Ethical Decision Making1

Ethical Decision Making : When Promoting the Patient’s Well-Being Infringes on

Basic Human Rights

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 Ethical Decision Making2

When Promoting the Patient’s Well-Being Infringes on Basic Human Rights

Healthcare workers frequently encounter challenging moral conflicts, especially when

advocating for a patient's health, which seems to clash with their fundamental rights. An example

of this problem is shown in the situation of Mrs. Sadie Smith, a 72-year-old woman who resides

by herself in circumstances that numerous people would view as inadequate. While Mrs. Smith

appears to be in good physical health, her unsanitary living conditions and disregard for personal

hygiene have raised concerns for her neighbors and home health nurse, Marian. The moral

problems surrounding the trade-off between promoting a patient's welfare and respecting their

independence will be examined in this essay, especially when intervention is required because a

patient's lifestyle choices threaten their welfare and health. This essay will argue that the Shared

Decision-Making Model provides the most ethical approach for Marian to balance the conflicting

demands of respecting Mrs. Smith's autonomy while also safeguarding her health and well-

being.

Ethical Dilemma with Regards to Ethical Principles in Conflict

The case of Mrs. Smith illustrates an ethical conflict in health care that concerns the four

fundamental principles of ethical health care: autonomy, beneficence, nonmaleficence, and

justice. Moral conflicts can be defined as situations where the manager or any person has to

choose the right thing to do and ends up right, as there is no one ethical way to solve it (Avant &

Swetz, 2020). In this case, the conflict raises whether Marian should subordinate her moral

principles and let Mrs. Smith live as she wishes or assist her because it is the right thing to do.

Autonomy

Self-determination is a broadly recognized ethical value in healthcare that implies the

patient's freedom to choose what will happen to them. It was premised on the premise that people
 Ethical Decision Making3

can direct their own lives and make decisions that suit them (Dunn, 2024). In the situation of

Mrs. Smith, her independence means a lot, given that she indicated her desire not to be intruded

on and left in her present situation. She has said that she does not require help or want any; this

reminds her of her right to autonomy.

The right to self-determination can be ethically problematic in the following ways: when

a patient decides on treatment options that endanger their health or status in society (Lewis &

Holm, 2022). Though, at present, Mrs. Smith is physically healthy and has no signs of disease,

her squalid living environment may lead to worsening her health in the future; for instance, she

may get sick from mold spores or bacteria. Marian should evaluate whether Mrs. Smith's right to

personal autonomy prevails over the risk involved in her chosen lifestyle.

Beneficence and Nonmaleficence

Basic ethics in healthcare include beneficence and nonmaleficence. They are considered

the pillars of the healthcare profession. According to Avant & Swetz (2020), beneficence is

doing well for the patient; it entails helping the patient recover or improve their life. Conversely,

nonmaleficence requires healthcare personnel to ensure that any harm they plan to inflict on the

patient is minor and justified (Cheraghi et al., 2023). It also means that they cannot injure the

patient in any way.

In this case, Marian, as a professional, must prevent the deterioration of Mrs. Smith's

living standards and her cleanliness. Failing to act may lead to the decline of Mrs. Smith's health

or the presence of other medical conditions that have not been diagnosed and her psychological

state as she continues to live in such an environment. However, any attempt to interfere with

Mrs. Smith's decision in some way would violate her self-autonomy, and this may cause her

psychological harm. This is not beneficial according to the principle of nonmaleficence.

Justice

Equity is the equal provision of resources, care, and patient attention. Justice within the

healthcare system ensures that resources, care, and attention are distributed fairly and equitably

to all patients (Sabatella, 2018). Marian must consider how much time and effort she can devote

to Mrs. Smith's case while still caring for her other patients with more urgent medical needs. If

Marian focuses excessively on Mrs. Smith's living conditions, she might not be able to properly

care for her other patients, putting their well-being at risk. The principle of justice mandates that

Marian must manage her obligations to all her patients and guarantee that her actions are just and

impartial. This factor increases Marian's ethical dilemma, as she must figure out how to best

distribute her time and resources to serve all her patients.

These principles create a conflict, making the situation ethical. There are no clear

solutions: any of them inevitably will violate at least one of the ethical principles. Since the

situation's complexity merits applying a rational approach to ethical decision-making, it is worth

introducing a structure that might be utilized in this case.

Ethical Decision-Making Model: The Shared Decision-Making Model.

