Speaker 1: Good morning. Today I'd like to discuss with you the topic ethical dilemma in healthcare practices. The content of presentation. We shall look at the clarification of concepts, concepts like ethics, ethical principles, dilemma, and ethical dilemma. We shall also look at the issues in ethical dilemma, how to address ethical dilemma, then do a summary of these points and offer some references. To begin with, let us attempt some clarification of concepts. This would help us to have a very focused handling of the concept involved in this presentation. The two main concepts in this presentation are ethics and dilemma. They are often used in different fields of studies with slightly different interpretations. To foster a better understanding, we shall clarify the aforementioned concepts. We are also going to portray the application within healthcare practices. What is ethics? Ethics is a study of moral principles that governs a person's behavior or the conducting of an activity. Virtually all disciplines has its ethical components that studies its activities. For example, medical ethics is a moral principle that governs the practice of medicine. It is important to mention that there is a difference between ethics and morality. Ethics are a formal system of belief that guides our behavior while morality is more personal and can vary from individual to individual. There are four principles of ethics that needs to be considered before discussing ethical dilemma because ethical dilemma is essentially the conflict of ethical principles. Ethical principles are nothing but guidelines for ethical considerations. These principles of ethics are at one point or the other in conflict, resulting to ethical questions and a need for decision-making. The principles of ethics are respect for autonomy, whether autonomy from an individual or collective basis, a perspective. The second is beneficence, which means to provide the benefits and non-maleficence, which means do no harm and justice, which entails discourse like equity and fairness and distributive justice. So what is a dilemma? A dilemma is a situation in which a difficult choice has to be made between two or more alternatives, especially equally undesirable ones. It involves significant value conflicts among different interests, usually caregivers and patients. Dilemmas are normal. They provide learning opportunity and they are handled the case. Ethical dilemma, also known as moral dilemma, a situation in which there are two choices to be made, neither of which resolve the situation. In an ethically acceptable faction, in such cases, societal and personal ethical guidelines can provide no satisfactory outcome for the chooser. Ethical dilemma assumes that the chooser will abide by societal norms, such as code of law or religious teaching, in order to make the choice ethically impossible. A look at this picture shows us how ethical principles are involved in ethical dilemma. In this picture, we see the four ethical principles being engaged in ethical dilemma. In this case, the person who is in dilemma is considering autonomy versus beneficence, non-manifestations versus justice. So the question is, what is the person going to do? What decision is going to be made in such a way that these principles are respected? In a particular setup for nurses, for instance, ethical dilemma come up from time to time. And in the process of offering care to patients, they could be faced with these dilemmas as regards to maybe instances like patient autonomy breaches, respecting patient cultural religious belief, informed consent to treatments, and protecting patients' rights. It is a normal daily occurrence in healthcare practices. But what is more important about ethical dilemma is how they are resolved. Because the way they are resolved will determine whether the patient's right is being respected or not. So this takes us to how do we address ethical dilemma. There are different approaches in handling ethical dilemma. And the desired outcome will determine which approach to choose. It is also important to note that a decision could be a combination of different approaches to ethical dilemma. The three major approaches to ethical dilemma are consequentialist approach, which is focused on results. It's a result-oriented approach. This is often the approach taken by public health. We have the deontological approach to ethical dilemma, which is an action-oriented approach. This is the approach that focuses on duty ethics, you know, considering the means to an end, you know. And the third approach is the ethical virtue approach, which is centered on the character of the individual. So any of these approaches could be used to address ethical dilemma. Like I said, it depends on the preference of the institution, the goals of the institution, the policy of the institution that would determine, you know, which of this approach will be adopted, and the case at hand. Continuing that discussion, having theoretical framework to deal with ethical dilemma. Dilemma is only an important aspect of the task. There are some recommended practical steps to be taken. One of those steps or to be one of the steps to be taken is identifying the dilemma and the ethical principles at conflict in the case. Each case, in each case where there is a dilemma, there are two things usually at conflict, the ethical principles, and of course, the questions, the need, the questions that come up in the case, and the need to make decisions. So identifying first of all, the dilemma, knowing that there is a dilemma, and of course, identifying the ethical principles at conflict in the case is the first step to take in addressing the dilemma. Then a careful analyzing of the situation. And also providing solution, preferring alternative solutions. Sometimes you could have more than one solutions to the identified problem. And then after identifying, providing those alternative solutions, one is expected to interrogate those solutions, side by side, which of them best address, attend to the question that is being posed. This step is also very important, is the second step in addressing ethical dilemma. Then we may move from there to make a report to the immediate team of care provider, beginning with the leader of the team. By that I mean that when a caregiver is confronted by an ethical dilemma, it is advised that such dilemma is shared with the team, you know, is discussed with a team of care providers, so that they could be like a team approach to addressing the issue. Other reasons for that is that it could also offer an opportunity for teaching, for learning, for education, where other caregivers can come to be aware of the ethical dilemma, and how they could address the ethical dilemma should it come up in a different case, within the process of offering care in a facility. You're moving from there, you could consult with the ethics, the law, the policy resources available at your workplace, then adequate documentation of the various steps taken to address the dilemma is very important. Then finally, you could, when you develop the final decision, in that ethical dilemma, it is always advisable that we process it and put it in form of an ethics education model, which could be helpful for capacity building in a workplace. So these are the steps that we could take to address ethical dilemma. And I need to state here that there is no particular or one way to attempt to address ethical dilemma, because it depends on the case at hand, the policy of the institution, it depends also on the values or the ethical principles at conflict that will determine how ethical dilemma may be addressed in a, you know, in a particular place. So far, in this presentation, we have attempted to define ethics, and dilemma, and ethical dilemma, we looked at the ethical principles. And we mentioned that in a dilemma, it is usually a conflict between ethical principles side by side with the need to make decision in providing care for a patient within healthcare system. We highlighted some ethical dilemmas that healthcare providers like nurses confronted with, I will mention that ethical dilemma could come up in the process of getting informed consent, in the process of privacy and confidentiality, in the process of, you know, other activities that happen day to day within the healthcare system. We also raised or mentioned the issues involved in ethical dilemma. And we preferred some guidelines that could help to address ethical dilemma. One of the words I would like to use to summarize this presentation today is that ethical dilemma are better approached from a team perspective, it is not advisable for an individual to try to tease it out. Because when we when a team perspective is brought to attend to ethical dilemma, it not only help to reach a more balanced ethical decision, it could also be a resource for capacity building within an organization which will help to, like improve the reservoir of knowledge, and to help us confront such issues should they occur, maybe in a different case, within the organization. I want to thank you for your attention. You may leave some questions in the post below and I'll be glad to reply you. Thanks for your time. Transcribed by https://otter.ai