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chapter 4 | Questions of Values and Ethics 49 CikguOnline
other extreme, if a friendship had not been involved, bleeding. He had a total right hemiplegia and was
would Addie react the same way? completely nonresponsive, with a Glasgow Coma
Scale score of 8. He had been on IV fluids for 4 days,
When working with others, it is important to hold
and the question was raised of placing a percuta-
true to your personal values and morals. Practicing
neous endoscopic gastrostomy (PEG) tube for enter-
virtue ethics, i.e.,“doing the right thing,”may cause
al feedings.The older of the two children asked what
difficulty due to the possible consequences of the
the chances of recovery were. The physician
action. Nurses should support each other but not at
explained that Mr. Sussman’s current state was
the expense of patients or each other’s professional
probably the best he could attain but that “miracles
duties. There are times when not acting virtuously
happen every day” and stated that tests could help in
may cause a colleague more harm.
determining the prognosis. The family asked that
Ethical Dilemmas these tests be performed. After the results were in,
the physician explained that the prognosis was
What is a dilemma? The word dilemma is of Greek
grave and that IV fluids were insufficient to sustain
derivation. A lemma was an animal resembling a
life. The PEG tube would be a necessity if the fam-
ram and having two horns. Thus came the saying
ily wished to continue with food and fluids. After
“stuck on the horns of a dilemma.” The story of
the physician left, the family asked the nurse, Gail,
Hugo illustrates a hypothetical dilemma, with a
who had been with Mr. Sussman during the previ-
touch of humor:
ous 3 days, “If this was your father, what would you
One day, Hugo, dressed in a bright red cape, walked do?” This situation became an ethical dilemma for
through his village into the countryside. The wind Gail as well.
caught the corners of the cape, and it was whipped in
If you were Gail, what would you say to the fami-
all directions. As he walked down the dusty road,
ly? Depending on your answer, what would be the
Hugo happened to pass by a lemma. Hugo’s bright red
possible principles that you might violate?
cape caught the lemma’s attention.Lowering its head,
with its two horns poised in attack position, the ani-
mal began to chase Hugo down the road.Panting and Resolving Ethical Dilemmas
exhausted, Hugo reached the end of the road, only to Faced by Nurses
find himself blocked by a huge stone wall. He turned
to face the lemma, which was ready to charge. A deci- Ethical dilemmas can occur in any aspect of life,
sion needed to be made, and Hugo’s life depended on personal or professional. This section focuses on
this decision. If he moved to the left, the lemma would the resolution of professional dilemmas. The vari-
gore his heart. If he moved to the right, the lemma ous models for resolving ethical dilemmas consist
would gore his liver. No matter what his decision, of 5 to 14 sequential steps. Each step begins with
Hugo would be “stuck on the horns of the lemma.” the complete understanding of the dilemma and
concludes with the evaluation of the implemented
Like Hugo, nurses are often faced with difficult decision.
dilemmas. Also, as Hugo found, an ethical dilemma The nursing process provides a helpful mecha-
can be a choice between two serious alternatives. nism for finding solutions to ethical dilemmas.The
An ethical dilemma occurs when a problem first step is assessment, including identification of
exists that forces a choice between two or more the problem. The simplest way to do this is to cre-
ethical principles. Deciding in favor of one princi- ate a statement that summarizes the issue. The
ple will violate the other. Both sides have goodness remainder of the process evolves from this state-
and badness to them, but neither decision satisfies ment (Box 4-2).
all the criteria that apply. Ethical dilemmas also
have the added burden of emotions. Feelings of Assessment
anger, frustration, and fear often override rational-
Ask yourself, “Am I directly involved in this dilem-
ity in the decision-making process. Consider the
ma?” An issue is not an ethical dilemma for nurses
case of Mr. Sussman:
unless they are directly involved or have been asked
Mr. Sussman, 80 years old, was admitted to the for their opinion about a situation. Some nurses
neuroscience unit after suffering left hemispheric involve themselves in situations even when their