (2016). Practitioner’s guide to ethical decision making (Rev.

ed.). Retrieved from http://www.counseling.org/docs/default-source/ethics/practioner’s-

guide-to- ethical-decision-making.pdf

Huber, D. Leadership and Nursing Care Management. [VitalSource Bookshelf]. Retrieved

from https://bookshelf.vitalsource.com/#/books/9780323389662/

The PLUS Ethical Decision Making Model - Ethics & Compliance Toolkit. (2019). Retrieved

August 10, 2019, from https://www.ethics.org/resources/free-toolkit/decision-making-

model/

Weinforth, G., Fakin, R., Giovanoli, P., & Garcia Nunez, D. (2019). Quality of Life Following

Male-To-Female Sex Reassignment Surgery. Deutsches Arzteblatt, 116(15), 253-260.

Retrieved August 10, 2019, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546862/.