Ethical dilemmas tend to appear in any medical profession. According to Allen (2018), for a situation to be regarded as an ethical dilemma, it has to meet three criteria. First, it is not the individual being affected directly by the consequences of the decision made by other person: an agent takes up the mandate of making the right choice for the principal (person being affected directly). Second, there has to be more than one course of action to be chosen to resolve the issue. Third, irrespective of the solution chosen, a moral standard would be compromised. Basically, a perfect solution does not exist, and it is up to the agent who has been entrusted with the right to make the decision. In this case, a 41-year-old woman with an advanced case of breast cancer and being developmentally delayed since birth has requested that she does not want to undergo further cancer treatment. The above case is an ethical dilemma since it meets the three criteria required for a situation to be considered like this. First, the patient has asked the nurse to make the decision to take her off further cancer treatment. Second, there are different courses of action that the principle can take, as it is guided by different ethical frameworks. Third, regardless of the course of action that would be chosen, one or more ethical principles would be compromised. The answer to the course of action that has been requested by the patient must be generated through the use of the utilitarianism framework. My values shall be expounded upon, the utilitarian model ought to be looked at, and then, the ethical dilemma must be solved as guided by my values and utilitarian model.
In the nursing profession, I am guided by four core principles, autonomy, beneficence, non-malfeasance, and justice. Autonomy is also known as the right of self-determination. According to the National Academy of Sciences (2014), autonomy refers to the right of an individual to make their own decisions free from any form of manipulation or coercion. In relation to an ethical dilemma, the principle of autonomy means that a patient has not been guided into making a particular decision through the use of coercion or any manipulative tactics. I believe that if a patient is of sound mind and understands the repercussions of the decision that they are making, then their principle of self-determination has not been compromised.
Beneficence is the second core value. It basically means that a decision that has been made by the medical practitioner is one that is in the best interest of a patient (Williams, 2018). The care for a person comes first, and the medical professional should strive to ensure that they take care of a patient’s needs regardless of how they feel about the situation.
The principles of non-malfeasance and justice are my third and fourth values respectively. The first one ensures that the physicians do no harm to their patients. Additionally, as guided by the principle of non-malfeasance, a practitioner should also not make any decisions whose ancillary effects would cause harm. Such principle is the one that is most challenging to adhere to when it comes to an ethical dilemma, as from different angles, the solution chosen to deal with the moral issue may appear as though the medical practitioner is causing harm to the patient. Justice is a hard concept to define. However, my definition of justice is doing what is right in relation to the patient. Justice is also a core principle that is challenged when a solution is being chosen for an ethical dilemma. Therefore, autonomy, beneficence, non-malfeasance, and justice are my core values.
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Utilitarianism is an ethical framework that is used to deal with ethical dilemmas. Utilitarianism basically states that there is no right or wrong course of action as long as an outcome is good (McCombs School of Business, 2018). Thus, it is a mode of consequentialism. It means that the result of a decision that has been made has to generate the highest overall good in relation to everyone and everything (Driver, 2014). It departs from egoism, as its main premise is that a decision or action taken is considered proper as long as it promotes the highest good for an individual who is making it. The effects of the utilitarian decision or action taken should not only have a good outcome on the individual making a decision, but it should have a good outcome on as many people as possible. When utilitarianism is applied in relation to an ethical dilemma, it is not only the highest good of the medical practitioner that should be pursued; it is the highest good of a patient, their family and friends, as well as a medical practitioner that should be sought. One person’s highest good does not count more than another person’s highest good. Based on the above exposition of the utilitarian theory, it shall be used to come up with a solution to the ethical dilemma.
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The Solution to the Ethical Problem
A 41-year-old woman with an advanced case of breast cancer and one who has been developmentally delayed since birth has requested that she does not want to undergo further cancer treatment. The ethical dilemma is that if she stops her cancer treatment, she may go into remission, which may then result in her death. Additionally, she is developmentally delayed, which puts her decision-making skills in question, and that makes the problem an even bigger ethical dilemma. My solution is that I would stop the cancer treatment, as she has requested. As guided by the utilitarian ethical framework, the decision is neither right nor wrong until the consequences of the decision have been felt. The result of the decision is that she may die, but she would be saved from much more pain in the end. The woman has an advanced case of breast cancer, and the probability of her recovering may be quite low. Putting her through further treatment that would cause her more pain and may result in an excruciating death is not good in the end.
The decision to stop the cancer treatment is in agreement with three of my core principles and disagrees with only one of them. The condition of the principle of autonomy has been met. Though the patient has been developmentally delayed from birth, she is lucid enough to make her decisions and understand the consequences. Moreover, she has not made the decision under coercion or manipulation. The principle of beneficence is also in agreement with the final choice. Stopping the cancer treatment is her highest good since with advanced cancer, the probability of her surviving is very low. Thus, rather than pushing her to experience more pain, stopping the cancer treatment would be her highest good. The principle of justice is in agreement with the decision that has been made. Stopping the cancer treatment is the right thing to do for her. The principle of non-malfeasance may not agree with the decision that has been made depending on the view that one takes. Stopping the patient’s treatment may be construed as causing them harm, thus violating the principle of non-malfeasance. On the other hand, one may consider continuing the patient on further therapy as causing them the most significant harm, thus deciding to stop the treatment adheres to the principle of nonmalfeasance. Therefore, the solution to the ethical dilemma will be to stop the treatment.