You are working in your new job in a suburban Accident and Emergency department. A young woman, named Jenny, presents complaining of abdominal pain. She tells you she has been too ill to go to the chemist to have her regular does of methadone. Methadone is a drug given to heroin addicts to help them get off their addiction. Jenny is placed on a trolley bed and the doctor inserts a cannula in her forearm.
The duty nurse says to you with a wry smile, "that's Jenny; she's a regular. You'll get to know her and all of her charming family. They're all heroin addicts. You often see them hanging around the Mall, near the pub. Look at her, she's off her face. There's no way she should be getting methadone!" The nurse then pulls a large book off a bookcase and hands it to you, saying "here, you can read all about our regulars so you know what to do when they show up".
The book contains names and descriptions of various people. You find some of the comments amusing, for example, you read about a man, Ken, who "presents after the pubs close complaining of renal colic and requests morphine. Sometimes he asks for an ambulance to take him home. His hands look like he hasn't done a hard day's work in his life."
The nurse comes to you and says "I'll sort Jenny out now. You want to see something funny? Come on". She then shows you an ampoule of Narcan. Narcan is a drug given to reverse the effects of narcotics such as heroin. It has a rapid and dramatic effect. "We'll pretend we're flushing her cannula. Then she'll be able to get herself to the chemist." The nurse administers the Narcan to the unsuspecting Jenny. Within seconds Jenny leaps up in her bed and swears loudly at the nurse.
1. Identify what you consider to be the key ethical issues in this scenario.
2. What considerations are relevant in deciding which are the ethical issues?
3. Who are the "stakeholders" in this situation? (Stakeholders are people who have interests that should be taken into account).
4. What do you suggest be done in this situation?
Dec 9, '06
The nurse's attitude is horrid, first off.
She has likely committed an illegal act by giving the Narcan without a doctor's order. She has prevented a patient from seeing a physician, she has experimented on her without permission, she has diagnosed and prescribed, she needs to lose her license post haste.
Everyone named is a stakeholder.
I suggest you stop the nurse from giving the Narcan and get the freaking physician to see the patient!
Dec 9, '06
are u wanting us to do your homework?
I think it is abvious what the ethical issues are, many of them. The most obvious is giving a med. without informing pt. and was there an order?
As difficult as it is all patients have to be treated with dignity and respect.
Nurses and Docs in the ED do tend to get Jaded, and I don't blame them.
I could go on but I will stop for now.
I have to get ready for work.
Dec 9, '06
If this is your homework, many people will be happy to help. However you generally will get more assistance and good will if you post what YOU have done so far, or specific problems you are having with the assignment, rather than expecting people to do the assignment verbatim.
Dec 9, '06
Not at all sure about that book with the FF names and details in it. Is it an official book? Is it discoverable in court? Are there personal opinions and observations about the patients (the kind you aren't supposed to chart in the MR)?
Giving a drug without a doc's order goes without saying, but I'm not overly happy with the idea of giving the patient a drug she's not aware she's getting and lying about flushing the line. The discussion might not be a comfy one about why she's not getting the methadone (assuming the doc has said she's not getting it) but someone has to have that chat with her, FF or not.
When it comes to FFs, EVERYONE is a stakeholder. We pay the bills on this stuff, for the most part.
Intersting questions though - it really IS easy to get jaded. But it'll be the one time that FF comes in and we're jaded, that she'll really have something lifethreatening, and our butts will get burned. I'd rather do 50 EKGs on 50 BSCP FF's than miss the one that will get my license and livelihood.
Dec 9, '06
Yes, this definitely looks like a homework question.
You need to look it up hon.
Dec 9, '06
How come a while ago I got blasted for telling a student to look something up rather than helping, and yet people here are telling her to look it up??
The book is a big no-no. We used to have a frequent-flyer book but HIPAA prohibits having one anymore.
Dec 9, '06
I don't know what your other post was - I'm happy to help, but I'd like to see SOME effort on the part of the person. Helping is one thing, doing the whole assignment is another!
Dec 12, '06
Patients expect to receive help when they are sick, and they expect to receive help so that they do not become sick. Our society is set up to provide this within reasonable limits of care. The nurse responsibility is to meet these reasonable expectations.
In the scenario the nurse ignored Jenny’s complaint of abdominal pain she was unconcerned of her dilemma instead she labeled her and the family as ‘all heroin addicts’, I thought her behaviour was so unethical, no respect to individual feelings and emotion although Jenny may not hear her comment I personally think it is un professional.
Autonomy is commonly described as the right to self-determination, the ability to control what happens to us and how we behave. It is an important ethical principle as it involves respect for individuals and personal space. It is also a principle which is reflected in a number of areas of health law, particularly in relation to one’s right to consent to treatment and to receive information about one’s treatment.
Ethical issues in the scenario:
Giving medication with out consent
Administering medication without prescription
Narcan is only available on a Doctors prescription
The side effect if its given quickly:
Nausea & vomiting
Suggestions for question 1?
Dec 12, '06
From the terminology in the first post, it would appear that the OP is from the UK or Australia or some other country outside the US.
While ethical considerations don't necessarily change from one locale to another, legal matters do vary considerably.
One example is HIPAA. We in the States know this is the gold standard, but to say that the nurse in question violated HIPAA would be inaccurate. The "spirit" of HIPAA may have been compromised, but the actual law does not apply outside the US.
To the OP: Please tell us your thoughts on the questions you posted. As others have stated, we're glad to students work through their ideas, but if this is a homework assignment, we don't want to rob you of the opportunity for independent thought.
Dec 12, '06
thanks for helping. i try and put my input too..
Dec 12, '06
What would be the ethical action to take if we saw a physician rather than a nurse about to administer the Narcan to this lady? I think I'd need to Question - maybe remind the physician about hypertension and seizures?
What the questions are probably digging for is the patient autonomy model of medical ethics which will focus on maximizing patient's long-term interests. You are supposed to complain about the failure in confidentiality (gets around the US-centered HIPAA law but addresses the same issue) and complain about the lack of respect shown the patients (like the comment about the guy who never worked a day in his life). I got help from a sleepy medical ethics professor on this one:
The basic formulation of an autonomy-based approach to medical ethics is that you give the patient what they want. This is not to say this is the best decision but it is probably the one that is being looked for.
For the stakeholder model, simply list everyone in the story, including Jenny's family by the way. This is an exhaustive model and everybody has a stake in the outcome. Just list everyone; there are no non-stakeholders in the story. The problem with the stakeholder model is that we teach it as everybody effectively having an equal right when they have an interest in the case. This isn't how it works in real life, however. The teachers get it wrong ... they're usually measuring your sensitivity to ethical issues rather than any real critical thinking skills.
There are two issues here: What is the ethical/legal implication?
What does your teacher (if there is one) want?
Good luck to you; hope this is helpful rather than confusing. What works for me as a student is to regurgitate the "correct" answer from the teacher's notebook to my notebook without either one of us thinking at all. Later, after the grade, go back and actually try to find something meaningful, something you can use. The LAST thing to do is actually ask an ER nurse, who would have the best, real-life, answer. That's why the ER nurse helps by telling you to go look it up in your book, because her real-life answer would lower your grade. It isn't the textbook answer, or the notebook answer given in class, which would be the "right" answer. But we can't actually SAY that ... but I'm just a student who often says the wrong thing. Be Careful. Say what they want you to say, and then run to a Real ER nurse for help if this happens to you in practice.
Last edit by abooker on Dec 12, '06
: Reason: I was asleep when I wrote the first one & made error
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