Question 1717

Question Answered step-by-step Ginger Berrian, a registered nurse and the nurse manager, walks ontoan oncology unit. Thelma Galinsky, a bedside nurse, comes up to her and screams, “I’ve had it! Dr. Little is telling Mr. Winter’s family that all is well and ordering another round of chemo and everyone except Mr. Winter and his family know that he is dying! Besides, he is still a full code.” Ms. Berrian knows that Dr. Little has a reputation for not knowing the limitations of medicine and for inappropriately treating those who are actively dying with life-sustaining medical technology. The words hospice and palliative care just do not seem to be in his lexicon – not to mention the work “dying”. Unfortunately, Dr. Little has a huge practice (and makes a lot of money, making large donations to the hospital) and his patients like his warm and cheerful bedside manner. Earlier efforts to change his practice have been unfruitful. Thelma Galinsky, the nurse who just screamed, has been a passionate patient advocate, but you have noticed recently that her efforts to advocate for patients have been subdued. This time she tells you in no uncertain terms that she does not want to care for any of Dr. Little’s patients – which would be a scheduling nightmare since there are so many.Commentary This case raises ethical issues at many levels. We might note first that Mr. Winter cannot possibly have given an acceptably informed consent to his chemotherapy if he does not know his true medical status. Thus, the treatment Dr. Little is providing (and in which Ms. Galinsky is being asked to cooperate) is probably in violation of informed consent law as well as informed consent ethics. Moreover, Dr. Little has probably lied to the patient about his prognosis or at least spoken in a deceptive or misleading way. That raises questions about the ethics of truth telling. It is not clear whether Mr. Winter remains mentally competent. If he is, there may be issues about why Dr. Little and the rest of the healthcare team are dealing with the family rather than the patient. For now, let us focus on the unpleasant dilemma of Ms. Galinsky and her supervisor, Ms. Berrian. They seem to understand that the patient, Mr. Winter, is not being treated in an ethically appropriate manner and that they are the victims of Dr. Little’s expectation that they will cooperate in his approach. While that might have been the expectation in an earlier era, it no longer fits with the understanding of the nurse and other members of the healthcare team as professionals with responsibility for their actions. The challenge is trying to figure out an appropriate response. In our study of ethics and professional practice, we know that nurses have a number of avenues of inquiry to discuss their concerns. In this case the nurse could confront the physician directly, the nurse could turn to colleagues and as a team they could approach the physician or the physician’s boss (Head of the department). The nurse could turn to the Ethicist at the hospital or the ethics committee. Ultimately the nurse started with her supervisor, Ms. Berrian. In this case, the supervisor, Ms. Berrian, is already aware of the issue and bears some responsibility in assisting to resolve the matter. One approach, removing Ms. Galinsky from Dr. Little’s cases, does not address the underlying issue of the patients who are being treated inappropriately. It merely shifts the burden to other nurse colleagues. Ms. Berrian, the supervisor, may have other resources available, including consultation with the physician colleagues of Dr. Little and the Director of Medicine. This particular case presents another option since it appears that the treatment of the patient may well be illegal as well as unethical. Ms. Galinsky, with the assistance of Ms. Berrian, might need to bring the case to the attention of the legal counsel for the hospital.Using the above information, apply this scenario to the ethical decision-making framework: -Individually Reflect on the case and the commentary. Write down your initial thoughts/reactions. Health Science Science Nursing NLM 201 Share QuestionEmailCopy link Comments (0)

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