10.8 : Ethical Dilemmas II

Resolving an ethical dilemma in healthcare involves a systematic approach that considers every aspect of the issue, respecting both the patient's needs and values and the healthcare professional's ethical obligations. Here are potential steps to resolve an ethical dilemma:

1. Identify the ethical problem and dilemma: Begin by recognizing the presence of an ethical issue. An ethical dilemma arises when conflicting moral principles or values necessitate choosing between two or more equally undesirable alternatives. For instance, a patient with a terminal illness may wish to refuse life-sustaining treatment, conflicting with the healthcare team's duty to preserve life. Similarly, an unconscious patient who has verbally expressed to their loved one, acting as their medical power of attorney (MPOA), a desire not to receive life-sustaining measures presents a critical ethical dilemma when no DNR order is in place.
2. Gather relevant information: Collect detailed information pertinent to the ethical dilemma, including the patient's health status, family background, religious beliefs, cultural factors, and insights from healthcare literature. It is also important to include any verbal commitments made by the patient about their care preferences as communicated through their MPOA, as well as the implications of these preferences for medical decisions.
3. Determine the ethical elements of the problem: This step clarifies the facts, values, opinions, and principles involved. It requires a thorough examination of one's own biases and the acknowledgment of others' viewpoints. Key ethical values to consider include autonomy (the patient's right to make decisions about their own life), beneficence (the obligation to do good), and non-maleficence (the duty not to harm).
4. Verbalize the problem: Articulate the ethical dilemma concisely, encapsulating the issue's essence. For example, an appropriate way to verbalize the above issue might be "Should the healthcare team respect the unconscious patient's previously expressed wish to refuse treatment, thereby honoring their autonomy, or intervene to preserve life, adhering to the principle of beneficence?"
5. Determine possible courses of action: Identify all viable options for action, considering the resources available for guidance and support. These could include consulting with ethics committees' legal advisors, or drawing upon the expertise of interprofessional team members. In cases like that of an unconscious patient without a DNR but with a verbal commitment to a loved one, it might be crucial to refer the matter to the ethics committee for navigating the complexities of patient autonomy versus clinical obligations.
6. Create and execute an action plan: Develop a plan of action, considering several alternatives to address the dilemma effectively. The plan could include further discussions with the patient's family, seeking a second opinion, or arranging a meeting with an ethics committee to explore all possible options thoroughly and ensure that the patient's wishes are ultimately honored.
7. Evaluate the plan over time: Continuously assess the effectiveness of the implemented strategy. The healthcare professional must be prepared to adjust the course of action based on the outcomes and any new information that emerges. If the initial plan does not lead to a satisfactory resolution, further actions should be considered, ensuring the ethical dilemma is addressed comprehensively.

Through this structured approach, healthcare professionals can navigate ethical dilemmas with a clear framework, ensuring decisions are made thoughtfully, respecting all individuals involved, and adhering to ethical principles, with a focused commitment to honoring patients' wishes as expressed or communicated through their designated proxies.