This paper applies Uustal's (1993) nine-step ethical decision-making model to a real clinical dilemma encountered in nursing practice. The scenario involves a child diagnosed with a brain tumor whose parents administered marijuana without physician knowledge or consent. Drawing on virtue ethics, the paper walks through each step of Uustal's framework — from identifying the problem and clarifying personal ethical values to evaluating alternatives, selecting an acceptable course of action, and assessing outcomes. The paper also addresses the role of the American Nurses Association Code of Ethics in shaping nurses' professional duties and guiding morally sound clinical decisions.
Uustal (1993) proposed a decision-making model that offers tangible steps for arriving at a morally acceptable solution when experiencing an ethical dilemma. Generally, nurses are frequently faced with ethical dilemmas that are largely attributed to the nature of their work. One ethical dilemma encountered in a clinical setting involved a child diagnosed with a brain tumor. Before the diagnosis, the child had been severely ill and went several days without eating, which increased the severity of his condition. Even though the physicians were doing their best to save the child's life, the family became extremely worried. As a result, his parents gave him marijuana based on their extensive knowledge of its medical benefits. While the decision proved beneficial in the short term, the child faces the risk of experiencing a recurrence of the brain tumor (James, 2011).
Uustal's model of decision-making can be applied to this dilemma by working through its nine steps. The ethical ramifications of the situation include giving an illegal drug to a child, carrying out treatment procedures without physician consent, and a probable erosion of trust in the health care facility and its personnel. Based on Uustal's model, the first step in resolving the issue is identifying the problem — specifically, that a child was given an illegal drug without the doctor's knowledge or consent.
The second step involves clarifying the personal ethical position relevant to the situation. In this case, that position is virtue ethics, which is grounded in values such as self-control, compassion, trustworthiness, integrity, honesty, courage, and prudence. From this perspective, the parents should have notified the physicians and nurses of their decision to give the child marijuana so that health care personnel could evaluate him thoroughly.
Third, several alternatives exist, including holding consultations with the physicians about the marijuana, trusting the physician's judgment and following the existing treatment plan, and transferring the child to a facility where the drug is legally used for medical purposes. Fourth, the most important alternative would be to consult the physicians about the marijuana use, followed — if the physicians disagree — by transferring the child to a hospital where medical marijuana is legalized. The need for consultation is driven by the value of honesty, since the physicians mistakenly believed the child's recovery was due solely to their treatment plan. Fifth, the first alternative would foster cooperation from the hospital's health care team, including the physician, and would enable the child to be monitored appropriately. Transferring the child to another hospital, however, would carry increased risks because of the time required before he could receive further treatment.
"Selecting, planning, implementing, and evaluating the ethical action"
"ANA code and professional obligations shaping nursing practice"
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