Arizona State University College of Nursing NUR 316 Due on March 14, 2012 Ethical Decision Making Case

Study Directions Pair up with another student (see assigned pairing) Using the Clinical Ethical Decision Making model provided, select, discuss, and critically examine one of the following case studies. Enter relevant data into each of the four cells of the model for the case study you select. Analyze this case by discussing the following: 1. Which action would you take as the nurse in this situation? 2. Which ethical theoretical perspective informs your choice of action? 3. Which provisions and interpretive statements in the Code of Ethics for Nurses support your choice of action? Submit jointly, the one case study analysis consisting of the model used as a worksheet and 1 page in which you address items 1-3 above.

Case Situation #1 Edith, a 68 year old woman, was admitted to the inpatient unit at the Behavioral Health Hospital after a suicide attempt with an overdose of antidepressant medication. She was diagnosed with major depression with psychotic features. After the initial evaluation and mental status exam, she was found to have impaired judgment and decision making capacity. This is not the first admission for Edith. She has been treated in the past for depression and reports of non-compliance with her medications---antidepressant and antipsychotic. She has no family or guardian to help support her during her times of crisis or to help her make decisions about her care. She wants to be discharged home now. The psychiatrist, who is new to this agency, believes that the only treatment that will help her at this time is a course of electroconvulsive therapy (ECT). When presented with this recommended treatment, Edith says, No shock treatment ever. The psychiatrist tells Edith that it is the best treatment to help her and that he cannot discharge her home for her own well-being. He then asks the nurse to talk with Edith about ECT and its benefits and to convince her to sign the consent for a course of treatment. Case Situation #2 Jason, a 27 year old, newly married man, was admitted to the inpatient unit after being brought to the hospital by the police. He had been found wandering around a Babies-R-Us store parking lot. He had been diagnosed with Schizophrenia, paranoid type five years before and had been seen by a team at the psychiatric out-patient clinic. He has been on antipsychotic medication which he reports, I take them most of the time when I can afford it. It costs a lot you know? He has a part-time job that pays minimum wage. When Jason talks with the nurse after admission, he tells her, Nobody knows about me. Nobody can know. No one can be trusted. Its our secret. When his pregnant wife comes to visit in the hospital Jason refuses to talk to her. She then approaches the nurse and asks, Whats wrong with him. He wont talk with me. Tell me whats wrong with him. I have a right to know.

kdm/bpf Spring 2005

CLINICAL ETHICAL DECISION MAKING

CONTEXT
FACTUAL SITUATION
Found wandering outside Previous medical diagnosis of paranoid-type schizophrenia States partial adherence to medication orders when he can afford it Refuses to see wife and inform wife of medical condition

ETHICAL SITUATION
Moral Conflict: Moral Distress--the clear choice of following the patients right to autonomy is affected by his mental state of paranoia. Principles: Autonomy, beneficence Theoretical Perspectives: Deontology, relation-ship based Moral position of key individuals: Nurse as patient advocate and judge of patients present mental state. Wife as caretaker of husband. Moral Agent: He may or may not be considered a moral agent based on his mental state. Quality of Life: Degree of independence is questionable based on how he was found, and how is mental state is inhibiting his caretakers need-to-know basis

Options & Possible Outcomes

The nurse can go against patients right to autonomy and inform the wife of his condition. The nurse can refuse to disclose information based on patients right to autonomy.

External Influences
Economical with the ability/inability to purchase meds Social with decision of whether or not to inform wife of medical diagnosis Legal of breaching patient confidentiality and informing wife of husbands condition Community resources and whether or not there are any available to help patient afford his meds Political programs available to make medications more accessible for patient Socio-cultural- whether its right or not for patient to refuse to inform wife of diagnosis.

CONTEXT ACTION SELECTED

EVALUATION

BPF 2004

In the given situation, our decision would be to adhere to the patients right to autonomy and not disclose his medical status to his pregnant wife. We found there be moral distress in making the decision due to the conflict of the patients right to autonomy and his impaired state as a moral agent. The fact that the patient was found roaming the streets indicates his need of a caretaker should be aware of his situation, however the patient was in a paranoid state and was unwilling to disclose his condition to his wife. We decided the best course of action at this point in time is to medicate and stabilize the patient and revisit this dilemma once he has been stabilized. We are making this decision based on the ethical theoretical perspective of Deontology.