The document summarizes an ethical dilemma faced by a pediatric nurse, Betsy, regarding her neighbor Alice's daughter Shirley. Betsy notices Shirley having seizures but Alice refuses medical treatment due to her religious beliefs. Betsy discusses the situation with Dr. Campbell and Shirley's parents but they remain resolute to rely on prayer alone. This presents an ethical dilemma for Betsy between respecting autonomy and ensuring beneficence/nonmaleficence. The document analyzes the case using principles of ethics and effective communication approaches.

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Applying Ethical Principles
Learner’s Name
Capella University
NHS4000: Developing a Health Care Perspective
Instructor Name
August, 2020
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Applying Ethical Principles
Health care professionals often face ethical problems during their practice that require
them to use their moral values and principles when making decisions. The four fundamental
principles of health care ethics—autonomy, beneficence, nonmaleficence, and justice—act as
yardsticks for fair and ethical decision-making. These ethical principles are widely accepted in
the field of health care. Medical practitioners and health care administrators often use these
principles to make decisions when faced with complex situations involving patients.
Overview of the Case Study
Betsy is a dedicated pediatric nurse known for the care and concern she shows her
patients. Her neighbor and friend, Alice, lives with her husband and 4-year-old daughter, Shirley.
Alice and her husband are followers of Christian Science, a belief that advocates spiritual healing
and discourages most types of medical intervention. One day, when visiting Alice and Shirley,
Betsy sees Shirley experience what seems like a seizure. The child suddenly becomes

2. unresponsive and has a brief staring spell, with her eyes rolling upward. The episode lasts for 20
seconds, during which she seems completely unaware of her surroundings. While Shirley is
having the seizure, Alice sits by her side and prays but takes no other action. Betsy is concerned
about the little girl’s condition and probes her friend for details. Alice tells Betsy that Shirley
used to have around 15–20 such episodes a day until a few months ago; this has now reduced
to
about 12. Alice attributes the improvement in Shirley’s health to her prayers and faith.
However,
this does not help Betsy feel comfortable about Shirley’s condition. She is almost certain that
Shirley has epilepsy, which, if not treated on time, could have profound health implications. At
the very least, she thinks Alice should have Shirley’s symptoms accurately diagnosed.
Understanding the gravity of the situation, Betsy sets up a meeting with Shirley’s parents
and Dr. Campbell, director of the neurology department at her hospital. She treats this meeting as
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an intervention, and both she and Dr. Campbell express their concern for Shirley’s health.
They
stress on the fact that the improvement in Shirley’s symptoms does not necessarily mean she
will
be cured. They empathize with Alice and her husband’s reluctance on account of their
religious
faith but reiterate the importance of getting Shirley’s symptoms diagnosed. To prove their
point,
they present studies that describe how seizures can be indicative of illnesses such as epilepsy,
which could negatively affect her cognition and behavior. Shirley’s parents are grateful that
Betsy and Dr. Campbell are concerned about their daughter’s health but remain resolute
about

3. going against their faith. They believe that prayer will cure her. Betsy is faced with an ethical
dilemma of whether she should respect the parents’ religious beliefs and not intervene in the
matter or perform her moral obligation as a health care professional.
Analysis of Ethical Issues in the Case Study
In the case study, the main factor that led to Betsy’s ethical dilemma is Shirley’s
parents’
refusal of medical assistance for their daughter owing to their Christian Science beliefs. When
Betsy notices Shirley’s seizures, she thinks it is her duty to make sure Shirley receives
medical
attention. As she respects the religious faith and belief of Shirley’s parents, she decides to
explain the risks that seizures could involve. She also includes Dr. Campbell in the conversation
so that he could provide an objective opinion to make them understand the need for medical
intervention. However, Shirley’s parents are certain that prayer will cure her seizures.
Considering that their attitude could result in serious health implication for Shirley, Betsy is
concerned about the little girl receiving appropriate medical attention (Baumrucker, et al., 2017).
Using the Ethical Decision-Making Model to Analyze the Case Study
The three components of the ethical decision-making model—moral awareness, moral
judgment, and ethical behavior—can help analyze the ethical issue outlined in the case study.
Whereas moral awareness is knowledge of the existence of an ethical dilemma, moral judgment
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involves choosing between the right and wrong actions when posed with such a dilemma. Both
moral awareness and moral judgment lead to ethical behavior. Ethical behavior is taking the right
action to resolve a dilemma. Betsy’s moral awareness is reflected by the fact that she
recognizes

