Ethical Dilemma in Child Healthcare: Principles and Responsibility

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What is Ethics? Ethics are standards of behavior, developed as a result of ones concept of right and wrong (Judson & Harrison, 2010). Code of ethics is a list of principles that is intended to influence the actions of healthcare professionals within an organization. Ethical principles help guide the decision-making process among healthcare workers in complicated situations. This paper will review the assigned case study and provide the reader with the ethical issues and principles.

Ethical Dilemma in the Case of the 8-Month Child

The case study discussed an 8-month old child brought into the emergency department by the mother due to inconsolable crying.

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It was reported that the child had been crying since picked up at daycare. The nurse found that the child's vital signs were slightly elevated and child's thighs were edematous and warm to the touch. The assessment was then presented to the physician; concern was expressed that the child may have been injured. An x-ray was ordered revealing fractures to both femurs.

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The mother was informed of the findings by the physician; after speaking with the mother the physician decided it was not child abuse and therefore, the situation did not need to be reported.

The ethical issues involved in this case study are the nurse and physician's responsibility to report suspected child abuse. Social services should have been consulted to assist in the process of reporting the situation to Child Protective Services (CPS). Hardy and Armitage state "In all actions concerning children, the best interests of the child shall be a primary consideration" (2002, p. 109).

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In this case, the primary consideration was not in the best interest of the child. According to Judson and Harrison the physician has the responsibility to understand the tools for diagnosing and treating abuse and to be familiar with the available resources (2010). The nurse in this case has the ethical duty to report the physician for not having concern regarding a possible child abuse situation. Healthcare professionals have an ethical duty to expose unethical behaviors by other members of the healthcare field.

Nursing has progressed over the years into a respected and honorable profession. Insaf Altun (2008) states it best by saying, "The six key roles of nursing are: advocacy, promotion of a safe environment, research, participation in shaping health policy, in patient and health systems management, and education" (p. 839). The two key roles the nurse in this case study failed to provide for the patient are advocacy and promotion of a safe environment. If the nurse was using good moral and professional judgment, he or she would have reported the situation immediately for the wellbeing of the child.

Three Ethical Principles Important in This Case

Three of the ethical principles that are discussed are nonmaleficence, veracity and paternalism.

The first ethical principle is nonmaleficence, meaning first do no harm (Judson and Harrison, 2010). A question asked by Milton and Cody (2001 p.290) was, "How can one keep from doing harm if one acts without knowing what the reality of the lived experience is for the person?" In the case study, neither the nurse nor physician knows what happened to the child or the reality of the circumstances that led to fractured femurs. The healthcare professional would have upheld this ethical principle and the law by reporting the suspected abuse, thus doing no harm and protecting the child from further harm.
Another ethical principle that the physician could have used is veracity. The ethical principle of veracity deals with the truth or truth telling (Henry, 2005). The physician in this case should have discussed the health status of the child with the mother, made a "good" moral judgment, and told the mother the incident must be reported to CPS; the case could have been presented to the mother in a non-accusatory manner. The physician should have been reported for assuming the incident did not need to be reported. Furthermore, the nurse should have stepped forward and reported the incident, thereby promoting veracity on behalf of the case at hand.
The third ethical principle in the case study to discuss is paternalism. At times paternalism is viewed as a negative act because it allows healthcare providers to make decisions for the patients (Andre & Velasquez, 2008). The facts in the case study provide for an excellent example of when paternalism should be exercised. The nurse or physician in the case study could have used paternalism as a guiding ethical principle to do what was right for the safety of the child by reporting the incident. The child has no voice to defend or protect him or herself and in this situation, the nurse should have advocated for the patient.

Why Following Ethical Principals is Important for Healthcare Professionals

The three ethical principles mentioned above are valued in my personal and professional life as a mother, nurse and student. The first ethical principle discussed nonmaleficence has been a personal value of mine throughout my life, used in all aspects of my life. The second ethical principle, veracity is maintained most of the time. I believe there are situations where telling the person the whole truth would not have an optimal outcome. The third ethical principle mentioned paternalism is used at times in my professional life as a nurse and in my personal life as a mother.

The outcome of the case study could have been optimal for all involved the child, mother, nurse, and physician if the situation occurred at a children's hospital. The likelihood of staff in a children's hospital to have the proper training on signs of, diagnosing, treating, and reporting suspected abuse is much higher than an adult focused medical center.

The American Association of Heart Failure Nurses incorporates ethical principles in the respect of advancement of care, education, and research to promote the best outcomes for patients' with heart failure. One ethical principle used by the association is beneficence; this principle is used by providing evidence-based research, treatment, and education for patients and healthcare professionals. Using evidence-based medicine the association is giving optimal care for this patient population.

Using ethical principles healthcare professionals can ensure they are making good moral decisions regarding care and treatment of patients. The ethical principles do not have to be a value of the healthcare professional, but must be upheld for the best interest of the patient.

References

Altun, I. (2008). Innovation in behavior patterns that characterize nurses. Nursing Ethics, 15(6), 838-840. Retrieved April 20, 2009, from
EBSCOHost database.
Andre C. & Velasquez M. (2008). For your own good. Retrieved April 21, 2009, fromhttp://www.scu.edu/ethics/publications/iie/v4n2/owngood.html
Hardy, M., & Armitage, G. (2002). The child's right to consent to x-ray and imaging investigations: issues of restraint and immobilization from a multidisciplinary perspective. Journal of Child Health Care, 6(2), 107-119. Retrieved April 20, 2009, from SAGE database.
Henry, L. (2005). Disclosure of medical errors: Ethical considerations for the development of a facility policy and organizational culture change. Policy, Politics, & Nursing Practice, 6(2), 127-134. Retrieved April 21, 2009, from SAGE database.
Judson, K. & Harrison, C. (2010). Law and ethics for medical careers (5th ed). New York,NY: McGraw-Hill.
Milton, C. & Cody, W. (2001). The ethics of bearing witness in healthcare: A beginning exploration. Nursing Science Quarterly, 14(4), 288-296. Retrieved April 20, 2009 from SAGE database.