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Applying Ethical Framework in Practice

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Applying Ethical Framework in Practice

Grand Canyon University: NRS – 437V
June 14, 2015

Ethics and Nursing Practice This paper will address the use of the Uustal’s decision making models in regards to analyzing a specific scenario that has precipitated an ethical dilemma in regards to providing medical care. The scenario consist of a 6-year-old who has developed a high fever accompanied by violent vomiting and convulsions while at school. The hospital physician makes a diagnosis of meningitis and requested to begin treatment. The child’s parents are divorced with the mother, who is not the biological parent retaining custody. The mother is a Christian Scientist and is refusing medical treatment due to religious reasons. The child’s biological father requests that treatment be provided and that another independent physician be consulted in regards to the care.
The Ethical Dilemma
A large responsibility of being a parent to make decisions on how to best care for their children. This encompasses how to best discipline them, what activities they may engage in, what foods they eat, and the medical care they receive. Parents have a duty to assure that the decisions they make take into account what is in the best interest of their child. As medical personnel we are both ethically and legally responsible to advocate for our patients. When a parents decisions may likely cause injury, be abusive, or be derelict it is our duty to address that decision. Medical personnel should make every attempt to obtain a resolution by educating and maintain an open dialog with the parents. If unable to elicit a decision that provides for the safety of the child, the involvement of the state’s child protection agency and the court system should be employed. The parent whose belief causes them to refuse medical treatment should be provided with a clear understanding of the medical problem, options for treatments, consequences if treatment is withheld, and an outline of the actions the medical facility will take if an appropriate resolution is not made (Orr, Novotny, & Perkin, 2003). In this scenario the mothers is relating her belief in the Christian Science religion as a reason not to treat the child for meningitis. The Christian Science religion believes that prayer will heal physical and mental illness. They do not go to doctors or believe in the use of medicine. Although this is the general belief of the Christian Science, a spokesman for the religion, Gary Jones states “That if a form of treatment is not working, parents have an obligation to investigate other alternatives.” This has been interpreted to mean the use of medical treatment for children (Robinson, 2010). Due to the diagnosis and the seriousness of Bacterial meningitis it is important that it be treated with an appropriate antibiotic as soon as possible. If left untreated it can cause hearing loss, learning disabilities, brain damage, or death. The use of early appropriate treatment of the disease is started it can help reduce the chance of death to less than 15 % (Center for Disease Control and Prevention (CDC), 2014). The ethical dilemma being how to best provide for the safety of the child while remaining respectful to the mother’s religious beliefs.
Uustal’s Decision Making Model
The use of Uustal’s 9 step decision making model can help to determine what an appropriate ethical decision would be in regards to this dilemma presented. Utilizing the tool will allow for an objective and cognitive decision to be made, rather than an emotional one. Uustal’s 9 step model allows for value clarification along with maintaining the steps of the nursing process (Grand Canyon University, 2011).
Step 1. Identifying the problem: A 6 year old has been diagnosed with Meningitis. The legal guardian, who is not the biological mother is refusing medical treatment due to her Christian Science beliefs. The biological father is requesting treatment along with an independent consultation. The medical staff wish to begin treatment as soon as possible to help decrease the chance of serious complications or death.
Step 2. State your values and ethical position: The healthcare personnel do not believe that prayer alone will help to cure the meningitis. They believe that it is imperative to begin antibiotic treatment as soon as possible to reduce the risk of serious complication or death of the child.
Step 3. Alternative ways to resolve the problem: Allowing for a Christian Science practitioner to come in and provide care along with the necessary medical treatment. Allowing the Christian Science practitioner to provide care along with the close monitoring of the child for further complications. Utilizing the state’s child protective service agency to obtain temporary custody of the child to allow for medical treatment to take place.
Step 4.Examine the alternatives: A. Following the mother’s wishes and not providing treatment. B. Following the father’s wishes, seeking out an independent consultation and starting treatment. C. Allowing for a Christian Science practitioner to come in and provide care along with the necessary medical treatment. D. Allowing a Christian Science practitioner to come in and provide care along with careful monitoring for further complication. E. Contact state child protective services to assume the ability to provide care.
Step 5. Possible outcomes for each of the scenarios: A. Following the mother’s wisher to not provide treatment could cause serious long term complications or even death. B. Following the father’s wishes to start treatment. Prior to the ability to implement the father’s wishes it must be determined whether he has the legal right to do so. The delay in treatment could allow for serious or long term complications to occur. C. Allowing for a Christian Science practitioner to provide treatment alongside of the medical treatment would allow for the religious beliefs of the mother to be respected, and the treatment of the child to occur. This would decrease the chance of long-term complications or death. D. Allowing the Christian Science practitioner to provide treatment along with careful monitoring. Although this would respect the religious beliefs of the mother, without early treatment there is a high chance of serious complications or death. E. Contacting state child protective Services would allow for treatment of the child and decrease the chance of complication or death, but could cause a further dispute between the healthcare professionals and the mother.
Step 6. Prioritize alternative scenarios: 1. allowing the Christian Science practitioner to provide treatment along with medical treatment. 2. Contacting stat child protective services. 3. Following the father’s wishes to begin treatment with an independent consultation. 4. The Christian Science practitioner providing treatment along with careful monitoring. 5. Following the mothers wishes to withhold medical treatment.
Step 7. The Plan: Provide the mother with an in-depth explanation of Meningitis, the laboratory values that determined the diagnosis, the possible complications, and national statistics related to treatment verses not treating. Offer the option to have a Christian Science practitioner provide treatment along with the medical treatment. Explain the care givers responsibility to provide necessary care and that if consent is not given the state’s child protective service agency will be contacted.
Step 8. Implementation of the plan: The above plan was implemented.
Step 9 Evaluation of the plan: This plan most importantly allowed for the successful treatment of the child. If the mother accepted the hospital position and gave consent for treatment this would allow for both the mothers religious beliefs to be respected and the safe care of the child.