The main moral dilemma examined in this scenario is whether Marian should respect a

patient's autonomy and allow Mrs. Smith to make her own decisions or intervene, even if it goes

against Mrs. Smith's desires for her well-being. The shared decision-making model can be

employed if faced with this ethical dilemma. This model involves the partnership between the

healthcare provider and the patient in making decisions that would be in the best interest of the

patient while at the same time observing the patient's autonomy. The model involves the

following steps:
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1. Information Sharing: The healthcare provider informs all the patient's data, outcomes,

benefits, and choices regarding some actions. Consequently, Marian would have to talk

about risks to Mrs. Smith's health that might be related to her environment and the

options to receive assistance.

2. Deliberation is a discussion between a patient and a healthcare worker in which pros,

cons, hopes, and worries are emphasized or considered. Marian would listen to Mrs.

Smith for not accepting help and search for any prejudice the latter may have.

3. Decision Making: The healthcare provider and the patient agree on how to manage a

patient's care to meet the patient's decisions. However, the provider decides based on the

patient's best interest. Marian would attempt to persuade for the optimal outcome in

which they would honor Mrs. Smith's liberty and, at the same time, consider the possible

adverse effects on her health.

4. Implementation: The decision made with the patient's consent is performed with the

healthcare provider's help if and only if needed. As for Mrs. Smith, Marian would always

shadow her since she would be helpful if Mrs. Smith's situation deteriorated or if she

accepted help.

Considerations for and Against Intervention

For Intervention:

1. Promoting Health and Safety: Mrs. Smith is physically healthy, but her living conditions

pose potential health risks. The accumulation of dust, dirt, and mold, along with the

presence of cockroaches and unsanitary practices, could lead to health problems over

time. Long-term exposure to such conditions could result in respiratory issues, infections,

or other health complications.

2. Professional Responsibility: As a health care professional, Marian's responsibility is to

care for and check the health status of her patients. She must do this while considering

the nature of time and the resources she has. If Mrs. Smith's living conditions put her at

risk or are detrimental to her well-being, then failure to address such a situation appears

to disregard this duty.

3. Legal and Ethical Obligations: Sometimes, doctors, nurses, or other medical practitioners

have a legal and moral duty to blow the whistle whenever they find themselves in a

vulnerable position observing situations that endanger patients' lives. Marian may need to

decide whether her duty to protect Mrs. Smith is paramount to respecting patients' self-

determination since it involves a substantial shift and could be perceived as intrusive.

4. Potential for Harm: Mrs. Smith's refusal to clean her living space and personal hygiene

may suggest a lack of awareness of potential harm or an inability to care for herself

properly. If she is suffering from a mental health issue, such as depression or cognitive

decline, this might impact her decision-making abilities.

5. Community Impact: Mrs. Smith's apartment's unpleasant conditions are affecting her

neighbors and other residents. The presence of cockroaches and strong odors could be

considered a nuisance and might lead to tensions within the community.

Against Intervention:

1. Respecting Autonomy: The case of Mrs. Smith, for example, has made it clear to the

writer that she is okay with her current lifestyle and does not need help. Self-sufficiency

means that she has freedom of choice regarding her dwelling circumstances, irrespective

of how unhygienic the surroundings look to others.

2. Potential for Harm vs. Actual Harm: The difference is between the risk of harm and harm

that can be inflicted on a person out of his/her position of power. It may not be easy to go

to the police station or any other authority to remove her from her house since we won't

have substantial proof that her current living conditions are adversely affecting her health

or possibly endangering her.

3. Justice and Resource Allocation: Marian has other patients and no time to sit, chat, or

listen to life's woes. She has to do this while considering the nature of time and the

resources she has. Spending too much time caring for Mrs. Smith undermines other

patients' care; hence, time becomes scarce and may need to be more fairly utilized.

4. Legal and Ethical Constraints: When one is compelled to alter one's lifestyle or

environment, one has legal and ethical rights. These protections are only necessary where

there seems to be sufficient cause that the person cannot make reasonable decisions

affecting his or her well-being.

5. Quality of Life: Some people do not care about cleanliness, as they prefer to be familiar

with their environment. Lack of cleanliness may also be attributed to Mrs. Smith's not

valuing cleanliness as much as she values her freedom and personal space.

Final Decision

Considering all the pros and cons of intervening and non-intervention, the most ethical

thing to do is to find a middle ground that would respect the patient's right to self-determination

and consider possible neglect of her living conditions. Marian should sit down with Mrs. Smith

and share information about risks associated with the lifestyle Marian has learned about from her

patient. She also should provide options that Mrs. Smith would find satisfactory as they should

respect her choice.

