If ‘Ethics’ Stresses You Out…Grab Some Colors

Ethical Decision Making for Nurses: Case Studies

Janie Butts, Ph.D., RNProfessor

Elizabeth Tinnon, Ph.D., RN, CNEAssistant Professor

Our Belief

“Many people argue that we are living in a

time when society is moving away from the

moral absolutes that have guided right and

wrong behaviors to an era of making decisions

derived from ethical relativism. This means

actions right for one person are not necessarily

right for others and different cultures believe in

and practice different moral codes.”

continue to next page

cont’d.

“If this is accurate, can nurses, when making

an ethical decision, maintain some sense of

assurance that they chose a right action?”

“Although we believe nurses cannot always

have an absolute assurance that they made right

ethical choices, they do have the Code of Ethics

and other books to guide them in making difficult

decisions. Given our current moral landscape,

nurses must now, more than ever, be sensitive to

ethical issues in their surroundings and be able to

analyze them within a decision-making

framework.”

Dr. Janie Butts and Dr. Elizabeth Tinnon

Presentation Content

• A case study on violation of humanity lost.• A case study on right to refuse treatment.

Case Study of Humanity Lost

A male, Mr. C., age 42, has a lung cancer

from smoking, which is now metastasized to the

brain and is in and out of the hospital regularly.

Recently, he was admitted again for treatment.

He is liked by the staff nurses, but as the tumor

progressed, he displayed combative and hostile

treatment, such as attacking a nurse with an I.V.

pole. Pharmacological management did not

help him calm down. Then, he was placed in 4-

point restraints according to policy. (continue to next page)

cont’d.

The nurses called for an ethics consult

because “When we walk into his room what we

see is an animal tethered to a bed. His patient

gown is often awry because of his

restlessness, and he lies there in glorious

nakedness. His condom catheter often comes

off, and his sheets are urine soaked. He

moans….it’s hard to think of him as a person.

Somehow we lost the man we knew and love.”

Question

What do you see as the top twocentral ethical issues?

Question

Why do you agree or disagree with the following statement:

The more vulnerable people are because of illness or marginalizing factors, the more they

command my compassion and respect.

Question

Why do you agree or disagree with the following statement:

I need to be compassionate and respectful to those innocently affected by disease or injury—so long as abusive behaviors did not cause the

disease or infirmity.

Broken colors still color. The same can be said of nurses.

Patient’s Right to Refuse Treatment Mrs. Smith is admitted to your home health

agency with a diagnosis of multiple diabetic ulcers.

Upon admission you are aghast at the condition of her

ulcers and overall general health. As you progress

through the admission Mrs. Smith insists that she is

unwilling to follow a diabetic diet or take her

medication as ordered. When the physician returns

your call for orders she asks about the patient’s

willingness to follow the plan of care. You inform the

physician that the patient is willing to allow dressing

changes but is unwilling to follow any other part of the

plan.

continue to next page

cont’d.

Then, the physician states that she is unable

to continue to provide medical care to the patient

and Mrs. Smith is not admitted. Mrs. Smith tells

you that she will contact her daughter and they

will find another physician. One month later Mrs.

Smith’s daughter calls you very upset stating that

her mother is in very bad shape and asks that you

come to the home. Upon entering the home you

observe what appears to be gangrene on both

feet and Mrs. Smith is very lethargic. You arrange

for the patient to be taken to the hospital where

upon Mrs. Smith undergoes a bilateral below the

knee amputation.

What is the First Ethical IssueYou See in This Scenario?

What Are The Ethical PrinciplesAt Stake?

Do You Think the Doctor Had theRight to Dismiss the Patient?

Do You Think Mrs. Smith had the Right to Refuse Treatment?

So, Again…If ‘Ethics’ Stresses You Out…

Grab Some Colors

References

Beauchamp, T., & Childress, J. (2013). Principles of biomedical ethics. New York: Oxford University Press.

Butts, J., & Rich, K. (2016). Nursing ethics: Across the curriculum and into practice (4th ed.). Burlington, MA: Jones & Bartlett Learning.

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA: MD: Silver Spring, MD.

Fry, S., Veatch, R., & Taylor, C. (2011). Case studies in nursing ethics (4th ed.). Sudbury, MA: Jones & Bartlett.

Jonsen, A., Siegler, M., & Winslade, W. (2015). A practical approach to ethical decisions in clinical medicine (8th ed.). Boston: McGraw-Hill Education.