**8. Some ethical dilemmas**

Healthcare professionals regularly encounter ethical dilemmas while carrying out their duties [3, 17, 27]. Some situations in which ethical dilemma can occur are discussed below:


the world due to the covid019 pandemic [34]. Also coupled with the increase patient load in intensive care units [35]. In other to protect the public, there is the ethical dilemma when a patient with the signs and symptoms of the Severe Acute Respiratory Syndrome-2 refuses to get tested.

4.**Medical Error**: Errors can occur in any profession but it can lead to fatalities in some sectors. Some of such sectors are the aviation, architecture and medicine as any mistake can lead to disability and even death. Not all medical errors can lead to disability and death but it may increase hospital stay and loss of work days. This is a serious issue especially as there are increase cases of litigation. There is the ethical dilemma of weather the patient or client should be informed about medical errors when they occur.

Ethical dilemma is also encountered when dealing with "Do Not Resuscitate Order".

## **9. Ethical dilemma: case report**

A 72 years old woman was brought to the emergency room in a developing country by her children with complaints of unconsciousness and difficulty in breathing of 24 hours duration. She is a known hypertensive not compliant with her medications. On examination, she was not pale, unconscious with a Glasgow Coma Scale of verbal response – 1, eye opening – 1, and motor response – 1 with a total of 3/15. She was not cyanosed, in respiratory distress evidenced by flaring alae nasi and subcostal and intercostal recession. Oxygen saturation was 76%, she was gasping for breathing, auscultation of the chest yielded vesicular breath sounds. Respiratory rate was 60 cycles per minute and pulse rate was 100 beats over minute, regular and full volume. Blood pressure was 150/100 mmhg. A diagnosis of cerebrovascular accident was made. She was placed on oxygen, 20% mannitol and normal saline. After admission, the patient was not improving and the patient's caregiver was paying out of pocket for the management of the patient. After twenty four hours of hospital admission, the patient's daughter requested that the patient was in a bad clinical state therefore she wants the oxygen to be discontinued, that she (the daughter) feels that the mother may not survive the illness. She was counseled on her mother's condition but she still insisted that the oxygen should be discontinued. After much argument, she was asked to write an undertaken that she is the one requesting for the discontinuation of oxygen therapy. At this point she refused to put it down in writing and started crying. The oxygen was never discontinued.

### **10. Discussion of the case report**

This is a case of ethical dilemma on end of life care and care of a patient unable to make decisions. When patients are unable to make decisions for themselves such decisions are made by a legal caregiver who may be patient, child, guardian or legal representative. In some developing countries like Nigeria where the extended family system is practiced and the people live a communal life, the caregiver may be any relative or even a neighbor; the group of people who cannot make decisions for themselves are the unconscious patient, children and minors and the mentally impaired. Some of the decisions made by a caregiver may not always be in the best interest of the patient. For instance in this case, the patient is unconscious and the caregiver is her daughter. Even though the patient was in bad clinical state, oxygen

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war zones.

**12. Principles of medical ethics**

*Medical Ethics*

training.

*DOI: http://dx.doi.org/10.5772/intechopen.95382*

**11. Institutional review boards**

therapy was necessary for her management hence the dilemma of whether or not to discontinue the intranasal oxygen. There is conflict between the ethical principles of autonomy and maleficence. This can lead to litigation against the attending physician. If the physician decides to obey the wish of the caregiver, even though she takes an undertaken, the conflict of maleficence in which a doctor is required not to do harm may arise. The physician will have no justification to discontinue the administration of oxygen if taken to a court of law as he or she has received medical

In the practice of medicine, research is an important and essential tool [36–38].

Since the olden days, it is believed that the doctor knows it all and also knows the best [41]. These have been challenging as there is an increase in litigation against doctors, practice and implementation of ethical principles helps as the preventive measure against such medical litigation and jurisprudence. Modern medicine is faced with several ethical problems [29]. Some of these problems can be abated by ethical principles. Clinicians try to do their best for their patients by providing the best medical care available. These ethical principles guide physicians in decision making in the course of their work especially where there are ethical dilemmas and helps in the resolution of ethical conflict [27]. Hence physicians generally act in the

Institutional review boards are ethical committees in institutions that analyze and review proposed research protocols, it serves as a deliberation forum in which ethical issues in medical researchers are analyzed (WHO). Some institutions have more than one institutional review board [39]. Institutional review board plays an important role in medical practice. Some of these roles of the institutional review boards are to protect human subjects in the course of any medical research [39]. This is because some researches may have detrimental effects on research participants, some of these effects may lead to morbidity and even mortality. Institutional review board act as risk benefit analysis intermediary between research participants and the researcher. They also determines if the research should be commenced or not [38]. They ensure that the research is conducted as specified by the researcher in the research protocol. Institutional review boards are important in the improvement of medical practice by working with researches to apply good ethical principles in their research [40]. Each institutional review board has its guidelines. Some have documents that must be used while applying for ethical approval for any study. The institutional review boards are made up of persons with expertise in medical ethics and medical specialties. There are different types of institutional review board namely national ethics committee, research ethics committee and clinical ethics committee (WHO). Globally, there are different local and medical national institutional review boards and communities [17]. An example of a national ethics committee is the National Health Research Ethics Committee of Nigeria (NHREC). In medical research, the human subjects are a very valuable resource hence there safety has to be protected [37]. Extra scrutiny is done on research that will be carried out among vulnerable populations [38]. This is to avoid coercion in the recruitment of research participants. The vulnerable populations are children and minors, older persons, the mentally retarded, pregnant women and people in conflict and

therapy was necessary for her management hence the dilemma of whether or not to discontinue the intranasal oxygen. There is conflict between the ethical principles of autonomy and maleficence. This can lead to litigation against the attending physician. If the physician decides to obey the wish of the caregiver, even though she takes an undertaken, the conflict of maleficence in which a doctor is required not to do harm may arise. The physician will have no justification to discontinue the administration of oxygen if taken to a court of law as he or she has received medical training.
