Essay Sample on Exploring Ethical Dilemmas in Nursing During the COVID-19 Pandemic: An In-Depth Analysis

Introduction

Nursing has always been regarded as a profession rooted in self-sacrifice, commitment to duty, and obedience to physician directives. The moral complexity of the profession has been under-recognized for many years. Most people base their understanding of the profession on the expectations that nursing professionals must have the required qualifications to perform their duties and that they should hold high levels of accountability in their practice (Roycroft et al., 2020). As the nursing practice is regarded as a moral endeavor, the nursing code of ethics is used to cement the obligation of nurses to their patients, society, interprofessional relationship as well as their commitment towards the upholding the code of ethics. The nursing profession is characterized by poor working conditions that neglect the safety of the nurses as they discharge their duties. The ethical challenges that are caused by internal and external pressures make it urgent to address the moral distress that nurses have to deal with as a result of these ethical dilemmas. This paper aims to evaluate the healthcare delivery system during the COVID-19 pandemic, and how the ethical dilemmas that nursing practitioners are faced with, on their moral distress (Zhu, 2020). The arguments of this paper will be passed on various principles of nursing ethics such as the principle of autonomy, the Principle of beneficence, the principles of justice, and the utilitarianism theory.

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The ethical issue identified for this research with regard to limiting moral injury in the healthcare professionals during the COVID-19 pandemic is that, when nurses and other nursing professionals are limited by external forces from providing healthcare services to patients based on what they believe is right, they are morally distressed (Lachman et al., 2015). The moral distress piles up due to the surge in COVID-19 infections, mortality, among other issues. In addition to working with constrained resources, and limited information on the virus, nurses have limited time to process the daily happenings that result from the pandemic. It has become common for healthcare professionals to doubt their decisions with regard to providing healthcare to COVID-19 patients (Fernandez et al., 2020). The accumulation of moral distress has been referred to as the crescendo effect. Based on the proposition of the theory that presented the term crescendo effect, there are three ways through which moral injury among nursing professionals can be prevented during the COVID-19 pandemic.

Safety of Nursing Professionals

Nursing professionals working in the frontline in the fight against COVID-19 are going through a serious ethical concern as they are forced to discharge their duties in conditions that expose them to significant and inadequately understood risks. This puts their physical and mental wellbeing in jeopardy. Exposure of healthcare workers to infectious diseases is nothing new, nurses have been at the forefront of fighting pandemics such as HIV/AIDS, SARS, and Ebola among others (Roycroft et al., 2020). What is different about the COVID-19 pandemic is that there is no adequate information regarding its pathophysiology, transmission mechanism, contagion, and susceptibility among other factors. There is no sufficient data to prove that the personal protective equipment (PPE) that nurses are provided with protects them from contracting the virus.

The protection of healthcare workers who are at the forefront of fighting the pandemic poses an ethical question as to the willingness of the workers to providing care for patients. Also, it has proved difficult for healthcare workers to reach the level of healthcare service that is expected of them. The American Nurses Association code of ethics, revised in 2015, stipulates that the primary duty of a nursing professional is to the recipient of the care (Fernandez et al., 2020). The recipient can be an individual, a family, or a community. Also, the code states that nursing professionals have a duty to promote their health and safety. These ethical responsibilities combined with civic and personal interests cause moral injury to nurses. Nursing professionals are doing their best to balance their duties with personal interests to continue providing the much-needed health care services to COVID-19 healthcare recipients (Roycroft et al., 2020). This is further complicated by the inadequacies of the healthcare system that has always disregarded their calls to improve their working conditions.

Treatment of moral injury identified among nurses involved in the treatment of COVID-19 is limited and is hindered by the perception of the affected nurses on their conditions (Morin, 2015). Difficulties in making decisions, the futility of the treatment process, and ethical and moral dilemmas concerning the safety of nurses are some of the main causes of the moral distress that nurses engaged in the fight are faced with (Zhu, 2020). They have to make split-second decisions when patients’ worth suspected COVID-19 infections present themselves to healthcare centers. Sometimes, the nurses put their ethical obligations of providing care to patients before the obligation of ensuring their safety. The inadequacies of the healthcare system concerning providing protective gear and decision making support structures are the dimensions that can be deduced from the ethical dilemma of the safety of nursing professionals.

