Nursebob's MICU/CCU Survival Guide
Critical Care Concepts
Ethical Decision Making in Critical Care

12.11.03

Nurses working in critical care are faced with ethical dilemmas on a daily basis. At times it is difficult to keep things in perspective. The values and beliefs of the nurse may at times be in conflict with those of the patient. It is incumbent on each nurse to understand not only the values and ethics of the patient but those of himself.

What is an ethical dilemma?

The nurse may be faced with situations in the critical care unit, which may have much disagreement, on what is the correct course of action. These may be internalized based on the nurse values and beliefs as well as external as related to the values of others . These situations may at times cause the nurse not to know how to act and may not take any course of action since both may be contrary to the nurses internalized beliefs. You have two choices and both may appear correct.

Characteristics of an ethical dilemma?

With an ethical dilemma there is a real choice. The nurse must keep in mind that people have significantly different value judgments. Simply obtaining more information will not resolve the dilemma. The answers may come from various sources. Medicine Philosophy and Nursing Religion have both came into play. Often the problem may not be solvable and there may not be any right or wrong.

Beneficence, justice , autonomy, veracity and respect for persons are characteristics, which all nurses must have in order to be ethical. We must always keep the needs and safety of the patient first in our care. We must never inflict evil or harm. Justice and fairness are qualities, which must be cultivated. Remember that all patients have autonomy. That is individuals can make decisions for themselves and health care workers must respect their decision. This is especially difficult when the patients beliefs and values are in conflict with our on. Individuals have to be competent .

There are situations where autonomy can be violated such as; prevention of suicide , protection of third parties, maintain integrity of the health care profession and the maintaince of institutional order. The respect for others and veracity or truth telling are paramount in our profession. Confidentiality or privacy is another dilemma which nurses find themselves in today. While each patient has the right to confidentiality there are times when it may be violated. Such as contagious diseases which must be reported, gunshot wounds and other violent crimes which must be reported. Child abuse is another incident that must be reported .

References:
Lemone & Burke The Medical-Surgical Nurse fifth edition, 1995, Chapter 1
Leininger, M., Transcultural care principles, human rights, and ethical considerations,
Journal of Transcultural Nursing, 3, 21-23

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