Application Of Moral Ethical Decision Model

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Case Study

Jane, a stunning 27-year-old, has been enjoying the excitement that comes with her prime age. An avid motorsports fan and racer, Jane was successful with a well-paying law career and the handsome young Chad for a prospective husband. One day as Jane and Chad were having a good time in their newly acquired Corvette Stingray racing down the street, Chad lost control of the car and hit a huge tree. Jane had so much trust in the safety properties of the car and Chad’s driving skills to the extent she was not wearing her seatbelt. She sustained a severe spinal cord injury, leaving her paralyzed from the neck down the rest of her body. Only her neck and head could move. Chad sustained minor injuries was discharged two days later. After three years of care, Jane felt she could no longer burden her 75-year old mother who cared for her most of the time as Chad went to work. Besides, the family had begun to face financial constraints. Jane explained the situation to her primary physicians and requested to be euthanized. She explained her request, saying her mother was too old to take care of her, the financial constraints were eating into the family savings without any end in sight, and there was no quality in her life anymore. She strongly warned the physician against mentioning this to the family, adding that it should be discreet and remain between the two. For this, Jane would leave a large portion of her savings to the physicians. The physician did not give Jane a straightforward answer but assured that he would explore all the options and get back to her with a response in one week.

Issues in the Dilemma

There are numerous issues in this dilemma, but the major one is physician-assisted suicide. Jane has opted for euthanasia as a means of ending all the frustrations surrounding her palliative state. The second major issue is patient confidentiality. The physician is torn between keeping the problem a secret as requested by Jane and sharing it with the family, in which case, he will have broken client confidentiality despite the gravity of the matter. Thirdly, there is the issue of integrity if the physician decides to perform the procedure, keep it from the family, or even attempt to influence them to agree to Jane’s request. The fourth, and probably least of all the issues here is that of bribery. The physician may not grant Jane her wish because he is convinced that it is the right course of action, but since he is eyeing the monetary promise Jane made to him.

Options for Resolution

The obvious first option for the physician is to deny Jane her request for euthanasia and, instead, help her live as a quadriplegic. Here, the house would be modified to suit her new state, complete with a wheelchair and other instruments. The major advantage of this decision is that the physician would save a life and live by the ethical code of care. Another advantage is that Jane’s loved ones will still have her around, and she may even finally learn and adapt to her new lifestyle. On the contrary, however, as the situation continues, the family may hit a financial dead-end and lack funds to take care of Jane’s medical demands. Her aging mother may no longer be able to take care of her because of old age, leaving her only in the hands of Chad, who, as of now, is just a boyfriend. Lastly, Jane will no longer enjoy her life and may spend the rest of it in regrets and greatly frustrated. The second option is to carry out the procedure in a discreet manner, as requested by the patient. The physician will have saved the family the impending financial problems and ended Jane's misery and low-quality life. He will also have acted in line with patient confidentiality. On the contrary, the physician will be contravening his responsibility and the main reason for his profession - care and preservation of life. In fact, he may be sued if the family finds out and could be held liable for murder. The last option for resolution is to discuss the issue with Jane's family, involve the hospital management, and decide on a way forward. The only con of this option is that the response is uncertain and may even take time as Jane remains in the current state.

Best Option

In all the options above, the physician is doomed in one way or the other because euthanasia remains a highly controversial and forbidden issue in some jurisdictions (Banović, Turanjanin & Miloradović, 2017; de Beaufort & van de Vathorst, 2016). The lesser evil and the best option would be breaking the code of client confidentiality and involving both the family and the hospital management in the issue. Regardless of the controversy, physician-assisted suicide is becoming legal in most jurisdictions; therefore, the conversation is slowly becoming more ethical than legal (Spence, Blanke, Keating & Taylor, 2017). In fact, Mastro and Mason (2017) found that this practice is more acceptable when it involves a younger person than an elderly patient. Based on these developments, physicians would be more open to considering such requests. While processing the requests, healthcare professionals must involve the families because it is the only sure way of promoting a patient’s agency (Ho, 2008). According to ten Cate, van Tol and van de Vathorst (2017), the criteria for granting a physician-assisted suicide request include an agreement from the family, a resigned attitude of the patient, and proper resolution of any pending conflict. Jane is already resigned, given her explanation. What remains now is involving the family and resolving any ethical, legal, or professional conflict by engaging the hospital management. The option takes into consideration the opinions of all the stakeholders in this matter. It also absolves the physician of any integrity and professional misconduct issues if he considers the two remaining options.

Hypothetical Application and Evaluation

In a hypothetical situation where this choice is adopted and implemented, it will be solely done from an ethical angle of the patient-advocate model where physicians are required to uphold human dignity and respect patient choices (Guido, 2014, p.45). Even then, two significant issues, namely consent and patient confidentiality, cannot be ignored. Guido (2014, p.118) states that consent requires the primary healthcare provider to disclose materials in ways that patients can understand so they can make better choices. The fact that Jane voluntarily requested physician-assisted suicide could be taken for consent. Yet, the physician should still, with utmost transparency, explain the case to the family and get their informed consent to indemnify the healthcare facility and professionals involved legally. In attaining this form of consent, the physician has to involve the family and contravene the patient's confidentiality in the process (American Nurses Association, 2014). Since there is no better option than this particular one, contravention of confidentiality could be the compromise that has to be made for the ultimate resolution of this dilemma. It is important to note that most situations involving an ethical dilemma include a compromise. The best the physician can do in light of this situation is to explain to Jane the significance of such a step and clarify that her wishes cannot be granted otherwise.


Jane’s controversial request presents the physician with issues around patient confidentiality, integrity, bribery, and physician assisted suicide. The physician has the option of denying, granting the request or involving Jane’s family and the hospital management in the issue. Each option has both advantages and disadvantages, but the best choice would be to involve both the family and hospital management because it respects both the patient autonomy and considers significant of a patient’s family. Even then, patient confidentiality issues still have to be addressed.

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GradShark (2023). Application of MORAL Ethical Decision Model. GradShark.

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