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ethical dilemma, moral distress



  1. Schroeder, Karla DNP, MHA, RN, ANP-BC, NE-BC
  2. Miller, Casey MSN, RN, ANP-BC
  3. Shaw, Heather GNP-BC
  4. Hutton, Lynn LCSW


Pregnancy in the presence of serious illness and treatment can create a moral and ethical struggle. There is little literature to provide an ethical framework for decision making when women become pregnant while receiving aggressive care for any serious illness. The family and care team often have moral distress as they provide support and are integrally involved in decision making. A case study is presented to describe a complicated patient scenario and how all involved can develop emotional, moral, and ethical struggles as care is delivered. In clinical cases where nurses feel that their own ethical and moral frameworks are either in conflict with patient, family, or health care provider decisions, or feel that patient and family wishes conflict with one another or the health care system, emotions and distress rise to the surface. In these situations, nurses can advocate for standard practice and to use an ethical framework for decision making, such as the 4-box method, to help decrease moral and ethical struggles as technology continues to advance in health care.