Essay: Applying an Ethical Decision-Making Model

Case Scenario
Reuben is a 23-year old male living under the care of his parents. At the age of 17, Reuben was diagnosed with lymphoblastic leukemia. Immediately after the diagnosis, he was put under intense treatment and was on remission for three years. Reuben and his family members were highly elated by this new health progress. However, later on, Reuben fell ill and the doctors realized that the disease had recurred with severe liver damage being evident. The doctors have therefore, considered Reuben to have a poor prognosis and referred him to a hospice. However, his parents are against this idea and are advocating for more aggressive and potentially life-prolonging treatment. Besides, the parents have urged the nurses to avoid disclosing the devastating news to Reuben. Recently, Reuben has been complaining of general body weakness and also expressing his wish to know the truth about his illness from the nurses.

Step 1: The Identification of an Ethical Problem
Reuben’s case presents an ethical dilemma for the nurses in deciding whether, to be honest with the patient and reveal the truth or to obey the parents wish. Solving ethical dilemmas in nursing is crucial in promoting the delivery of safe and quality care to patients (Milliken, 2018). Notably, the doctors have recommended Reuben’s transition to end-of-life care. Likewise, Reuben feels weak which an indicator of dwindling health. Delaying the decision may lead to Reuben’s death without getting the truth. On the other hand, revealing the information may lead to conflicts between Reuben, the medical team and his family. This is a case of applying autonomy and fidelity nursing principles in end-of-life care decisions. The question remains; should the nurses reveal to Reuben the poor prognosis and the doctor’s recommendation?

Step 2: The Collection of Additional Information to Identify the Problem and Develop Solutions
The indisputable facts in Reuben’s case include his age, diagnosis, doctor’s recommendation, parent’s opinions, and his wish to know the truth. Additional information that may be needed in coming up with an informed ethical decision for this case include: Why is Reuben insisting on knowing the truth? Why are Reuben’s parents against revealing the truth? Which other aggressive treatment options are available for Reuben?

Step 3: The Development of Alternatives for Analysis and Comparison
The nurses are presented with a difficult scenario that requires careful analysis and subsequent determination. Although the nurses may consider some actions to be morally upright, they might be restrained by legal and institutional policies (Celis & Méndez, 2019). In the case of Reuben, the nurses have three options. Firstly, the nurses can tell Reuben the true status of his medical condition. Secondly, the nurses can tell Reuben to make inquiries about his medical condition from his parents. Thirdly, the nurses can decide to discuss Reuben’s underlying medical condition in the presence of his parents.

Step 4: The Selection of the Best Alternatives and Justification
The best alternative for the nurses would be to explain to Reuben the status of his medical condition and the available options. This can be done either in the presence of his parents or with Reuben alone. In this case, respect for Reuben’s autonomy should come first. Although his parents wish the best for him, Reuben has overall control over his body and it’s only fair for the nurses to let him make decisions on how to live and die. Notably, telling him the truth will allow Reuben to share his thoughts on what he thinks will be beneficial or harmful for the remaining part of his life. The nurses should therefore strive to uphold the quality of care, autonomy and justice in making their final decision.

Step 5: The Development of Diverse, Practical Ways to Implement Ethical Decisions and Actions
Revealing the devastating medical information should be done in a compassionate and skilled manner. According to studies, nurses should share the pain of life and death decisions with the patient and their families (Hoskins et al., 2018). In this case, the nurses must ensure that the information is organized in a way that does not cause psychological harm to both Reuben and members of his family. For instance, the nurses should hold a meeting with Reuben’s parents and try to make them understand that withholding the information from Reuben cannot change the diagnosis and the poor prognosis. Besides, the nurses should let the parents know that revealing the information to Reuben will give him a chance to prepare for his impending death. The nurses should also let the parents know that the revelation won’t have any negative consequences on Reuben’s health. The nurses will have fulfilled their obligations both to Reuben and his family by successfully implementing these actions.

Step 6: The Evaluation of Effects and Development of Strategies to Prevent a Similar Occurrence
The nurses should evaluate the situation after revealing the devastating news to Reuben. This will assist in ensuring that Reuben and his family remain strongly united. In the future, the nurses should let the families know that patients over 18 years are responsible for making their health decisions unless incapacitated. Besides, the nurses should inform the families of patients that medical practitioners will assist in disclosing critical medical decisions such as the transition to end-of-life care. Lastly, the nurses should let family members know that medical practitioners will remain honest to the patient and will promptly respond to any questions raised.

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Celis, I. V., & Méndez, C. C. (2019). Moral Distress, Sign of Ethical Issues in the Practice of Oncology Nursing: Literature Review. Aquichan, 19(1), 1-16.
Hoskins, Katelin, Grady, Christine & Ulrich, Connie M., (2018). Ethics Education in Nursing: Instruction for Future Generations of Nurses. Online Journal of Issues in Nursing, 23(1), 1-11.
Milliken, A., (2018). Ethical Awareness: What It Is and Why It Matters. Online Journal of Issues in Nursing, 23(1), 1-7.