Ethical Dilemma: Shared Patient Decision Making Dilemma

Shared Patient Decision Making Dilemma

Recently, healthcare was dominated by a paternalistic mindset in which medical practitioners acted on their assumptions and preconceived notions rather than considering the preferences of their patients. This unethical practice has since been replaced by one that is significantly more ethical. The idea of shared patient decision-making, which is an extension of patient autonomy, empowers patients by allowing them to collaborate with health care providers to make essential care decisions. Patient and caregivers collaborate to make decisions about testing, treatments, procedures, and overall care plan in shared decision-making.

Health care practitioners should learn about their patient’s values, beliefs, and ambitions to establish a trusting and respectful relationship. They must be aware of a patient’s history and how elements such as age and race may influence their decision-making.

Patients are more satisfied with their care and more likely to follow prescribed treatment programs when they are actively involved in decision-making and have a respectful, compassionate relationship with their caregiver (Haahr, 2020).

A dilemma may arise when the relationship between the patient and the nurse is worsened. When a nurse subjects a patient to a kind of treatment that the patient does not want for various reasons, the patient tends to hate the nurse, creating a bad relationship. This results in an ethical dilemma as the nurse cannot decide whether to continue administering the necessary treatments or follow the patient’s request. The only option to solve the dilemma is to engage the patient in every decision-making stage before performing any treatment procedures. It is equally good for a nurse to take a step and administer treatment to the patient without permission if the patient’s situation is critical.

Utilitarian Ethical Theory

The rationale for choosing this theory is that an action is considered correct because it adheres to a rule leading to the greatest good. The correctness or wrongness of a particular action depends on the correctness of the practice. In utilitarian ethical theories, an action’s likelihood of resulting in desirable or undesirable consequences is used to gauge its moral acceptability. A utilitarian would claim that the action that produces the most significant benefit for the greatest number of people is morally correct.

The two forms of utilitarian ethical theories include Act and rule utilitarianism. Act utilitarianism is where good actions have equal moral weight, even if they provide just marginally more happiness than alternative actions that someone could take. Rule utilitarianism is where the rules followed should be right if they promote a high level of utility.

Rule utilitarianism incorporates legal requirements into its structure and strives for fairness (Mandal et al., 2016). Decisions are made according to predefined rules, which are based on evidence and result in better decision-making. Rule utilitarianism holds that a morally correct decision follows the rules and laws, thus producing better consequences. Patients are included in the decision-making process, making decisions that are equitable to all stakeholders a possibility. The rule utilitarian’s goal is to help the most significant number of people to the greatest extent but in the fairest and most just manner possible.

The patient’s request is too crucial and should be considered to ensure a fair and just decision is met. This is to prevent any form of an ethical dilemma that may arise in the process ad; thus, the utilitarian theory guides the decision-makers to achieve a good decision.

Decision-Making Model

The moral decision-making model outlines five critical decision-making steps. Nurses, particularly in light of the options available to them, often face complex ethical dilemmas. There are two reasons why the nurse needs to employ a tested ethical decision-making model. First, it is a proven method for patient care in the emergency room. The second consideration is that the model incorporates all stakeholders involved in finding a solution for the case. An ethical dilemma is defined first to facilitate the application of the decision-making model. When patients are required to receive the treatment they dislike, the dilemma may arise. The second step is to consider all available options, identify the associated costs and benefits, and choose an option. Patients may refuse rehabilitation because they do not have a sufficient understanding of the available treatment options.

Resolving the dilemma would be the third step in the process. All of the options in Step 2 should be thoroughly evaluated and compared to the concepts of care and justice to ensure they are ethical. To ensure that the selected option is legal, reasonable, and fulfils the patient’s needs and desires, nurses must be vigilant during this step (Guo, 2020). In the fourth step, you’d use the option you’ve selected. If the patient stayed on her rehabilitation program, this would mean that the patient would remain in a rehabilitation facility or be transferred to a long-term care facility. (Guo, 2020). Finally, an evaluation of the action is required whereby the nurse must look at the entire decision-making process. Participants involved in the decision-making process and implementation of the final decision should be included in a review.

There is a collaborative aspect to healthcare whereby treatment goals and care plans must be established together by patients, families, nurses, and physicians. Nurses, particularly in light of the options available to them, often face complex ethical dilemmas. Team members need to keep in mind their values and their choices when they collaborate because each person’s values will influence those decisions. The patient’s caregivers, including nurses and physicians, and the patient themselves might feel that the patient will fully recover.

Still, the patient thinks there is no chance of fully recovering, so the value of their continued care is not apparent. To ensure that healthcare focuses on the patient’s needs, nurses should employ ethical decision-making models. Additionally, shared decision-making goes beyond simply providing people with information. To ensure their patients’ overall well-being, healthcare providers should first explore their patients’ values, beliefs, and goals and develop a trusting relationship.

Doctors should comprehend their patients’ backgrounds and recognize the effect factors like age and race have on their judgment. Just as patients must consent to treatment before it can proceed, medical practitioners must take extra precautions to ensure patients fully understand the information shared with them and the potential outcomes of their decisions. If patients agree to a treatment plan but fail to comprehend it fully, they may argue with medical staff, resulting in an ethical dilemma.

Even here, the communication and advocacy skills of nurses’ aid in making the shared decision-making process more effective. Patients may find themselves unable or unwilling to follow through on a care decision for many reasons, including issues that prove more difficult than expected or do not live up to expectations. A nurse’s role is to help patients communicate and collaborate.


Guo, K. L. (2020). DECIDE: A decision-making model for more effective decision making by health care managers. The health care manager, 39(3), 133-141.

Haahr, A., Norlyk, A., Martinsen, B., & Dreyer, P. (2020). Nurses experiences of ethical dilemmas: a review. Nursing ethics, 27(1), 258-272.

Mandal, J., Ponnambath, D., & Parija, S. (2016). Utilitarian and deontological ethics in medicine. Tropical Parasitology, 6(1), 5. Web.

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