Ethical Nursing Dilemmas: Vaccination & Patient Autonomy

Choose ONE of the scenarios listed in this workbook to write for your summative assessment. Some points you may want to consider with regards to the scenarios might be:

1. Why is the scenario an ethical dilemma?
   • What are the ethical principles in conflict here?
   • Are there any nursing values at stake here?
   • Are there any cultural or societal norms to be considered?
2. What frameworks could be used to decide on the course of action?
   • How would ethical theories view this scenario? Would any ethical theories be useful in deciding what to do next?
   • How could the bioethics principles be applied to the scenario in deciding the next course of action?
   • Are there legal aspects that need to be considered in this scenario?
   • What are the professional implications of this scenario?
3. What do you think are the key points you will take away from this discussion for future practice?
4. Scenario 3 – Mrs Devi
   Mrs Devi is the mother of a five-year-old child named Shalini. Shalini does not have any medical history or allergy history. Mrs Devi received a letter from the Health Promotion Board reminding her that her children should receive mandatory vaccinations. Mrs Devi has self-scheduled a childhood immunization appointment at the polyclinic. During the appointment, the attending nurse noticed that the child did not receive any vaccination since birth. The nurse explained the Singapore National Childhood Immunization Schedule (NCIS) and measles and diphtheria vaccines are compulsory by Singapore law. The nurse also explained to Mrs Devi the benefits, side effects, and importance of vaccines. However, Mrs Devi still refused to vaccinate Shalini as she strongly believed that vaccines could cause serious side effects, despite the nurse’s explanation. During the conversation, Mrs Devi revealed that nurses should respect her rights and her decision not to vaccinate her children. Additionally, Mrs Devi also said that all children in Singapore are vaccinated, which is enough to protect her children from measles and diphtheria as herd immunity has developed in the community.
5. Scenario 4 – Mr AhmadMr Ahmad, an 82-year-old man with a history of moderate dementia, is brought to the emergency department (ED) with a high fever, confusion, and agitation due to a serious urinary tract infection (UTI). His cognitive function has noticeably declined, and the nurses suspect that the infection has worsened his dementia symptoms. While he is usually able to recognize his family members and participate in simple conversations, today, he appears disoriented, struggles to recall where he is, and repeatedly expresses a desire to leave. Despite medical advice that he requires IV antibiotics and close monitoring, Mr Ahmad insists on being discharged against medical advice. However, the attending nurses and doctors believe he lacks the capacity to make an informed decision about his care. His agitation escalates when staff attempt to persuade him to stay, leading him to raise his voice and try to remove his IV line. His family members, who are usually involved in his care, seem exhausted and frustrated. When the medical team seeks their input, they respond dismissively, saying, “Just do what you think is best, we can’t handle this anymore.” However, they do not provide formal consent for Mr Ahmad to stay, nor do they attempt to convince him to remain in the hospital.

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Nursing Assignment Answers: Expert Answers on Above Questions

Ethical dilemma
In case of scenario 3 of Mrs Devi, it is considered as an ethical dilemma because there is a conflict between the public health safety and parental autonomy.
Conflict in ethical principles
The conflict is identified in respect to the ethical principles of autonomy and beneficence in the sense that it is the parents right to decide which challenges the autonomy whereas action results in doing good for the child which is beneficence principle.
Nursing values at stake
The nursing values that are at stake in the given scenario include the respect for cultural beliefs, and the evidence based practice.
Cultural/Societal norms
The cultural/societal norms that need to be considered include personal distrust in vaccines, parental authority etc.
Frameworks to be used
The Framework that can be used in this context is Singapore nursing board code of ethics and the four principles of bioethics.
Ethical theories
The ethical theories that are relevant in the given scenario are utilitarianism and deontology ethics. Utilitarianism is valid as the benefits from vaccination are more compared to individual risk whereas the ethical theory of deontology is valid as that is a duty to follow the vaccination specification.
Legal aspects
The Singaporean law makes it compulsory to apply vaccination for measles and diphtheria.
Professional implication
Personal implication from the given scenario is to achieve a perfect balance between the legal application with patient-centred communication.
Key takeaway
The key takeover from the given scenario is to make cultural sensitive communication and emphasize more on public health laws.