4. the circumstances surrounding Shirley’s condition. Her moral judgment is reflected by her
decision to try to convince Shirley’s parents to get Shirley medical help because she believed
that it was the right thing to do. Betsy’s ethical behavior constitutes the action she takes to
resolve the dilemma. This, in turn, depends on her personal judgment and the four principles of
health care ethics (autonomy, beneficence, nonmaleficence, and justice) she should abide by as a
health care professional.
Effectiveness of Communication Approaches in the Case Study
Listening plays an important role in patient–physician communication. By listening to
Alice, Betsy learns of the frequency of Shirley’s seizures and the reduction in their
occurrence.
She also learns that Alice and her husband believe that this reduction is due to their prayers and
faith in Christian Science. Therefore, active listening helps Betsy understand the situation better.
Betsy is aware that if she decides to get medical help for Shirley without the consent of
Shirley’s parents, she would be violating their right to informed consent and overstepping
her
boundaries as a health care professional. So, she decides to present them with the information
they need to make an informed decision. She maintains an open communication with
Shirley’s
parents while explaining the impact of seizures on their daughter’s health. She stresses the
importance of immediate diagnosis of Shirley’s seizures. Thus, by being respectful of
Shirley’s
parents’ emotions and providing them with complete information about the problem, Betsy
communicates the situation to them in an effective manner.
During the discussion with Shirley’s parents, both Betsy and Dr. Campbell are
empathetic toward Alice and her husband’s reluctance to get the necessary medical help for
their

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daughter on account of their religious faith. Betsy seems to have involved Dr. Campbell so that
he could share his objective expert opinion based on his experience in dealing with patients who
have similar symptoms. She probably thought that Shirley’s parents would change their
decision
if Dr. Campbell reiterated that Shirley could develop severe cognitive problems (such as learning
difficulties and memory deficits) or behavioral problems (such as irritability, anxiety,
hyperactivity, and mood swings) if her seizures are neglected. However, they were unable to
convince Shirley’s parents to get Shirley medically diagnosed.
Although Betsy followed a systematic approach while dealing with the issue at hand, it
seems to have been ineffective as Shirley’s parents continued to stand by their faith in
prayer.
However, listening patiently to patients’ problems and showing empathy and genuine care
while
communicating with them are some lessons that health care professionals can take back from this
case study.
Resolving the Ethical Dilemma by Applying Ethical Principles
The four ethical principles of autonomy, beneficence, nonmaleficence, and justice are
often employed to resolve ethical dilemmas related to health care. Autonomy refers to accepting
and understanding patients’ values, beneficence refers to acting for the welfare of patients,
nonmaleficence refers to not doing harm to the patient, and justice refers to treating patients
fairly without bias.
The ethical dilemma that Betsy faces in this case involves three of the four basic
principles of medical ethics. In the case study, the ethical dilemma is caused by the conflict

6. between the principles of autonomy on the one hand and beneficence and nonmaleficence on the
other. Betsy preserves the autonomy of Shirley’s parents by respecting their religious beliefs
and
not coercing them to get the girl correctly diagnosed. She further ropes in Dr. Campbell to try to
explain to them the importance of getting an accurate diagnosis.
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Approaching Child Protective Services—a social service agency run by the government
to counsel and support children and their families and promote child welfare—could be
considered by Betsy as an ethical means to resolve the dilemma. As Betsy is obligated to help
Shirley get medical care (beneficence) and prevent any harm that might be caused from ignoring
her seizures (nonmaleficence), she could seek intervention from Child Protective Services.
Although involving Child Protective Services could result in overriding the ethical principle of
autonomy, Betsy might have to take this decision keeping Shirley’s best interests in mind
(Baumrucker et al., 2017).
Conclusion
The four principles of health care ethics can be applied by health care professionals to
analyze and resolve ethical dilemmas. In the case study, Betsy has to decide between respecting
Shirley’s parents’ religious beliefs and performing her moral obligation as a health care
professional by helping Shirley seek medical care. The proposed solution involves upholding the
principles of autonomy, beneficence, and nonmaleficence to resolve Betsy’s ethical dilemma.
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References

