Applying ethical principles to an ethical dilemma

Summary of a suicidal patient case study 

Healthcare professionals face ethical dilemmas during practice due to many reasons. Some of the reasons are medical errors leading to blame culture, assisted suicide, patient information privacy, life support decisions based on decision-making authority, negligence, and other ethical dilemmas (Park et al., 2015). The purpose of this paper is to analyze a patient suicide case study ethical dilemma to apply an ethical decision-making model to mitigate the issue. 

The case is of a patient, Mr. Green who has suicidal tendencies after admitting to the health care facility. Mr. Green is an old gentleman who is 57 years old. The patient was admitted to the oncology unit of the health care facility in Brisbane, Australia. Seven years ago, he was diagnosed with prostate cancer but did not take surgical and medical treatment. The patient chose alternative therapy and treatment but has failed to follow up on his condition with the assigned urologist since then. Now, he has contracted hypoproteinemia and anemia. A series of diagnostics tests were conducted and it was found that the cancer has metastasized to the bones (Jie, 2015). 

Further, the spread has reached lymph nodes, and the tumor has invaded the bladder and affected the functioning of the left kidney. It was estimated that he would live for six to twelve months, but the latest diagnosis after the cystoscopy indicated that tumor growth was fast and he will live for four to six weeks. Further, it was determined that medical or surgical interventions are not possible at this time. The healthcare professionals suggested palliative care. However, the patient informed the nurse that he had enough and wanted to end his life, but urged the nurse to disclose this information and intentions to anyone (Jie, 2015). This constitutes an ethical dilemma as keeping communication with the patient, honoring their wishes, and promoting health by fulfilling nurse responsibilities collide with each other (Suhonen et al., 2018). 

Ethical dilemma in the case study

It is the nurse’s duty to discuss different options with the patient to make a decision that is based on the patient’s choice and wish (Awenat et al., 2017). For example, a patient on life support can give decision-making rights to his family member to make the right decision when he is not capable of decision-making (Campo-Engelstein et al., 2015). However, in this case, the decision to end the life is against the core responsibilities of a nurse. Further, health care professional should keep their conversation with the patients confidential. However, the issue leads to legal, philosophical, moral, and professional dilemmas as ending a life and keeping the information private is against the professional practice code of nursing (Goligher et al., 2017). For example, a nurse can persuade a patient with terminally ill cancer not to drink or smoke to extend the possibility of life. Another example is midwives can highlight the complexities of normal birth in a particular case to suggest a caesarian (Diema Konlan et al., 2019). Another aspect is even if the nurse honors the wish of the patient, the intervention to end the life should be well-thought and based on clinical outcomes. Suicide attempts leading to more complex problems and patient not dying reflects poor decision-making even though the patient’s autonomy was considered (Goligher et al., 2017). For example, healthcare-assisted suicide poses less risk compared to individual suicide attempts without precautions (Goligher et al., 2017). 

Individual ethical decision-making consists of understanding moral awareness of the case based on individual, organizational, and cultural values and morals then making the judgment based on communication, issue analysis, and exploring options, and finally acting based on different aspects to make the right decision to the case (Snyder Sulmasy & Mueller, 2017). Thus, the most important ethical dilemma faced by the nurse in this situation is whether to inform other health professionals and violate the patient’s consent and autonomy or keep the secret and subject self to moral and professional responsibility as a nurse and as a human (Jie, 2015). This constitutes the moral awareness aspect of ethical decision-making. 

