An ethical dilemma

Let’s be completely honest here. Writer to reader, especially if the person reading this comes from a medical profession background. We’re taught throughout our years of studying, be it in a practical or classroom environment, with it being reinforced into our brains until it becomes second nature, that we should treat all our patient’s equally. But in a practical sense? It’s not logical. Sure, ethically we’re all intelligent enough to know that all patient’s deserve the same treatment, and to be treated the best to our capabilities but in my last 2 years in a clinical environment there’s a trend that’s started to develop with the patient’s that i treat. Don’t get my wrong, I’m open to criticism here but this is what I’ve realized. A ethical dilemma that incorporates morals, ethics AND human rights.

You get a 45 year old female who presents with a right CVA, left sided hemiparesis and presents with expressive aphasia, but understands everything. Most importantly the patient presents with chest complications. The patient has an accumulation of secretions that are directly affecting her respiratory capabilities. According to Nursing reviews (2013) “Chest physiotherapy (CPT) is a technique used to mobilize or loose secretions in the lungs and respiratory tract. This is especially helpful for patients with large amount of secretions or ineffective cough.Chest physiotherapy consists of external mechanical maneuvers, such as chest percussion, postural drainage, vibration, to augment mobilization and clearance of airway secretions, diaphragmatic breathing with pursed-lips, coughing and controlled coughing.”

The patient continues to refuse treatment, and this is resulting in her chest worsening each day. Each day, I try and convince the patient of the benefits of the treatment, although uncomfortable for the patient, and the negative results of continuously refusing treatment. Over time I begin to see a slow deterioration as her chest becomes progressively worse and worse. This agitates me as I know for a fact, a proven fact that I CAN help.

I struggle to sympathize with the patient, and to try and see from their point of view and how being in hospital, with a newly diagnosed stroke as well as not being able to speak may affect them. But surely, when a medical professional informs you on the importance of doing something, you comply?  Morally I am at the point where I have tunnel vision in the sense that I know what’s beneficial for the patient, and the improvements the patient can make granted she co-operates or consents to treatment. Ethically, I am obliged to attempt to reason with the patient, to try and understand what they’re going through, and to attempt to make further inquiries as to why they are refusing treatment, whether its depression or socially related. I know ethically it is not right to leave the patient unattended/ not treated, but it’s gotten to the point where I feel even approaching the patient’s bedside to ask them about treatment has become a waste of my time.No matter how hard I plead, or educate, she just continually refuses. Eventually I stand back and start to think to myself, how much time am I wasting on a daily basis trying to convince someone that has her mind set, instead of putting my time and energy into another patient who will benefit faster.

I understand this is a negative approach to have towards patients, I am not defending myself at all here and I believe that a physiotherapist should ethically do everything possible to improve the well-being of the patient.So ethically, yes, I’m obliged to treat her the best I can. Morally, I become hardhearted and distant from her as I beg and plead on a daily basis to allow me to treat her.

It removes the joy out of my work when I have to beg a patient to co-operate with me. The best day’ I have are with people that are determined to get better.

I guess what I’m saying is that we all have favorites. We all have patient’s that we enjoy working with, and those we just want to get out the way. But that’s what makes us human. We aren’t robots, and as hard as I may try to narrow the gap between how I choose favorites, I somehow think that they will always be that gap that differentiates each one of my patients.


Chest Physiotherapy. (2013, September). Retrieved October 7, 2016, from

Judson, MA, Sahn, SA (1994) Mobilization of secretions in ICU patients. Respir Care39,213-226


4 Replies to “An ethical dilemma”

  1. Hi Keegan.
    Thank you for sharing this post about your clinical experience. I can relate to this ethical dilemma and I’m sure many students who work in a clinical setting on a daily basis can too. I completely understand where you are coming from and your views about this dilemma. It is a very tough position to be in as we know the benefits of our treatment. However after explaining this to the patient they still refuse. This is where it becomes challenging to walk away, as ethically we shouldn’t be persuading patients’ to accept treatment as they have the right to refuse. But how do we just walk away knowing their condition will worsen without our help.

    Here are some areas where you can improve:

    Sentence structure, grammar, spelling: Overall it was a well structured post with good use of paragraphs. There were minor grammar and spelling errors.

    Content: The content was appropriate and related to your topic of choice. There was good use of personal views and experiences, however more use of literature would have enhanced your post slightly.

    Multimedia: Good use of appropriate pictures, a video would have been nice to watch to enhance your post.

    References: In-text referencing corresponds to the reference in your list. References need improving.

    Thank you for your interesting post, I look forward to reading your next blog post. I hope my comments are helpful for your final blog post and future posts.


  2. I think we have all experienced such in a clinical setting. it’s very difficult when a patient refuses treatment as important and crucial as chest, as we know the detrimental effects this might have . but the the end of the day the patient has a right to refusal and there is nothinges more we can do…..

    I like the fact that you gave your honest opinion and did not try and sugar coat your thoughts. there’s a few errors in terms of grammar. your reference can improve as well so try using more recent articles. media aspect of the blog can improve maybe adding a video. relevant to the topic.

    interesting post though!


  3. Greetings Keegan, interesting post and I like how you expressed yourself throughout the blog. To be honest I also have those days at clinical practice where I have patients who I just want to get out of the way and focus on the good patients who makes me love what I am doing, there are days where I even re-arrange my patient list so that I would see the stubborn and ‘not so nice’ patients first and leave the good ones for last, so that I would end my day on a happy and positive note. I then end up providing best treatment to certain patients and not to others, and according to ethics this is wrong. It is important sometimes to put yourself in your patient’s shoes and understand what they might be going through, and it is also important to just let them be, because in this case you have done all that was needed to be done in order to make the patient understand the importance of chest physiotherapy but still refused, what else is there to be done at this stage? Because forcing her would then be going against her rights as a patient and human being.
    It would be great if you also use the patients’ rights charter to support your argument. I only found one gramma error, you have referenced your work well and there is good use of media to strengthen your argument. Good work Keegan.


  4. Hi Keegan. I appreciate your frustration with the situation you describe and see the challenges you mention as being very real. But what I don’t see is your empathy for the patient. The frustration you describe is all yours. As Linda has said in the comments, try to understand what the patient is experiencing and to take the difficult step of “letting them be”. You might try connecting with the patient beyond simply trying to get them to accept your treatment.


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