This essay is written based on the ethical decision making process in relation to an event that occurred in a health care setting. The essay will describe the case of the patient (see Appendix A) where a decision had to be made in a patient’s best interest. To discuss the importance of ethical decision making, the essay will analyse the situation from legal, ethical and clinical perspectives by applying the four core principles of ethics. Moreover, the essay will also discuss the involvement of multidisciplinary (MDT), focuses on skills that are used by the team such as leadership and effective communication. Arguably, shared decision making model will also be discussed in relation to this case scenario. Complying with Nursing and Midwifery Council (NMC, 2015) patient identity has been changed, to maintain the confidentiality, thus the patient will be referred as Margaret (pseudonym).
Margaret has been diagnosed with metastatic of breast cancer. According to Swanton and Johnston (2012), metastatic of breast cancer is known as the tumour that has spread from the breast to other parts of the body such as brain, liver, and lungs. In relation to Margaret the symptoms present such as nausea and vomiting is associated with metastases breast cancer of the brain (Foy and Blowers, 2009). This is also supported by Harris (2010) who articulates that nausea and vomiting are common symptoms that are caused due to increased pressure in the brain stream called vomiting centre when the patient is in an advanced stage of the cancer. Harmer (2008) argues that metastases of cancer cannot be treated but the symptoms such as nausea and vomiting can be controlled with “antiemetic” medication. Relieving side effect is an important aspect of cancer care treatment to prolong and enhanced quality of life (Foy and Blower,2009). Moreover, the National Institute for Health and Clinical Excellence (NICE, 2004) also recommends the health professional to deliver the range of physical, emotional, social and spiritual support while caring for people with advanced cancer. The goal of treatment for Margaret is to promote comfort and focus on relieving the symptoms.
Decision-making is recognised as the process where the problems are identified and the appropriate choices have to make as a result of the alternatives (Dietrich, 2010). In a health care setting, decision is very crucial and integral part of the nursing. As front-line health care nurses spend their maximal time in direct patient care facing many challenging situations while delivering care that give rise to ethical dilemmas (Thompson et al, 2013). Likewise, Standing (2017) also supports that nurses are the substantial decision maker as the have the earliest opportunity to identify deterioration of the patient’s condition.
Many health care professionals practise different decision making model such as DECIDE model, shared model in order to attain the best possible outcome for their service user. However, in the Margaret case scenario, the student nurse witnessed the team using ethical decision making model while dealing with a moral dilemma when Margaret son contested the medical decision of using a syringe drive. Griffith (2014) defines moral to what a person believed is right or wrong depend upon their experience, culture, religion and education.
Ethical decision-making model is described as a rational framework through which effective decision-making can occur while dealing with ethical dilemmas, as this model draws core principles and values that held central to most health professions to promote good quality practice (Griffith and Tengnah, 2014). According to Thompson et al (2013) an ethical dilemma is a recognised as a conflict in which health professionals have to choose between two equally unsatisfactory alternatives or actions and should have moral reasons for choosing each action. This is where the application of ethical principles needs to be applied to justify the judgement of the decision which are made regarding ethical action (Griffith and Tengnah, 2014). The author further posits that the ethics of healthcare were first introduced by the American philosophers Beauchamp and Childress in 1998 and is based on four key principles of biomedical ethic which are respect for autonomy, non-maleficence, beneficence and justice.