An ethical dilemma is essentially a situation with no good alternative. For example, the Good Samaritan's commitment to care for a wounded man seems clear-cut (Lk 10:25-37). The man needed help. The Samaritan tended his wounds. However, what if he had found a whole tribe of wounded people but only had the time and resources to care for one? When you have more than one neighbor with conflicting needs, you have an ethical dilemma.
Furthermore, Jesus taught, "If anyone strikes you on the right cheek, turn the other also" (Mt 5:39). We should not respond to violence with violence. But what if someone went beyond striking you on the cheek and began abusing your child? Or what if a tyrant murdered thousands of people? Should you simply turn away? Is there ever a time when violence deserves a violent response? When following an ethical principle endangers other people, you have an ethical dilemma.
An ethical dilemma puts us in a position where it is impossible to do the right thing. We can only discern the least-worst alternative. There are no good answers or perfect solutions in the face of an ethical dilemma, only painful choices.
So how can we make those choices faithfully? The prophet Micah asked, "What does the LORD require of you but to do justice, and to love kindness, and to walk humbly with your God?" (Mic 6:8). This requires a three-step process. First, we need to understand the situation fully. Second, we explore the norms-rules and principles-that apply. Finally, we propose alternatives and choose the least-worst of them.
What's Going on Here?
Ethical dilemmas are by nature messy and more complex than they appear on the surface. They involve a network of people with conflicting interests. Personal biases, cultural values and emotional baggage cloud the situation. Power struggles, often subtle or disguised, may sway the evidence. You will need more than human wisdom to uncover the heart of the problem.
As you attempt to define the dilemma, try to discern who is involved-usually more than the obvious factors. For example, Marilyn F. suffered a post-operative pulmonary embolism. Her physician ordered an apparently unsafe dose of morphine every two hours for "pain." Marilyn was not complaining of pain; she was complaining of shortness of breath. Her husband had insisted on the morphine order. Later, he confided to the charge nurse that he was in love with another woman and hoping that his wife would die. He had hired a private duty nurse to care for his wife and made sure she gave the morphine. The nurse realized the problem was much bigger than a potential overdose. It was conspiracy to murder.
An ethical dilemma puts us in a position where it is impossible to do the right thing.
What issues were at stake? In this case, the issues included the sanctity of life, violation of the law, the patient's rights and the nurse's responsibility. Furthermore, letting this incident slide could have created a precedent for euthanasia in this hospital.
What further information did the charge nurse need to make an informed decision? She needed to know the emotional and relational aspects of the situation, the legal implications and the philosophical assumptions of those involved.
Knowing Right from Wrong
While established codes for nursing guide ethical behavior, the civil law also applies in this situation. Euthanasia is still illegal in the United States, although the move toward allowing physician-assisted suicide in some states is testing the limits. The law holds nurses accountable for administering an unsafe medication dose-even under a physician's orders. The charge nurse was responsible for this patient's care, even though she did not personally administer the morphine.
Christian nurses have a higher authority than either civil law or professional standards and codes. The Bible provides clear guidelines for right and wrong, including the Ten Commandments and other biblical norms. We need to be familiar with Scripture, so that when questionable situations arise, we already have a strong foundation on which to base our decisions.
Reading about bioethics, attending professional continuing-education offerings on ethics, reviewing case studies and discussing ethical concerns with more experienced colleagues will also make us more aware of the norms to follow when facing ethical dilemmas.
Deciding to Act
Ethical deliberation is not merely an academic exercise; it should lead to action. Here is where ethics get messy.
In the situation above, the nurse was young and scared. She decided to first discuss the situation with her supervisor, who went with her to confront the attending physician. He ranted but reduced the dosage. The private duty nurse was removed from the case. The husband threatened to sue the hospital. Marilyn died four weeks later, and her husband married the other woman. A happy ending? No, but it could have been worse.
Perhaps that's the crux of ethics-preventing the worst from happening. That is also the outcome of walking humbly with our God in a sinful world.
JAS