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“Morality plays a distinctive role in the lives of human beings (Killen, 2002),” by
providing principles for social organization. This includes direction on how to “control the use of
specialized and skills that are important in highly valued aspects of human life” (Killen, 2002).
Professions are one example of these social structures developed to control those special skills
and knowledge. Professions set the norms that define professional practices, however, “the
norms of the profession are not the ultimate determinants of right and wrong (Killen, 2002).”
Ethical issues arise in the daily clinical situations registered nurses (RN) encounter in the
operating room (OR). Because my patients are under anesthesia the important ethical issue of
autonomy is violated because the patient is unconscious and unable to speak for him or herself. I,
I work with three gynecologists from a nearby practice who operate at my facility
10 hours. The group would move from room to room like an assembly line performing surgeries
on the patients in no particular order, operating together, and sometimes leaving the facility to go
deliver babies at other hospitals. While all three doctor’s names were on the consent, I often
heard the surgeons telling their patients that he would be with them the whole time during their
surgery. This is untrue. Sometimes two of the doctors would perform and finish the third
doctor’s surgeries before the third doctor even arrived at the facility. When patients ask me “is he
This paper will evaluate the moral dilemma that results when ethic principle of truth-
telling and beneficence are in conflict when a surgeon is mechanically competent but has
unethical practices. I will use the MORAL model to evaluate the current dilemma while
Running head: MORAL MODEL 3
weighing all the options and choosing the best possible outcome for the greatest number of
Dilemma
The dilemma related to this questioning of the surgeon’s competence is that there are
multiple ways I could respond to the patient’s request, and it is difficult, sometimes impossible,
to determine the “best” choice of answer for the patient’s needs. According Provision 3, of the
American Nurses Association (ANA) Code of Ethics for Nursing, “the nurse promotes,
advocates for, and protects the rights, health and safety of the patient” (ANA, 2015).
Additionally, “in the context of a patient-nurse relationship, the nurse’s legal duty is to ensure
that the treatment provided complies with the standard of care” (Mathes & Reifsnyder, 2014).
I know the two responses I would give to the patients in this situation are simple and
straightforward. I can tell them how I honestly feel, my truthful feelings about the gynecologist
group or I can smile, nod my head and agree as I roll them back to the OR suite. The reason its
an ethical dilemma is because there is no right answer. Culturally a nurse is not supposed to talk
poorly of the surgeons. What happens in the OR stays in the OR. When asked questions nurses
should “sugar coat” the information to uphold the allusion that the surgeons are in charge and we
are his employees. By speaking up I may cause patients to cancel surgeries and therefore lose
money for both the hospital and the surgeon. I may lob if my employers find out. Alternatel, if I
do not speak up I will uphold the lie that the surgeons are operating on the patients they say they
are, and are involved from start to finish, never leaving the patient’s side as they claim. I may
even be putting my own license on the line by allowing this to happen without speaking up.
Furthermore, I do believe the surgeons are competent in the surgeries they perform. They are not
Running head: MORAL MODEL 4
my first choice but that is information not shared with a patient because my opinions are not
facts.
I know that from the hospital and surgeon’s perspective I have no right to speak my
opinions to patients. I know they would not want their patients to know they were not in the
room for the entire surgery as they claimed. I know the surgeons could risk losing their license or
facing malpractice or negligence charges. The hospital could lose accreditation or magnet status.
The OR metrics would be skewed in this situation because I would be spending more time
talking with patients causing delays in cases and wasting OR time. In the operating room time is
money and an OR minute is worth much more than any minute of my work. Additionally,
stockholders in the hospital do not want these types of discussions taking place because it
decreases revenue and puts less money in their pocket. No one likes to wait in the OR. They
would rather us take a patient back and get started on time than make sure we are doing what is
in the best interest of the patient. As RNs, we must advocate for our patients because they can’t
and don’t understand how our system works or how to make sure they are best looked out for.
Unfortunately, the nurses who are taking care of these patients in the OR have the least amount
of autonomy to pursue these patient needs. They barely have time to go to the bathroom much
less to make sure a patient’s consent is true and based on valid expectations.
