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Ethical dilemma & decision making

Ethical dilemma & decision making


 In present day times, nurses are facing ethical dilemmas while their practice in comparison to other health care professionals especially those that have to look after patients who have mental health issues. The case study that has been selected for the purpose of this research paper displays ethical dilemma that is being faced by a social worker Cindy while working with a 15 year old patient Ben. The client was admitted as an outpatient after a suicide attempt. Ben confided in Cindy about his sexual relationship with an older man who was 30 years of age and wants Cindy to keep it as a secret. The essay will thus highlight the case with respect to Ben’s attempt to suicide, his illicit relationship, identification of the ethical dilemma that arose from the case, discussion about the ethical theories and principles that are applicable to the case study and then apply them to the code of ethics for social workers and further provide recommendations on how to solve this scenario.

Identification of ethical issues  

The ethical dilemma that has been demonstrated in the case study is whether the social worker Cindy should tell her other team members about Ben’s suicide attempt and his relationship with an older man without the consent of the patient. If the social worker chooses to delve the information about the patient to her team members then Ben will be monitored closely by the other social workers for preventing suicide attempts and being in a sexual relationship with a minor. However the autonomy of the patient and his confidentiality would face violation. Failing to disclose all the information would lead Ben to commit suicide and further harm him if no intervention is made (Chally & Loriz, 1998).

While analyzing the case, there are three ethical principles primarily that are in conflict with one another:

a.       Respect for autonomy: having the personal freedom to make choices that are correct and appropriate.

b.      Non Maleficence- ethically states that it’s the duty not to allow infliction of harm.

c.       Beneficence- states that one needs to do well and stop doing harm.

It is the incompatibility amongst two ethical principles that give rise to a dilemma.

Analysis of ethical issues and conflicts


Discussion of ethical principles

According to research that has been conducted, there is a relationship prevalent amongst the ethical principles and the occurrence of ethical dilemmas. There is an incompatibility that exists amongst two ethical principles. Especially when the scenario that is being depicted has a moral ground to it can be made use of. However in doing so one of the two ethical principles will certainly violate the other. In the case of Ben and Cindy, the principle of autonomy and that of beneficence will be applied in an equal manner however each of them will violate one another. Here there is incompatibility amongst the concept of autonomy and beneficence as in the given case study it is the reason that is giving rise to a dilemma whether Cindy should inform her team members about Ben’s attempted suicide and his relationship with an adult that is not legal. The principle of non maleficene is also given consideration that provides support to the principle of beneficence. Hence while keeping this case in mind; the above mentioned ethical principles are in conflict with one another (Bruce, 2002).  While using the principle of beneficence and non malefiecence an assessment needs to be made about the patient’s perception of his relationship and the pros and cons of self harm. Hence in this case, Ben’s perspective about his attempted suicide and illicit relationship needs to be kept in consideration. Here the patient’s idea of benefit is to be able to commit suicide and continue his sexual relationship while Cindy’s behavior of not disclosing the information would not be considered to be harmful from his point of view. The principle of autonomy is based upon the patient’s freedom to make their own decisions. Autonomy also calls for health care providers, nurses and social workers to give respect to the confidentiality of the patients and take prior consent from them. Application of this principle to the case study would lead to ignorance of the patients ability to commit suicide and cause further self harm (Tschudin, 2006). This choice of not disclosing the patient’s information would basically be a form of assisted dying. Hence though Ben’s autonomy needs to be given its due respect it is imperative that it cannot certainly be above the law that states that the behavior of professionals helping in assisted dying is prohibited completely.

The ethical theory apply to this case

Apart from the ethical principles, the theory of utilitarianism is what is most applicable in the case study that has been provided to us to help reach a moral decision. Utilitarianism stressed upon the fact that good action is the action that helps in enhancing pleasure and lowers pain in a majority of people, hence becoming the most imperative fundamental principle of ethics. As per this theory, the correct moral action helps in development of the best suited outcome for a large number of people (Jie, 2015). The patient, his family, the social worker and the health staff that are a part of Ben’s cases hence an ethically appropriate choice is an action that provides benefits to all of them. Whilst comparing the viable options of the social worker in the case, keeping the relationship a secret could cause the patient to commit suicide if things don’t go his way, thereby benefiting only the patient as his main desire is to die. Suicide creates a negative impact upon the friends and family of the patient concerned. Thus keeping it as a secret from her team members is not an ethically appropriate moral decision.

Telling the other team members is appropriate as it would help in preventing the suicidal tendencies of the patient and help in a suitable intervention. This will enhance the life of the patient and at the same time ensure his safety. Thus making his family and health care providers safe and happy. Maintenance of the patient’s health and safety is the top priority of the social workers and health care providers. It gives them a feeling of satisfaction when they carry out their duty thus telling the team members will the ethically correct decision as it benefits a large number of people in the given case study.

