Moral Dilemmas

Nurses General Nursing

Published

when a patient presents with something that is in conflict with your own moral code, how do you best handle the situation and meet your professional obligation to care for the patient?

Specializes in OB, M/S, HH, Medical Imaging RN.

I can seperate the person (the body) from the person (who they are) and care for them the same as I would any member of my family. I have no problem doing that because that is my job. It doesn't mean that I agree with their lifestyle or with what they have done. It only means that I need to follow the doctors orders and be as pleasant to them as I am the other patients.

My moral dilemmas come from doctors and/or families who use bad judgement. i.e. an 88 year old patient having a heart cath, the patient has severe dementia, multiple chronic health problems, and is a DNR. I ask why a heart cath? Will this patient be forced to go through open heart surgery should the heart cath reveal a problem? The patient renal function is less than optimal and the cardiologist wants the heart cath stat regardless of the renal function. Would he do that to a member of his family? :crying2: Why do it to a helpless defenseless patient?

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Specializes in OB, M/S, HH, Medical Imaging RN.
one time i assisted w/a pedophile in dying.

we know these people are sick, but this.guy.was.SICK.

but since our med'l dir brought him in, our hands were tied.

very difficult case, and all nurses had refused to care for him.

so i took him....not ideal, since i come w/a hx of yrs of sexual abuse.

days later, as he was rapidly deteriorating, he asked me if he was going to hell.

i just looked at him, his face human for the first time- frightened, vulnerable...

and quietly told him i didn't know what God's plans were:

but was confident he'd be going to a place where no other children existed.

that, regardless of his sins on earth, i personally did not believe people are punished in the hereafter.

rather, it was a time of reflection, understanding, healing and ultimately, growth.

it was a rough death for him....and me.

but he died much more human than when admitted, and w/hope.

i think we both healed a little bit, that day.

leslie

Thank you leslie for sharing that story flowerysmile.gif

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Specializes in Dialysis, Nephrology & Cosmetic Surgery.

Couldn't agree more - when this situation arises I ask the Consultant to consider who we are doing this for? Certainly not the patient, I admired one of our Intensive care Consultants comments when described some of our interventions as torture. Sometimes we prolong death rather than prolong life.

I can seperate the person (the body) from the person (who they are) and care for them the same as I would any member of my family. I have no problem doing that because that is my job. It doesn't mean that I agree with their lifestyle or with what they have done. It only means that I need to follow the doctors orders and be as pleasant to them as I am the other patients.

My moral dilemmas come from doctors and/or families who use bad judgement. i.e. an 88 year old patient having a heart cath, the patient has severe dementia, multiple chronic health problems, and is a DNR. I ask why a heart cath? Will this patient be forced to go through open heart surgery should the heart cath reveal a problem? The patient renal function is less than optimal and the cardiologist wants the heart cath stat regardless of the renal function. Would he do that to a member of his family? :crying2: Why do it to a helpless defenseless patient?

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Specializes in Cardiac x3 years, PACU x1 year.

No flaming here. I am in complete agreement with you! My feelings are, I can't help you if you can't help yourself...:redpinkhe

I feel like I have a confession to make - my original response was that I tried to be non-judgemental. I have reason to be reminded of a patient I nursed as a newly qualified nurse about 12 yrs ago. He was grump to say the least but I could put up with that, I had also recently completed a course in aromatherapy and when time allowed I would offer hand / foot massage to the patients. He was one of the ones that I would treat - he really benefited from these, he would relax and sleep well after having his feet massaged. He was a chronically ill man but was getting better and was due for discharge soon. After being home on weekend leave we had a phone call from his GP who basically said that she didn't want him discharged as he had a very long history of domestic violence that had resulted in his wife having hospital treatment on occasions and on the home visit had again been violent towards his wife. I had never known a case of domestic violence before this and was really disturbed by it, to the point that when he asked me if I could massage his feet I would always make excuses and I also confess to being abrupt with him after that and couldn't look him in the eye. I confess further - and I know this is going to get me shot down in flames - to feeling some some frustration towards the wife for staying with him and allowing this to happen to her. I also couldn't understand why the grown up children could allow this to continue.

That was a long time ago and I am a little more clued up about the dynamics behind domestic abuse and the reasons why the person being abused feels powerless and unable to get out of the situation they are in.

Thankfully I have not encountered this same senario since so I cannot comment on how I would deal with it now.

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Well, nurses can say we don't judge our patients, but we're also human, so I don't believe for a minute that they don't. We all do. However, how we REACT to that internalized judgment is what differentiates us from the non-professional.

The professional may feel INSIDE that a behavior, attitude, or whatever is not in the patient's best interest. Heck, we KNOW this much of the time (the diabetic who insists on sugary snacks, the COPDer who is admitted for the fifth time this year and still smokes, the new mother who comes back from a smoke break and cuddles her newborn with a choking cloud around her).

But OUTWARDLY, we must be neutral, or at least non-accusatory: "here's your pamphlet, let me tell you what I think might help your condition, do you know that this doesn't help your recovery, etc.."

I think anyone who says they absolutely never judge another person is probably kidding themselves (if they really believe it) or just out and out not being entirely truthful. Humans judge one another. It's in our nature. We can TRY to be more understanding, and yes, BE understanding, but that doesn't mean we don't judge.

I frequently have patients whose behaviors, I know, have landed them in my care. My internal thoughts are "you moron, you did it AGAIN, and AGAIN, and now here we are...AGAIN". My actions? "Mr. Smith, sorry to see you here again...maybe I can help you stay out for awhile!" I give them good care, and good education, and what they do with that when they LEAVE my care is up to them.

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Wow! Excellent discussions about moral dilemmas. Thank you to everyone who dug deep and reflected on their own beliefs and interactions with others.

Next questions about this:

How does your organization/unit/peers support you when these delimmas arise?

What do you recommend are "best practices" for dealing with the cognitive disonance?

What have you done in the past that worked/did not?

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To add another post to this thread (cos I really like discussing this subject), I'm always weary of those in shackles.

I once saw the most disgusting thing regarding this. A man who was here illegally, was picking pumpkins when the cops showed up with immigration officials, this man took off running, along with everyone else and he tripped over a pumpkin and broke his heel.

He was bought into hospital and shackled to a bed, he spoke almost no english and was left without pain relief or surgical intervention for 2 days. He also had two very mean prison guards with him. He finally got surgery and then was only perscribed paracetmol 6 hourly. He spent days shackled to a bed with those guards, in pain, and not knowing what the heck was going on. It was so sad because he was going to be sent back to his country on discharge.

Now, I accept that overstayers needing medical treatment are taking the place of a citzen who pays taxes, but still, they could have been nicer to the man. And shackles?? It wasn't like he could get up and run off! The other nurses were just as mortified and were trying to assure all the students that this wasn't normal practice to overstayers.

As for paedophiles, I've cared for them in mental inpatient units, the way I look at it, they're sick and need help. Society almost lets off the woman with post partum depression who harms/kills her babies, why can't we that accepting of the paedophile?

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I know how you feel, I am personally against abortion. As a nurse that does not mean that I would not treat a sick woman who has had an abortion or judge her for that ; however, I would not participate in helping to perform an abortion, and as a nurse I would not work in a situation that would require that I do so.

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