NUR 906 Module 3: Discussions
Module 3: Discussion 1
A clear ethical dilemma occurs when a hospital faces a shortage of dialysis machines after a natural disaster. Patients with kidney failure flood the facility, but only a few machines remain functional. The medical team must decide whether to allocate dialysis to those with the best chance of survival or distribute time equally among all patients regardless of prognosis. A 30-year-old patient with acute kidney injury may recover completely after several sessions, while a 70-year-old patient with chronic renal failure may require lifelong treatment. Choosing between individual fairness and population benefit raises difficult ethical questions about justice, equality, and utilitarianism. The tension between doing the most good for the greatest number of people and protecting individual rights creates distress for healthcare professionals and families, testing the balance between compassion and resource stewardship in crisis care situations.
The long-term challenge in this scenario involves maintaining equity, transparency, and public trust in medical decision-making. When resource allocation favors those with higher recovery potential, marginalized populations such as the elderly, disabled, or chronically ill may feel neglected or devalued. These patterns can exacerbate social and health disparities, erode trust in institutions, and lead to ongoing moral distress among clinicians who must repeatedly make ethically complex decisions (Emanuel & Persad, 2023). Over time, inconsistent policies across hospitals or regions can intensify perceptions of injustice and undermine the credibility of healthcare systems. Balancing fairness and efficiency requires consistent ethical guidelines that are both medically sound and socially acceptable.
A tangible long-term solution involves developing standardized national protocols for rationing scarce medical resources grounded in ethical and evidence-based principles. These guidelines should emphasize transparency, fairness, and community involvement in decision-making. Hospitals can establish ethics committees to review and guide allocation choices during emergencies. Expanding investment in preventive healthcare, early disease management, and infrastructure resilience can reduce dependence on scarce resources (Hanson et al., 2022). Education and communication strategies should inform the public about how allocation decisions are made to strengthen trust. Long-term planning that integrates technology, predictive data, and ethical oversight can help prevent future shortages and promote justice across healthcare systems while preserving compassion and accountability.
References
Emanuel, E. J., & Persad, G. (2023). The shared ethical framework to allocate scarce medical resources: A lesson from COVID-19. The Lancet, 401(10391), 1892-1902. https://doi.org/10.1016/S0140-6736(23)00812-7
Hanson, K., Brikci, N., Erlangga, D., Alebachew, A., De Allegri, M., Balabanova, D., & Wurie, H. (2022). The Lancet Global Health Commission on financing primary health care: Putting people at the centre. The Lancet Global Health, 10(5), e715-e772. https://doi.org/10.1016/S2214-109X(22)00005-5
Module 3: Discussion 2
A situation of low-value care might occur when a patient with terminal lung cancer is kept on full aggressive treatment, including chemotherapy and repeated imaging, despite clear evidence of disease progression and severe side effects. The patient has poor appetite, continuous pain, and emotional exhaustion, while the family believes more treatment might still provide a cure. As a nurse, I would carefully assess the situation and initiate communication with the patient’s primary care provider about their declining condition. I would advocate for an honest and compassionate conversation with the patient and family regarding the goals of care and expected outcomes. I would encourage discussion about transitioning to hospice or palliative care to improve comfort and dignity. My focus would remain on supporting informed decision-making, respecting the patient’s values, and promoting comfort rather than prolonging suffering through interventions that no longer provide measurable benefit. Documentation and interprofessional collaboration would follow.
Ethical principles that guide such cases include beneficence, nonmaleficence, autonomy, and justice. Beneficence entails actions that promote patient well-being, while nonmaleficence cautions against harm caused by futile treatments (Cheraghi et al., 2023). Autonomy emphasizes the patient’s right to make informed choices about their care, and justice encourages responsible use of limited healthcare resources. A shared decision-making approach helps balance medical facts with patient goals, ensuring transparency and respect in every choice. When conflicts arise, consulting an ethics committee or palliative care team can help facilitate fair and patient-centered resolutions (Oakes & Radomski, 2021). Nurses must apply critical thinking, communication skills, and ethical reasoning to advocate for compassionate, appropriate, and value-driven care in end-of-life situations.
References
Cheraghi, R., Valizadeh, L., Zamanzadeh, V., Hassankhani, H., & Jafarzadeh, A. (2023). Clarification of ethical principle of the beneficence in nursing care: An integrative review. BMC Nursing, 22(1), 89. https://doi.org/10.1186/s12912-023-01246-4
Oakes, A. H., & Radomski, T. R. (2021). Reducing low-value care and improving health care value. JAMA, 325(17), 1715-1716. https://doi.org/10.1001/jama.2021.3308
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Module 3: Discussion 1
1. Describe a scenario that challenges ethical perspectives on disbursement of scarce health care resources considering individually focused vs population focused solutions.
2. In your example, what are the challenges in substantive, long-term differences.
3. Consider solutions that may make a tangible, long-term difference.
Module 3: Discussion 2
1. Imagine a scenario in which you perceive the patient to be receiving care of little value. What do you do?
2. What ethical principles and decision-making approaches can help guide your actions?