MDS 430 Educational Narrative
[Name redacted; Identifying information altered throughout document]
At a young age I knew my childhood was not normal. I grew up surrounded by drugs, alcohol, and violence. My father was mentally ill and was self medicating with drugs and alcohol. He was physically abusive toward my mother. He passed away when I was seven and I knew that if he had not died he would have seriously harmed or killed my mother. I was exposed to things without being given a choice. I knew when it was time for me to make my own life decisions drugs and alcohol would not be a part of my life. I have faced ethical and moral issues early in my life and feel my childhood has greatly influenced my values and beliefs today.
1. Name at least four Ethical Systems you’re familiar with, and give the basic characteristics of each of these systems and a brief example for each System of when it could be applied.
Some ethical systems I am familiar with are Deontology, Divine Command Theory, Utilitarianism, and Virtue Ethics. Deontology is an ethical system that follows a set of rules that are based on generally accepted morals of a society, and says that you don’t break those rules no matter what. An example of deontology is how I treat my patients in my nursing job. I strive daily to provide good care, be kind, and do my duty for my patients, and if there is a question about whether or not I should do something, I can turn to Deontology and see what the answer is, though I don’t always follow that answer if there is a gray area. I also use the Virtue Ethics system in my nursing career. Virtue Ethics is practicing good character all the time so when you have an ethical decision to make, you’ll likely make the right one. It’s about what kind of character you want to have. I try daily to provide the best care I can for my patient, this involves more than taking care of their needs when they are in the office. It also consists of providing patient privacy, making sure the patients rights have not been violated, refilling medication when needed, and communicating with insurance companies when needed. I want to have the kind of character that puts patients first over the profits of corporations or businesses, so this guides my Virtue Ethics system. Divine Command theory is defined as moral standards dependent on whether God thinks it is right or not. I grew up in a household with a religious mother who based her morals on that of the Bible. As a child my brother and I were frequently told not to do something because it is a sin according to the Bible. And Utilitarianism is the ethical system that says to make the choice that benefits the most people, even if it might be harmful to a small number of people. An example I heard recently on the radio of Utilitarianism is a CEO of a company who took a big pay cut so that his employees could make larger salaries for a better living wage. He is still comfortable, and his workers are able to buy houses or have families, and the company’s profits went up, so his decision benefitted more people even though it was somewhat of a hurt to him.
2. Tell us a story from your experience where you had to make an ethical decision with large implications that had long-term effects on people’s careers or livelihood. How did you come to that decision? What ethical system did you use at the time?
In my training and career as a nurse I have been faced with ethical and moral issues that have tested my values. In the healthcare field there are ethical principles to guide your decision making process where patients are concerned such as patient rights, patient confidentiality, equality, and patient safety. These principles provide a structure on how to treat your patient. During my clinical training I was assigned to the surgical department. I was the only female present in the operating room. The patient was a female patient having shoulder surgery and the nurses here preparing her for surgery. They sterilized the area and had to lift her arm. When lifting her arm they began to laugh and wave her arm back and forth. They were making jokes about her “bat wings”. I did not know what to do. I was shocked that these male nurses felt their behavior was appropriate. They were in a position of authority and they were behaving unethically. I thought who was I to question or “tattle” on them. I was afraid to say anything. I followed this patient to the recovery floor and cared for her the next several days. After spending time with this patient and getting to know her, I knew I had to say something regardless of the nurses position. Later I spoke to my nursing instructor and told her the details of the incident. I explained I felt the hospital should be made aware of this behavior. Not only was their behavior unethical it showed a callousness toward the patient and others in the room. I spoke to the manager of the surgical department at the hospital and explained the situation. She assured me this behavior was unacceptable. In looking back at this situation I wish I had the courage to speak up in the operating room for the patient when she was unable to have a voice. I did eventually take an ethical stance based on Virtue Ethics because I wanted my character to show that I would stand up for this patient. This experience taught me to try and be courageous even in the face of authority when you know something is wrong. Being courageous does not mean not being fearful. It’s taking action in the face of fear. Their actions, comments, and the decisions they made were in direct conflict with the ethical structure of healthcare, deontology and patient rights. As healthcare workers we have a duty and obligation to do what is good for the patient. The ethical systems that drove my decision to speak with my nursing instructor was Virtue Ethics and Deontology. The patient has a right to respectful care. They violated that right with their unacceptable behavior. I felt a duty and obligation to make my patient to make the nurses supervisor aware of their behavior.
3. Give an example of how you’d apply an ethical system to a hypothetical real-world personal situation. Then detail how a different Ethical System would be applied to the same real-world situation and have different but equally justifiable results. Using upper-level Bloom, discuss the relationship between Ethical Systems and Real World Situations as seen in these examples.
We all have values and beliefs that have been influenced by our upbringing and our life experiences. Those values and beliefs are frequently tested in small ways and occasionally in larger more meaningful ways. The relationship between your ethical system and real world situations is that real life tests that system daily interact with others and when self reflecting. An example of an ethical system being tested is one’s view about drug use. In our country today there are states that have legalized marijuana. Your ethical view of this may be different depending on where you live. If you are in a situation where drugs are offered to you, do you decline or join in to be accepted? Your belief is that drugs are morally wrong and are harmful to society, you would be using the Utilitarianism ethical system to say that outlawing drugs does the most good to the most people. Drug use is viewed as wrong because of the consequences for society as a whole and the consequences for yourself. A different ethical stance such as Ethical Relativism may have a different result. If you live in culture where drug use is acceptable and legal, your moral principles about drug use may be different. If offered drugs you may partake because this behavior has not been viewed as unethical, it is a part of the culture. I was exposed to drug use early in my childhood and saw the destructiveness of drug use and addiction. Because of my negative experience my ethics stances on drug use is that it is unacceptable for myself. My ethical system is Virtue Ethics, I have a standard for myself regarding these issues and hold myself to high moral standards.