A possible compromise could be made by offering some slight alterations that would not

cause a radical change in Mrs. Smith's living conditions. For instance, Marian might have

suggested hiring a homemaker to clean the apartment weekly or a nurse to visit often and help

wash, among other duties. Such interventions would let Mrs. Smith take control of her life and

ensure that the health and safety issues mentioned by neighbors and landlords are best

addressed. If Mrs. Smith is still unwilling to accept assistance, Marian should abide by her

decision, though, write down all the incidents and observe her health status every time she pays

her hourly visit. This strategy enables Marian to meet professional obligations without

trespassing on Mrs. Smith's self-governance.

Conclusion

The case of Mrs. Sadie Smith underscores the ethical concerns in healthcare, weighing

patient well-being and entitlements. Marian can utilize the Shared Decision-Making Model to

honor Mrs. Smith's autonomy while managing her health risks. Striving for a balanced approach

is consistent with beneficence, nonmaleficence, and justice, guaranteeing ethical, patient-focused

treatment. This situation highlights the crucial role of ethical contemplation in making healthcare

decisions and seeking advice to guide decisions for the patient's well-being ethically. Healthcare

providers must comprehend moral conflicts, seek advice from coworkers or ethics boards, and

make informed decisions. Ultimately, care must focus on patient rights, dignity, and

safeguarding against harm while encouraging ethical and beneficial choices. Healthcare

decisions are guided by ethical principles, focusing on protecting patient welfare and rights.
 Ethical Decision Making9

References

Aljeezan, M. K., Altaher, Y. Y., Boushal, T. A., Alsultan, A. M., & Khan, A. S. (2022). Patients'

Awareness of Their Rights and Responsibilities: A Cross-Sectional Study From Al-Ahsa.

Cureus. https://doi.org/10.7759/cureus.32854

Avant, L. C., & Swetz, K. M. (2020). Revisiting Beneficence: What Is a 'Benefit', and by What

Criteria? The American Journal of Bioethics, 20(3), 75–77.

https://doi.org/10.1080/15265161.2020.1714808

Black, B. (2019). Professional Nursing E-Book. Elsevier Health Sciences.

http://books.google.ie/books?id=J1GfDwAAQBAJ&printsec=frontcover&dq=Black+B.

+Professional+nursing+e-book:+concepts+%26+challenges.+Elsevier+Health+Sciences

%3B+2019.&hl=&cd=1&source=gbs_api

Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023).

Clarification of ethical principle of the beneficence in nursing care: an integrative review.

BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01246-4

Dunn, H. (2024). Ethical decision-making: exploring the four main principles in nursing.

Nursing Standard. https://doi.org/10.7748/ns.2024.e12346

Fagerström, L. M. (2021). A Caring Advanced Practice Nursing Model. Springer Nature.

http://books.google.ie/books?id=ZUw2EAAAQBAJ&pg=PA156&dq=Gastmans+C.

+Dignity-enhancing+nursing+care:+a+foundational+ethical+framework.

+Nurs+Ethics.&hl=&cd=3&source=gbs_api

Fry, S. T., & Veatch, R. M. (2006). Case Studies in Nursing Ethics. Jones & Bartlett Learning.

http://books.google.ie/books?id=BotJKlc24MkC&printsec=frontcover&dq=Fry+
 Ethical Decision Making10

%26+Veatch+(2006)+Case+Studies+in+Nursing+Ethics+(3rd+ed).+Jones+

%26+Bartlett+Publishers&hl=&cd=2&source=gbs_api

Lewis, J., & Holm, S. (2022). Patient autonomy, clinical decision making, and the

Phenomenological reduction. Medicine Health Care and Philosophy, 25(4), 615–627.

https://doi.org/10.1007/s11019-022-10102-2

Nampewo, Z., Mike, J. H., & Wolff, J. (2022). Respecting, protecting and fulfilling the human

right to health. International Journal for Equity in Health, 21(1).

https://doi.org/10.1186/s12939-022-01634-3

Newham, R., Hewison, A., Graves, J., & Boyal, A. (2020). Human rights education in patient

care: A literature review and critical discussion. Nursing Ethics, 28(2), 190–209.

https://doi.org/10.1177/0969733020921512

Olejarczyk, J. P., & Young, M. (2021). Patient Rights And Ethics. StatPearls.

https://pubmed.ncbi.nlm.nih.gov/30855863/

Sabatella, F. (2018). The Influence of Empathy and Mindfulness on Ethical Decision-making.

http://books.google.ie/books?

id=xPqI0AEACAAJ&dq=Influence+of+empathy+and+professional+values+on+ethical+

decision-making+of+emergency+nurses:

+A+cross+sectional+study&hl=&cd=4&source=gbs_api

Annotated Bibliography
 Ethical Decision Making11

Aljeezan, M. K., Altaher, Y. Y., Boushal, T. A., Alsultan, A. M., & Khan, A. S. (2022). Patients'

Awareness of Their Rights and Responsibilities: A Cross-Sectional Study From Al-Ahsa.

