A 48-year-old man with a history of alcohol abuse had just undergone surgery, and I provided him with postoperative care, including pain management. However, the patient refused medications because of his religious beliefs. He stated that he was a sinner, and he believed that God wanted him to suffer to redeem his sins. As a Christian, I believe that God wants the good for all of his children, and, even if a person commits sins, he can atone for them by leading a virtuous life rather than suffering. In addition, as a nurse, I believe that I must relieve the pain that my patients experience because pain causes them to have unnecessary physical and emotional suffering. Therefore, I was faced with an ethical dilemma of whether I should administrate pain medication against the patient’s will.
Pain is common in clinical practice, and nurses have an ethical obligation to relieve it to alleviate patients’ suffering. My patient had moderate to severe pain, which could prolong his recovery and significantly reduce his quality of life if left untreated. Table 1 presents my ethical decision-making process, aiming at reconciling the patient’s values, my values, and professional standards.
Table 1. Ethical decision-making process.
an individual’s ability to make own choices and be free from coercion (Keatings & Adams, 2019)
the duty to prevent and avoid doing harm (Keatings & Adams, 2019)
the duty to do the best for their patients (Keatings & Adams, 2019)
ensuring fairness to all patients and their families (Keatings & Adams, 2019)
|My moral values/beliefs||Individuals have the right to make autonomous decisions after being well-informed |
Every person has the right not to feel pain
|Not to administrate pain relievers means to do harm by causing the patient to suffer||I should do everything within my power to make patients feel better||Relieve pain in all patients suffering from pain after surgery|
|Patient’s values/beliefs||Believes in his sins |
Thinks that his sins can be atoned by considerable suffering
|Believes that his suffering is God’s will||Is confident that the refusal of pain medications will benefit him by redeeming his sins||Every person who has committed sins should suffer|
|Professional Standard||Nurses should respect patients’ autonomy and wishes; |
Nurses should inform patients about the consequences of their choices (Gregory et al., 2018).
|Refusal to act would violate the principle of nonmaleficence (Keatings & Adams, 2019).||Weight the benefits and burdens of different courses of action (Gregory et al., 2018).||In all clinical settings, nurses should relieve pain to allow patients to live with dignity (Keatings & Adams, 2019).|
|Possible outcome||The client’s care needs are met according to his values||The nurse avoided causing harm to the patient. The patient feels safe and free from suffering.||The patient received the care needed. The nurse increases confidence in the decision-making ability.||The nurse’s professional standards improve and serve as a guide for further decision-making.|
Based on the above analysis, I see that the principle of autonomy conflicts with the other three principles. My priority will be to avoid harm and do the best I can for the patient’s well-being.
As a nurse, I am obliged to do no harm to the patients and contribute to their well-being. In the given case, my values coincide with professional standards but do not align with the patient’s beliefs. Therefore, my duty will be to provide the patient with information about the consequences of his choice to refuse pain medications. I will also appreciate the patient’s religious beliefs and encourage him to see God’s will in a different light to help him see that he is not obliged to suffer. If he remains firm in his decision after being well-informed about the consequences, I will explain that I will have to administrate medications against his will. This is because the principles of nonmaleficence and beneficence prevail in this situation since, without medications, the patient’s recovery will be delayed, causing him harm.
Gregory, D., Raymond, C., Patrick, L., & Stephen, T. (2018). Perspectives on the art and science of Canadian nursing (2nd ed.). Wolters Kluwer.
Keatings, M., & Adams, P. (2019). Ethical and legal issues in Canadian nursing. Elsevier Health Sciences.