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If ‘Ethics’ Stresses You Out…Grab Some Colors
Ethical Decision Making for Nurses: Case Studies
Janie Butts, Ph.D., RNProfessor
Elizabeth Tinnon, Ph.D., RN, CNEAssistant Professor
Our Belief
“Many people argue that we are living in a
time when society is moving away from the
moral absolutes that have guided right and
wrong behaviors to an era of making decisions
derived from ethical relativism. This means
actions right for one person are not necessarily
right for others and different cultures believe in
and practice different moral codes.”
continue to next page
cont’d.
“If this is accurate, can nurses, when making
an ethical decision, maintain some sense of
assurance that they chose a right action?”
“Although we believe nurses cannot always
have an absolute assurance that they made right
ethical choices, they do have the Code of Ethics
and other books to guide them in making difficult
decisions. Given our current moral landscape,
nurses must now, more than ever, be sensitive to
ethical issues in their surroundings and be able to
analyze them within a decision-making
framework.”
Dr. Janie Butts and Dr. Elizabeth Tinnon
Presentation Content
• A case study on violation of humanity lost.• A case study on right to refuse treatment.
Case Study of Humanity Lost
A male, Mr. C., age 42, has a lung cancer
from smoking, which is now metastasized to the
brain and is in and out of the hospital regularly.
Recently, he was admitted again for treatment.
He is liked by the staff nurses, but as the tumor
progressed, he displayed combative and hostile
treatment, such as attacking a nurse with an I.V.
pole. Pharmacological management did not
help him calm down. Then, he was placed in 4-
point restraints according to policy. (continue to next page)
cont’d.
The nurses called for an ethics consult
because “When we walk into his room what we
see is an animal tethered to a bed. His patient
gown is often awry because of his
restlessness, and he lies there in glorious
nakedness. His condom catheter often comes
off, and his sheets are urine soaked. He
moans….it’s hard to think of him as a person.
Somehow we lost the man we knew and love.”
Question
What do you see as the top twocentral ethical issues?
Question
Why do you agree or disagree with the following statement:
The more vulnerable people are because of illness or marginalizing factors, the more they
command my compassion and respect.
Question
Why do you agree or disagree with the following statement:
I need to be compassionate and respectful to those innocently affected by disease or injury—so long as abusive behaviors did not cause the
disease or infirmity.
Broken colors still color. The same can be said of nurses.
Patient’s Right to Refuse Treatment Mrs. Smith is admitted to your home health
agency with a diagnosis of multiple diabetic ulcers.
Upon admission you are aghast at the condition of her
ulcers and overall general health. As you progress
through the admission Mrs. Smith insists that she is
unwilling to follow a diabetic diet or take her
medication as ordered. When the physician returns
your call for orders she asks about the patient’s
willingness to follow the plan of care. You inform the
physician that the patient is willing to allow dressing
changes but is unwilling to follow any other part of the
plan.
continue to next page
cont’d.
Then, the physician states that she is unable
to continue to provide medical care to the patient
and Mrs. Smith is not admitted. Mrs. Smith tells
you that she will contact her daughter and they
will find another physician. One month later Mrs.
Smith’s daughter calls you very upset stating that
her mother is in very bad shape and asks that you
come to the home. Upon entering the home you
observe what appears to be gangrene on both
feet and Mrs. Smith is very lethargic. You arrange
for the patient to be taken to the hospital where
upon Mrs. Smith undergoes a bilateral below the
knee amputation.
What is the First Ethical IssueYou See in This Scenario?
What Are The Ethical PrinciplesAt Stake?
Do You Think the Doctor Had theRight to Dismiss the Patient?
Do You Think Mrs. Smith had the Right to Refuse Treatment?
So, Again…If ‘Ethics’ Stresses You Out…
Grab Some Colors
References
Beauchamp, T., & Childress, J. (2013). Principles of biomedical ethics. New York: Oxford University Press.
Butts, J., & Rich, K. (2016). Nursing ethics: Across the curriculum and into practice (4th ed.). Burlington, MA: Jones & Bartlett Learning.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA: MD: Silver Spring, MD.
Fry, S., Veatch, R., & Taylor, C. (2011). Case studies in nursing ethics (4th ed.). Sudbury, MA: Jones & Bartlett.
Jonsen, A., Siegler, M., & Winslade, W. (2015). A practical approach to ethical decisions in clinical medicine (8th ed.). Boston: McGraw-Hill Education.