Original ArticleThe patient suicide attempt – An ethical dilemma case studyUnder a Creative Commons
license Open access AbstractCase descriptionNurses face more and more ethical dilemmas during their practice nowadays, especially when they are taking care of the patient at end of life stage. The case study demonstrates an ethical dilemma when
nursing staff are taking care of an end stage aggressive prostate cancer patient Mr Green who expressed the suicide thoughts to one of the nurses and ask that nurse keep secret for him in Brisbane, QLD, Australia. Ethical dilemma identificationThe ethical dilemma is identified as “if the nursing staff should tell other health care team members about patient's suicide attempt without patient's consent”. AnalysisTo better solving this case and making the best moral decision, the ethical theory, the ethical principles and the Australian nurses' code of ethics values statement, the associated literature relative with this case are analyzed before the decision making. Ethical decision makingAfter consider all of the above factors, in this case, the best ethical
decision for the patient is that the nurse share the information of Mr Green's suicide attempt with other health care professionals. ResultsIn Mr Green's case, the nurse chose to share the information of Mr Green's suicide attempt with other health care professionals. The nursing team followed the self-harm and suicide protocol of the hospital strictly, they maintained the effective communication with Mr Green,
identified the factors which cause patient's suicide attempt, provided the appropriate nursing intervention to deal will these risk factors and collaborated with other health care professionals to prefect the further care. The patient transferred to a palliative care service with no sign of suicide attempt and other self-harm behaviors and passed away peacefully 76 days after discharged with his relatives and pastors accompany. KeywordsEthical dilemmas Suicide attempt Ethical theory and principles Copyright © 2015 Chinese Nursing Association. Production and hosting by Elsevier B.V. Chapter 3: Ethical Dilemmas and the Process of Effective Resolution
With values as focal point, the National Association of Social Workers has created a framework that is used by social workers to address ethical dilemmas. The framework includes six
steps:[1] - Determine whether there is an ethical issue or/and dilemma. Is there a conflict of values, or rights, or professional responsibilities?
- Identify the key values and principles involved. What meanings and limitations are typically
attached to these competing values?
- Rank the values or ethical principles which – in your professional judgement – are most relevant to the issue or dilemma. What reasons can you provide for prioritizing one competing value/principle over another?
- Develop an action plan that is consistent with the ethical priorities that have been determined as central to the dilemma. Have you conferred with clients and colleagues, as appropriate, about the potential risks and
consequences of alternative courses of action? Can you support or justify your action plan with the values/principles on which the plan is based?
- Implement your plan, utilizing the most appropriate practice skills and competencies. How will you make use of core social work skills such as sensitive communication, skillful negotiation, and cultural competence?
- Reflect on the outcome of this ethical decision making process. How would you evaluate the consequences of this
process for those involved: client(s), professional(s), and agency(ies)?
In comparison, Evans and MacMillan (2014) have developed a framework involving 10 steps to make ethical decision-making efficient and practical. This framework is specific to law enforcement officers and addresses the consideration of laws, regulations, policy, and procedures that other frameworks assume will be followed, but in law enforcement are very important to avoid charges and allow cases against suspects
to proceed. The framework concludes with a follow-up to determine the effectiveness of the course of action taken by the officer. As a simple alternative to these frameworks, students should consider the following framework: - Establish the facts surrounding the ethical dilemma.
Facts are important in law enforcement. To investigate all cases, officers must rely on facts to guard against misinformation and cognitive biases. This is also true in ethical dilemmas that
we face. If the facts are not known to us, we must investigate everything that surrounds the dilemma to ensure we are acting on the right information. Avoid acting on rumours and gossip by verifying information through factual information and evidence. - Determine your legal obligations and duties.
We must be sure what our professional and legal obligations are. Professional and legal obligations will likely allow us to easily decide on a course of action to take in an ethical
dilemma. However, while professional and legal obligations may not always require a course of action that coincides with these obligations, our awareness of any professional and legal obligations must be known to allow us to be fully cognizant of the consequences of our actions should we choose to ignore professional or legal obligations. - Establish the interested participants involved.
It is important to know who will be impacted by the course of action that we decide
upon. Often the primary participants are easy to identify and it is the secondary participants that are often not considered. These may include friends, families, or employees that are related somehow to the primary participants in the ethical dilemma. Knowing the impact of the decision made to secondary participants may be particularly important for a decision made with utilitarian underpinnings; where the rights of those who are not part of the majority may not be considered. - Determine
the ethical values of each participant.
Determining ethical values is important to allow us an understanding of what is truly at stake. A participant in an ethical dilemma may value loyalty as the most important value. However, another participant may value equality as the more important value. When considered, the value of loyalty may not compare with equality, depending upon the ethical dilemma. - Consider normative ethical theories as an aide to determine a course of
action.
When considering options, normative ethical theories may assist us in determining the consequences of actions, or the duties we may be obligated to follow that fall outside of the laws, rules, and procedures. We may also assess whether the decision we are considering is rational from another perspective we have not considered. We may also settle on an option, and rely on an ethical theory to assist us in articulating the reasoning behind the option we have chosen. - Consider
options that would be ethically sound.
There may be several options to consider, and each option ought to be considered critically by determining what harm it would cause and what values the person being harmed holds. The participant should consider the positives and negatives of the decision and determine the risks and benefits associated with each option, as well as the benefits of each action, with these values in mind. - Consideration of the possible negative and
positive outcomes of each possible option.
Try to predict what may otherwise be unintended consequences of your decision. These consequences may not be readily apparent, but they require a critical analysis of the consequences of your decision. To help with this, try asking the following questions: - Would the action taken be well received if it was on the front page of a newspaper? While this should be a consideration, keep in mind that often the right decision may be the
least popular in public opinion.
- If the decision is job-related, would the agency or company you work for still hire you if it knew you would make this decision? If the answer is yes, then this should give weight to the decision you are about to make.
- If the decision is not job-related, would the agency you would like to work for still hire you if it knew all the facts surrounding the dilemma and the decision you would make? If the answer is yes, then this should
give weight to the decision you are about to make.
Implement options after considering steps 1-7.
What are the 5 ethical principles of nursing?
The 5 nursing ethic codes are: nonmaleficence, beneficence, autonomy, justice, and privacy/confidentiality.
What are the 7 nursing ethical principles?
The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.
What is the first step in resolving ethical dilemmas facing nurses?
The first step in resolving an ethical dilemma is to gather information relevant to the case from the perspective of the patient, family, institution, and society. Next, the nurse should distinguish among facts, values, and opinion.
What are the correct steps to resolve an ethical dilemma of a clinical unit?
Place the steps in correct order.. Clarify values.. Ask the question, Is this an ethical dilemma?. Verbalize the problem.. Gather information.. Identify course of action.. Evaluate the plan.. Negotiate a plan.. | 
