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An
ethical dilemma is essentially a situation with
no good alternative. For
example, the Good Samaritan’s commitment to care
for a wounded man seems
clear-cut (Lk 10:25-37). The man needed help. The
Samaritan tended his wounds.
However, what if he had found a whole tribe of
wounded people but only had the time
and resources to care for one? When you have more
than one neighbor with
conflicting needs, you have an ethical dilemma.
Furthermore,
Jesus taught, “If anyone strikes you on the right
cheek, turn
the other also” (Mt 5:39). We should not respond
to violence with violence. But
what if someone went beyond striking you on the
cheek and began abusing your
child? Or what if a tyrant murdered thousands
of people? Should you simply turn
away? Is there ever a time when violence deserves
a violent response? When
following an ethical principle endangers other
people, you have an ethical
dilemma.
An
ethical dilemma puts us in a position where it
is impossible to do the right thing. We can only
discern the least-worst alternative. There are
no good answers or perfect solutions in the face
of an ethical dilemma, only painful choices.
So
how can we make those choices faithfully? The
prophet Micah asked, “What
does the Lord require of you but to do justice,
and to love kindness, and to
walk humbly with your God?” (Mic 6:8). This
requires a three-step process.
First, we need to understand the situation
fully. Second, we explore the
norms—rules and principles—that apply. Finally,
we propose alternatives and choose the
least-worst of them. What’s Going on Here?
Ethical dilemmas are by nature messy and more complex
than they appear on the
surface. They involve a network of people with
conflicting interests.
Personal biases, cultural values and emotional
baggage cloud the situation. Power
struggles, often subtle or disguised, may sway
the evidence. You will need more
than human wisdom to uncover the heart of the problem.
As
you attempt to define the dilemma, try to discern
who is involved—usually
more than the obvious factors. For example, Marilyn
F. suffered a
post-operative pulmonary embolism. Her physician
ordered an apparently unsafe dose of
morphine every two hours for “pain.” Marilyn
was not complaining of pain; she was
complaining of shortness of breath. Her husband
had insisted on the morphine
order. Later, he confided to the charge nurse
that he was in love with another
woman and hoping that his wife would die. He
had hired a private duty nurse to
care for his wife and made sure she gave the
morphine. The nurse realized the
problem was much bigger than a potential overdose.
It was conspiracy to
murder.
What
issues were at stake? In this case, the issues
included the sanctity of
life, violation of the law, the patient’s rights
and the nurse’s
responsibility. Furthermore, letting this incident
slide could have created a precedent for
euthanasia in this hospital.
What
further information did the charge nurse need
to make an informed decision? She needed to
know the emotional and relational aspects of
the situation, the legal implications and the
philosophical assumptions of those involved. Knowing Right from Wrong
While established codes for nursing guide ethical
behavior, the civil law
also applies in this situation. Euthanasia is still
illegal in the United States,
although the move toward allowing physician-assisted
suicide in some states
is testing the limits. The law holds nurses accountable
for administering an
unsafe medication dose—even under a physician’s
orders. The charge nurse was
responsible for this patient’s care, even though
she did not personally
administer the morphine.
Christian
nurses have a higher authority than either
civil law or professional standards and codes.
The Bible provides clear guidelines for
right and wrong, including the Ten Commandments
and other biblical norms. We need to be
familiar with Scripture, so that when questionable
situations arise, we already have a strong foundation
on which to base our decisions.
Reading
about bioethics, attending professional
continuing-education offerings on ethics, reviewing
case studies and discussing ethical concerns
with more experienced colleagues will also
make us more awareof the norms to follow
when facing ethical dilemmas. Deciding to Act
Ethical deliberation is not merely an academic
exercise; it should lead to
action. Here is where ethics get messy.
In
the situation above, the nurse was
young and scared. She decided to first
discuss the situation with her supervisor,
who
went with her to confront the
attending physician. He ranted but reduced the
dosage. The private duty nurse
was removed from the case. The husband threatened
to sue the hospital. Marilyn
died four weeks later, and her husband married
the other woman. A happy
ending? No, but it could have been worse.
Perhaps
that’s the crux of ethics—preventing
the worst from happening. That
is also the outcome of walking humbly with
our God in a sinful world.—JAS |
