There are several ethical decision-making models that

There are several ethical decision-making models that have been designed specific for ethical decisionmaking. The MORAL Decision-Making Model is one of them. Model is represented by the mnemonic MORAL: Massage the dilemma. Collect data about the ethical problem and who should e involved in thedecision-making process. Outline options. Identify alternatives and analyze the causes and consequences of each. Review criteria and resolve. Weigh the options against the values of those involved in thedecision. This may be done through a weighting or grid. Affirm position and act. Develop the implementation strategy. Look back. Evaluate the decision making. What would you tell Sam ? Sam is a 65-year-old patient who has been admitted and assigned to your care 10 days ago. He has undergone teststo rule out a malignancy. The tests confirm that he has cancer with the likelihood that it has metastasized. His doctor hastold Mr. Jones and his family the results. The family wants Sam to undergo treatment even though the doctor has indicatedthat such efforts would have a poor probability of success. You have developed a close and trusting relationship withSam during his hospitalization. Sam’s family approaches you and begs you to encourage Sam to have treatment asthey feel you would be able to influence his decision. When you tell the family you are uncomfortable with their request,they say, “at least, please don’t discourage him from having further treatment, we know he trusts you.” That evening youthink about the ethical ramifications of this dilemma. Massage the Dilemma In thinking about Sam, you decide that he, as the patient, is the most important person in this dilemma. The physician, the family, and you as a professional nurse also have lesser stakes in the outcome. You haveinterpersonal conflict. Personally, you know your values and you value quality of life over quantity, but thatis your personal value and may not be right for Sam. Moreover, you do not want to alienate the family or thedoctor or do or say anything that would contradict your own values or your professional ethics. Youunderstand that the family is desperate to save their father, and this may be clouding their judgment. You aresure that Sam will ask you what you would do if you were him and you are dreading that . You have the following options Option 1. Ask the head nurse on your unit to assign Sam to another nurse. This would prevent futureintrapersonal conflict. But it does not address the problem. Option 2. Say nothing. When Sam asks you what you would do, merely say you are not permitted to give himpersonal advice and tell him to speak with his doctor. In this way you are not interfering with the doctor-patient relationship and also not going against the wishes of the family. This is a safe option for you but does not help Sam. Option 3. Since you know what your own values are, be specific with Sam. You know that you value quality of life or quantity. Tell him that if it were you fac­ ing this decision you would not seek further treatment but would return to your home and spend as much quality time as possible withyour family. While this is an honest response, it does neglect involving the family or the physician in the decision. Option 4. Tell Sam that the decision is too important for only you to give him advice and ask him if he will let you set up a conference with Sam, yourself, his doctor, his family, and a social worker so that you could all discuss this important deci­ sion. Tell Sam you will be there to support him andhelp him ask appropriate ques­ tions so he can make an informed decision. This option involves all the important stakeholders in the decision, but it does put Sam, who is already vulnerable, in a situation against his family should he decide not to seek treatment. Review the Options In reviewing your options decide your personal values? As an RN you are expected to yield to your professional values, which option reflect your professional values ? Doing what is in the best interests of Sam, should be your main goal and your criteria for action. Affirm Position and Act Sam reluctantly agreed to a conference, and you approached his physician who was very supportive of such aconference. The social worker was eager to participate. However, when you approached Sam’s family onlyhis wife agreed to attend the conference. All of his children were angry at you for arranging theconference and felt you had “over­ stepped your duties.” You sat by Sam during the conference and madesure that all his questions were adequately. How would you address all his children anger regarding the conference you arranged? Look Back As a result of the conference, Sam decided not to undergo further treatment. His wife was very tearful, but she promised Sam that she would support his decision and make sure his children did not pressure him to do nything further. How do you address Sam’s wife concerns ? Sam’s children filed an official complaint against you but your supervisor upheld your actions. Although you felt youractions were appropriate, you were troubled by Sam’s children’s continued anger. Sam died 4 months later and Sam’schildren never forgave your “interference.” How would you react if Sam was not your patient? React to your decision-making process in this situation?

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