What Would You Do?

A patient was dying from a massive myocardial infarction in the intensive care unit. His son wanted to be at his side in his final moments. It was 1975, and the hospital policy was very clear; visiting hours in the ICU were 10 minutes every 4 hours. What would you do?

When emergency nurses are faced with similar difficult decisions, it is important that they have a framework upon which they can make a choice. This process has become known as ethical decision making. Unlike other principles that may guide one's personal life, ethical decision making in nursing must encompass personal, professional, societal, and cultural values, along with ethical principles. It is difficult, if not impossible, to separate any of these aspects when we are making ethical decisions for ourselves or our patients.

Beneficence or providing a “good” or “benefit” for a patient is a primary ethical principle. Disregarding the visitation rules would be beneficial for the patient and his son; however, it may not benefit the nurse who would be “breaking” the hospital rules and facing possible punishment.

Fairness or justice, another significant ethical principle, would dictate that if one visitor could stay, why not everyone? It also could direct the nurse to ignore all visitation rules, thereby potentially causing chaos, which may result in poor patient care.

Many times nurses find they suffer from a “dual loyalty complex.” This complex results from having to choose between the needs of the patient and the “rules and regulations” imposed by their employers, physicians, regulatory bodies, and sometimes even society.1

Providing care at the end of this patient's life should include his family. Care, another important ethical principle, involves expressing concern, attending to, and providing aid as needed. Caring may occur with or without the awareness of the patient.

Developing an ethical framework will facilitate making a decision that is beneficial for both the patient and the nurse. Iserson2 and Cassells and Gaul3 offer an example of a simple ethical decision-making framework. This process includes the following steps: assess and identify the problem or ethical issue; develop a plan based on ethical principles; list the consequences of the decision; consider personal values; and identify a process for implementation and evaluation.

This month the Journal of Emergency Nursing includes 3 articles that discuss ethical issues that frequently challenge emergency nurses: emergency contraception, drug diversion by emergency nurses, and role delegation. In addition, David Reynolds has written a Letter to the Editor requesting that you submit your ethical dilemmas to the Journal and describe how you have (or have not) dealt with them. We hope this request will afford emergency nurses an opportunity to explore these issues, and through your feedback, help develop a framework to assist in dealing with these ethical challenges.

So, what would you do? I allowed the son to stay with the patient (his father) until he peacefully died.