Essentials of Nursing Leadership and Management, 5th Edition

chapter 4 | Questions of Values and Ethics 49

other extreme, if a friendship had not been involved,

would Addie react the same way?

When working with others, it is important to hold
true to your personal values and morals. Practicing
virtue ethics, i.e., “doing the right thing,” may cause
difficulty due to the possible consequences of the
action. Nurses should support each other but not at
the expense of patients or each other’s professional
duties. There are times when not acting virtuously
may cause a colleague more harm.

Ethical Dilemmas

What is a dilemma? The word dilemmais of Greek
derivation. A lemma was an animal resembling a
ram and having two horns. Thus came the saying
“stuck on the horns of a dilemma.” The story of
Hugo illustrates a hypothetical dilemma, with a
touch of humor:

One day, Hugo, dressed in a bright red cape, walked

through his village into the countryside. The wind

caught the corners of the cape, and it was whipped in

all directions. As he walked down the dusty road,

Hugo happened to pass by a lemma. Hugo’s bright red

cape caught the lemma’s attention. Lowering its head,

with its two horns poised in attack position, the ani-

mal began to chase Hugo down the road. Panting and

exhausted, Hugo reached the end of the road, only to

f ind himself blocked by a huge stone wall. He turned

to face the lemma, which was ready to charge. A deci-

sion needed to be made, and Hugo’s life depended on

this decision. If he moved to the left, the lemma would

gore his heart. If he moved to the right, the lemma

would gore his liver. No matter what his decision,

Hugo would be “stuck on the horns of the lemma.”

Like Hugo, nurses are often faced with difficult
dilemmas. Also, as Hugo found, an ethical dilemma
can be a choice between two serious alternatives.
An ethical dilemma occurs when a problem
exists that forces a choice between two or more
ethical principles. Deciding in favor of one princi-
ple will violate the other. Both sides have goodness
and badness to them, but neither decision satisfies
all the criteria that apply. Ethical dilemmas also
have the added burden of emotions. Feelings of
anger, frustration, and fear often override rational-
ity in the decision-making process. Consider the
case of Mr. Sussman:

Mr. Sussman, 80 years old, was admitted to the

neuroscience unit after suffering left hemispheric

bleeding. He had a total right hemiplegia and was

completely nonresponsive, with a Glasgow Coma

Scale score of 8. He had been on IV fluids for 4 days,

and the question was raised of placing a percuta-

neous endoscopic gastrostomy (PEG) tube for enter-

al feedings. The older of the two children asked what

the chances of recovery were. The physician

explained that Mr. Sussman’s current state was

probably the best he could attain but that “miracles

happen every day” and stated that tests could help in

determining the prognosis. The family asked that

these tests be performed. After the results were in,

the physician explained that the prognosis was

grave and that IV fluids were insuff icient to sustain

life. The PEG tube would be a necessity if the fam-

ily wished to continue with food and fluids. After

the physician left, the family asked the nurse, Gail,

who had been with Mr. Sussman during the previ-

ous 3 days, “If this was your father, what would you

do?” This situation became an ethical dilemma for

Gail as well.

If you were Gail, what would you say to the fami-

ly? Depending on your answer, what would be the

possible principles that you might violate?

Resolving Ethical Dilemmas

Faced by Nurses

Ethical dilemmas can occur in any aspect of life,

personal or professional. This section focuses on

the resolution of professional dilemmas. The vari-

ous models for resolving ethical dilemmas consist

of 5 to 14 sequential steps. Each step begins with

the complete understanding of the dilemma and

concludes with the evaluation of the implemented

decision.

The nursing process provides a helpful mecha-

nism for finding solutions to ethical dilemmas. The

first step is assessment, including identification of

the problem. The simplest way to do this is to cre-

ate a statement that summarizes the issue. The

remainder of the process evolves from this state-

ment (Box 4-2).

Assessment

Ask yourself, “Am I directly involved in this dilem-

ma?” An issue is not an ethical dilemma for nurses

unless they are directly involved or have been asked

for their opinion about a situation. Some nurses

involve themselves in situations even when their