MORAL Model
There are two options I have chosen to explore using the MORAL model. The first option
is my current practice. I tell the patient the surgeon is a competent or skilled choice. The second
practice I have never tried. The truth. What I truly think about the surgeon’s competence has
The benefit of telling the truth, that you don’t think the surgeon is ethical in his practice,
is that you didn’t lie. Lying is unethical and immoral in most situations. The patient will also
know the truth and have all the tools he or she needs to truly give “informed consent.” The
patient may cancel the surgery and find someone more suitable to do their surgery. The negatives
are that the patient may have the surgery anyways and go to sleep panicking. They may not heal
as quickly due to stress. They may imagine a problem that is never actually there. The harm from
this type of veracity would include defamation of the surgeon. Without hard facts my opinion is
not a valid source of information. The problem with this truth is that it is that the group of
surgeons are basically competent and they have comparable outcomes to other surgeons. For this
The doctor would not like for the nurse to divulge how things work behind the OR doors because
it would open them up to law and malpractice suits by almost any patient the surgeons had
operated on in the past. It would bankrupt the group. The doctors think it is ok because no one is
getting hurt, and the surgeries are getting done efficiently and properly. This could also hurt the
hospital system because it owns the gynecological practice. Once word got out they could have a
civil action lawsuit brought against them. The financial ramifications of my telling the truth are
huge, which honestly makes the dilemma all the more daunting.
I know the truth might save future women from suffering. The societal / professional
norms are that the doctor, the one you researched for weeks, and gathered all the information on
the one you chose to performed your procedure, is the surgeon who is cutting you open and
performing your surgery in its entirety. Telling the truth may elicit changes related to the surgical
norms as a whole. It may make governing agencies come down harder on hospitals that are
Unfortunately, medicine is now about money. They want perioperative nurses to move
faster, take on more cases, and keep them moving. This means no matter what you get this
patient into the operating room on time. The benefit to me keeping the surgeon’s unethical
practices to myself is that I get to keep my job. I get to continue to work for the hospital and the
surgeons are making more money so they stay happy and continue bring in more patients and
make even more money for the hospital system so the hospital system is happy. In terms of doing
the most good for the most people this seems like the obvious choice. However, this option does
not represent the patient as a stakeholder in the equation. Patients deserve the respect to make
choices based on actual results. Whether or not the surgery outcome is favorable is irrelevant to
the patient that feels their autonomy has been stripped away.
Plan
Given these two opposite approaches it is clear that both are valuable for different
reasons. If one is approaching the situation from a utilitarian perspective the choice is easy.
Continue the practice as is and don’t tell the patients what is really going on. However, I believe
that veracity is more important here. People should not be lied to about their medical procedures.
History proves that people do not like to be lied to about their health. I believe there is a way that
both could happen. A combined multifaceted approach towards the dilemma could eliminate the
situation all together. If the doctor would spend a bit more time with the patients while
consenting them for surgery explaining how he and his surgeons practice and have the patient
agree to the situation. This would not cost anything and gives the patients the option to say no. It
shouldn’t even hold up the surgery schedule because if someone does not consent the case could
be moved to the end of the day and keep the other rooms moving forward. This small change
could make the situation and ethically sound one based on the principles of beneficence,
Running head: MORAL MODEL 7
autonomy and justice. The doctors will effectively do the most good, creating the least amount of
harm, while respecting the rights and dignity of the stakeholders and promoting the common
good. I propose to call a meeting including the OR director, the physician group and some of the
Conclusion
While there is never a situation that works out perfectly I believe there is very little to
give up and so much to gain for all the stake holders in the situation. I wish I had explored this
issue earlier because as a nurse, I need to make sure that the principles and ethics that are
morally significant are upheld as the profession moves into the future. I have been blindly
maintaining the status quo when I could have easily already dealt with this issue. I look forward
to using this paper to speak with my director about changes we can and will make regarding this
Reference
Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Healthcare Infection Control
Killen, A. R. (2002). Stories from the Operating Room: Moral Dilemmas for Nurses. Nursing
Ethics, 9(4).
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (Eds.). (2016). Policy & politics
in nursing and health care. (7th ed.). St. Louis, MO: Elsevier. ISBN: 978-0-323-24114-1
Mathes, M. & Reifsnyder, J. (2014). Nurse’s law: Legal questions and answers for the practicing