Your thoughts.. Law and Ethics -- your ideas please!

WDWpixieRN, RN · Nov 25, 2006

Wow....how, er, interesting....it's kind of late here, and I'm suffering from a terrific head cold, but one very obvious stakeholder is that roomie....I could care less how people live their lives as long as they're not hurting others, but this is a sensitive issue, particularly for folks of a certain age or upbringing and in a setting where you're trying to provide the best of care for ill persons, I'd say that the roomie's definitely got a stake in how this situation plays out....as well as Sandy....

Good luck with the rest of it!!

DaFreak71 · Nov 25, 2006

Sandy is a 50 year old male-to-female transsexual. Sandy has the physical appearance of a male but dresses like a woman. Sandy prefers to be referred to as "she". Sandy has been admitted to a shared room in the palliative care unit where you work, and asks for help to get changed into her night dress. Over the next few days Sandy has several visitors, some of whom are clearly transsexual. A male patient in the room complains to a nurse about the character of Sandy's visitors. The nurse offers Sandy a private room in a quieter part of the unit.
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?

1. I consider the key ethical issue to be the roomates discomfort over Sandy's visitors versus the right of Sandy to remain in her room and have visitors. The implications are that Sandy is being shunned or hidden in a location of the facility to appease the roomate.

2. I personally look at situations like this and ask myself "who is going to be hurt the most by this action versus another action (or non-action). For example; am I hurting Sandy more by removing her from her room to accommodate the room mate or am I hurting the room mate more by allowing him to be bothered? In this particular situation I would say that I would be hurting Sandy more by moving her than I would by having a "tolerance" discussion with the room mate. Sandy stands to feel ashamed, rejected, depressed, etc. The room mate is simply annoyed.

3. The stakeholders are Sandy and the room mate.

4. I would talk to the room mate and find out the basis for his annoyance. He stated that he didn't like the character of the visitors, but are they bothering him? Being too loud? I'd find out more. If it boiled down to the room mate having a bias against transexuals, it might even be in Sandy's best interest to be moved based on the fact that if the room mate doesn't like the character of the visitors, he probably doesn't like the character of Sandy either. This places both of them in a potentially awkward situation. If the situation has the possibility to escalate, I would entertain the idea of moving rooms, but it would be just as appropriate to move the room mate as it would to move Sandy.

Just my 2 cents.

MB37 · Nov 26, 2006

what about moving Sandy's roommate? He's the one having a problem...

ldh, BSN, RN · Nov 26, 2006

To the OP: I know I'm going to get flamed, but I am growing tired of these sorts of posts in which it is obvious that the poster is a student who is trying to get someone else to do her homework for her (or him).

How about letting us know what your thoughts are regarding this case scenario instead of just throwing a case scenario (obviously retrieved straight from your textbook or syllabus) at us? Then we respond to your thoughts, and critical discussion and debate can start. I have enough homework; I don't need to do yours too.

BSNtobe2009 · Nov 26, 2006

That's a tough call, since she has not yet had the surgery yet to complete her transformation, and it's hard to figure out where to put someone like that, in the room with another man or another female...as that is what Sandy is living her life like.

I have two friends who are transsexuals. One has had the surgery, looks very, very good, but you can sort of "tell" that something is off.

I have another that has never had the final surgery, but I swear, she actually got a job working in the local Mall as a female and it was a huge joke among her friends that they obviously didn't know her true gender, and you wouldn't either. She walks through public places and never gets a second glance..except from guys that are checking her out (she is very beautiful).

Now, I'm sure I am going to be in the minority opinion, but I look at it like this....think about why they put women with women and men with men to start with....it's because of modesty reasons. It is inappropriate to put a transsexual, post-op or not, in the room with another man, because guess who transsexuals usually date? Men. The difference between them and gay men, is that transsexuals can't hide the fact they are living as a female, and this is an uncomfortable position for both the "roommate" and the patient to be placed in with the gender that they no longer associate themselves with. Transsexuals generally do not look at women as sexual objects.

charlize_j · Nov 26, 2006

Hi everyone,

I admit that I am a nursing student and I am new to the nursing environment and that is why I am posting questions from my school and I am thankful and grateful for any replies that I may receive from anyone from anywhere. I am grateful to learn from experiences of the current nurses. And as for the others who do not want to be helpful, its ok although your opinions are welcome.

