What is the difference between ethical dilemma and moral temptation

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If an individual does not recognize that he or she is facing an ethical dilemma then moral judgment is likely to occur? Study Guides. Trending Questions. Which algebraic expression represents this word description: the quotients of four and the sum of a number and three? All healthcare providers struggle to establish ethical decision making standards that provide guidance in a challenging practice environment, and the challenge is not unique to physical therapists.

One threat to ethical practice arises from within each profession as a result of materialistic self-interest and from the outside in terms of profit motivation. Another kind of challenge to ethics comes as the result of scientific advances such as mapping of the human genome, which made possible some procedures that raise ethical issues as to whether certain things should be done just because they are possible eg, cloning animals—or people.

A wealth of literature exists on the subject of ethical decision making. A search of this literature reveals that professionals are inconsistent in ethical decision making Smith, ; Tymchuk et al. Decision making is described by Brecke and Garcia as a course of action that ends uncertainty. The theory they developed requires that the uncertainty associated with the decision must be brought to a level where the decision can be made with confidence.

They also place considerable importance on the time that it takes to make a decision. The time line for decision making can range from a few seconds to several years. Brecke and Garcia developed a decision making process that consisted of four points related to a decision making time line. Decisions are made at different points on the time line, but at any point where action is not taken the decision will ultimately be made by default.

Initially, practitioners recognize that there is an opportunity to make a decision. The nature of the decision becomes clearer, and they determine what they will do and then commit to a course of action. Choosing the default option, or, stated more appropriately, permitting the default option to occur, can be potentially harmful to patients because failure to make a decision carries its own set of ethical concerns.

Healthcare providers have a responsibility to protect their patients from harm, and failure to make a decision may place the patient in a potentially harmful situation. Ethical decision making is the level that is expected and demanded of professionals. Pellegrino identifies ethical decision making as the integration of ethical principles with practical wisdom, enabling healthcare providers to make ethical choices.

Healthcare providers have specific standards and codes that guide practice; these are in the form of codes of ethics and professional practice standards Newkrug, Codes of ethics are generally broadly written. They help to identify issues, but they are not meant to serve as a methodology for ethical decision making. To recognize an action and carry out that action requires both knowledge and skill in the art of ethical decision making. Patients have the right to expect that their healthcare providers are involving themselves in thoughtful deliberation of ethical issues, with a commitment to take reasonable and rational action.

These steps warrant the trust of the patient and society. Unethical, self-serving behaviors result in a loss of trust by patients and their families. According to Dove , the loss of trust could be prevented with training programs that include the application of professional ethics to actual situations. End-of-life issues, caregiver challenges, and right-to-choose plans of care often become intertwined with ethical issues, and the medical team, patients, and families find that they are confronted by complex ethical decisions.

This is made more challenging when the issues involve one or more generations, who may have the same interests at heart but prefer different expressions of those interests.

There are many models for ethical decision making that help to organize the thoughts of the individual. Some are quite simplistic. Among the many models available is one offered by Kornblau and Starling This template provides the practitioner with guidance for collecting information about the problem, the facts of the situation, the identification of interested parties, and the nature of their interest: is it professional, personal, business, economic, intellectual, or societal?

The practitioner is then encouraged to determine if an ethical question is involved and if there is a violation of the code of ethics of the profession, or if there is a potential affront to personal moral, social, or religious values. This model also demands that any potential legal issue such as malpractice, or a practice-act infringement, be identified.

The practitioner is encouraged to gather more information if it is needed to make an appropriate decision. This is the point where the healthcare provider is encouraged to brainstorm potential actions and then analyze the course of the chosen action.

Another method of ethical decision making that is becoming increasingly popular with physical therapists is the Realm, Individual Process, Situation RIPS model Swisher, The steps of the RIPS model bring forward many of the aspects of a problem confronting the interdisciplinary team. This method essentially involves four steps Nordrum, To better illustrate the ethical decision making process, we will work through a case that involves issues of utilization.

You will see that the three primary components of the RIPS model are implemented in the case. Markham is 82 years old and he has been in relatively good health. He does have high blood pressure, and eight years ago he had bypass surgery. He lives with his year-old wife in the two-story home they have owned for more than forty years.

