52 unit 1 | Professional Considerations
case of Mr. Sussman, some of the questions that
could be posed by Gail to the family are as follows:
■“I have noticed the amount of time you have
been spending with your father. Have you
observed any changes in his condition?”
■“I see Dr. Washburn spoke to you about the test
results and your father’s prognosis. How do you
feel about the situation?”
■“Now that Dr. Washburn has spoken to you
about your father’s condition, have you consid-
ered future alternatives?”
Changes in patient status, availability of medical
treatment, and social facts may call for reevaluation
of a situation. The course of treatment may need to
be altered. Continued communication and cooper-
ation among the decision makers are essential.
Another model, the MORAL model created by
Thiroux (1977) and refined for nursing by Halloran
(1982), is gaining popularity. The MORAL
acronym reminds nurses of the sequential steps
needed for resolving an ethical dilemma. This ethi-
cal decision-making model is easily implemented in
all patient care settings (Box 4-3).
Current Ethical Issues
During fall 1998, Dr. Jack Kevorkian (sometimes
called Dr. Death in the media) openly admitted that
at the patient’s request, he gave the patient a lethal
dose of medication, causing death. His statement
raised the consciousness of the American people
and the health-care system about the issues of
euthanasia and assisted suicide. Do individuals have
the right to consciously end their own lives when
they are suffering from terminal conditions? If they
are unable to perform the act themselves, should
others assist them in ending their lives? Should
assisted suicide be legal? There are no answers to
these difficult questions, and patients and their fam-
ilies face these same questions every day.
More recently, the Terri Schiavo case gained
tremendous media attention, probably becoming
the most important case of clinical ethics in more
than a decade. Her illness and death created a
major medical, legal, theological, ethical, political,
and social controversy. The case brought to the
forefront the deep divisions and fears that reside in
society regarding life and death, the role of the gov-
ernment and courts in life decisions, and the treat-
ment of disabled persons. Many aspects of this case
will never be clarified; however, many questions
raised by this case need to be addressed for future
ethical decision making. Some of these are:
1.What is the true definition of a persistent
vegetative state?- How is cognitive recovery determined?
- What role do the courts play when there is a
family dispute? Who has the right to make
decisions when an individual is married?
4.What are the duties of surrogate decision
makers? (Hook & Mueller, 2005)
The primary goal of nursing and other health-care
professions is to keep people alive and well or, if
this cannot be done, to help them live with their
problems and die peacefully. To accomplish this,
health-care professionals struggle to improve their
knowledge and skills so they can care for their
patients, provide them with some quality of life,
and help return them to wellness. The costs
involved in achieving this goal can be astronomical.
Questions are being raised more and more often
about who should receive the benefits of this tech-
nology. Managed care and the competition for
resources are also creating ethical dilemmas. Other
difficult questions, such as who should pay for care
when the illness may have been due to poor health-
care practices such as smoking or substance abuse,
are also being debated.
Practice Issues Related to Technology
Genetics and the Limitations of Technology
In issues of technology, the principles of benefi-
cence and nonmaleficence may be in conflict. A
specific technology administered with the inten-
tion of “doing good” may result in enormous suffer-
ing. Causing this type of torment is in direct con-
flict with the idea of “do no harm” (Burkhardt &
Nathaniel, 2007). At times, this is an accepted con-
sequence, such as in the use of chemotherapy.
However, the ultimate outcome in this case is thatbox 4-3
The Moral Model
M: Massage the dilemma
O: Outline the option
R: Resolve the dilemma
A: Act by applying the chosen option
L: Look back and evaluate the complete process, including
actions taken