Tonya and Lydia are two senior nursing students assigned to work in the intensive care unit with a critically ill patient. The patient, Mr. Dunn, is an 87-year-old retired ironworker. He lives alone in an old two-story frame house. Mr. Dunn is diabetic. He is nearly blind and has moderately advanced prostate cancer and Alzheimer's disease. Mr. Dunn was admitted to the intensive care unit after he was discovered unconscious in his home by a neighbor. At that time he was ketoacidotic and had a very severe necrotic wound on his left leg. The surgeon plans to amputate Mr. Dunn's left leg but has been unable to get consent from either Mr. Dunn or his next of kin, a niece who lives out of town.

Tonya is proud of her efficiency as a nursing student. She makes rapid decisions. Tonya insists that Mr. Dunn must have the amputation. She boldly suggests to the physician that he have a surrogate appointed for Mr. Dunn so that the surgery can proceed. The course is clear to her. Lydia, on the other hand, is not certain of the correct course of action. She talks to Mr. Dunn and his niece about his condition. She wonders if the amputation is the best solution to his problem. She thinks about what his quality of life will be after the surgery. She worries about his ability to care for himself and about his state of mind should he be forced to live in a nursing home. She thinks about what she would want for her own father if he were in the same situation. Lydia falls asleep at night pondering these thoughts. She does not know how to go about solving the problem. Tonya is impatient with Lydia. She sees no benefit to the time and energy spent worrying about this problem when the solution is apparent to her. She dislikes wasting her time talking to Lydia about these concerns.

Think about It: Facing Ethical Dilemmas

What alerts you to the presence of an ethical dilemma?

How do you feel when confronted with difficult ethical decisions?

To what degree do you think nurses should become involved in making decisions such as the one described in the situation presented previously?

With which qualities of each nurse do you identify?