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Case Study Using the Deontological Decision-Making Process

Because finding affordable housing was difficult, 26-year-old Terry White lived with her 6-month-old son, Tommy, and his father, Billy Smith, in a one room of the landlord’s house. Ms. White was morbidly obese and was diagnosed with bipolar disease, Mr. Smith had served time for drug dealing and was out on parole and staying straight. Neither has finished high school. Mr. Smith’s past drug use had rendered him unable to do much manual labor because of heart damage, but on occasion, he would work in construction to support the family.

Public health nurse Jim Lewis had received a referral on Tommy when he was diagnosed with failure to thrive, (FTT) 2 months earlier, Ms. White (who had had two children removed from her custody by Child Protective Services (CPS) in the past) and Mr. Smith seemed to adore their baby so much so that Ms. White would hold the baby all day long. In the past 2 months, the nurse had taught Ms. White about infant nutrient and gotten her enrolled in the Women, Infants, and Children (WIC) nutrition program; as a result, Tommy had increased his rate of physical growth and was above the 5% level of his growth percentile. Yet he was not meeting his gross motor milestones per Denver Developmental Screening Test 11 (DDST111) testing. Mr. Lewis thought that Tommy was not allowed to play on the floor enough to progress in sitting, pushing his shoulders up, or crawling. Most of their small room was taken up with the bed and the boxes that stored their belongings. There wasn’t really space for “tummy time” or play. When not in the room, the family would take the bus to a discount store and spend the day walking around to get a change of scene. 

One week Ms. White told the nurse she was not taking her medications for bipolar disease anymore because they caused her to gain weight. The next week she confided that Mr. Smith had had a “dirty” urine specimen check and would have to return to prison in the near future. The following week Mr. Lewis found the family living in a run-down motel because they were evictee after a disagreement with the landlord. Ms. White was agitated, and she told the nurse that they had only $100, Mr. Smith was going to have to return to prison that week, and the motel bill was already $250. Ms. White knew she would be homeless soon without Mr. Smith’s support but refused to talk with her social worker about her needs. She asked the nurse not to tell anyone about her situation because she was afraid CPS would take Tommy from her. It was clear to Mr. Lewis that he might not know where Tommy was after they left this motel.


Using the ethical decision processes and the of code of ethics discussed in chapter 4 discuss and debate these questions. Considering the principle of      telling the truth, what are Mr. Lewis’s professional responsibilities to      Ms. White, to Tommy, and to the social worker assigned to this family? Using the generic ethical      decision-making framework discussed in chapter 4 and consider the      deontological ethical decision-making process:

a. How should Mr. Lewis respond to Ms. White’s request to not tell anyone about their situation?

b. What communication, if any should the nurse initiate with the social worker?

c. What communication, if any should the nurse initiate with others?  Using virtue ethics:

a. What actions would you take to resolve any moral dilemma you have about the safety of Tommy in this family situation?

b. If you do not tell anyone about the possible dangers to the child, what moral principles come into play?

c. If you do tell the social worker about the situation and the child is removed from the mother, what moral principles come into play for you? What ethical dilemmas may you      experience if you are the nurse in this case?  How can you deal effectively      with these potential dilemmas? 

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