Thank you.

AggieNurse99, BSN, RN · Nov 26, 2006

In response to the OP's question, I would ask both patients if either of them would like the private room. Obvioulsy the roommate is uncomfortable, and the patient is probably uncomfortable sharing a room with this particular roommmate. Why would I want to share a room with someone biased against me and my friends, simply based on what I look like?

I think this goes along with the OP's scenario:

I have had patients with previous gender reassignment surgery. These patients are always referred to in the physician's notes as "biologically male" and referred to in the hospital's computer system as male. So when a Mr. So-and-So calls to my department, and has an obviously female voice (thanks to hormone therapy), I always address the patient as Ms. So-and-So. I have a real problem with this, as these patients choose to live their life as another gender, and who is hospital administration to decide that they are classified as their biologic gender?

talaxandra · Nov 26, 2006

To the OP: I know I'm going to get flamed, but I am growing tired of these sorts of posts in which it is obvious that the poster is a student who is trying to get someone else to do her homework for her (or him).
How about letting us know what your thoughts are regarding this case scenario instead of just throwing a case scenario (obviously retrieved straight from your textbook or syllabus) at us? Then we respond to your thoughts, and critical discussion and debate can start. I have enough homework; I don't need to do yours too.

:yeahthat: People here are engaged and helpul. But at the very least show that you've give some thought to the quesion yourself.

BSNtobe2009 · Nov 28, 2006

In the case of my friend who is post-op, her driver's license has been changed to reflect female.

charlize_j · Nov 30, 2006

sandy and bruce have their own specific intrests, and this is their aim to have a full recovey. in the process of recovering therapeutic relationships are shown to significantly boost the moral and self esteem of patients. sandy's visitors are a type of therapeutic relationship. howver the issue we are presented with is that bruce doesnt like the character of sandy and all of her visitors. when looking at tim's possible room combinations for transgender peolpe, i think no matter what the combination is, some people will naturaly feel strange about sharing a room with a total stranger.

the transgender population of society is a very small minority, therefore when looking at the reactions of bruce it is some way undrestandable that he was a little out of his comfort zone, sharing a room with a person you would not meet every day. bruce's remarks about sandy and her friends may be discriminative however as we have all seen when doing our placements in hospitals, people who are sick are usually very emotional and scared, and small things can be blown out of proportion.

like bruce sandy's main intrest would to become better in health. and continuting with therapeutic relationships, sandy has the right to be visited by any family or frend that wishes to see her.

the nurses is now placed in one of the hardest situations. the nurse has an obligation to provide the best possible care to both of the patients. when the nurse receives the complaint from bruce it gets you thinking why should the nurse ask sandy to move and not bruce? because of sandy's gender should she in a way be victimised and asked if she would like to vacate the room and be placed in a private room. sandy could even the meaning of a 'private room'the wrong way. she could think that the nurse doesnt respect her gender choice.

with the infomation we have been givin i personally would very much struggle in making a decsion who i would ask to change room. it is obvious that as time goes on only more and more tension in the room is going to build up. the only way i think i could decide is if someone had said or physically expressed an action that was hurtful to the other room mate.

just wondering if any of you guys thinks they know who they would move?

justpoorfect · Dec 3, 2006

The OP's question says that both patients are on a Palliative Care unit, so I would assume that they are both dying? If that is the case, they each deserve to have the opportunity to make decisions in their end-of-life care that makes them both comfortable. Perhaps the roomie feels alone and abandoned when Sandy has such colorful support from friends, and really longs to be acknowledged? Or is he in extreme pain and exhausted by the comings and goings, not willing or able to engage in self-evaluation about his possible bigotry?

My take is to assess each patient's unmet needs, their willingness to show consideration for each other or part company with no hard feelings, and situate each according to their preference and the impact upon the unit as a whole (loud visitors, quiet area...), etc.