7. Baumrucker, S. J., Easterday, J., Stolick, M., McCall-Burton, M., Adkins, R. W., Winiger, D., &
Cook, C. (2017). Ethics roundtable: Parental autonomy and the minor patient. American
Journal of Hospice & Palliative Medicine, 34(3), 287–292.
http://journals.sagepub.com.library.capella.edu/doi/pdf/10.1177/1049909115608812
Capella University (2018). NHS-FP4000 Exemplar Sample Ethical Case Study. Capella Website:
xxx.
http://journals.sagepub.com.library.capella.edu/doi/pdf/10.1177/1049909115608812
Develop a solution to a specific ethical dilemma faced by a health care professional by applying
ethical principles. Describe the issues and a possible solution in a 3-5 page paper.
Length: 3–5 typed, double-spaced pages, not including the title page and reference page.
Font and font size: Times New Roman, 12 point.
APA tutorial: Use the APA Style Paper Tutorial [DOCX] for guidance.
Written communication: Use correct spelling, grammar, and punctuation.
References: Integrate information from outside sources to include at least two references (the
case study and an academic peer-reviewed journal article) and three in-text citations within the
paper.
Introduction
Whether you are a nurse, a public health professional, a health care administrator, or in another
role in the health care field, you must base your decisions on a set of ethical principles and
values. Your decisions must be fair, equitable, and defensible. Each discipline has established a
professional code of ethics to guide ethical behavior. In this assessment, you will practice
working through an ethical dilemma as described in a case study. Your practice will help you
develop a method for formulating ethical decisions.
**** Case Study: To Vaccinate or NOT?
Jenna and Chris Smith are the proud parents of Ana, a 5–day–old baby girl born
without complications at Community Hospital. Since delivery, the parents have bonded
well with Ana and express their desire to raise her as naturally as possible. For the Smiths,
this means breastfeeding exclusively for the first six months, making their own baby food
using pureed organic foods, and not allowing Ana to be vaccinated.

8. The Smiths are college educated and explain they have researched vaccines and decided the
potential harms caused by them far outweigh any benefits. They point to the rise in autism
rates as proof of the unforeseen risk of vaccines. Their new pediatrician, Dr. Angela Kerr,
listens intently to the Smiths' description of their research, including online
mommy–blogs that detail how vaccines may have caused autism in many children. The
Smiths conclude by resolutely stating they've decided not to vaccinate Ana, despite the
recommendations of the medical community.
Dr. Kerr begins by stating that while vaccines have certainly sparked controversy in recent
years, she strongly recommends that Ana become fully vaccinated. Dr. Kerr explains that
vaccines have saved the lives of millions of children worldwide and have been largely
responsible for decreases in child mortality over the past century. For example, the
decreased incidence of infection with the potentially fatal Haemophilus influenzae type b,
has resulted from routine immunization against that bacterium. Similarly, epidemics such
as the recent outbreak of measles are usually associated with individuals who have not been
vaccinated against that pathogen.
Dr. Kerr goes on to endorse the general safety of vaccines by informing Ana's parents that
safety profiles of vaccines are updated regularly through data sources such as the federal
government's Vaccine Adverse Event Reporting System (VAERS). The VAERS, a
nationwide vaccine safety surveillance program sponsored by the Food and Drug
Administration and the Centers for Disease Control and Prevention, is accessible to the
public at https://vaers.hhs.gov/index. This system allows transparency for vaccine safety by
encouraging the public and healthcare providers to report adverse reactions to vaccines
and enables the federal government to monitor their safety. No vaccine has been proven
casual for autism spectrum disorder (ASD), or any developmental disorder. On the
contrary, many studies have shown that vaccines containing thimerasol, an ingredient once
thought to cause autism, do not increase the risk of ASD.
Finally, Dr. Kerr reminds the Smiths that some children in the general population have
weakened immune systems because of genetic diseases or cancer treatment, for example. It
may not be medically feasible to vaccinate such children. Other children are too young to
receive certain immunizations. Instead, these children are protected because almost all
other children (and adults) have been vaccinated and this decreases their exposure to
vaccine–preventable illnesses (VPIs). This epidemiological concept is known as “herd
immunity.― As more parents refuse immunization for their healthy children, however,
the rate of VPIs will increase. This puts vulnerable children at significant risk of morbidity
and mortality. Routine childhood immunization contributes significantly to the health of
the general public, both by providing a direct benefit to those who are vaccinated and by
protecting others via herd immunity. Dr. Kerr concludes by stating that after considering
the risks versus the benefits of immunization, most states require vaccinations before
children can attend school. Parents may decide not to vaccinate under specific
circumstances, however, which vary by state.

