Ethical dilemma !

  1. Hello, I am a first year student and I have an Ethical dilemma. Can anybody help?!

    You are working afternoon shift as a third year student on a medical ward, caring for a patient who is in the terminal stage of cancer (metastasised). You have known him since his admission over 3 weeks ago, and awere that it has been difficult to effectively control his pain for some time. His wife and children have benn very supportive, but are distressed about him suffering. Durinf your shift it becomes apparent that the patient will die shortly (not expected to survive the night). The doctors belive that they can not safely give him any more pain medication. The nurse in charge tell you to give him a "sponge" in bed and make him comfortable. However, when you start to wash him, he cries out in pain and begs you to stop. The more you continue, the more he screams. The nurse in charge still insist that you continue and that the patient be "sponged"!!!!

    What actions would you consider taking and why?!
    From an ethical perspective, how you would ensure that the "right action" is implemented?
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  2. 8 Comments

  3. by   ADN 2002
    I believe that ethically, if a patient requests that you stop doing something, then you stop doing it now. Patients absolutely have the right to refuse treatment (and a sponge bath is a "treatment" of sorts - something they're not doing themselves). The charge nurse has no business forcing something on a patient that the patient has already refused. Comfort measures do not include doing something that makes the patient more uncomfortable - the purpose is to keep them as comfortable as possible.

    The "right action" I suppose would be to refuse to give the bed bath and I would place a note in the charting that these are his wishes.

    (I hope this helps you, this is what I would do)
  4. by   BrandyBSN
    Absolutely! The patient ALWAYS has the right to refuse treatment, even if we have the best intentions. By refusing to listen to him, and not stopping the bath, you are actually commiting a criminal act... ie Assault and Battery. The same goes for an injection, if the patient refuses, and you give it anyway, you can be held legally liable for assault and battery.

    Document, Document, Document. Write in detail that the charge nurse has ordered you to give the bath against the clients wishes, and your best judgement. We have no right to inflict pain completing a procedure that can be done post mortem. He will die regardless, and we are not adding to him any benefit, but actually causing more harm to him emotionally. Your patients wishes are first and foremost, regardless of your orders. Refusing is well within the scope of your practice.

    Hope that helps
    BrandyBSN
  5. by   zannie
    I don't have enough experience to know exactly what I'd do in that situation.... however, have you considered taking a medical ethics class? I bet you might get some good insight?? I wanted to take it this semester, but they only offered it monday evenings and I work monday evenings, so I'm taking social ethics instead -- but it's just as interesting.

    --zannie
  6. by   horsin' around
    As a nursing student it is difficult to stand up for yourself to someone that is in charge. I agree with the rest of the members, you have to stop giving the bath, chart the situation, and then I would go and talk to the nurse that ordered you to give the pt a sponge bath. If you approach the nurse that ordered it in a professional way and explain why it was not done, at least the air is clear between the two of you and even if the nurse harbors resentment it will be out in the open.
  7. by   Katnip
    I agree. In my bio-med ethics class, the professor always said "patient wishes first,' within legal bounds. No nurse should have the right to tell anyone to do something that causes a patient severe pain if it has nothing to do realistic interventions.
  8. by   vinona
    Thank you all, very very much, for your replay and for the advice. I did stop the pocedure and i fell good abot it! Zannie, ethics is one of the subjects for the second year students in Australia
  9. by   TeresaRN2b
    I used to work for a lab as a phlebotomist doing blood draws at area nursing homes. I very often had patients refuse for me to do the blood draws and was still required to do them anyway. If the patient is not competent to make the decision themselves then they do not always have the right to make these choices. It was very difficult for me because I felt that the patients were competent to make the decision themself, but the staff and the patients gardians did not. Also, as a nurse I think part of your job is patient care and some times what is best for the patient does not feel good. I think I would handle the situation by explaining to the patient the importance of the procedure whether it be a sponge bath or something more involved. Often times patients if they understand why this needs to be done are more cooperative and understanding. All that being said if the patient was competant to make the decision for themselves they have every right to refuse treatment and I probably would have handled it the same as you.

    Teresa
  10. by   nursenat1
    I believe baths are very important in many different aspects however, if a patient is in so much pain that he begs you to stop a sponge bath I think you should respect the patients wishes and stop. I would explain the situation to the charge nurse and tell her that you feel uncomfrontable continuing the bath and ask her/him if she/he could find another nurse to continue the bath. If the man if going to die soon why should he have to suffer on his deathbed?? It is just not fair to the patient or his family.

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