Cureus. https://doi.org/10.7759/cureus.32854

Summary

The study evaluates patients' perception or understanding of their rights and

responsibilities in the healthcare facilities in the Al-Ahsa region of Saudi Arabia. In this case, the

researchers planned the paternalistic approach to the interaction because they expected that

patients' knowledge of their rights and responsibilities would need to be revised and depend on

demographic factors. The study was conducted on 300 patients from different healthcare

facilities in Al-Ahsa. Data were administered through a self-administered structured

questionnaire to capture patients' awareness of their rights and duties. This cross-sectional study

design was preferred since it provided a 'snapshot' of patients' awareness at a given time. The

study revealed that patients had a fair understanding of the patient's rights and responsibilities.

Further differences were noted according to the age, education, and type of centers

attended for health care. As seen in the results, the patients have some form of understanding

regarding their rights and responsibilities. Therefore, there must be a need to increase awareness

and share information. It is recommended that HC organizations launch awareness creation

programs regarding patient rights and responsibilities. This could enhance patients' experience,

thereby resulting in increased satisfaction. This was done to call for more research in relation to

the process of patient education and cultural effects on a patient's autonomy and activity level.

Avant, L. C., & Swetz, K. M. (2020). Revisiting Beneficence: What Is a 'Benefit', and by What

Criteria? The American Journal of Bioethics, 20(3), 75–77.

https://doi.org/10.1080/15265161.2020.1714808
 Ethical Decision Making12

Summary:

The article under discussion discusses the topic of goodwill in bioethics with an emphasis

on the identification of what a benefit is and the parameters to decide it. As the literature

describes, goodwill might require refinements to accommodate the prevailing ethical dilemmas.

The study has no sample of the participants; therefore, the study is theoretical. The article is

mainly based on the conceptual analysis method in exploring diverse meanings of the term

beneficence. The authors then provide an administrative reflection of the various pieces of

legislation and ethical theories to discuss the benefits of goodwill. The approach used in the

design is abstract; most of the work uses conceptual and analytical tools and is more concerned

with improving ethical ideas than investigating the real world. In this article, the authors contend

that beneficence, as understood currently, should be significantly elaborated and contain

viewpoints of the affected subjects. This is because there were not only efficacy outcomes for

patient candidates of chemotherapy but also preference, contextual, and other elements that

constitute the notion of benefit in the minds of healthcare professionals. It brings out the need to

continue the discussion on ethical principles in the healthcare domain and provides stimulus for

more research on the functionality of beneficence.

Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023).

Clarification of ethical principle of the beneficence in nursing care: an integrative review.

BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01246-4

Summary:
 Ethical Decision Making13

The research question of the integrative review is the following: how may the concept of

goodwill be defined and discussed in the nursing practice? Based on this, the authors assume that

beneficence has different meanings and uses in nursing. The review consists of a literature

review from other studies regarding beneficence in nursing. The research comprises an analysis

of literature and theories within social sciences. In this study, the authors used a literature

evidence search method, presenting empirical studies and theoretical articles on this subject. The

integrative design aims at integrating information from various sources to make it easier to

understand what constitutes beneficence. The specific discussion shows that beneficence is still

an ambiguous concept, and its recommendations are somewhat vague regarding the context and

peculiarities of the nursing practice and patients, who can require different degrees of care and

intervention. Beneficence should, therefore, be applied depending on the situation or the patient's

feelings, unlike the general procedures. The work advances knowledge of the concept of

goodwill within the context of the nursing discipline and recommends conducting more studies

about the role and effectiveness of the concept in patient care.

Dunn, H. (2024). Ethical decision-making: exploring the four main principles in nursing.

Nursing Standard. https://doi.org/10.7748/ns.2024.e12346

Summary:
 Ethical Decision Making14

The above article highlights the four central moral values in nursing: autonomy,

beneficence, non-maleficence, and justice, as well as the ways the principles are used in the

decisions made. The article does not pose hypotheses that can be tested. Still, the authors attempt

to present the reader with sufficient knowledge about ethical decision-making in the nursing

context. It is a review of ethical principles in ethical principles in nursing practice, which the

content is based on. This article employs theoretical analysis and examples to further explain the

use of ethical tenets.