9. Jenna and Chris Smith confirm their understanding of what Dr. Kerr has explained, but
restate that they do not want Ana vaccinated at this time. Dr. Kerr is perplexed as to what
to do.
**** Instructions
Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At
a minimum, be sure to address each point. In addition, you are encouraged to review the
performance-level descriptions for each criterion to see how your work will be assessed. For this
assessment, develop a solution to a specific ethical dilemma faced by a health care professional.
**** In your assessment :
Note: The case study may not supply all of the information you need. In such cases, you should
consider a variety of possibilities and infer potential conclusions. However, please be sure to
identify any assumptions or speculations you make.
Include the selected case study in your reference list, using proper APA style and format. Refer
to the Evidence and APA section of the Writing Center for guidance.
Summarize the facts in a case study and use the three components of an ethical decision-making
model to analyze an ethical problem or issue and the factors that contributed to it.
Identify which case study you selected and briefly summarize the facts surrounding it. Identify
the problem or issue that presents an ethical dilemma or challenge and describe that dilemma or
challenge.
Identify who is involved or affected by the ethical problem or issue.
Access the Ethical Decision-Making Model media piece and use the three components of the
ethical decision-making model (moral awareness, moral judgment, and ethical behavior) to
analyze the ethical issues.
Apply the three components outlined in the Ethical Decision-Making Model media.
https://media.capella.edu/CourseMedia/nhs4000element18816/wrapper.asp
Analyze the factors that contributed to the ethical problem or issue identified in the case study.
Describe the factors that contributed to the problem or issue and explain how they contributed.
Apply academic peer-reviewed journal articles relevant to an ethical problem or issue as
evidence to support an analysis of the case.
In addition to the readings provided, use the Capella library to locate at least one academic peer-
reviewed journal article relevant to the problem or issue that you can use to support your analysis

10. of the situation. The NHS-FPX4000: Developing a Health Care Perspective Library Guide will
help you locate appropriate references.
Cite and apply key principles from the journal article as evidence to support your critical
thinking and analysis of the ethical problem or issue.
Review the Think Critically About Source Quality resource.
Assess the credibility of the information source.
Assess the relevance of the information source.
Discuss the effectiveness of the communication approaches present in a case study.
Describe how the health care professional in the case study communicated with others.
Assess instances where the professional communicated effectively or ineffectively.
Explain which communication approaches should be used and which ones should be avoided.
Describe the consequences of using effective and non-effective communication approaches.
Discuss the effectiveness of the approach used by a professional to deal with problems or issues
involving ethical practice in a case study.
Describe the actions taken in response to the ethical dilemma or issue presented in the case
study.
Summarize how well the professional managed professional responsibilities and priorities to
resolve the problem or issue in the case.
Discuss the key lessons this case provides for health care professionals.
Apply ethical principles to a possible solution to an ethical problem or issue described in a case
study.
Describe the proposed solution.
Discuss how the approach makes this professional more effective or less effective in building
relationships across disciplines within his or her organization.
Discuss how likely it is the proposed solution will foster professional collaboration.
Write clearly and logically, with correct use of spelling, grammar, punctuation, and mechanics.
Apply the principles of effective composition.

11. Determine the proper application of the rules of grammar and mechanics.
Write using APA style for in-text citations, quotes, and references.
Determine the proper application of APA formatting requirements and scholarly writing
standards.
Integrate information from outside sources into academic writing by appropriately quoting,
paraphrasing, and summarizing, following APA style.