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Have you come across real life ethical dilemmas around brain injury? Maybe you have found yourself facing an ethical challenge?

This week I had been thinking a lot about an ethical dilemma posed at the end of a stunning presentation at a brain injury conference some time in the 1990’s.

The paper was presented by Rabbi Dr Milton Pine  describing his experience of brain injury. At the close of his presentation he said:

“if you are going to make us live, don’t bury us alive”.

This powerful statement has stuck in my mind since that time.  I believe it highlights an ethical dilemma around brain injury. The cost of emergency and acute care for a person, compared with what is provided for life long living, and community care. An ethical dilemma we could all  think more about.

I then decided to focus on ethics and ethical dilemmas about brain injury for this article. Unfortunately when I started thinking, researching, writing, revising. Thinking, researching, writing, revising.

I realised it was too big.  It kept growing.  Finally I realised it was not just one article.

So, here now is an introduction of sorts, to the huge topic of ethics and ethical dilemmas. If you start to wonder, reading the rest of this, where “brain injury” comes into the discussion – next week I promise!

To begin;

To get thinking about ethics and ethical dilemmas, have a look at this fascinating survey.

Doctors were asked to present the main ethical dilemma they have faced in their work. A large number of doctors were then surveyed about those ethical dilemmas, and how they would react to each challenge around ethics and ethical dilemmas.

If you have time read the comments as you go through each dilemma; they provide examples of real life situations and the wide range of responses.

[box style=”rounded” border=”full”]Medscape 2010 Physicians Ethics Survey[/box]

Confronting, interesting and thought provoking results.

Put yourself in the doctor’s shoes. Think about what your responses to each dilemma would be. Think about what the factors for a decision on each side might be? Look at the percentages for Yes and No – any surprises for you?

Ethics and Ethical Dilemmas?

It is a complex and tricky subject, think back to the examples in the presentation above. Were there simple easy answers? Probably not in most cases.

When supporting a person with brain injury we don’t always think about ethics and ethical dilemmas but they pop up and we do have to make decisions on how we are going to respond considering each person involved.

So what does ‘ethics’ mean?

I really like the St James Ethics Centre website, it’s an excellent place to start. There is a wealth of information given in an easy to understand way. For example in ‘Understanding Ethics’: they give a simple explanation to help get you started that includes:

“Few will be surprised to learn that the basic question of ethics has an ancient pedigree. Indeed, it can be traced back to a Greek philosopher who lived and taught in Athens during the fifth century BC. Socrates asked:

“What ought one to do?”

That seems like a starting place -What ought I to do?”

There is also an article on the Santa Clara University site “What is Ethics” that not only describes what ethics are. It also talks about what ethics is not.

What is an ethical dilemma?

What about ethics and ethical dilemma? Here are a few definitions that might help:

• “ Dilemmas arise when ethical reasons both for and against a course are present” (Pierce 1997)

• When you find “competing values, principles, and obligations” (Boland, 2006)

• ‘When every alternative would result in an undesirable outcome for one or more individuals (Fort Cowles, 2003) cites Loewenberg & Dolgoff, 1996)

• “The need to choose between equally unacceptable alternatives” (Hamric, Hanson, & Spross, 2002).

Do those definitions help? Does this prompt a memory of a situation you have been in?

For more information the following slide presentation was developed by Pauline Ansine BSN RN primarily for nurses. It is a short introduction to some of the factors that lead to ethical dilemma, and has relevance for supporters whatever role you might play.

[box style=”rounded” border=”full”]“The Concept of Ethical Dilemmas”[/box]

What can create an ethical dilemma?

Why do we find ourselves facing an ethical dilemma?

You can probably figure this out by thinking about ethics and ethical dilemmas you have faced in the past. Here is a sample of what can create ethical dilemmas:

• When our principles are challenged. E.g. Confidentiality and privacy. A person confides feelings of suicide, asking you not to tell anyone else. You are conflicted because you believe confidentiality is important but a life may be at risk if you do not pass on the information.

• Differing ethics of the people involved, leading to different ways of responding. E.g. differing religious groups holding different views respond differently to the same ethical dilemma.

• Pressure from others to change your ethical view or action. E.g People who become ‘whistleblowers’ often have enormous pressure put on them to remain quiet.

• Your ethical standards are being compromised. You are doing something outside of your beliefs and values. E.g. You go along with a treatment or strategy even though you do not believe it is humane.

• Other people involved are not clearly competently make their own choices and decisions. E.g. a person with dementia who has significant cognitive impairment.

For some concrete examples and a challenge to your thinking visit the St James Ethics Centre site and have a look at examples of  DILEMMA. They give a range of scenarios and ask difficult questions. They provide a challenge to your thinking and decision making. Better than watching telly!

New Discoveries About Ethics and Ethical Dilemmas:

I really call this “Down the rabbit hole” but that does not sound too professional.  It is the stuff I find each week that is interesting, but probably not really, completely, specifically relevant, – but interesting.

Ethics of Care

While doing the research for this post, I discovered an area of study called the “ethics of care”, it looked fascinating and relevant. I went looking for more.
I found an Ethics of Care organisation based in Holland. I have not had time to really check this site out, but it looks interesting and challenging. It seems highly relevant to the role of being a supporter and pretty fascinating stuff.

Ethics and the Vulnerable Client with TBI

I came across an organisation hosting a conference on ‘Ethics and the vulnerable client with TBI‘. OK, so there are hundreds of ‘ethics ethical dilemma’ conferences around the world. And YES I know the conference is in Georgia USA, and not possible for everybody.It’s nice to know the topic is important enough to have its own conference. And there might be information afterwards.

And while I do not know much about it you might just want to have a look at the organisation that is putting on the conference Side By Side Brain Injury Clubhouse.

If you know of other resources please leave a note in the Comments section below or send me an email HERE.

Addtional References and Resources Used in This Article:

Boland, K. (2006). Ethical decision-making among hospital social workers. Journal of Social Work Values & Ethics, 3(1). Retrieved from http://www.socialworker.com/‌jswve/‌content/‌view/‌27/‌44/

Braunling-McMorrow, D. (2004). Training manual for certified Brain Injury specialists (M. B. M. Lash & V. A. McLean, Eds., 3rd ed.). USA: Brain Injury Association of America.

Fort Cowles, L. A. (2003). Social work in the health field: A care perspective (2nd ed.). Binghampton, New York, USA: The Haworth Social Work Practice Press.

Hamric, A., Hanson, C. M., & Spross, J. (2002). Advanced nursing practice: An integrative approach (3rd ed.). Philadephia, USA: Elsevier Saunders.

St James Ethics Centre is a “fully independent not-for-profit organisation which provides a non-judgemental forum for the promotion and exploration of ethics and ethical decision-making. The Ethics Centre seeks to encourage people all over the world to ‘think … to create a better world’.”

And Finally:

This really is only a beginning, a tasting plate to encourage you to seek more.

Why bother?

Well understanding more about ethics and ethical dilemma particularly around brain injury can:

• help you be more prepared and guide you when challenges arise,
• help you protect the rights of all people involved,
• help keep you, and those around you safe.

And next week it really will be about Brain Injury.

Feel free to comment, correct, share in the Comments below.