Ethical Concerns Discussion Week 6
Four scenarios, four different principles in tension. Applying one framework uniformly across them will misread at least two, because the conflicts are not the same conflict.
Editorial process
Last reviewed · August 22, 2026
Four scenarios, four different conflicts
Work each scenario separately, because the tension is different in every one and a single framework applied across all four will produce the wrong answer twice. The vaccine refusal is a conflict between parental authority and a child's interests, complicated by a third party, since the risk falls partly on other children and on the immunocompromised. The evidence-based move is not persuasion at volume but presumptive recommendation, motivational interviewing, addressing specific concerns and maintaining the relationship, because exclusion from the practice removes the one person still having the conversation. State exemption law and school entry requirements belong here too, since they set what actually happens next. It is also worth separating what the parents fear from what they believe: a specific worry about an ingredient or a schedule is answerable with information, while a general distrust of institutions is not, and the two need different responses.
The cardiac arrest scenario is about goals of care and who decides. The questions are whether an advance directive exists, whether resuscitation is consistent with her expressed wishes, who the surrogate is, and whether the family present are asking for something that would not serve her. It also raises what to do in the absence of documentation, which is where the default toward resuscitation and the duty to seek information collide. The Crohn's scenario looks practical and is deeply ethical: cost-related non-adherence is a leading cause of avoidable admission, so the response is patient assistance programmes, formulary alternatives, social work referral and honest discussion of what treatment will cost, and justice is the principle in play rather than autonomy. The fourth scenario is stated only partially in the archived brief, so say what additional information you would need before you could reason about it, which is a better answer than inventing the missing facts.
Likely learning objectives
- Identify the specific principle in tension in each scenario.
- Apply evidence-based approaches to vaccine hesitancy rather than persuasion.
- Recognise cost-related non-adherence as a justice problem.
- State what information is missing rather than inventing it.
Assignment instructions
Read the full question
Review every instruction before using the planning guidance that follows.
As an advanced practice nurse, you will run into situations where a patient’s wishes about his or her health conflict with evidence, your own experience, or a family’s wishes. This may create an ethical dilemma. What do you do when these situations occur? In this Assignment, you will explore evidence-based practice guidelines and ethical considerations for specific scenarios. Scenario 1: The parents of a 5-year-old boy have accompanied their son for his required physical examination before starting kindergarten. His parents are opposed to him receiving any vaccines. Scenario 2: A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance. Scenario 3: A 27-year-old man with Crohn’s disease has been admitted to the emergency room with an extreme flare-up of his condition. He explains that he has not been able to afford his medications for the last few months and is concerned about the costs he may incur for treatment. Scenario 4: A single mother has accompanied her two daughters, aged 15 and 13, to a women’s health clinic and has requested that the girls receive a pelvic examination and be put on birth control. The girls have consented to the exam but seem unsettled. Scenario 5: A 17-year-old boy has come in for a check-up after a head injury during a football game. He has indicated that he would like to be able to play in the next game, which is in 3 days. Scenario 6: A 12-year-old girl has come in for a routine check-up and has not yet received the HPV vaccine. Her family is very religious and believes that the vaccine would encourage premarital sexual activity. Scenario 7: A 57-year-old man who was diagnosed with motor neuron disease 2 years ago is experiencing a rapid decline in his condition. He prefers to be admitted to the in-patient unit at a hospice to receive end-of-life care, but his wife wants him to remain at home. To prepare: · Select one scenarios, and reflect on the material presented throughout this course. · What necessary information would need to be obtained about the patient through health assessments and diagnostic tests? · Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected. To complete: Write a detailed one-page narrative (not a formal paper) explaining the health assessment information required for a diagnosis of your selected patient (include the scenario number). Explain how you would respond to the scenario as an advanced practice nurse using evidence-based practice guidelines and applying ethical considerations. Justify your response using at least 3 different references from current evidence based literature.
Turn the brief into deliverables
- 01A separate analysis for each scenario.
- 02The ethical principle in tension in each.
- 03Evidence-based guidance for the vaccine conversation.
- 04The goals-of-care and surrogate questions in the arrest scenario.
- 05Practical and justice-based responses to the cost barrier.
- 06A statement of missing information where the scenario is incomplete.
Each scenario, its principle, then the guideline
Vaccine refusal and the third party
Set out parental authority, the child's interests and community risk.
What the assessor is likely looking for
Recognition that the risk extends beyond this child.
What the evidence says about the conversation
Give presumptive recommendation and motivational approaches.
What the assessor is likely looking for
An approach that preserves the therapeutic relationship.
Arrest in advanced cancer
Address directives, surrogate authority and goals of care.
What the assessor is likely looking for
The default in the absence of documentation, stated explicitly.
Cost as an ethical problem
Treat cost-related non-adherence as a justice issue with practical responses.
What the assessor is likely looking for
A named mechanism such as a patient assistance programme.
The scenario you cannot yet answer
State what information is needed before reasoning about the fourth case.
What the assessor is likely looking for
Missing information named rather than supplied.
Where the guidelines and ethical frameworks sit
Recommended databases
- NCBI Bookshelf
- AAP
- PubMed Central
- Walden Library
Search sequence
- 1.Find the evidence on presumptive versus participatory vaccine recommendation.
- 2.Read the advance directive and surrogate rules for your jurisdiction.
- 3.Search for cost-related non-adherence and its association with admission.
- 4.Check your state's vaccine exemption and school entry requirements.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Medical Ethics
StatPearls, NCBI Bookshelf · 2026
Medical ethics, for identifying which principle is in tension in each case.
Advance Directives
StatPearls, NCBI Bookshelf, National Library of Medicine · 2023
Advance directives, for the arrest scenario and surrogate authority.
Bright Futures
American Academy of Pediatrics · 2025
Preventive care guidance, for the vaccine conversation in a well-child visit.
Motivational Interviewing
StatPearls, NCBI Bookshelf · 2024
Motivational interviewing, for the evidence-based approach to hesitancy.
Access to Health Services
Healthy People 2030, Office of Disease Prevention and Health Promotion · 2024
Access evidence, for cost as a determinant of adherence and outcome.
Before you post to the Week 6 forum
Common mistakes
- Applying autonomy to all four scenarios regardless of the actual conflict.
- Recommending dismissal from the practice for vaccine-refusing families.
- Treating the cost scenario as a social problem rather than an ethical one.
- Assuming an advance directive exists when the scenario does not say.
- Inventing facts for the incompletely stated scenario.
Submission checklist
- Is each scenario analysed separately?
- Have you named a different principle where the conflict differs?
- Is your vaccine guidance drawn from evidence rather than from persuasion?
- Have you addressed who decides in the arrest scenario?
- Did you say what you would need to know for the incomplete scenario?
Use this guide to plan and review your own work. Follow your institution's rules and read Brinevia's academic-integrity policy.
Written by
Maren Caldwell
MSN, RN, CNE
Medical-surgical nursing, pharmacology and NCLEX preparation
Maren is a registered nurse with over 15 years of clinical and educational experience in medical-surgical nursing. She writes on NCLEX preparation, patient care fundamentals, pharmacology and evidence-based practice.
Reviewed by
Dr. Tessa Redmond
DNP, RN, CNE
Evidence-based practice and clinical education
Tessa is a doctorally-prepared nurse educator. She reviews Brinevia content for clinical accuracy and alignment with current evidence-based guidelines.