Conclusion Determining what an ethical solution is to a medical dilemma can be simplified using a decision making model such as Uustal’s. By utilizing this tool we can explore the possible alternative treatment choices. This will allow for best chance for all parties to be satisfied with the treatment that is ultimately provided and allow for the best medical outcome for the patient.
Dialog with the patient Ms. Xxxx we would like to explain the seriousness of the meningitis infection that you child has. The laboratory results show us that your child defiantly has this infection. It is very important that we begin giving her the medicine as soon as possible. The longer we wait to start giving her the medicine the greater the chance that she could lose her hearing, have lifelong problems learning, have permanent brain damage, or even die. We understand that your religious beliefs normally use prayer rather than medicine to treat illness. Under these circumstances this treatment alone would not be enough to help cure the infection. We would like extend the invitation to have a Christian Science practitioner come in to provide treatment, alongside the treatment we are providing. We are asking you to please give your consent to begin treatment. We understand your position and know that you want to do the best for your child. That is what we want also. (Wait to see if she gives consent)
That being said we do have to inform you that if you do decide to go forth with refusing treatment we will be legally and ethically obligated to contact the state’s child protective service agency. In doing this we will ask that they take custody and allow us to provide the necessary care needed to provide for the well being of your child.

References
Center for Disease Control and Prevention (CDC). (2014, April 1). Bacterial Meningitis. Retrieved June 14, 2015, from http://www.cdc.gov/meningitis/bacterial.html
Grand Canyon University. (2011). Ethical decision making. Retrieved from https://lc-ugrad1.gcu.edu/learningPlatform/user/users.html?token=g2Gf%2ft0Z%2bW0Xpyr2oI6%2f6ljC7YFQnnelMBHVJkYO32SWo%2fo6gnJu2wKFyp13f2kU&operation=home&classId=1604858#/learningPlatform/loudBooks/loudbooks.html?viewPage=current¤tTopicname=EthicalDecision Making&operation=innerPage&topicMaterialId=4f143f37-aeb2-45b7-b766-f5896d387c29&contentId=5831fdd9-df5a-41e2-a18d-301ac231a0c7&
Orr, R., Novotny, W., & Perkin, R. (2003). Faith-Based Decisions: Parents Who Refuse Appropriate Care for Their Children. AMA Journal of Ethics, 5(8). Robinson, B. (2010, August 1). Two Christian groups that oppose medical care. Retrieved June 14, 2015, from http://www.religioustolerance.org/medical2.htm

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