DEBER BERHAN UNIVERSITY ASRAT WOLDEYES HEALTH SCIENCE

CAMPUS

SCHOOL OF NURSING AND MIDWIFERY

DEPARTMENT OF PEDIATRIC AND CHILD HEALTH NURSING

Module: Ethico - Legal Issues in Nursing

Course code: GNurs5012

Assignment: ethical dilemma solving

Instructor: Ass. Professor Kassa M.

By: Esubalew D.

Id: DBU1700154

December, 2024

Debre Berhan, Ethiopia.

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Table of Contents
INTRODUCTION.....................................................................................................................................3
CASE SCENARIO....................................................................................................................................3
REFERENCE............................................................................................................................................6

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 INTRODUCTION

Ethics refers to a method of inquiry that assists people to understand the morality of human

behavior. It is a formal reasoning process used to determine right conduct (Berman, 2016).

A dilemma is a situation in which two or more choices are available; it is difficult to determine

which choice is best and the needs of all these involved cannot be solved by the available

alternatives (Kjervik, 2010).

An ethical dilemma is a situation in which the agent has to choose the best ethical alternative

for the principal. Ethical dilemmas in health care involve issues surrounding professional actions

and client care decisions. Ethical issues are real life issues (Silvestri, 2023). There is no one way

of resolving such situations. Each situation will be different, depending on the people involved

and the context (Kjervik, 2010). However, ethical decision-making models provide mechanisms

or structures that help you think through or clarify an ethical issue. There are a number of models

from which to choose from, but there is no one best way to approach ethical decision-making

(Berman, 2016)

CASE SCENARIO

Alem, a 28-year-old woman, arrived at the Adult Emergency Outpatient Department (AEOPD)
complaining of fever, chills, sore throat, and generalized malaise. She stated that her symptoms
had been worsening for approximately a week and that she looked tired. An HIV test was
ordered as part of a thorough workup to rule out conditions like acute HIV infection and other
viral illnesses because Alem's clinical presentation suggested a possible viral infection.

Alem was told in private that the test results were positive for HIV. She was shocked and
worried about the stigma and effects of the diagnosis, specifically asking the healthcare provider
not to tell anyone, including her family, that she had been sexually active with several partners

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and was unaware of her status. Alem specifically asked the healthcare team not to tell her
partners or family that she was HIV positive.

I Faced an ethical dilemma, needing to balance Alem right to confidentiality against the
potential public health implications of not informing her sexual partners or advising them about
HIV testing.

Step I: Collect, Analyze, and Interpret the Data

Patient’s Wishes: Alem has requested confidentiality about her status, expressing concerns
about the stigma and potential personal and social consequences of the diagnosis, including her
family and sexual partners.

Family Wishes: No family members were involved in her care

Extent of the Physical and Emotional Problems: Alem, in her early stages of HIV infection,
experienced shock, fear of stigma, and potential anxiety about disclosure due to her manageable
prognosis with appropriate treatment.

Competence of the Patient: she was alert, oriented, and mentally competent to make healthcare
decisions, and her request for confidentiality appeared informed and deliberate.

Physician’s: The physician had confirmed the HIV diagnosis and recommended antiretroviral
therapy (ART) to manage her condition. Partner notification was suggested as part of her care.

Step II: Stating the Dilemma

The ethical dilemma revolved around two conflicting principles:

Confidentiality: The patient’s right to privacy and autonomy in keeping her HIV status.

Public Health Responsibility: The healthcare team is tasked with preventing harm by
promoting disclosure to sexual partners.

Step III: Ethical Principles Involved

Autonomy: Alem had the right to make decisions about her healthcare and maintain
confidentiality regarding her diagnosis.

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Beneficence: The healthcare team aimed to act in the best interest of both alem and her partners
by encouraging disclosure and ensuring appropriate care.

Nonmaleficence: The team was obligated to prevent harm to Alem through trust breaches or
disregarding her autonomy, while also considering the potential HIV transmission to her
partners.

Justice: The healthcare team needed to ensure fairness and access to care for both alem and her
partners, without compromising the rights of either party.

Step IV: Analyzing the Advantages and Disadvantages of Each Course of Action

Option 1: Respecting the Patient’s Confidentiality

Advantages: upholds patient autonomy and privacy, maintains trust between patient and
healthcare provider, and avoids potential legal and ethical violations related to unauthorized
disclosure.

Disadvantages: potential risks to sexual partners, including potential harm and delayed testing
and treatment, which could increase the likelihood of further transmission.

Option 2: Disclosing the Patient’s HIV Status to Partners

Advantages: The intervention safeguarded her sexual partners by enabling them to seek testing
and treatment, and reduced the risk of further HIV transmission within the community.

Disadvantages: The breach of confidentiality, trust, and potential legal consequences for the
healthcare team were all deemed unacceptable.

Step V: Making the Decision and Ethical Theory

Deontology focuses on adhering to rules, duties, and obligations. The healthcare provider has a
duty to maintain Alem's confidentiality, as per professional codes of ethics and laws like patient
privacy acts. However, there is also a duty to prevent harm to others, such as Alem’s sexual
partners.

Utilitarianism emphasizes maximizing benefits and minimizing harm for the greatest number of
people. Disclosing Alem’s status might protect her partners from harm but could violate Alem’s
trust and autonomy
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Decision: The healthcare team decided to respect Alem confidentiality while strongly
encouraging her to inform her sexual partners.

Step VI: Implementing the Decision

Confidentiality: The healthcare team respected Alem request to keep her HIV status private.

Counseling and Education: They provided comprehensive education on the importance of

They discussed safe-sex practices and harm-reduction strategies.

Support Resources: Alem was referred to HIV counseling services and peer-support groups to
help her process the diagnosis and navigate disclosure. She was informed about the legal and
ethical implications of knowingly exposing others to HIV without informing them.

Documentation: The team clearly documented Alem decisions, the counseling provided, and the
follow-up plans.

Follow-Up: Regular follow-up visits were scheduled to monitor her health and provide ongoing
support.

REFERENCE

1. Silvestri, L. A., & Silvestri, A. (2023). Saunders comprehensive review for the NCLEX-
RN® examination (9th ed.). Elsevier. ISBN: 978-0-323-79530-2

2. Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s fundamentals of nursing
(10th ed.). Pearson.

3. Kjervik, D., & Brous, E. A. (2010). Law and ethics for advanced practice nursing.
Springer Publishing Company.