According to the ethical decision-making model, moral awareness is the recognition that an ethical issue exists. When he first took the clinical director position, E.L. Straight realized Hopewell Hospital, just like many other hospitals, employed physicians that did not provide quality patient care; specifically, the general surgeon Dr. Cutrite. Using his moral judgement, Mr. Straight filed paperwork to limit Dr. Cutrite’s practicing privileges to avoid future patient harm. Now, based on the information he has received, Mr. Straight is in a position where his APPLYING ETHICAL PRINCIPLES ethical behavior has the potential to either cause harm to his career or act in the best interest of the patient. Communication for Prevention Based on the information provided in this case study, it is quite possible the event could have been avoided had the nurse circulator communicated the need to perform a “time-out” during the procedure. This is a standard occurrence where all surgical activity is placed on hold and a checks and balances of all instruments used are counted. Another missed opportunity for a successful encounter occurred at the conclusion of the surgery. The nurse did not question the whereabouts of the cap to an inventoried syringe that had been used by Dr. Cutrite. Ethical Principles for a Resolution Healthcare is considered ethical if it involves four principles; autonomy, justice, beneficence, and non-maleficence. Before being told Mrs. Jameson had already been discharged from the hospital, E.L. Straight suggested taking the patient back into surgery to look for the needle cover under the guise her incision and deep sutures required a second check. This approach violates the patient’s right to autonomy and justice by impeding their decision-making process. In addition, the intent of beneficence and non-maleficence can also be called into question. Prior to Mrs. Jameson’s abdominal surgery, previous concern had been raised regarding the declining skills and knowledge of her surgeon, Dr. Cutrite. The solution to the ethical dilemma in this case study is never revealed. However, the expectation is every detail was taken into consideration and someone in Mr. Straight’s chain of command realized there was a duty to inform the patient. There would be no need to assign individual blame, but the organization has a moral obligation to take responsibility