Ethical Issues, Case Study Example

Within this case, there are multiple ethical issues that we face in properly handling the care and decision-making for Mr. E.  It is an ethical code and law that the wishes of the patient must be followed in terms of medical treatment, if the patient is viewed as capable of making such decisions.  In this scenario, Dr. G and I have determined that Mr. E is unable to properly make a rational decision so the decision then becomes thrust upon the shoulders of his next of kin, which happens to be Mr. B.  Unfortunately, Dr. G breaks a very important law and ethical code in informing Mr. H of the status of Mr. E and providing him with the ability to make the decision to use the ventilator for Mr. E.  This decision is not his to make, and according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule, the state laws restrict health care information to be shared only with family members if they are the patient’s personal representative.  This is usually a title provided under the power of attorney. Therefore, the decision lies with Mr. B and with him alone, and he has not granted consent to perform any specific type of action for treatment.

Autonomy provides the patient with the ability to self-determine the treatment that will be used with his or her own situation.  In this case, Mr. E has previously written that he does not want any feeding tubes, ventilators or other actions like CPR to be used to resuscitate during problematic situations.  These are his wishes and must be followed.  According to the nursing code of conduct the patient has a right to self-determination for treatment that should or should not be utilized in all cases of his or her physical well-being.  Unfortunately, Dr. G is purposely looking to implement the recommended strategy at any cost.  Autonomy must be followed, unless the autonomy is lost during a time where the patient cannot make a rational decision.  In this case, the patient has made his decision prior to the dangerous situation he is in currently, so the doctor and I must treat Mr. E to the best of our abilities without using the treatment methods he has restricted.  Furthermore, nurse autonomy provides that we must focus on the central issue of doing what is best for the patient.  In this situation the Board of Medicine requires that we follow the defined wishes of Mr. E and use the autonomic philosophy to restrict our treatment methods.

Meanwhile, it is unethical for both the doctor and I to put Mr. E on the ventilator with his own permission.  It is bordering on unethical if Mr. B were to even give us permission, although we have reasonable grounds to believe that Mr. E was not in a rational state of mind now or even when he wrote his specific instructions in the nursing home.  Therefore, it can be ethically justified for Mr. B to make the decision, so long as the health of Mr. E is not harmed and leads to a full recovery.  However, it is my responsibility to report Dr. G for speaking with Mr. H about this matter.  It is not Mr. H’s responsibility to make such a decision and it is against the law and our medical code of ethics to share such information with anyone other than Mr. B.  It is our responsibility as nurses to maintain the treatment methods that are approved by the patient and are best for the recovery of the patient.  In all cases, the overall benefit of the patient is the top priority, not the wishes of the doctors or nursing professionals.  In this scenario, I have seen and heard Dr. G sharing the information with Mr. H on the status of Mr. E.  I should immediately share with Mr. H that he does not have the authority to make any decisions on Mr. E’s treatment methods and must share the information with Mr. B immediately.  This is the extent of my involvement with Mr. H.  To protect Dr. G and the medical staff, I will not explain that Dr. G has broken the law and violated our code of ethics, but I must maintain a relationship with Mr. H that restricts the amount of information shared with him from this point on.

As a nursing professional, I have a direct responsibility for the welfare and medical treatment of the patient.  I want to see that he is properly treated and will receive the resources necessary to continue to maintain a high quality of life.  I should also focus on the mental quality of life that the patient is seeking to maintain.  In this situation, if Mr. E were to be resuscitated or revived from any problematic situations against his previous wishes, he would not life a mentally high quality of life.  Therefore, it is my responsibility to ensure that Mr. E and all patients receive the best treatment possible and to explain to them the benefits of all treatment methods available to them.  I should not restrict the ability of the doctor to provide medical care, but at the same time it is my responsibility to protect the patient from unlawful acts by other professionals and unethical behaviors that restrict their rights as patients.