Moral distress occurs in a situation where one knows what the ethically correct thing to do but feels powerless to make a decision (Epstein, 2008). Ethical dilemma on the other hand occur when which one recognizes that a problem exists, and that two or more ethically justifiable but mutually opposing actions can be taken (Jamleton, 1984). Whatever choice made has significant unpleasant effects. An example of a legal ethical dilemma that a nurse can face in their practice is when they have to violate their own/hospitals rules against abortion to care for a woman who has had one. This situation does not offer any desirable resolution, because if the nurse takes care of the woman, she violates certain principles, and if she does not, the woman might die.
A physician can violate the ethic that stipulates that they shall respect the patient’s right, and also violate the same law of respecting the patient’s right and freedom of movement, if they consider such movement a threat to the patient’s life or the life of others. Contravening this law would not constitute a criminal offense because it is in the patient’s best interest and the welfare of those the patient may interact with.
Instances of ethical and law violation.
A decision that would prevent violation of the ethical principle and prevent the law from being violated may constitute a decision by the patient or his family specifically instructing through an attorney what should be done, either because it was the patient’s will or the will of those responsible for them. For example, a family insisting on tube feeding their old father, in spite of the costs and the discomfort that that causes him, instead of letting him die naturally.
Ethical principles and laws.
Legal principles and laws that apply to the ethical dilemma include beneficence, nonmaleficence, respect for autonomy, and justice. Beneficence is where people are required to do or promote good for others, Nonmaleficence involves people avoiding risk or causing harm to others, Autonomy involves people having the right to self-determination and includes the right to respect, privacy, and information necessary to make decisions to others, and finally, Justice entails people treating others equally and fairly regardless of disease or social or economic status.
Ethics and law have been known to be inseparable as laws and both have some level of dependence. Laws are based on morals and ethics, whereas ethics, rely on stipulated laws for them to be followed and applied in the society. An illustration of this fact is The Affordable Care Act which addresses this inequity by requiring most U.S. citizens and permanent residents to purchase health insurance The law also addresses insurances choices and costs, and puts into place certain rights and protections for consumers. This act was developed on the basis of ethics such as, beneficence, and justice, in the sense of equal opportunities for all. An example of a case study in the USA was back in January 1983 in Missouri when Nancy Cruzan lost control of her car and sustained serious injuries that resulted in her being in a vegetative state for several years, prompting the Missouri state government to ‘arrogate to itself’ the power to define life. The state was in an ethical dilemma and had to decide what legal action to take on the basis of ethics that is beneficence and non- maleficence
Differences between legal and moral reasoning
Various differences exist in legal and moral reasoning. One of these is that legal reasoning comes from laws, made of legislations and court orders whereas ethical reasoning consists of reasoning based on morals and what is right and humane. The second difference is the context of exchanges of legal and ethical reasoning. Legal processes occur in courts whereas ethical reasoning occur in social contexts, for example, they can be inclusive or exclusive depending on the participants’beliefs and practices. In Nancy Cruzan’s case, the court would have applied a legal-ethical model to solve the case by first consulting her family or next of kin, to find out what her preference would have been if she had a chance to choose, or what would be the least painful and costly experience for them. Alternatively, the court can infer the advice of the health practitioners, for example the involved nurses and thereby get the best and most ethical course of action for her.
Some of the recommendations to resolve advanced practice nurses moral distress in the dilemma above include, the state liaising with health practitioners to ensure that these dilemmas are resolved in the best way possible. Furthermore, courts can use statutes by other courts that have had to make and take similar action if the results were fair and just. The third recommendation, involves hospitals setting up their own ethical and lawful responses for potential dilemmas such that when they occur, the nurses can refer to them to make the right decisions.
In conclusion, the law and ethics are inseparable in the medical practice and have to be referred to when making decisions on the best medical practices to avoid being unethical and breaking the law.