Should Ms Worthen perform dialysis on the patient? Would it make a difference if the patient himself, rather than family members, requested the procedure? Should hospitals be allowed to require nurses to perform duties when they are ethically and/or morally opposed? Why or why not? When, if ever, should a nurse be able to refuse treatment to a patient? Why or why not?
Suggested completion date: October 31, 2008
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17 comments:
EDDIE. PRATT
10/28/08
BIOTHICS-SCENARIO #10
Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by Nurses in acute setting; KEY WORDS:
DISTRESS * ETHICAL CLIMATE * NURING * MORAL DISTRESS *
SENSITIVITY * SHORTAGES. That is why we have such a high turnover in the medical field. Yes, she should get her job back or go and get another one.
I dont think that any Worthen, shouldve been forced to perform the procedure. The hospital staff were wrong because in the nurses code of provisions it states that "if personally opposed to the delivery of care in a particular case because of the nature of the health proplem or procedures to be used the nurse is justified in refusing to participate. Such refusal should be made known in advance(which she did in her previous encounter with the patient and was given another duty instead) and in time for other appropriate arrangements to be made for client's nursing care.This provision is in place for a reason and personally, I think that it is in the best interest for the patient to have someone who believes in what they are doing and not just going through the motions performing a procedure. Regardless of who ordered the procedure, I don't believe that it would make a difference to Worthen. She had had issues before in treating this patient and believed the treatment to be detrimental and risky to the patient. M Longtin
In response to Eddie:
I think that high turnover in addition to a break down of efficency in our healthcare system also comes from the fact that the different rules and provisions are left to intrepretation openly by individuals who have their own agenda as I believe was illistated in this case.
Ethical dilemmas means no clear right or wrong answer. And a somber reminder that ethical dilemmas surface because we all have different intrinsic values. I presume this particular case is rather stemmed from the lack of clear understanding of Principle of Healthcare Ethics (Mitchell & Haroun, 2007, Introduction to Healthcare), which articulates the eight ethical principles of healthcare worker responsibilities.
Was patient well informed of his or her risky condition? (we don’t know). With available case information, I have no choice but taking side to perform dialysis to respect patient’s request. It’s his or her choice to take the possible risk.
One of the core principle is respecting patient’s autonomy. Based on this principle coupled with many subcategories of laws and regulations, it’d be difficult for physicians deny the patient’s request unless otherwise...(Advanced directives, living will, emergency case, etc., whole another slippery slops!). Here is the simplified list of the Eight Ethical Principles:
1. Preserve Life
2. Do good
3. Respect autonomy (patient’s)
4. Uphold justice
5. Be honest
6. Keep promise (contract)
7. Be discreet (HIPAA)
8. Do no harm
There’s no information about the interaction between physician and the patient’s family member. Perhaps, physicians may face lawsuit from patient’s family if things go sour? Most importantly, this is an example of healthcare concept called “respondeat superior,” which means a physician could be held liable for the consequence of a medical assistant. In this case Ms. Worthen refuse to perform dialysis.
In hindsight Ms. Worthen should have clearly discussed this case’s ethic and legal matter with her employer when it was surfaced a several months earlier.
Note. Introduction to Healthcare is text book for the class HCC130.
JWK
She had performed the procedure before and didn't object until she had trouble with it. That makes me question what her moral and philosohical objections were. In my opinion keeping someone alive who hasn't expressed a wish to die or is not irrevocably comatose is moral. There is also an employee/employer relationship to consider. The nurse was being paid to do a job she was unwilling to do. The solution from an employer prospective is not to pay her anymore i.e. termination. I don't think the nurse has the ethical high ground to refuse to do life sustaining treatment. The article said the family wanted the patient kept alive, so I'm assuming the patient is comatose. I disagree with the family's decision, but it is their decision to make. I would support the employer in this case, with the limited information presented.
Greg Dawson
She had performed the procedure before and didn't object until she had trouble with it. That makes me question what her moral and philosohical objections were. In my opinion keeping someone alive who hasn't expressed a wish to die or is not irrevocably comatose is moral. There is also an employee/employer relationship to consider. The nurse was being paid to do a job she was unwilling to do. The solution from an employer prospective is not to pay her anymore i.e. termination. I don't think the nurse has the ethical high ground to refuse to do life sustaining treatment. The article said the family wanted the patient kept alive, so I'm assuming the patient is comatose. I disagree with the family's decision, but it is their decision to make. I would support the employer in this case, with the limited information presented.
Greg Dawson
Well this is certainly tricky. The nurse does not have the right to decide whether or not to do the procedure. She has done the procedure before and ran into complications. If the patients family has been made aware of the life threatening risks of the dialysis and they still give the go ahead on the procedure it is the nurses obligation to respect the wishes of the patient and his/her family. The number one rule to health care delivery is to set your personal feelings and values aside, it is not about you. A nurse should never be able to refuse medical treatment to sustain life if it the wishes of the patient. I do not think that it made a difference if he or his family made the decision because he obviously had something stating that one of the family members were power of attorney and that therefore gives them all decision making rights.
