This paper will consider two potential ethical dilemmas which may result from the practice of nursing, especially when focusing on the care of infants and of new borns. The essay will consider each of the dilemmas in turn and will conclude by suggesting a possible solution to the dilemma which is relevant according to good medical practice and an attention to existing scholarship on the nature of ethics within the medical profession.
One dilemma which one is likely to encounter is the dilemma around circumcision. This is a dilemma which explores questions such as agency and personal health as well the notion on consent on behalf of the patient. The practice of what is termed ‘non therapeutic circumcision’ is often highly controversial and has led to several major debates about the possibility that there may be a moral duty to prevent it. This is understood to be circumcision administered in traditional ways and without the use of any anaesthetics or any other medical conditions which would be used to alleviate the pain of the operation. On the other side of this debate exist groups who insist for cultural or religious reasons that they wish to conduct a ‘non-therapeutic circumcision.’ Typically arguments for non therapeutic circumcision tend to focus on the cultural and traditional aspects of the procedure, something which makes it qualitatively different from the practise of circumcision in which therapeutic methods are used.
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"Ethical Dilemma Essay".
One muslim organisation described such a process as follows; ‘Being circumcised is an important rite of passage for any Muslim male…it is accepted by non-muslims for health and hygiene reasons, but for us it is part of our faith’ (Qtd in Mussell, 2004 258.) Typically debates about the ethics of male circumcision tend join themselves to a focus on notions of autonomy which have come to the fore in debates surrounding medical ethics since the 1970s. For example, existing British legislation states categorically that; ‘The welfare of the child patient is paramount and doctors must act in the best interests of the child in each individual case’ (JME, 2004).
It is possible to conceive of the following ethical dilemma involving non-therapeutic circumcision If a child suffers from an illness very early in their life, before the traditional time for circumcision they may be brought into hospital and require treatment. The nurses providing such treatment will know, in this case, that the child’s parents may well seek to circumcise it when it is released from hospital and to perform this circumcision in a non therapeutic way as it would fit in with their specific cultural beliefs and practices. Nurses in this case would be aware that the infant is at risk from such a procedure as unnecessary amounts of pain or physical trauma should be avoided while the child is recovering from their illness. As such issues regarding agency are raised as well as the capacity for an infant to make a decision regarding their own health. It is also the case that the parents may not be as entirely well-informed as to the consequences of their actions.
On this occasion the doctors may choose to inform the parents that they should not circumcise the child while they are recovering, or they may seek to perform the procedure themselves ensuring that aesthetic and proper medication are used in order to prevent the operation from leading to serious consequences. Assuming that the parents refuse this, and insist that the child will be circumcised in a non-therapeutic way then doctors involved must take what action is necessary in order to secure the best interests of the child. At all points it would be the responsibility of the nurse in this situation sure that the parents of the child are as well informed as possible and that doctors treating the child are equally aware.
The second possible dilemma that this paper will discuss is also one which can be seen to focus again on problems of agency. In this case, the agency of a mother in labour. It is conceivable that someone may endure an extremely long labour and that this person may know that, if certain pain killers were to be administered, then they would run the risk of permanently damaging their child due to an allergy which they both carry. As a result of the length of the labour, which has now led to the uncertainty over whether or not the child may be born healthily, it possible the mother may begin to request pain killers, despite the fact that they may harm the baby, if they survive the birth. Nurses in this position would be left with the dilemma of whether or not to accept the agency of the mother seeking to ease her pain, or whether to act in the best interests of the child and potentially consider the fact the mother, as a result of the labour process, is not in sound mind, and refuse to administer painkillers because they may risk harming the baby.
As mentioned, this is a dilemma which concerns conceptions of agency. In this case, the agency of the mother to make a decision. To begin to solve this dilemma it is possible to note that it is has been commented that patients frequently abandon their decision making capacity to their doctors. One specialist notes that she found ‘autonomy [of patients with regard to their treatment] to be striking by its absence in the concerns of people who are sick, and that the doctor patient relationship is often entirely one-sided’ (Stirrat & Gill, 2005 128). It is not out of the ordinary for doctors to overrule the wishes of a patient in situations in which the former attempts to manifest an autonomy which the doctor does not believe them to have. This should be borne in mind the the nurse decides to withhold painkillers from the patient.
It also possible to note that, if the nurse believes that they have a responsibility to give the child the best chance of survival, they may appeal to the fact that withholding medication is not necessarily compromising autonomy, and they are taking no positive action. This is a key point in medical ethics as serves to show that a doctor may generally not be held responsible should they withhold medication which they know to be dangerous to a patient and which they do not need absolutely in order to prevent a life threatening situation (Doyal, 1990 10).
§In short, therefore the solution of this dilemma would remain up to the decision of the nurse. The sovereignty of their decision in the situation can guaranteed both by the fact that it normal for a doctor to overrule a patients wishes and also by the fact they are not actively taking any positive action that will bring harm to the patient.
- “The Law and Ethics of Male Circumcision: Guidance for Doctors.” (2004) Journal of Medical Ethics. 30 (3) 259-263.
- Doyle, Len. (1990) “Medical Ethics and Moral Indeterminacy.” Journal of Law and Society. 17 (1) 1-16.
- Mussell, R. (2004) “The Development of Professional Guidelines on the Law and Ethics of Male Circumcision. Journal of Medical Ethics. 30 (3) 254-258.
