Medical personnel are faced with hard decisions to make on their behalf and the behalf of their patients. In making these decisions, they must be guided by some professional ethics which are essential for them. At the same time they are guided by the nature of human life and the humanity in them and other expectations from the society at large which is condensed together as ethical principles of health care. In the event of creating a balance between all these issues, a dilemma may arise. An ethical dilemma is a struggle between the patients’ freedom on one hand and the principles of health care ethics. These principles include among others: beneficence, patients autonomy, nonmaleficence, veracity, justice or fairness, confidentiality and role fidelity. Ethical dilemmas involving patients are solved using these principles and ethical theories. (Nordgren & Fridlund 2001)
Mr. Zol was a 50 year old man when he started showing symptoms of hypotension, impotence, dizziness, and feelings of heaviness in the whole body. He went to the hospital in Parkinson’s disease research, education, and clinical centre and was diagnosed with a disease called Shy-Drager syndrome which is one of the manifestations of multi system atrophy. After diagnosis patients do not leave for over a decade. (Sjostrom, Hohnberg & Strang 2002)
He nursed his condition for some years and on his 56th birthday, he went back to the hospital but this time in a wheel chair, with muscle stiffness, leg weakness, muscle wasting, depression, multiple ulcers, weight loss, and other multiple complications. He could hardly care for himself apart from the fact that he was able to, feed himself. His ex-wife and son wanted to seek an alternative place of care. After some few months, complications developed in the feeding and communication systems and so he had difficulties in swallowing and communications. He was therefore taken to palliative care unit for specialized care. Some special diet was recommended and given to him but he refused to take it, instead he opted for hamburgers which were brought by the ex-wife. Due to this, he reduced weight and his condition deteriorated. The physician was informed and he ordered for nasogastric tube feeding. The tube was inserted and Mr. Zel removed it within an hour of its placement and refused the reinsertion claiming that he was terminal and he wanted to eat regular food. He knew about the disease and its prognosis and wanted to take chance with regular food but the doctor knew that it was not good for him. There was a dilemma here. (Constance, 2006)
The principles of healthcare dictate that the physician should act in a way that the patient benefits all the time. This is the principle of beneficence. But also the patient has freedom to decide for himself what ever he wants. The physician is also guided by a principle of nonmaleficence. This is where a doctor or physician is supposed to decide the belief that it is for the welfare of the patient. In this case, there is a struggle between a patient’s autonomy on one end and the principles of acting for the benefit of the patient and inflicting no harm to the patient on the other end. (Edge & Groves 2005)
The physician is supposed to protect the life of the patient under whatever circumstances. In this case he is supposed to ensure that Mr. Zel uses the right food because if this does not happen, he will be choked and he is likely to die. The doctor is also entitled to respect the decisions of Mr. Zel because he has a right to informed decision. (Nordgren & Fridlund 2001)
The ethical committee team met to resolve the dilemma using the principles of health care ethics and the rights of the patient. Because Mr. Zel had a right to make informed decision, and that he knew the implications of what he was doing, they followed his decisions and an order was given to the physician to allow him take regular food. Some precautions were taken in the process of giving the food. (Constance, 2006)
If we consider this case, we discover that some health care principles were violated in the effort to respect the autonomy of the patient. Initially the principal of autonomy of the patient was violated when he was given the food he did not want through nasal tubes. The physicians and the nurses violated the principal. He removed the tubes within an hour. The principle of beneficence which is the act of doing well all the time for the benefit of the patience was violated. The committee and the doctors and nurses knew very well that it was good for Mr. Zel to take the food that could not harm him. But after much deliberation they decided to let him take the regular food he wanted which could lead to his death. This is another case where the nurses and the doctors and the ethical committee violated a very important principle. (Constance, 2006)
This case study shows how ethical dilemmas are encountered in the health care. In most cases the dilemma results when one is trying to balance all the principles or when one is trying to apply one or two principles in expense of other principle. They also result due to different beliefs of the parties involved. (Wenning & Shlomo 2000)
In such a case, the principles of the Kantian ethics theory can be applied here in the bid to solve the dilemma. Since nothing is intrinsically good, whatever is good is a good will or motive. I will be guided by the good motive of respecting the wishes of Mr. Zel and ensuring that he has a meaningful and quality life but not a frustrated and quantitative life. What benefit is there in giving someone some stuff he does not value. Even if you give it and the person lives forever, he will never be happy in this live. You are supposed to ensure that a person lives life in its fullest even if he lives for a single day. Isn’t this a good motive? (Richard, 1979)
The utilitarian may argue that an act is good if it brings about more goodness than the evil or bad consequences. One may argue that removing these nasal pipes from feeding and giving him regular food would bring some more evil than good. This is because of course if the doctors prescription is followed Zel would live longer than if his autonomy is respected and in this way he will live longer than if he continued eating the regular or normal food. This is qualified to be a good action because life is better than death. (Richard, 1979)
Life is indeed better than death. But we should also remember that happiness is better than suffering. Besides who says that Zel must die if he takes regular food? And who said that there is nothing else that can be done to prolong his life while he is still taking the regular food. One should not limit himself to one option especially if the option brings about suffering to the subjects in questions. The theory by Kent explains that the actions done should be an end by themselves but not a means to an end. By trying to impose unwanted foods to Zel, the physician will only be trying to find a way of holding on to the principle of beneficence to end criticism which is not necessary. (Richard, 1979)
Ethical dilemmas are real. Many people have found themselves fighting within their hearts, trying to decide which principle to follow and which one to ignore. Some times it becomes hard to balance all of the principles to s satisfaction. What ever dilemma, the ethical theories can be used to give an insight for a way out.
Constance, W. (2006). An ethical dilemma involving a shy-drager patient: a case study. Journal of Neuroscience Nursing, (Neurosciences research), 46, 15-16.
Edge, R., & Groves, J. (2005). Autonomy vs. paternalism: A contest between virtues. In C. L. Esperti (Ed.), Ethics of health care: A guide for clinical practice (3rd ed., rev., pp. 143 -166). Clifton Park, NY: Thomson Delmar Learning.
Nordgren, S, & Fridlund, B. (2001). Patient’s perceptions of self-determination as expressed in the context of care. Journal of Advanced Nursing, 35(1), 117-125.
Richard, T. (1979) “The Varieties of Ethical Theories, Buffalo Psychiatric Center. Web.
Sjostrom, A., Hohnberg, B., & Strang, E (2002). Parkinson-plus patients: An unknown group with severe symptoms. Journal of Neuroscience Nursing, 34, 314-319.
Wenning, G. K., Shlomo, B., Hughes, A., Daniel, S. E., Lees, A., & Quinn, N. E (2000).
What clinical features are most useful to distinguish definite multiple system Atrophy from Parkinson’s disease? Journal of Neurology, Neurosurgery And Psychiatry, 68, 434-141.