4. Create and defend a solution to a current large-scale, broad, and complex social problem, using an Ethical System.
A broad complex social problem that has affected me personally and professionally is prescription drug use. As a nurse I understand the need and benefits of pain medication, but I also have seen and experienced the destructive aspect of addiction. The ethical system I think is appropriate when trying to find a solution is Utilitarianism. Prescription drug addiction killed more than 70,000 in 2019. This is a complex social problem because it involves the addict, the physician, pharmacy, insurance companies, and pharmaceutical companies. I think the solution starts with the pharmaceutical companies taking more responsibility for regulating the distribution of the mediation. There should be no marketing for pain medication and the drug companies should monitor more closely where the majority of the medication is going. The physicians have a responsibility to their patient to do what is in the best interest of the patient even if the patient does think so. I worked for a physician who had strike rules when prescribing pain medication. The patient had to sign a pain contract, be seen monthly, agree to other drug free methods of pain control, and submit to random drug tests. If these rules were violated he would no longer continue to prescribe the medication. I saw many times patients become angry when they could not get their medication. We had an elderly female patient that stated she had lost her prescription. Even though she had been a patient for several years and we had not had any issues with her I had to do what was best for her. I discussed the situation with the physician and informed her she would have to submit to a drug test to confirm she had been taking her medication correctly. When the test came back it showed no drugs in her system. She had been supplying her daughter with her pain medication. Because we chose to do what was right for everyone involved, the physician, the patient, and the community, we prevented further abuse by her daughter.
I feel as a country we need to do what is best for the majority of our country instead of what benefits the drug company. The drug companies make a large profit from these medications that are well known to be additive and destructive more than they are helpful.
Personally I have seen how drug addiction can destroy a family. My spouse had three shoulder surgery before he was 40 and had chronic mild pain. He visited with a physician that prescribed him oxycodone 10mg tablets. The physician did not think about the consequences of his action. My spouse became addicted very quickly and eventually needed more medication and harder drugs to satisfy his addiction. Our family struggled for many years and it took the support of extended family and drug rehabilitation to recover our lives back. The physician did not explore alternative pain management options such as physical therapy, steroid injections, or referral to a surgeon for reevaluation. He went for the easy fix and guaranteed himself a repeat patient. The physician has a responsibility to the community as a whole to utilize other non pharmacological methods of pain management. The insurance companies play a large role in what the patient can afford and prescription pain medications are cheap. Physical therapy, occupational therapy, and chiropractors may not be covered by insurance companies because of the cost. The insurance companies should base coverage of services based on need not cost to the company.
This is a complex social issue that affects every aspect of our society and should be treated with the majority of society in mind and detailed evaluation of consequences. The consequences for not addressing the issues at the core is costing our country lives, unstable family relationships, increase in criminal activity, increase in inmates, and poverty.
5. Give an example from your experience when your Ethical System clashed with someone else’s Ethical System. How did the situation resolve and how did your communication play a role in that resolution? How do you communicate with someone who has a different Ethical System than you and your decisions are in conflict?
I strive to be kind and just in my daily interactions and try to achieve excellence in my nursing career. I grew up in a religious community with perceived high moral standards. I use the word perceived because the community I grew up in and currently reside in, has the viewpoint that if you are in that religion you are automatically seen as virtuous. If you are not, then you are seen as someone with loose moral standards. I am not in that religion and for many years have felt like an outcast and a bad person. Through my experiences in this culture I have come to see that I do have high moral standards and strive to be a person who makes good decisions for me and my family based on our situations and viewpoints. Being any religion does not give you an automatic good moral compass. I moved when I was 11 and started my 6th grade year at a local middle school. On my first day of school the first question I got asked was “What church do you go to?” Right away I felt like an outcast. I grew up in a religious household with standards based on God. I understood early on that I was seen as someone who was bad and made bad decisions. During my teenage years I grew to understand that more. In many of my classes the teacher treated me differently. The teachers went to church with the students’ parents and they conversed with them in class with respect and kindness. I got little to no attention from most of my teachers. I was the designated driver for my friends because I was the only one with a car. At parties the “religious” students who looked down on me at school would be drinking and doing drugs at these parties. I was frequently asked if I had drugs they could buy. I felt they assumed because I was there and not from their religion that I would have drugs. Nobody took the time to get to know me or to see who I was. I lived based on my standards, I did not do drugs because of the exposure as a young child. During the teenage years I was influenced by other beliefs and values. I began to question my own beliefs and culture of my home. With my exposure to the religious community and my own strict religious upbringing I discovered my own belief system. I did not want to treat others as I had been treated. I wanted to be kind, interested in others, and truthful to myself. I wanted others to see that I am more than not of their religion. I stopped trying to be invisible. At work I do not hide behaviors others may see as immoral, such as drinking alcohol, previous divorce, or living with someone I am not married to. I have found treating others with acceptance, kindness, and honesty about who you are helps build relationships with people who have different belief systems.