I believe this case scenario would be an ethical dilemma. A dilemma is when someone has to make a choice between two options that are mutually exclusive and equally unfavorable (Burkhardt & Nathaniel, 2014). So when faced with an ethical dilemma, the basic ethical principles conflict with one another (Boyd, 2015). A moral dilemma arises when a person has to make a decision between what is morally right or wrong (Bennett, 2017). With that being said, this scenario is not a moral dilemma because it is not based on what the nurse considers to be right or wrong.
One reason why this is an ethical dilemma is because there are ethical principles that the nurse needs to choose from. Another reason this is an ethical dilemma because an ethical dilemma is a process when a person makes logical and consistent decisions based on their moral beliefs (Burkhardt & Nathaniel, 2014). The military RN has to decide between force-feeding the prisoner or respect his autonomy and allow the prisoner to be on a hunger strike. The nurse has to logically think of what decision to make based on their moral beliefs. The nurse should not think of what is right or wrong because that would lead to many ethical issues with this situation.
The ethical principles that are in conflict are autonomy and nonmaleficence. The ethical principle of autonomy obliges one to respect the independent choices someone makes (Burkhardt & Nathaniel, 2014). The prisoner made an independent decision to protest his capture by going on a hunger strike. The nurse has an obligation to respect the prisoner’s decision to go on a hunger strike. However, if the nurse chooses to respect this prisoner’s autonomy then the ethical principle of nonmaleficence cannot be upheld. The ethical principle of nonmaleficence obliges one to prevent and remove any harm (Burkhardt & Nathaniel, 2014). By allowing the prisoner to go on a hunger strike, this will harm the prisoner’s body from lack of nutrients and could lead to their death.
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I believe there are three virtues at risk, which are: compassion, discernment, and integrity. Compassion is when someone can imagine themselves in another person’s situation (Burkhardt & Nathaniel, 2014). In the nursing field, having compassion is an exceptionally important characteristic a nurse should portray.
The nurse needs to be able to understand what their patient is going through and show sympathy and discomfort of their patient’s suffering (Burkhardt & Nathaniel, 2014). By having compassion as a nurse this provides a sense to their patient that their condition and concerns are being heard, recognized, and acted upon. This virtue is at risk because the nurse is in a difficult position. The nurse sympathizes with the prisoner and is unsure of what to do. As a military nurse, they have a duty to follow orders but as a nurse you are supposed to have compassion and respect for every patient.
The next virtue at risk is discernment. Discernment is a sensitive insight that involves acute judgment and understanding, leading someone to make a decisive action (Burkhardt & Nathaniel, 2014). This helps give the nurse insight to make an appropriate action in this situation. A discerned nurse would be able to recognize and understand the needs of their patients. This virtue is at risk because the nurse needs to use acute judgment and understanding of what their patient needs. The prisoner might want someone to listen to him and have them understand their point of view.
The last virtue at risk is integrity. Integrity is the soundness, reliability, wholeness, and integration of a moral character (Burkhardt & Nathaniel, 2014). A person who has integrity is consistent with their actions, convictions, and emotions and is trustworthy (Burkhardt & Nathaniel, 2014). This virtue is at risk because if the nurse does not know if they should follow their moral beliefs or to listen to their superiors. When a nurse acts inconsistently or in a way that is not supported by their moral beliefs this virtue is compromised (Burkhardt & Nathaniel, 2014). The nurse needs to follow what they believe in. If they do not stick to what they believe in then their integrity will be compromised.
There are a few limits to autonomy. A practitioner is not obligated to honor requests from patients or their families about interventions that are outside the accepted standard care or oppose the practitioner’s ethical views (Burkhardt & Nathaniel, 2014).
Another limit is the amount of resources available and the circumstances of the economy. Autonomy can also be limited when it can cause harm to the patient or someone else (Are there limits to a patient’s autonomy in making health care decisions?, 2013). In this case scenario, with the prisoner refusing to eat causing starvation, their autonomy could be overridden since it is causing permanent harm to their health, affecting body and organ damage and could eventually cause their death.
The Code of Ethics is a guideline to how nurses are supposed to act in a professional way and make ethical decisions. It has nine provisions for nurses to follow. The most important provisions are the first three. The first is to have compassion and respect for every person. The second is to set your primary commitment to the patient.
The third is to protect the patient’s health, rights, and safety (American Nurses Association, 2015). These three provisions can guide the nurse by invoking conscientious objection. A conscientious objection is when a person refuses to perform any legal responsibilities due to their personal beliefs or morals (Berlinger, 2008). By invoking this, the nurse believes that force-feeding the prisoner is unethical because it goes against the nursing code of ethics. A nurse is to treat every patient equally with compassion and respect for their health, rights, and safety. However, force-feeding the prisoner is going against the code of ethics for nurses.
