Ethical Dilemma

  1. I need some advice about a patient that I admitted last night. I know we've all debated about these situations in nursing school but I've never had this happen to me in real life before.

    The pt came to emerg with increasing SOB. CXR showed a large mass, probably cancerous. Also, L pleural effusion and pneumothorax. Pt very uncomfortable, ++SOB, on 100% NRB O2. Long story short the family does not want the pt told about his dx. Pt is completly competent but does not speak English, thus far we have been relying on his family to translate information for him.

    Doctors have agreed not to tell the pt yet, but have refused to do any invasive procedures without him being aware. Therefore no bx. So were in a situation where we doing nothing more than pain control and comfort measures on a pt who is full code. We are watching him die and he doesn't even know it!

    If anyone has any advice or has been involved in a situation like this one, please share. Thanx.
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  2. 21 Comments

  3. by   gizzy76
    sounds like a tricky situation! have you spoken with the nurse manager for advice?
  4. by   Darlene K.
    Does your hospital have an ethics commity? If so, I would contact them asap! If not, call risk management.
  5. by   RNonsense
    I, thankfully, have never been in your position. Sounds rather unpleasant. You are your patients advocate. Does the patient have a family doctor that speaks the language? Did anybody ask this family why?
  6. by   hapeewendy
    RUN RUN RUN to your nursing supervisor , speak with the dr, ethics committee whatever it takes!
    this is NOT right...
    if the patient is a full code, actually it doesnt really matter if he is DNR Or not , the most basic rights of this patient are being ignored and violated!!!!!
    u are this patients advocate and as a nurse you have a responsibility to act in his best interest...
    doing nothing is not in his best interest is it?
    making a supervisor or the MD aware of your concerns about this situation shows that you do infact care about this patient, and are trying to protect the license you worked so very hard for ....
    good luck , keep us posted..
  7. by   Tweety
    Incident Report. Ethics Committee. Management. Let all these in on it.

    Sounds like a family conference with an interpreter is in order.

    It's a shame that the family wouldn't agree to at least a chest tube to relieve the pneumo. They need some serious educating.

    I don't have any answers for you, let us know how it turns out.
  8. by   Nurse Ratched
    Not to dredge up that thread again, but I remember some people were questioning using the "family friend" to translate for the Jessica Santillan family. Seems like when there is a potential conflict of interest there should always be a third party disinterested translator.

    This person has EVERY right to get his diagnosis. Not speaking the language doesn't make him stupid - he's gotta know something is up.
  9. by   sjoe
    In some cultures, and this one was NOT specified, it would be a very big mistake to "tell it like it is," as we pretend that we do here in the US. In order to criticize or second-guess this decision, we would need to know more about what culture this patient comes from.

    Despite what some global planners think, the US way is NOT always the best way for everyone.
  10. by   researchrabbit
    At KU, we were required to have a professional interpreter, and the hospital employed people who could be pulled from their other jobs for this purpose as well as a staff of two who spoke several languages (including sign). If none of these were available, an interpreter service was used. I was delighted to work with the interpreters there on several occasions. They were SOOOO good.
  11. by   Jay Levan
    Please pardon me but are you all practicing in a different country??? Have you not been oriented to the HIPAA regs.?? Family has no rights that supercede the PATIENT'S RIGHTS period.Not only that but if this patient finds out that you have been withholding information about his health ie Diagnosis Prognosis proposed treatment plan etc. and an attorney finds out about the case he will start adding the fines that the primary caregiver, the doctor, the Hospital etc. have all been guilty of in not revealing this patients information (PHI) and he will see how fast he can get to $25,000 dollars each violation by each of the afore mentioned parties will be liable for these amounts of cash all the way up to $250,000 need I explain further, I think not. Please do not trust me just go to US Gov/HIPAA and read my friends READ.and be enlightened.
  12. by   angelbear
    I would think that unless this person has given a poa to one of the family members that the family has no right eithically or legally to make any decisions on his behalf . A perfectly competent person has a right to know regardless of the situation. IMO
  13. by   angelbear
    ohh, Good point about the HIPPA. Speaking of which why did the family need to know his diangnosis. Unless of course they have a POA.
  14. by   essarge
    While I'm still a student, I have seen incidents like this in our ER. The standard is to call in an interpretor to 1. make sure that things are traslated correctly and that the family is not "protecting" the other family member. 2. It is explaine to the family in a very nice way that, while it is appreciated that they want to "help" the family member, it is their right in this country to be informed of EVERYTHING that is going on. This includes diagnosis, prognosis, treatments available, etc. 3. If the family refuses or argues, then the hospital very nicely tells them that they will not be allowed to visit the patient until all of the above have been met.

    The important thing is also to bring in social services to counsel the family and allow them to express their concerns while still keeping patient rights as the number one priority.

    If all of the above objectives cannot be met, then, the ethics committee is contacted.

    Hope this helps.

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