Sam's Choice By Karen Collins

In Sam’s Choice (Collins, 2010), Sam’s visiting nurse, Karen Collins, RN, faces an ethical dilemma where she has to choose either patient advocacy and autonomy or beneficence. As a retired veteran, Sam was very independent and determined to be able to stay in his own home and live his life on his own terms. After an injury, which resulted in hospitalization, however, a healthcare home nurse, Collins, was sent to his home to evaluate his health as well as his living situation. Upon this assessment, Collins determined that the best thing Sam could do for his health was to move to a long term-care facility or assisted living facility. This option, in Collins’ opinion, would have provided the most beneficence to Sam, which is an important ethical principle every nurse must consider when working with patients. Sometimes, however, patients do not share the same values as the nurse and choose to make their own decisions on what is best for their health. This was definitely the case with Sam; Collins writes, “to me, it was evident that a long-term-care facility was the best option for Sam—but obviously this wasn’t evident to him. So instead of trying to change his mind, I turned my attention

and energy to supporting his choices” (Collins, 2010, p. 49).
In this ethical dilemma, Collins decided it would be most ethical to allow Sam to have autonomy and to advocate for the independent decisions he would make.

This aspect of the story made me feel a little upset as I put myself in Collins’ shoes and tried to imagine myself in Sam’s small home, knowing that his decision wouldn’t be of the best interest to his health. Nevertheless, I understand how important it is to be an advocate for each and every patient and be able to support his or her decisions even if I disagree. After making the decision to be on board with Sam’s decisions, Collins worked to make his living situation the best it could be and used the ethical principle of non-maleficence to guide her care of Sam by doing everything she could to avoid further harm of her

patient.
In the end, Collins was able to look back on her professional relationship with Sam as a positive experience, as it provided a chance to reflect on the various ethical principles nurses work with to provide care for each patient. She concludes, “Sam never let me forget that my job as a patient advocate is to support my patients’ decisions as best I can—even though I might not agree or make the same choices for myself” (Collins, 2010, p. 49).