The ethical decision making

After analyzing all the ethical principle that suit the case study that has been provided the theory of utilitarianism and the legal concepts state that it is not ethically correct nor allowed by the law for Cindy to keep Ben’s relationship with a 30 year old adult a secret as the child is only 15 years of age and is a minor. The act of sharing the information about the patient’s recent suicide attempt and illicit relationship fits the principles of beneficence and non malefience. It gives benefit to a large number of people and hence is the morally appropriate decision as per the theory of utilitarianism. Also as per the ethics and values of the social health care workers it is their prime responsibility to provide the best health services for all their patients and take positive steps to ensure no suicide takes place. As per research it has been found that it is essential for social workers and nurses to take positive steps so that the issue of mental health can be solved. Hence sharing the information about the patient is the most appropriate decision that the social worker Cindy needs to take for the best interests of her patient, Ben.

The opinion in the associated literature

 Contemporary literature has been taken into consideration for the purpose of the cases to analyze the ethical dilemma that is prevalent. Research has stated that social workers and health care nurses often have the same attitude and feeling as the case of Cindy with her patient Ben as they want to protect their patient and bring no harm to them (Freeman, 2001). It has also been found that nurses and social care workers take positive steps to prevent suicides and it is their duty to make sure that their patient is provided with all the help required to heal and not attempt suicide.

Discussion of professional codes

 The social work profession is mainly based upon a set of core values. These values have been imbibed by social care workers for years and form the foundation of the perspective of this area of health care. These values are:

1.      Service

2.      Social justice

3.      Dignity and worth of the person

4.      Importance of human relationships

5.      Competence

6.      Integrity

These values set social work apart from the rest of the services that are available to help improve the life of other individuals. The NASW code of ethics has six purposes that it follows as it guiding beacon. The code helps in identification of the main values upon which the mission of social work is formed (Shersher, 2017). It is designed in such a manner that it helps in identification of ethical dilemmas where conflict could arise/


Proposals for professional practice

Alternatives for action: prior to sharing the information with her team members, Cindy should have gathered all the information that she possibly could about her patient Ben for instance if he had a plan to commit suicide if his relationship did not go well and his reasoning approach. She should have also mentioned about placing him in treatment as an inpatient and discussed how it would help him to overcome his mental health status and its benefits.

Ethical Principles for the alternative

Beneficence application is based upon taking steps that are positive in nature so that others can be helped. While Non Maleficence’s application is that the nurses take actions to make certain that the patient in consideration does nothing that would bring harm to him rather than being ignorant and not discussing the patient’s nature for self harm.


In the health care industry cases pertaining to suicide attempts and sexual exploits with minors or adults has become a rather common occurrence. Hence the ethical issue with respect to Ben’s case needs to be looked into as it of grave importance. Social workers and nurses have their own responsibilities where they need to be aware of ethical dilemmas and complication that are in sync with their practices. However there are some intrinsic points that provide aid in solving ethical dilemmas in a just and rationale manner. Firstly, prior to commencing it is essential to conduct a complete assessment of the current situation of the patient while making a decision as it helps the social worker and the nurse to decide the mental status of the patient and whether he is competent enough to suicide and thus take steps to correct the problem.

For making the best decision ethically and morally, it is imperative that a complete analysis about the ethical theories, the principles , literature available and the national nurses code of ethics is carried forth prior to making a decision. Once a decision has been taken by the nurse, the next step is to handle the attempt to suicide by the patient. Here the suicide protocol comes into play and is one of the best methods that can be used for dealing with such a scenario. It gives a guideline for the staff that helps in handling the patient. Collaborating with health care professionals, social workers and psychologists is another efficient way to devise a care plan for the patient.


 Bruce, D. (2002). GM ethical decision making in practice. Ethics In Science And Environmental Politics2, 75-78. http://dx.doi.org/10.3354/esep002075

Chally, P., & Loriz, L. (1998). Ethics in the Trenches: Decision Making in Practice. The American Journal Of Nursing98(6), 17. http://dx.doi.org/10.2307/3471749

Edwards, S. (2009). Nursing ethics. Basingstoke: Palgrave Macmillan.

Freeman, M. (2001). Ethics and medical decision-making. Aldershot, Hants, England: Ashgate/Dartmouth.

Jie, L. (2015). The patient suicide attempt – An ethical dilemma case study. International Journal Of Nursing Sciences2(4), 408-413. http://dx.doi.org/10.1016/j.ijnss.2015.01.013

Jie, L. (2015). The patient suicide attempt – An ethical dilemma case study. International Journal Of Nursing Sciences2(4), 408-413. http://dx.doi.org/10.1016/j.ijnss.2015.01.013

Shersher, J. (2017). Social Work Ethics: 5 Common Dilemmas and How to Handle Them Responsibly | MSWGuide.orgMswguide.org. Retrieved 14 October 2017, from https://www.mswguide.org/blog/social-work-ethics/

Tschudin, V. (2006). Book Review: Bioethics: a nursing perspective, fourth edition. Nursing Ethics13(2), 209-209. http://dx.doi.org/10.1191/0969733006ne848xx




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