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Table of Contents
Professional performance often requires making complicated decisions and tradeoffs in order to stabilize the situation or provide an appropriate solution. It is especially challenging and complicated in the sphere of healthcare since the decisions and dilemma solutions in the given profession primarily relate to health and life of a patient. There are different types of dilemmas in nursing, and the ethical ones are the most controversial. The present paper focuses on the problem that relates to organ allocation and terms of the waitlists. Moreover, the aim of this work is to analyze the currently discussed premises for making changes in the waitlists order and core values involved in the decision making concerning organ assignment.
According to Lo (2012), “ethical dilemmas often evoke powerful emotions and strong personal opinions; however, emotions and opinions are not a satisfactory way of resolving ethical dilemmas” (p. 3). Clinical ethics is a set of judgments and rules, which guide the healthcare personnel in the process of interaction with the patients, treatment course and patient care. Nonetheless, ambiguity of particular values and controversy of the situations often impose complex dilemmas on the medical staff. Park (2011) underlines the acute necessity for tools and techniques targeted to provide more confidence for nurses while making decisions in order to solve a peculiar ethical dilemma.
Lo (2012) also posits that there is fundamental and important difference between the notions of professional and clinical ethics, which is vital for efficient nursing performance. To be more precise, clinical ethics refers to decisions concerning relationship, attitudes, and opinions involving moral values and judgments, whereas professional ethics relies on the codes and oaths (Lo, 2012). The drawbacks of the latter encompass the following important aspects: 1) codes are designed by medical experts, but not the patients, whereas the core concern related to the healthcare performance should be welfare of the patients; 2) excessively paternalistic Hippocratic tradition predetermines particular aspects of the medical care that are strongly criticized and limit patient’s role in decision making about his or her health; 3) oaths are general, and fail to cover all the potential scenarios and cases (Lo, 2012). Hain (2014) supports the scholar underlining that conformist tradition and limited potential for nursing practice are crucial barriers to creating a constructive healthcare environment, within which the ultimate value is to ensure the best condition for each patient. Hence, it is necessary to provide a set of constructive and comprehensive guidelines targeted to assist in the process of decision making.
Organ allocation is a vivid example of the most complicated ethical dilemmas that is often imposed on the healthcare personnel. Western policies prioritize utility and justice in the context of organ allocation dilemmas. However, Veatch and Ross (2014) underline that the preference should be given to the ethics that positions justice as a central element in decision making process providing “the sickest the opportunity to recover their health, even if that means a less efficient system for allocating organs” (p. 301). Nonetheless, it may be regarded as a rather radical approach. Hence, the developed framework should involve tradeoff between utility, justice, and rights.
It is crucial that each healthcare professional comprehends the major purpose and potential efficiency of the established framework for decision making facing an ethical problem. Therefore, the introductory part should specify effectiveness, consistency, rapport with colleagues and patients, and qualitative improvement of competence as the core benefits of the provided guidelines. In addition, this part outlines the basic values each nurse should adhere to in the nursing performance, and especially employ in such critical cases. To be more precise, these values include honesty, sincere concern about the patient’s health and overall well-being, proficiency, and respect for other person’s rights (Iglehart, 2013).
The guidelines consist of three core steps and delineate the most important methods in the course of analysis, such as evaluation of an ethical dilemma and consequent decision making. It is essential to adhere to the currently functioning laws and standards (Lavee & Brock, 2012) and, at the same time, remember the utmost purpose of each healthcare professional, namely, not to cause any harm and strive to cure both body and soul of a patient. Hence, the first stage of the decision making process will require proper use of the core values.
The next step required to choose the proper solution predetermines selection of a relevant model. According to Keller, Kwo, and Helft (2013), there are particular approaches to organ allocation based on the specific benefits. To be more precise, the nature of these benefits may be different, from severity of the health condition and threat of a lethal ramification to political and social priority (Muireann, Linda, & Vardit, 2012). Moreover, there are certain benefits based on the age group, when the elderly and the infants may have a priority in the waitlist. However, a benefit-based approach involves several ethical considerations, and finding appropriate solution is a challenge for the healthcare experts. Land and Dossetor (2012) opine that organ allocation is often transformed in literally justice commerce case. Hence, the ethics and even legal considerations may be often violated. It means that the guidelines should vividly highlight ethically relevant decisions.
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First, all the decisions of a nurse should depend not only on particular emotions or opinions, but on the basic standards of the efficient healthcare process. Second, a medical expert is expected to employ the Golden Rule, namely, to act in such a way, in which he prefers to be treated if he were a patient. Such a model of behavior is crucial for a healthcare professional because it will result in the most optimal and justified decision making.
Third, priority issues if any should be properly justified. The notion of being properly justified should refer to the most serious and destructive ramifications in case when a particular organ allocation for a patient is absent in the given period of time. To be more precise, if one person can potentially die if there is no timely organ transportation, and the condition of another one will result only in temporary pain and difficulties, the choice is apparent. Another case, which has not many alternatives, is when both patients are imposed by the serious hazards and their names are close in the waitlist. Nevertheless, a situation when the levels of severe condition related to the potential outcomes are different, but equally serious, imposes a huge dilemma. Ethical decision is also considered as a proper one, when both patients have temporary complications, but nothing alarming, and the organ transplantation is conducted according to the waitlist. The benefits based on political, social, kinship and even age difference are not regarded as properly justified ones.
Finally, a stage of solution provision requires a constructive decision that relies on the values of justice, honesty, and healthcare proficiency as well as satisfies the interests of the patients in the best way.
Thus, ethical considerations involved in decision making regarding organ allocation and assignment often imposes challenging dilemmas. It is crucial that the decision concerning organ assignment involve not only professional ethics, but also the clinical one. Furthermore, a set of guidelines has been developed in order to ensure that the solutions in such cases are more efficient and ethical. Consequently, the nurses are expected to follow the Golden Rule and remain objective in their judgments.