Aspects of Ethical Decision-Making

Professionals must act in accordance with the moral principles guiding their careers to maintain competency. Clinicians apply the four-box method to deliver professional and ethical resolutions. The four segments of the theory are medical indications, patient preferences, life recognition, and the observation of contextual factors (Foley, 2017). This essay discusses how I applied the four topics approach and considered the ethical dimensions of a patient’s case in my nursing career.

I was on duty last week when an ambulance stopped at the doors of our reception. The patient was brought in with an acute medical problem: a dislocated ankle and a deep cut on his right thigh. That night I was the only attendant serving the emergency department. The goal of treatment was to facilitate pain relief until the doctor’s arrival in two to three hours, which would benefit the patient and avoid harm from non-professional care. The probability of success of the chosen option was high, but medical treatments could not be indicated in case of the patient’s refusal.

The patient was aware that I could offer first aid services, and we needed a doctor for further clarification and treatment. The man was mentally capable and legally competent since he could explain the injury incidence and how it happened. I informed the patient of the benefits and risks, obtained his consent, and found that he preferred direct injections over tablets for pain relief. The injuries were so severe and painful that the patient did not want any contact, making the nursing process difficult for me.

According to my observation, I could tell that the patient would heal and resume normal walking, although there would be a short period of limping after treatment. Following the treatment plan was crucial to retain the normal leg functions, while non-professional care could result in partial healing and revisits to the hospital. For patients who are incapable of evaluating their quality of life, surrogate decision-makers can express such a judgment. Furthermore, it was essential to consider the biases that could prejudice my patient evaluation, such as a belief that men are physically strong. In healthcare practices, ethical issues such as preferences, informed consent, decision making, privacy, and availability of resources arise, while quality-of-life assessments can cause changes in treatment plans (Santos et al., 2017). The treatment plans adopted by medical attendants must be based on interests to improve the patient’s quality of life. Suicide is considered a legal crime, while ethically, people argue whether it is permissible or impermissible.

The quality of nursing services can be affected by business interests to handle many patients for profit purposes. Family members are the closest third parties in making clinical decisions in case of mental incapacity and unconsciousness. Furthermore, the patient’s wishes should set the limits of confidentiality. Hospital bills and the cost of treatment are the major hindrances of clinical decisions. Lack of adequate resources such as medicines may lead to adopting other nursing options, such as using herbs and home remedies; however, some religions go against modern treatment methodologies. The consequences of clinical decisions may result in legal conflict in cases of death or deterioration of a patient’s health due to unprofessional choices made. Legal compliance, social reputation, and patient referrals are the key considerations of clinical research and education that influence clinical decisions. Public health and safety issues concerning hazardous substances or infections can affect clinical decisions. The interests of healthcare attendants may affect clinical decisions as they disagree about the quickest treatment method and its quality.

In conclusion, I was of great help and assistance to the patient by facilitating pain relief and injuries treatment. The four-topic method helped me assess the man’s health conditions, recognize preferences, provide quality care services, and adhere to legal and ethical factors. Based on the approach, I delivered care and pain relief as we waited for further treatments. My nursing success proved the four-box method as an effective and recommendable approach in providing quality health care services.


Foley, M. (2017). Lesson 6: 9/23 – Clinical ethics: The four topic approach [Slides]. CASN.

Santos, É. I. D., Alves, Y. R., Silva, A. C. S. S. D., & Gomes, A. M. T. (2017). Professional autonomy and nursing: Representations of health professionals. Revista Gaucha de Enfermagem, 38.

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