An Integrated Ethical-Decision-Making Model for Nurses

Topic: Medical Ethics
Words: 950 Pages: 3


Today, ethical and legal issues are key characteristics of almost every profession. In nursing, integrating various models helps individuals recognize their rights and obligations from various standpoints (Park, 2012). In this case, a pregnant woman survived a car accident that resulted in serious brain traumas and the necessity of palliative care while her husband died. Her parents know her intention not to extend and support her life by employing medically assisted nutrition and hydration. The increasing awareness of the patient’s legal rights during treatment often conflicts with the healthcare moral standards and ethical requirements (Reynolds & Mitchell, 2019). In Kansas, withholding life-sustaining procedures in pregnant women is not legal. Thus, an integrated ethical decision-making model should be addressed to understand what solutions the woman’s parents should make. In particular, the intensity and nature of the ethical issues are higher in the healthcare sector, where professionals are dealing with human life.

An Integrated Ethical Decision-Making Model in Nursing

The first step in decision-making is to state an ethical problem and prove that the situation is ethically complex. The case is centered around the tragic event where a pregnant 29-year-old woman suffers a car accident, making her suffer an unrecoverable brain injury. There is a high probability that she could be on life support, which contradicts her healthcare treatment directive. The conflict in achieving her wish is that she is pregnant, and a child’s life poses an ethical dilemma on whether the life support should be removed.

The next step is collecting information about the case and its related concepts. According to Miller (2018), many practicing nurses have doubts about their roles concerning the patient’s advance directives. They need to save human lives and protect their well-being, but they cannot contradict the patient’s will and follow their directives properly. The advanced directive is used to show the patient’s wishes for medical care in a situation where they cannot talk. Thus, a person decides, reduces the burden on their loved ones, and gives details to the healthcare provider’s treatment plans.

Alternatives should ensure that the situation might achieve rational decision-making. An advanced directive for a debilitated patient is not the same as a declaration of consent from the patient in control of all their abilities (Hester et al., 2019). Patients only state the associated medical choices they need once in a critical situation for advanced directives. At the same time, an unborn child has a right to live, and the mother’s right is not the only one to be followed in this case. Thus, in this case, the alternatives are related to several stakeholders: the patient, her unborn child, and her parents. First, hospice care may be postponed, and life support should be continued. Second, hospice care should be supported as a part of the patient’s original plan. Among the major questions that linger in the minds of the loved ones is how best they can use the available resources to benefit the patient. However, the advanced directives have made it possible for patients to explain how best they want to be taken care of while in a critical situation.

Besides, an alternative should be found because the actions described in the woman’s directive are illegal in Kansas. As the parents are the only caretakers left responsible for the woman, they make the decisions for her. Hence, they should seek legal advice to fulfill their daughter’s desire. Eighteen American states in the country do not have the pregnancy clause for the advanced directive, while 13 other states are silent on the matter. This option has a legal background compared to the previous alternative, which is based on ethical rights and human choices.

Several strategies might be taken: either to end hospice care and try to support the patient’s life or to end any medically advanced support and choose hospice care. As a nurse, my position to ensure an appropriate outcome is to communicate with the patient’s parents because the legal right to withdraw life-sustaining medical care has no effect in Kansas. Thus, my specific actions should include communication, support, and explanation of the situation to the parents in the clearest way. My position is not to keep the patient on life support, but Janet’s parents should decide as the woman’s only legal representatives. My reasoning is that life prolongation could be temporary, and her intrinsic right to life with dignity would not be followed. Thus, the parent’s decision is the only correct legal and ethical approach in this case, and my support and understanding are my direct ethical responsibilities.

The decision to stop life support can be justified by the utilitarianism theory, and this strategy is ruled by the amount of pleasure and suffering. Accordingly, the approach ascertains morals and immoral by focusing on the outcomes. That is to mean that an ethical choice is the one that results in the greatest good for most people. The strategy based on the deontological perspective is related to duty and obligation, and the patient’s rights should be respected. As parents claim their daughter did not want this, they will suffer knowing that their daughter’s advanced directive is not followed. By fulfilling the advanced directive, the final will of the daughter is fulfilled, which would ease her parents’ grief.


In conclusion, after evaluating the situation, I think others’ morals and ethical perspectives are never simple in nursing. The only issue to be considered in this case is that the patient’s advanced direction was made as her only wish. Her fetus does not have legal rights, and her parents should follow her recommendations. Therefore, withdrawing all life-sustaining procedures is the most rational decision for the patient’s parents to make and avoid legal or ethical controversies.


Hester, D. M., Eisenberg, L., & Guidry-Grimes, L. (2019). Regulating decisions for incapacitated pregnant women. JAMA, 322(9), 894-895. Web.

Miller, B. (2018). Nurses preparation for advanced directives: An integrative review. Journal of Professional Nursing, 34(5), 369-377. Web.

Park, E. J. (2012). An integrated ethical decision-making model for nurses. Nursing Ethics, 19(1), 139-159. Web.

Reynolds, J. M. K., & Mitchell, C. (2019). ‘Inglan is a bitch’: hostile NHS charging regulations contravene the ethical principles of the medical profession. Journal of Medical Ethics, 45(8), 497-503.

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