The author discusses ethical decision-making literature and ethically related case studies

in nursing. It is also an informative work concerned with describing and introducing ethical

concepts and norms. The article clearly shows how ethical principles may be applied in decision-

making in nursing practice. This article should immensely benefit the nurses, as it would help

them gain more knowledge on ethical principles to use and sort out issues as they do their work.

The article is helpful in the analysis of ethical principles in nursing and contains valuable

information on how to implement them in practice.

Lewis, J., & Holm, S. (2022). Patient autonomy, clinical decision making, and the

Phenomenological reduction. Medicine Health Care and Philosophy, 25(4), 615–627.

https://doi.org/10.1007/s11019-022-10102-2

Summary:
 Ethical Decision Making15

The article uses phenomenological reduction to evaluate patient autonomy in clinical

decision-making. To this end, phenomenological reduction may be helpful in better

understanding patient self-governance and decision-making. This study is a form of primary

research; it is theoretical, and the writer did not use any sample of people. According to the

article, patient autonomy can be explained more specifically through phenomenological analysis.

The authors discuss several clinical decision-making scenarios based on the phenomenological

theories discussed in the literature.

The design is traditional and research-based since its key concepts are philosophical. To

this end, the article posits that phenomenological reduction will afford to understand patient

autonomy and sharpen the clinical lens. Healthcare professionals can employ phenomenological

reduction to enhance understanding of the patient's autonomy in a clinical context. The article

offers the philosophical discourse on autonomy and provides the conceptual framework for

translating phenomenological perspectives into healthcare practice.

Nampewo, Z., Mike, J. H., & Wolff, J. (2022). Respecting, protecting, and fulfilling the human

right to health. International Journal for Equity in Health,

21(1).https://doi.org/10.1186/s12939-022-01634-3

Summary:

This article discusses how the human right to health can be respected, protected, and

fulfilled with a focus on healthcare systems and policies. The authors presume that only sound
 Ethical Decision Making16

policies and practices can protect the human right to health. The analysis is also concerned with

the policies and practices of several healthcare organizations. This article employs policy review

and case studies to assess the realization of the right to health. The authors, therefore, discuss

health policies and practices globally and locally to determine their efficiency in protecting

health rights.

The design is analytical and descriptive because the proposed work aims to assess health

policies and their relation to human rights. The article focuses on the need to have adequate

health policies and deal with health policies to have health policies respect the right to health and

meet the aspiration of meeting this right. They should improve and ensure policies that would

uphold the right to health for the citizens. The study fills the gap within the current discourse on

health rights and can be used as a framework for assessing health policies and practices.

Newham, R., Hewison, A., Graves, J., & Boyal, A. (2020). Human rights education in patient

care: A literature review and critical discussion. Nursing Ethics,28(2), 190–209.

https://doi.org/10.1177/0969733020921512

Summary:

This article discusses the involvement of human rights education in delivering patient

care and nursing practice. Thus, the authors assume that increasing awareness of people's rights

can benefit patients. Literature from the different studies that have been done on human rights

education in the healthcare field is used in the review. This article employs a literature review
 Ethical Decision Making17

and critical analysis to evaluate the effects of human rights education. Having reviewed the

literature, the authors also critiqued the evidence to assess the impact of human rights education.

The design is non-orientated to analyze research, especially regarding the review and literature

base. Given this, the review recommends that human rights education be necessary to enhance

nursing patient care and ethical concerns. Healthcare institutions must introduce and execute

broad-based human rights education to promote improvement in the nursing profession and, thus,

upgrade patients' health. The study reveals the importance of research emphasizing human rights

education in healthcare organizations.

Olejarczyk, J. P., & Young, M. (2021). Patient Rights And Ethics. StatPearls.

https://pubmed.ncbi.nlm.nih.gov/30855863/

Summary:

The article gives the reader an understanding of patient rights and ethical issues

concerning the practice of health care. The authors do not present specific hypotheses to be

supported or not supported but instead seek to provide the reader with an extensive overview of

patient rights and ethics. The content was derived from reviewing articles and case works, among

them the question of patients' rights and ethical issues. As a result, the article analyses patient
 Ethical Decision Making18

rights and moral principles using only a qualitative approach. The authors synthesize current

literature and guidelines from various countries about the rights and ethics of patients.

The overall layout of the work is informative and not moralistic as it describes principle

ideas of patient rights and ethical questions. The article shows that advocacy of patient rights in

healthcare practice is a vital policy requisite. The patients' rights should also be respected, and

the various providers should understand the ethical principles of healthcare. Consequently, the

article is helpful to the present and ongoing discourse on patient rights and ethics since it is a

valuable source of information for healthcare education and practice.