During a pandemic such as the COVID-19, nursing professionals find themselves working in environments that require them to strike a balance between limited resources and healthcare standards that are invoked in times of such crisis and the ethical standards of healthcare that have been long-standing. They are often required to make extreme decisions regarding emergencies that are caused by disasters or pandemic such as the COVID 19 (Fernandez et al., 2020). In times of pandemics or disasters, the resources available for healthcare services are usually limited. When nurses find themselves operating in situations such as these, the utilitarian theory is used to guide their decisions and actions. The theory usually stresses the transparent provision of healthcare services, protection of the general public, restriction of the liberty of individuals, and fair allocation of resources.

Ethical Theories and Approaches

Several ethical theories and frameworks have been used to explain the mental distress and its dimensions in the nursing profession. These theories act as the guide in the decision-making process when ethics are in play (Morin, 2015). They represent the viewpoints and opinions that guide people in their decision-making processes (Zhu, 2020). It is therefore important to understand that people make decisions in different ways based on the same information and rules. This makes it easy to understand decision-makers make their decisions based on a set of common goals that they have set to succeed in different aspects of their lives.

Bioethics

Also, it is worth mentioning that all these ethical principles are interconnected to legal, beneficence, autonomy principles. These are known as the four principles of bioethics (Dunham et al., 2020). During a pandemic such as the COVID-19, nursing professionals find themselves working in environments that require them to strike a balance between limited resources and healthcare standards that are invoked in times of such crisis and the ethical standards of healthcare that have been long-standing (Roycroft et al., 2020). They are often required to make extreme decisions regarding emergencies that are caused by disasters or pandemic such as COVID-19. In times of pandemics or disasters, the resources available for healthcare services are usually limited (Zhu, 2020). When nurses find themselves operating in situations such as these, the utilitarian theory is used to guide their decisions and actions. The theory usually stresses the transparent provision of healthcare services, protection of the general public, restriction of the liberty of individuals, and fair allocation of resources.

The Principle of Autonomy

Self-rule that describes the principle of autonomy is based on the person that an individual has and is safe from possible interference and regulation by external persons, and also from external limitations that would influence negatively the decision making the process of nursing professional about their own lives. Nursing professionals at the front line during the fight against the COVID 19 pandemic should be respected. This could be interpreted to mean that their rights to hold opinions, make choices, and to react based on their beliefs and personal values (Roycroft et al., 2020). This principle can be considered as an extension of the principle of beneficence that has been discussed earlier. A nursing professional who is independent and control over their own lives must make decisions based on results that lead to achieving the lifestyles that they desire or currently enjoy.

The Principle of Beneficence

Based on this principle, a nursing professional invoked in the delivery of healthcare services during the COVID 19 pandemic should make their decisions based on what the deem right and good. This raises the need from an ethical point of view on the whole decision-making process based on “do good”. The extent of “do good” is not quantifiable under the circumstances that nurses are faced with as they struggle to deliver healthcare services to the most vulnerable under the classifications of needs based on the utilitarianism theory discussed in later sections of this paper.

Nursing Theories

Utilitarianism

The meaning of the word utilitarianism provides a vivid description of the theory that seeks to guide nursing and healthcare practice. The word means producing results that result in the greatest achievable level of happiness. Based on this theory, the impacts of the COVID-19 pandemic on the physical and mental health of nursing professionals at the front line could raise ethical dilemmas when nursing professionals are forced to adapt to a new code regarding the management of a pandemic of this magnitude (Fernandez et al., 2020). The ethical dilemma arises because, during this COVID-19 pandemic, the theory of utilitarianism cannot be used alone to guide nursing practice.

Justice

If the utilitarianism theory is used solely to guide nursing practice during COVID-19 pandemic, it should be used with the proper and thorough understanding of justice (Fernandez et al., 2020). The code that guides justice in nursing is attributed to the minimum requirement by Aristotle: Equals must be treated equally, and un-equals must be treated unequally. This principle is regarded as vague because it does not provide for ways of determining whether two persons are equal, and to what extent should they be treated to consider the treatment equitable (Roycroft et al., 2020). This vagueness has been identified as both the virtue and vice of this theory. Interpreting the Winland-Brown et al., (2015), due to the pandemic, the healthcare system has transformed rapidly because it leaves a lot of room for different interpretations and applications of judgments in various actions, circumstances, and care intentions in the healthcare environment since the virus outbreak (Zhu, 2020). Most research injustice in healthcare indicates that there are different classification in the order in which healthcare services are delivered to COVID-19 patients.