Ethical Dilemma


I am working on a paper for an ethical dilemma I have seen in clinical and I have one but can't quite round out my statement.

A patient (child) had a cleft palate fixed and lives in a long term care facility due to numerous other issues. However, parents are not happy with the very VERY small keloid that has formed and are planning on sending him back into surgery to have it removed on the states money......I know there is something here....allocation of resources? I just can't get my statement together. Thanks

Specializes in Critical Care. Has 8 years experience.

I don't think that is an ethical dilemma, that is more of exerting some control in a situation where they have little to no control.

Specializes in SICU, trauma, neuro. Has 16 years experience.

Autonomy in the face of a judgmental nursing student? (Referring to the "very VERY small," "on the state's money" comments.

The keloid is in the hard palate area? Or at the site of a cleft lip repair, i.e. visible? I would want it removed too. Has the surgeon determined that the benefits of the surgery outweigh the risks? I would think so, since surgery is in the treatment plan.


6,528 Posts

The ethical principle you are trying to come up with is that of distributive justice.

While we must be careful not to judge others, distributive justice is a principle inherent in nursing. The most frequent and obvious example is that of the prioritization that we all must do every day. When you assess a group of patients and decide which needs your help first, you are utilizing the principle of distributive justice. You have a resource (time) and you distribute that out a certain way based on the priority of needs you've assessed. That's why sometimes I may simply have to attend to someone with difficulty breathing even though another one of my patients is in pain. That's not inherently judging the patient who needs pain medication, it is using distributive justice to acknowledge that the person with the life-threatening situation must come first, and I must distribute my time that way.

Distributive justice also acknowledges that resources are not infinite and therefore it is up to governments and health care organizations to help decide policies about how financial resources will be distributed.

While bedside nurses would not be the ones to make a decision about the conflicts in the OP example mentioned, it is important to acknowledge the principle itself, and how it plays into healthcare decisions overall.

ETA: In the interest of ethics, here's my source:

Burkhardt, M.A. & Nathaniel, A.K. (2014). Ethics & issues in contemporary nursing (4th ed.). Stamford, CT: Cengage Learning.



183 Posts

I personally would not use your example as you stated it. Depending on where the keloid is, it could be uncomfortable. And if it is not medically necessary, the physician would be the one to strike it down, not nursing.

As for who pays the bill, they are covered and that bit of info is ethically irrelevant. They probably worked some point and paid taxes into the system. They have a right to use the system. Even if they didn't ever work, they have a right to the system. If it is deemed medically necessary, there is no dilemma.

If there was greater risk to the child to have the surgery than to not have it, there could be a dilemma there. If the child is end of life and a painful surgery would provide more harm than good with the life span left, that could be a dilemma.

As you have stated it, I don't see a reasonable ethical dilemma that would be worth writing a paper over. Peds is ripe with ethical dilemmas, and I just don't think this is one of them.

Specializes in Critical Care.

What is the ethical dilemma?

KelRN215, BSN, RN

1 Article; 7,349 Posts

Specializes in Pedi. Has 16 years experience.

Eh, I've been a pedi nurse for over 10 years and I don't see this as an ethical dilemma. Not even a little one. When you say the parents are having it removed "on the state's money", do you mean the child is on Medicaid?

Her are some examples of ethical dilemmas I've actually seen in pediatrics-

End of life child with a progressive, high grade, brain stem tumor. Parents insisted on having her trached because they didn't believe that she was terminal. Ethics team sided with the parents because they knew the trach wasn't going to prolong her suffering or change her prognosis. She died trached and vented in the ICU, after being pronounced brain dead.

Teenager with anti-NMDA receptor encephalitis. Parents read on the internet that this can be associated with ovarian tumors and insisted on an oopherectomy even though all of her ovarian scans were normal. The case went to court. The court sided with the family because the intention of the surgery wasn't to sterilize her.

P.S. pretty sure both of these children were on Medicaid, too. That doesn't may the situations any more or less ethically complex.