There are many ethical decisions that a nurse will encounter throughout their practice. Therefore, it is very important for a nurse to identify an ethical decision making model that best suits them. This will prove to be a vital tool in the, “heat of the battle.” The internal moral/ethical battle that lies within. The purpose of this paper is to evaluate a case study utilizing one of these ethical decision-making models. In this scenario involving a six-year-old, who has just been diagnosed with meningitis will be reviewed. In this scenario, the physician is requesting permission to treat from the parents. However, the child’s parents are divorced. The non- biological mother has primary custody of the child. She is a Christian scientist and insists on not continuing treatment for the child. The biological father, is in a different state, and insist that his child be treated. One such decision-making model that is widely used by medical professionals is the Four Quadrants approach. For the purposes of this essay, this model will be utilized in finding a resolution to this dilemma.
The ethical dilemma
The dilemma is that this child requires medical treatment. However, the parents are split and have conflicting views on treatment options. The non- biological mother with primary care, refuses treatment for religious reasons. The biological father, living in a different state, is requesting treatment. How can this situation be resolved?
The Four Quadrant Approach.
In order to aid the provider in this decision, it is beneficial to utilize the Four Quadrant Approach. This model is useful in that it, “helps to highlight areas of controversy and to clarify the principles underlying the circumstances of a clinical ethics case” (Schumann & Alfandre, 2008 Pg 42). In this model, there are four broad topics: medical indications, patient preferences, quality of life, and contextual features. Each of these topics, represents one quadrant. Within each quadrant by specific questions (Sokol, D., 2008 Pg 513).
A resolution for the dilemma.
The first category in the Four Quadrant Approach for decision-making is medical indications. This patient’s medical problem is that he/she has meningitis. In most cases, there is generally a good positive response to treatment, and children often make a full recovery. According to Royal Children’s Hospital Melbourne, “Most people will make a full recovery after meningitis, but it can take time” (The Royal Children’s Hospital Melbourne, 2010). This is to say, with some minor possible side effects such as hearing problems. Therefore, this child has a great chance a full recovery. If provided prompt medical treatment. If this is accomplished, severe consequences such as death can be avoided. The second category. In this approach involves patient preferences. This patient is not capable of making medical decisions for themselves.
Therefore, the medical provider must look to the parents. In this case, the non-biological mother has primary custody of the child, and is refusing care due to religious preferences. On the other hand, the father lives in a different state, and is requesting medical care for the child. In the third quadrant of this approach, quality of life is considered. Within this quadrant, benefits, nonmaleficence, and respect for patient autonomy are considered. Please treatment, this child stands to make a full recovery. With a few possible side effects. Some of which include general tiredness, frequent headaches, hearing problems, and mood swings. However, some children can be left with permanent damage and/or disabilities. In the fourth and final quadrant of this approach, contextual features are considered. Loyalty and fairness is taken into account.
In this case, it is important to note that the non-biological mother with primary custody of the child, wishes to deny treatment as per her Christian Science belief system. On the other hand, the father wishes to continue with medical treatment. Furthermore, reviewing the court’s orders on who has the final say in the event of a disagreement, may prove useful when considering the options. In this case, as there are conflicting beliefs amongst the parents, it seems the best interest of the child needs to be the deciding factor. Therefore, question three comes into play. The child stands to have a good chance of having a normal life with some possible minor side effects. Although there is some chance in major deficits were permanent damage. Based on this knowledge, and after closely considering the court’s orders, a medical provider may wish to decide on preserving the child’s life. An explanation to the family.
In this case, a significant amount of the explanation for the decision to continue with treatment, would be geared towards the mother. This is because the final resolution was in opposition to her religious beliefs and views. I would take her to a private room and discuss the reasons for our resolution. This would include the fact that the child has a good prognosis with few minor side effects, and a small chance of experiencing permanent damage or major deficits. I would explain that the court’s orders were taken into account, and that there were no rulings that pertained to the default decision in the case of a disagreement.
Additionally, I would allow her to do plenty of talking and show her the respect and sympathy. She deserves. I would also include that she is not being looked down upon in any way, and that her religious preferences were carefully considered before making the final decision. There are many different ethical decision-making tools available to healthcare providers. The tool utilized in this essay involved that of the Four Quadrants Approach. This tool was successfully utilized to help make a very difficult decision that would affect many lives. Is important that all healthcare providers take time to research possible methods of ethical decision-making. It is not a matter of if, but when, an ethical dilemma is encountered.
Schumann, J., & Alfandre, D. (2008). Clinical ethical decision making: the four topics approach. Hospital Physician, 44(12), 42-48. Sokol, D. (2008). The “four quadrants” approach to clinical ethics case analysis; an application and review. Journal Of Medical Ethics, 34(7), 513-516. The Royal Children’s Hospital Melbourne. (2010). Kids Health Info: Meningitis. (2010). Retrieved from http://www.rch.org.au/kidsinfo/fact_sheets/Meningitis/
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