Kayla Parent
Greg--
I agree. Although, we do not agree with the families decision to keep the patient alive it is not our decsion. If nurses were allowed to just decide not to provide medical treatment because they are scared of the outcome, I certainly would not want to go to that hospital if ever my life were in danger.
Kayla Parent
Michelle Camping
11-15-2008
In this case I agree with the nurses who pulled herself from the case. If you don't feel like you would serve the patient best you should pull yourself. She didn't think it was the best treatment or that she would be best for this patient. I would rather have someone drop then perform on me if they weren't the best for my procedures.
The hospital should be sued for wrongful termination. They should though think what this nurse should be assigned to in the future.
I would have done the same.
Michelle Camping
11-15-2008
Responding to jwk; I think they should respect the patients request, but they should make sure they assign a nurse who will do the treatment instead of waisting time on one they knew from before wouldn't perform the proceedure.
In the code of professional ethics for nurses it states that “If personally opposed to the delivery of care in a particular case because of the nature of the health problem or the procedures to be used, the nurse is justified in refusing to participate. Such refusal should be made known in advance and in time for other appropriate arrangements to be made for the client's nursing care.” I think Ms. Worthen did this and I don’t understand how she was justifiably fired. I think that if a nurse is morally or ethically opposed to a procedure, they should be able to refuse to do it as long as they believe the procedure is harmful to the patient’s health. Ms. Worthen believed that the dialysis was doing more harm than good on her patient. Seeing as the patient went into cardiac arrest both times he was in dialysis, I would say she is probably right.
I believe that if the patient himself was requesting the dialysis, it would make a little bit of difference because the family may just be keeping him alive for their own selfish reasons.
Erin
Ms. Worthen should have performed dialysis on the patient. I don’t think it would make any difference if the patient were requesting dialysis or his family. Nurses are required by hospitals to perform their job accurately while providing excellent patient care. A nurse may be ethically and/or morally opposed to perform certain tasks but they are still required to carry them out. What if a nurse practiced a certain religion where they did not believe in blood transfusions, so that nurse in turn refuses a blood transfusion to someone because she doesn’t believe in it. That is one of the difficult things about working in health care, you aren’t going to agree with everything that goes on, but that’s your job. Nurses are not allowed to refuse treatment to a patient. If a nurse sees a problem with the treatment they can certainly verify it with a doctor but they can’t refuse to carry out the task. I think she went about everything the wrong way. Instead of refusing the patient treatment she should have documented the adverse side affects of the dialysis treatment and then share the results with the patients doctor and her department’s Director.
Amanda Rhoades
Kayla-
You are going to be so great in the health care field. It is hard to set your morals aside but its awesome you already realize that's what has to happen.
Amanda Rhoades
I believe because the patient's family (I assume he could not) request to do the dialysis then it should be performed but the fact that he has obvious complications when it is performed, changes it. I think the nurse should be able to refuse treatment of this kind because it obviously is affecting the patient, she isn't doing it just because she doesn't want to. I think maybe the nurse she explain to the family (if need be behind the head nurse's back) and explain what it is doing to him, maybe then the family would have different wishes? This one is a little different because she is choosing to not do the treatment to save the patient that extra complications he would more than likely go through. I also think if the patient himself asked for the treatment, knowing what would probably happen and being able to experience it himself, then she should do it with no problems as long as he understood what was going to happen. Is it worth keeping someone alive to have to go through so many more problems?
Commenting on K.Parent
I agree with what was said but wouldn't you try to have the family see what it was doing to the patient? I think maybe they don't realize how many problems the treatment is causing him. Maybe they do and in that case I see them as selfish but I would just try to do everything I could to make sure everyone saw what was happening. (I do agree though especially how she should honor the duties of her job, even though at some times I am sure it is not easy).
I believe that the nurse should not have to do something that she is not comfortable with. She also has clearly stated that in the past and the hospital did not have a problem with it. I am sure that there were other nurses present who could have performed this procedure and this conflict would have been avoided. However, I do believe the hospital has the right to terminate her since she was asked to do a job in the domain of her field. If your employee is not doing as you ask then I believe you might as well find someone who will do it. But in this particular case she had already asked the hospital to be removed from this particular position. So I think that as long as she had proven herself to be a reliable worker than the hospital should have let the situation go. I don't believe this was an offense she should have been fired for. A suspension at most but termination of a good employee over one incident is not enough.
Joe King
It is unfortunate that the Worthern was fired and that she sued hosptial and lost. It is even sad that the family wants to keep patient alive even though treatments before are causing such damage. I think that Worthern did good in standing her position and not allowing the hospital to make her perform such acts. I would want someone performing medical treatment on me to think and consider all outcomes before just following orders.
Shundeen Cadman
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