Ethical Dilemmas in Nursing

Based on the four principles of biomedical ethics developed by Thomas Beauchamp and James Childress, a medical practitioner’s response is shaped by taking these principles into consideration before taking any action. For example, the principle of autonomy would allow patients to decide for themselves a course of action, as long as they are free from the control of others, and have sufficient understanding to be able to make a meaningful choice (Beauchamp & Childress, 1994). However, there can be instances where these principles can seemingly lead to inaction or even a conflict.

For example, let us consider the following hypothetical example. A patient is being rushed to hospital after suffering serious injuries, probably caused by a vehicular or industrial accident that has caused them to bleed excessively. While in the ambulance, the patient reveals that they belong to a faith that does not allow blood transfusions, therefore, they instruct the paramedics to only dress and treat the wounds. Upon arrival in the emergency room, nurses discover that the patient has lost a lot of blood, and that surgery may be required due to the severity of the injuries. The patient reiterated his beliefs on blood transfusions before passing out.

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The nurses are facing a dilemma; should they follow the principle of patient autonomy and treat and dress the wounds only, even if they know that this will only be a temporary solution? Or should they go ahead and, operate, giving the patient blood to replace what they lost because it is their obligation to do what is beneficial for the patient?

How do you weigh a patients’ physical welfare over their spiritual concerns? Do you treat them with the best care available, even if they would object to it if they could, or do you follow their wishes, even though you know well enough that these wishes are not in their best interest? Or should the nurse decide that the patient is not sufficiently aware of his/her situation in order to be able to make a reasonable decision?

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