NHS FPX 4000 Assessment 1 Applying Ethical Principles

Analysis of the case

It is important to identify the relationship between an ethical dilemma and ethical principles. The first aspect is the patient’s autonomy (Jie, 2015). Even though the decision to end life is the patient’s autonomy, it is taken after knowing that he will live for four to six weeks. He is not cognitively sound and facing emotional distress. This clouds judgment. Thus, the nurse should first establish communication to remove suicidal thoughts as it is her duty to suggest the best possible option to the patient. Snyder Sulmasy & Mueller (2017) argued that even when the patient has complete autonomy, but it is the responsibility of the nurse to implement clinical judgment by limiting cognitive biases. Goligher et al. (2017) supported physician-assisted suicide when a patient is in a vegetative state, but not when a patient can function properly and can live his remaining life. Jie (2015) recommended the nurse make a life-prolonging decision and persuade the patient to communicate with other professionals before making the decision as the ethical clash between beneficence, non-maleficence, and the principle of autonomy should result to benefit the patient.  

The core responsibility of the nurse is to protect the life of Mr. Green as it leads to the beneficence aspect of moral decision-making. The nurse should take positive actions even if at the time it is against the patient’s autonomy. Large et al. (2017) in their study concluded that nurses should identify the patients at risk to commit suicide to prevent it. Discussions with nursing staff and other healthcare staff help in assessing the situation based on individual and organizational values, policies, morals, and laws (Campo-Engelstein et al., 2015). Further, Awenat et al. (2017) reported that nurses go through psychological issues after assisting suicide, withholding suicide information, or witnessing their patients commit suicide. This indicates negative induced effects on nurses. 

Another aspect is non-maleficence. This ethical principle deals with an obligation to not to harm the patients knowingly or unknowingly. The nurse should make a decision that should harm the patient. For example, suicide attempts might not be successful and it might lead to other complications. The study by Shand et al. (2017) showed that the suicide survivors felt that the decision was instinctive and any outside help would have prevented them from committing the act. Barnfield et al. (2018) also highlighted the need to prevent suicide attempts to reduce potential self-harm. Therefore, violating the patient’s autonomy and informing others to make the right decision is the right choice in this case. However, it is important to explain the benefits and harms of different actions to Mr. Green so that understanding his perspective aids in mitigating the issue (Large et al., 2017). Ignoring the values of beneficence and non-maleficence over autonomy cannot be justified in this case as even under euthanasia, patients do not have a right to end their lives when they want and however they want (Jie, 2015). As a result, the nurse should inform others and persuade the patient not to commit suicide through communication, advocacy, and different therapies. 

Effectiveness of communication approaches

Eliciting and then responding to suicidal thoughts can help the patient understand the impact of a recent adverse event on the patient. This can be achieved by establishing paraprofessional or professional-patient interaction to gain trust and understand patient’s perspectives. Further, highlighting the possible adverse outcome of suicide and the possibility of prolonged life by giving examples of previous patients aids in relaxing suicidal thoughts (McCabe et al., 2016). Instead of group discussion, it is better to establish one-to-one communication first and then discuss the issue with others including family. It is also recommended to interact within the institutional setting or within the community to make the patient feel trusted (Shand et al., 2017). Instead of concentrating on conditions, it is better to focus on suicidal ideations. It is better not to highlight the possibility of healthcare complexities. Also, it is better to avoid discussing negative family or personal issues (McCabe et al., 2016). 

Ramberg et al. (2016) in their case study highlighted that nurses used education as a means to educate the patients to understand the complications of their actions. The process included establishing a nurse-patient relationship to gain trust and provide emotional support. It is advised to have a positive attitude and implement a persuasive communication strategy. Further, incorporating psychiatric nurses with sufficient training aid in preventing suicidal thoughts (Ramberg et al., 2016). 

Ethical principles

Establishing communication, educating patients, building trust, discussing with other health care staff, providing support, and having an attitude to prevent suicide and promote the well-being of the patient to prolong life is under the ethical principles of beneficence, non-maleficence, professional, and moral obligation (Ramberg et al., 2016). As explained in the ethical analysis section, the action plan is to promote health and benefit the patient by understanding his perspectives. As a result, the proposed solution is based on the ethical principles of beneficence, non-maleficence, and moral and professional obligation (Jie, 2015).