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Introduction

Nursing career has got a fair share of challenges. Ethical dilemmas in health care have become one of the notable problems that nurses face daily in their practice. The medical care system is always evolving, and in recent days it has become more complicated due to technological advancement and the emancipation of patient’s rights. The disagreements associated with ethical dilemmas arise because there is no clear-cut between the wrong and right. In spite of the fact that there is no one definite approach of identifying a wrong or right choice, there is a particular set of principles and values which nurses are expected to respect in their course of duties. Professional nurse practitioners, for example, family nurse practitioners, should be able to make rational decisions when faced with difficult health plights. This paper will describe a particular clinical scenario and identify the ethical dilemma features. It will also highlight the ethical principles which were violated, identify ethical barriers, and explain what I am going to do if I encounter the same moral dilemma again.

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The Clinical Situation (Dilemma)

Ethical dilemmas in nursing can be experienced anywhere regardless of the place where the nurse practices (Makaroff et al., 2014). Health dilemmas present challenging situations which demand solutions which are not entirely justifiable sometimes. The final decisions depend on different factors which include acceptable moral values and health provider viewpoints. I encountered a particular moral dilemma involving a patient who had been put on oxygen therapy at home via the use of portable oxygen machine. Already mentioned patient was a 56-year senior man diagnosed with the chronic obstructive pulmonary disease (COPD).The patient was earlier admitted to hospital with complaints of wheezing, breathlessness and a productive cough. The patient indicated that he is living with his wife and three children in one house. Furthermore, he had a history of smoking cigarettes. Doctor prescribed him broad spectrum antibiotics and oxygen therapy. Due to patient preference, he was discharged from hospital and allowed to continue with medication and oxygen therapy at home. However, the health care provider was supposed to visit the patient at home to assess the recovery progress and answer some questions which the client could have.

The patient was educated on how to use the oxygen machine and warned against smoking and lighting of fire in the room. He had been informed that this and other things connected to fire used near oxygen therapy device could cause fires which can burn the house and properties. Thus, he was advised to stop smoking since stoppage could reduce respiratory impairment, improve cardio-respiratory functioning and eliminate the risk of fires. The client adhered to the pieces of advice; he ceased from smoking, took the prescribe medications and utilized oxygen therapy. His health drastically improved and boosted his arterial oxygen saturation due to the improved airflow.

However, after three weeks, the patient found it difficult not to smoke. Thus, the patient began lighting up cigarettes again; oblivious of the dangers that smoking poses to himself and his family. I found out that the client had resumed smoking when I noticed cigarette remnants on the portable oxygen machine. I was upset, and I had to explain again to him the dangers which smoking pose to both his family and his health. To be more precise, smoking could adversely affect his young children and even cause fires which could burn the whole building, which could also endanger the lives of other tenants. There were only two options which the client could choose. He either had to quit smoking or to stop using the oxygen therapy. He preferred smoking to use of oxygen therapy. It was pretty difficult to convince the patient to change his mind. Unfortunately, his health dramatically deteriorated in a span of two weeks and got readmitted again in the hospital. At the hospital, he had no choice but had to cease from smoking.

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Ethical Dilemma Characteristics

According to the presented clinical situation’s moral dilemma, we should mention that it is linked to multiple commitments. The multiple commitments characteristic is evident in this clinical scenario. The concept of many undertakings involves nurse’s obligations to different stakeholders which include the patient, the community, health laws, employers, the administration and even the clients’ families (Hamric et al., 2013)The nurse practitioner concerns about the dangers being posed by smoking towards tenants, patient’s family, and the patient himself. She is committed to ensuring that none of the said individuals is adversely affected. What is more, woman was of the opinion that the patient should cease smoking but the patient chose otherwise. The nurse in the described clinical situation has an obligation to ensure that the patient does not suffer from harm associated with smoking and denying oxygen treatment. Another feature concept of the commitment in this scenario is that the nurse has an obligation to ensure that the patient does not endanger the lives of his neighbors through smoking near portable oxygen machine due to the possibility of fire. The decision-making in this clinical dilemma is challenging and stressful because there is no proper answer to this situation. Gonz?lez & Iffland (2014), for example, observed that empirical data could not sufficiently support decisions made in moral dilemmas.

Ethical Principles Which Were Violated

In the described clinical dilemma, the principles which were violated are neither criminal nor beneficence. The client chose smoking alternative even though smoking posed a huge risk for patient’s health and allowing the patient to make such decisions was committing harm to the patient. Of course, the nurse respected the principle of autonomy by allowing the patient to make his preferred choice. However the concept of beneficence was also violated because smoking can drastically worsen any good outcomes for the patient; and deteriorating health condition can not be a satisfactory situation for the patient (Grace, 2013). Thus, in this health ethical dilemma, any choice made is likely to violate some ethical principles.

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Barriers to the Ethical Practice

Ethical practice is rather difficult to attain due to various reasons. The equally opposing options or alternatives cause decision-making to be tedious. Furthermore, precise definitions of what is ethical and what is not are inconclusive. It is just the guiding fundamentals that provide a clue to what is considered morally correct or wrong. The patient’s rights and autonomy in making decisions tend to complicate the idea of health ethics. For example, the client may choose some alternatives which can cause harm but still his or her decisions must be respected. Also, conformist practice in nursing contributes to the poor ethical practice in medicine because nurse practitioners in some instances have to honor particular actions which may not be deemed moral. Thus, some nurses will support particular health interventions for the patients without subjecting such actions to moral evaluations (Hamric et al., 2013). In the clinical case provided above, what made the decision-making difficult is the presence of equally legitimate options. It means that it was not possible to allow the patient to continue with the oxygen therapy while smoking because he could endanger the lives of other people. Thus, he personally decided to smoke, but the utilization of oxygen therapy was stopped in spite of the fact that this could worsen his health conditions considering that he had the chronic obstructive pulmonary disease.

What I Will Do if Such a Clinical Situation Happens Again

Since I made this particular ethical decision in the described scenario and allowed my patient to choose smoking instead of the use of oxygen, I will still implement the same solution if I face similar situation. Moreover, I will fully explain to the patient all the information involving risks and consequences associated with each of his decisions. I am always trying to respect patient’s autonomy until it does not interfere with health risks to other people. I will apply the theory of principlism to such kinds of medical predicaments again if the same or related situation occurs one more time. This theory encompasses distinct concepts which include not harmfulness, beneficence, justice and autonomy. I prefer this approach because it contains essential elements which are present in other ethical theories and blends well with practical wisdom and values. The theory of principlism brings together all the elements of ethical theories which are consistent with most individual, societal and religious values systems (Grace, 2013).

Conclusion

The clinical ethical dilemma situation described in this paper is a complex one. It concerns the health care provider’s ethical background as this will influence the decision which is going to be made. In this case, patient’s behavior could expose himself and other to eminent danger. In spite of the fact that client was informed about the dangers of smoking he is adamant that he cannot desist from smoking. In respect of patient’s autonomy, he is allowed to continue smoking but was deprived of oxygen therapy from the portable oxygen machine. The decision is reasonable because smoking and using oxygen therapy could endanger the lives of his family and tenants due to the possibility of fire. Thus, it was necessary to adopt a decision that would not put the lives of others at risk. However, I felt sorrowful and compassionate for the patient when the phenomenon occurred. In case, such event occurs again I will still have the same perspective, but I will also give the patient full information about all the available alternatives.

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