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An ethical dilemma in nursing practice  

Nursing ethics can be defined as a branch of applied ethics which addresses the activities carried out within the domain of nursing. Nursing ethics and medical ethics share many standards, for instance respect for autonomy, non-maleficence and beneficence. This branch of applied ethics can be recognized due to its emphasis on collaborative care, maintaining dignity and relationships (Porche, 2004).

An ethical dilemma can be defined as a condition that calls for a conflict to exist between two moral alternatives. For instance, a man choosing an alternative between saving the lives of, a drowning baby and a drowning old woman who are equidistant from him.  This is clearly an ethical dilemma since both are not capable of saving themselves, while saving neither of the two is not satisfactory. Another fine instance is a need to feed one's famished family when the only option is to acquire the food by stealing. Now in this case, one is to choose whether to leave the family starve or to steal food (Aroskar, Davis & Fowler, 2009).


Nurses are more and more recognizing that they can put forward appropriate information and as well take part in decision-making concerning ethical issues. On the other hand, they experience inadequate communications within their profession, and there is no room to exchange their sentiments. Apparently the effects are upsetting and foiling for nurses whose work in hospital is bore upon by the policies set by other individuals.

Ethical dilemmas that are found in public health nursing practice are usually complex, and they involve communities, families, and institutions. It has been seen that an ethical dilemma originates incase a conflict occurs in beliefs, principles, values, duties, and rights, of a group, community, population, or an individual person with another or even a greater society. So that the public health nurses can explore excellent resolution to the encountered ethical dilemmas, they have to comprehend ethical principles, codes, and perspectives.  

According to Davis (1997), the ethical decision-making processes aid in the choice of a suitable ethical resolution by means of giving an outline of the steps which are used to comprehend the existing ethical dilemma and deciding on the most appropriate resolution. The recommended ethical decision-making process for the situations of dilemmas in public health is as follows:

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1.   A clear definition of the ethical dilemma as well as giving an outline on the conflicting ethical principles and issues.

2.  Identification of the public health stakeholders at family, community, group, and individual levels. 

3.   Collection of data that is appropriate to both faces of a given ethical dilemma.

4.   Putting in place a list of possible public health alternatives to settle the ethical dilemma.  

5.   Giving a description of the public health issues for each and every option that is listed.

6.   Considering each and every ethical principle, reviewing the codes of ethics, and finally determining the best option for resolving an ethical dilemma.  

7.   Implementation of the ethical resolution and defining the actions, concerning who to take them and when they should be taken. 

8.   Evaluation of the implementation and outcomes of the proposed ethical resolution. Considering the impact of the proposed ethical resolution on the stakeholders involved, individually. Assessment on whether the proposed ethical resolution as well as the reaction of the community to the resolution has altered the moral feelings, beliefs, or values of the society or community.

This process is intended to give thorough support for the public health nurses to reason through a given ethical dilemma.

An ethical problem concerning swine flu

During the treatment of the new H1N1 influenza A which is also called swine flu, there rises ethical dilemma for both nurses and other health care professionals to resolve. At first some questions arise concerning the vaccine, for instance questions about the person who will be the first to receive the swine flu vaccine when is ready, the person who will acquire the antiviral medication incase the supplies run short, and whether the government is at a position to control the liberties of individuals to contain the flu virus from spreading (Fowler, 2009).

These are some of the ethical questions that come about at first when the influenza pandemic emerges. In the case of nurses, physicians and other health care professionals, these are not the only questions but there are many more questions they have to enquire about for example:

Incase it is a usual business, for professionals, it should be very clear to understand there moral and ethical obligations. The case of the pandemic flu which is not a usual business allows for an ethical dilemma.  

According to Keegan (2009), Extensive spread of the disease caused by influenza virus in the midst of healthcare professionals could bring about shortages in staff, most likely among the staff members at the frontline, who usually at first get into contact with patients suffering from the swine flu. Some of the distinct possibilities which arise include assuming new responsibilities and also staff shuffling. In order to manage for the increasing number of the incoming patients of influenza on top of the usual workload, there should be a mandate to increase quantities of medicine and equipment which should be getting used up within no time. Through an unexpected or extended attack of the infected patients, the protective equipment at personal level as well as the antiviral medication can possibly become inadequate in some places, hence resulting into an increase of the risking level of healthcare worker.    

So that to achieve a state of equilibrium between the roles to offer caring services to patients as well as giving care for family and self, nurses, physicians and other healthcare professionals work extra hard. Considering a situation like the one of influenza virus infection, the healthcare professionals like nurses my show fear concerning their exposure to influenza which can place them at risk. These risks may be concerning their own health or the health of their spouses, elderly family members or their own children.  The healthcare professionals who may be expectant can show worry regarding their unborn children being exposed to the dangerous virus or if they can take medication to do away with the infection incase they are infected in due course of their pregnancy. Those healthcare professionals who as well suffer from persistent conditions that deteriorate their capability of fighting against infection, may get vaccinated, or take appropriate antiviral medication which can let them face a lot of personal risks (Keegan, 2009).  

The sufficiency of protection and contradictory commitments are the most significant worries of healthcare professionals including nurses during when they are considering their responsibilities in a given pandemic.  The needs to force one operate under unfamiliar principles of care for the period of pandemic may as well present an ethical dilemma.    Irrespective of whether the concerns are justified, they can easily control the healthcare professional's decisions on whether to continue working or stay back at home for the entire period of pandemic.

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