He is retired from an executive position at a large manufacturing company. His primary insurance is Medicare. Two weeks ago he awakened disoriented in the middle of the night and fell as he tried to get out of bed to use the bathroom.

His wife called and he was taken to the hospital, where it was determined he had sustained a right CVA with a resulting left hemiplegia. His course in the hospital was complicated by an unexplained fever.

When he had been fever-free for 48 hours it was determined that he could be discharged to a subacute facility to begin rehabilitation. Markham looks forward to starting rehab but is very tired and finds it difficult to tolerate the 30 minutes of therapy he is receiving in the hospital. He has only been out of bed for 20 minutes at a time and was exhausted afterward. He and his family are assured by staff that he will continue to get stronger each day.

At the subacute facility he is evaluated by physical therapy PT , occupational therapy OT , and speech therapy. He is found to have no speech deficits and no cognitive deficits other than mild confusion, which is steadily clearing. His entire program will thus consist of physical therapy and occupational therapy. He is to receive over an hour of service per day, seven days a week. The first day Tim sees Mr.

Markham, the patient is begging to return to his room after 15 minutes. His blood pressure has dropped and he had tachycardia. He is diaphoretic and becoming increasingly lethargic. Tim returns Mr. Markham to his room, recognizing that he will have to make up the time in the afternoon. Casey sees Mr. Markham after lunch and, though he wants to cooperate, Mr.

Markham cannot do more than 20 minutes before he is having difficulty keeping his head up. When Tim arrives to take Mr. Markham to PT in the afternoon he finds him asleep and difficult to rouse. Tim and Casey confer at the end of the day and find that between them they saw Mr.

Markham for 35 minutes. They report the situation to the rehab supervisor, who reminds them of the importance of achieving the full minutes and tells them to be sure to include the missed time over the rest of the week. He reminds them that if Mr. Markham cannot participate in therapy he may have to be discharged from the subacute facility to a nursing home.

Tim and Casey wonder if Mr. Markham should be at the assigned RUG level, the second highest level of therapy. They are concerned that, if they push him to achieve the level in which he has been placed, they could compromise his fragile medical condition. On the other hand, if he cannot do the program they have designed for him and he is sent to a nursing home, there is little chance of his doing well enough to ever return home.

Tim and Casey are very uncomfortable with the situation in which they find themselves. The following day they rearrange their schedules, switching a few patients to afford Mr. Markham more advantageous times of the day.

He does a bit better but still cannot achieve even 45 minutes of combined time. Once again they are told to make it work. The lower rehab category does not have sufficient time to justify a subacute stay for this patient.

They believe their supervisors do not share their concern and feel that their professional values could easily be compromised as they balance their desire to act with nonmaleficence not harming the patient while maintaining veracity being truthful regarding the treatment rendered. The following template, developed by John Nordrum , helps to establish a logical sequence for integrating the RIPS model with the work of Kornblau, Starling, and Kidder. Rule-based : follow the rules, duties, obligations, or ethical principles already in place.

Ends-based : determine the consequences or outcomes of alternative actions and the good or harm that will result for all of the stakeholders. This situation falls into the institutional realm. The care of the patient is being dictated by institutional policy. There is also a societal component here, because of the policies dictated by a third-party payer Medicare , care is determined largely on payment parameters; but a professional must weigh treatment outcomes vs.

On the one hand are moral intuitions and gut feelings about what should be done; these are based on moral beliefs and convictions.

On the other hand are opportunities to engage in ethical analysis so as to identify alternative courses of action and test whether those options are justified. A dilemma, in the most general sense, is a situation that requires a choice between two options that are or seem to be equally undesirable or unsatisfactory. There are nonmoral dilemmas, in which the choice is between options that are undesirable or unsatisfactory for reasons other than morality.

For instance, if a person seeks to buy both a book and a shirt but can only afford to purchase one of them, choosing one over the other will inevitably lead to disappointment, in that it will fulfill only one of the two desires. There need not be any moral dimension to this decision for it to be a dilemma. A moral dilemma is a situation in which the decision-maker has to give priority to one moral value over another Brinkmann, ; Maclagan, ; Toffler, In the opening example, Anne was morally committed to both keep the industrial project on track and reject the blackmail attempt.

