Ethics is of great importance within the healthcare industries. This is major attributed to the fact that people working within the healthcare industry deal with situations and circumstances which affects people’s lives directly.  Therefore, an ethical dilemma is a complex situation which involves an apparent mental conflict between moral imperatives, that in order to respect, leads someone to transgressing another. It is also referred to as an ethical paradox, since paradox plays a major function in ethical debates when it comes to moral philosophy. For instance, ‘love your neighbor as much as you love yourself’, sometimes contradicts the action of an armed rapist. If he/she makes a break through with his/her intention of rape, one will never be able to love him/her. Funnily enough, to preemptively restrain them is not understood as loving. This is an ideal example that illustrates how an ethical decision conflicts with an orgasmic decision that would be made only from the perspective of animal survival (Finkelman, 2012). However, it is important to note that people have complex relationship of which should not be neglected. For example, if one is ethically related to the neighbors that are attempting to kill him/her, then obviously their desire to kill him/her is likely to have resulted from mental illness on their part or stories narrated to them by other individuals. These kinds of conflicts can be solved by some sort of mutual agreement and well defined rules (Finkelman, 2012). 

As a matter of fact, ethical dilemmas are normally cited to try to sideline an ethical system or moral code and the world view that emerge from them (Finkelman, 2012). These arguments can be refuted by either proving that the claimed ethical dilemma is only apparent and therefore does not actually exist, that the solution to the ethical dilemma encompasses selecting the greater good and minimum evil, that the whole episode or the problem is omitting creative alternatives, or must hold since the case cannot be withdrawn from the context and still have a meaning. It is evident that these ethical dilemmas do affect registered hospice nurses as well as their patients. Hospice nurses are normally subjected to hectic day to day duties. They are expected to observe, assess, record symptoms work closely with physicians, administer medications and provide emotional support to patients.

Serious variations to some aspects of political, social, economic, scientific and technological areas of health care have caused an increase in complexity at workplace thereby propagating ethical dilemmas (Finkelman, 2012). Nurse administrators in the administration and specifically head nurses are repeatedly confronted with these dilemmas when making their daily administrative decisions requiring choices of moral and ethical nature. Studies shows that nurse administrators undergo ethical dilemmas involving quality of care issues and patient care, allocation of resources, issues related to staffing, conflict between organizational and professional philosophy and standards, concern with preventing harm, lack of skills to competently perform their duty, and professional autonomy (Pollock, 2011). Of all the major ethical dilemmas experienced at hospice, discrimination has become the most rampant.

Discrimination at hospice occurs in many ways. The first way is when a nurse is subjected to serious punishment like suspension from his/her duties for actually committing an offence that does not attract such kind of penalty (Finkelman, 2012). However, such discriminatory punishment is common at Hospice and is attributed to difference in race between the nurses and the managers. For instance, an African nurse was suspended from Hospice hospital in the United Kingdom for missing to attend to her duties without permission from the relevant authorities. She tried to explain her reasons for doing so, which was quite understandable, but all that fall into deaf ears. According to the manager, rules have to be followed to the letter.

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According to Pollock (2011), discrimination also happens when a patient is turned away by the managers following the fact that he/she is not their tribe mate. Hellers (2007), further asserts that instances of discrimination have become quite common in Hospice healthcare based institutions. For instance, two patients who are both suffering from cancer arrive at a hospice almost at the same time but unfortunately one of them is admitted while the other is sent back. On investigating, it is found out that this is to do with the tribal issue; the one sent away comes from a different tribe from that of the manager. Discrimination on the basis of sexual or gender orientation may be extremely difficult, but sincerely speaking, it is an essential issue to address. If this problem is not handled amicably, then it is bound to become a disaster. Many a times, some of the male managers do not admit male patients into the Hospice that they control and instead prefer to give admission to female patients. Actually, this does not apply only to patients, but also to qualified nurses to be recruited.

Other patients at Hospice are also discriminate against on the basis of their health conditions. It has commonly been noted that managers and those responsible for the admission of patients rarely admit seriously ill and the patients with special needs (Hellers, 2007). The main fear being that, such patients require a lot of attention which to some extent prove to be expensive. Lastly, ignorance and hatred of managers have also propagated discrimination thereby leaving the nurses and the patients stranded on how to handle the situation. That is, whether they should adhere to manager’s discriminatory acts or assist the patients. 

Discrimination, as a major ethical dilemma, is a serious drawback to the ethical standards of operations expected of an institution such as Hospices and well being of the patients. It therefore means that if such form of ethical dilemma is not addressed, it is might turn out to be an international disaster and these hospitals will lose the real meaning of why they were established. There are several ways that can be adopted in order to cab such problem. Current workforce especially the managerial part of it is constituted by individuals who are more diverse in nationality, culture, religion, age, education, and socioeconomic status. It is obvious to mention that Hospice managers enter the work force with different values, goals, perceptions of acceptable behaviors, and backgrounds. This composure of diverse, multicultural managers can be asked to effectively work together in the spirit of cooperation, respect for the institution and patients they observe which minimize discrimination (Lo, 2009).  

Moreover, only training of managers cannot effectively control discrimination (Lo, 2009). This implies that, new measures need to be adopted. These include; sensitizing and educating managers on the importance of shunning discrimination on their juniors and their patients, ensuring that Hospice institutions are well staffed by nurses from different ethnic backgrounds and lastly formulating and enhancing laws to handle discrimination (Lo, 2009). It is also essential to set vigilant penalties on managers found exercising discrimination in the institutions that they manage (Lo, 2009).

In conclusion, most of ethical dilemmas that have faced nurse and patients visiting Hospice hospitals are attributed to discrimination. Such uncertainties have in themselves made nurses be caught in a state of indecisiveness especially on whether they should adhere to their managers or attend to patients as nursing ethics demands.  On the other hand, patients turned away or ignored on the basis of their race have sometimes found it hard to come into terms with the situation or even get medication for their wellbeing. Owing to the side effects that ethical dilemma cause to Hospice hospital, it would be prudent for appropriate measures to be taken on the issue so as to promote nursing ethics.

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