Ethical Dilemma in Nursing and Moral Distress

There has never been a time where there exists so many advances in medicine and technology which allow healthcare professionals including nurse RNs and travel nurses the ability to offer a wide range of treatment options. At the same time insurance and administrative restraints, rising healthcare costs, and scarce resources can lead to ethical issues and conflicts. As cultures become more diverse, a difference in beliefs about treatments may exist between providers and patients which in turn leads to ethical dilemmas.

Moral distress occurs when a provider struggles between what is an ethically appropriate treatment for a patient and the inability to discuss their views. Many healthcare facilities have ethical committees and consultants to address this issue. Even nursing and medical schools are addressing ethics in their programs, recognizing the need to provide professionals with the skills to address these conflicts.

Yet many nursing professionals still feel this is a reoccurring issue. Many responded to a nytimes.com article about moral distress agreeing that is was a big concern and that the threat of malpractice and insurance requirements are contributing factors. Some suggested having patients fill out a treatment directive would help in alleviating this problem. Clearly many professionals had left or were thinking about leaving the nursing profession due to the strain of dealing with moral distress. Several critical care nurses had witnessed family members, who were facing a family crises and, desperate not to lose a loved one, would make decisions in the family’s interest and not necessarily the patient’s. The occurrence of a situation where the patients best interests or wishes are not always respected during end-of-life care due to families insistence on prolonging the inevitable only grows each day with advances in medicine coupled with an increasing rise in an older population. In addition, many voiced the opinion that today’s medicine is not about prolonging life but rather about improving quality of life and some even agreed that euthanasia should be legalized.

In regards to this issue, the Hospice Foundation of America will be presenting a program live via satellite and webcast on “Diversity and End-of-Life Care”. The program aims to discuss challenges faced by healthcare professionals whose cultural values may differ with those of patients and families and how we can respect and support each other even though our beliefs and preferences may differ. “Our goal in hosting this teleconference is to increase sensitivity by helping professionals in our community acknowledge how their own cultural values and assumptions influence the delivery of care. There are many times when cultural considerations may cause ethical concerns or moral distress and this program will discuss those challenges,” Community Relations Director for Heart To Heart Hospice Tiwana O’Rear said. The teleconference will be broadcast Wednesday, April 29. More information can be found at http://www.hospicefoundation.org/teleconference .

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