In that situation, one of these moral commitments had to give way at the expense of the other. She did not have a clear System 1 intuition, and even after initial System 2 reflection, the dilemma and tension remained. A moral dilemma can occur because of a prior personal mistake. This is called a self-inflicted dilemma. A classic example is the Bible story about King Herod. Salome consulted her mother about what she should wish for, and she decided to ask for the head of John the Baptist on a platter.

The king now had a choice between honoring the promise to his stepdaughter and honoring the life of John the Baptist. The king had inadvertently designed a moral trap for himself—a dilemma in which, whatever he decided, he would be acting immorally.

One contemporary and everyday instance of a self-inflicted moral dilemma involves double booking. Say that an individual makes separate and incompatible promises to two people she will be somewhere at She cannot keep both promises and thus must choose which one to break. She may have good moral reasons to keep both promises, but she must choose between them. In a narrow sense, a moral dilemma is a situation in which the moral values at stake are of equal importance.

In this example, the two appointments have equally strong pull and significance. Neither choice is less wrong than the other. This situation is one in which moral wrongdoing is inescapable Gowans, In a wider sense, there can be moral dilemmas in which a person has strong moral reasons to act in one way, as well as notable—but not equally strong—moral reasons to act in another way.

When considering the nature of two promises, it may be reasonable to conclude that it is better to fulfill one rather than the other. Deciding to keep the former promise and break the latter means a loss of some moral value, but it is not really a hard moral choice, as no one will have reason to challenge or cast doubt upon the rightness of the decision.

The choice, in other words, is between a lesser wrong and a greater wrong. If an individual double-books, but one meeting has a higher priority than the other, the person whose meeting is canceled will be disappointed and irritated but will likely understand the decision based on the priority of keeping the other promise. In the Herod case, there is an imbalance in the moral weight of the two options.

Herod, in his exuberance, made a questionable promise to Salome, and in turn, she took advantage of the situation and made a horrific request. Herod had stronger moral reasons to spare the life of John the Baptist than he had to keep his word to his stepdaughter.

He would give up some moral value either way, but one option was morally superior. This situation can still be called a moral dilemma—although not in the pure sense of representing a decision between moral values that are on equal footing. False moral dilemmas are instances in which it is clear what ought to be done but in which there is temptation or pressure to act in another way.

In business ethics, the distinction between true and false dilemmas has also been described as the distinction between dilemmas and temptations Brinkmann, , p. The knowledge gap between the professionals and the clients is such that the risk that clients will detect such choices is minimal. The professionals may claim that they are facing moral dilemmas when, for example, opportunities arise to overcharge clients. In the vocabulary of this book, the most appropriate term for such a situation is false dilemma.

This situation may resemble a real dilemma in that the decision-maker must decide between two options that are both undesirable in some way, as cheating the client feels wrong, but so does turning down a chance to earn extra money. However, the former feeling has a moral component that is lacking in the latter. Thus, conflict-of-interest situations are generally false moral dilemmas with only superficial similarities to real dilemmas.

In connection with the dichotomy between real and false dilemmas, the continuum between them needs to be acknowledged, as Maclagan suggested. On one side of the spectrum, there are situations in which there is perfect balance between the opposing moral values. For example, being compassionate toward another person and being honest with that person can have equal moral weight. In some other cases that involve self-interest, however, the distinctions are not so clear-cut; for instance, pursuing self-interest on an organizational level can have some moral value.

Concrete cases belong somewhere on the spectrum between purely real and purely false dilemmas. How exactly should this situation be classified: as a real or false dilemma? This depends on the details of the case. The analysis that Anne had to make in preparation for her decision did not require her to precisely place the dilemma on this scale, but it did require her to acknowledge the nature of the situation in general.

First, she handed over the PCs so that the bureaucrat would turn the electricity back on, thus getting the project on track again. Second, she invited the senior bureaucrats from the nearby town to a meeting in which she explained that the company wanted to contribute to the local community—but not in such a haphazard way. Instead, she proposed a systematic plan in which the company would help the town to modernize its electronic equipment. With this initiative, Anne came to be on better terms with the local administrators, thus avoiding further blackmail situations.

Ben is the manager of a small private banking unit within a large financial services group. Results have slumped recently, mainly due to a bitter conflict between one employee and some of his colleagues. They complain that he is rude and difficult to cooperate with.