Ethical dilemma's nurses face

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    Hey all,

    I am hoping you can help me. I am in the BSN program here where I live and my partner and I have to do an ethical writing assignment. We need to write about a legal/ethical conflict that NURSES would deal with directly. The problem is I have not had the opportunity to work out side of nursing school as a nurse yet and he has very little experience. I am hoping that perhaps some of you can offer some suggestions from some legal/ethical conflicts you might have run into in your nursing career. If you would be willing to help I would sure appreciate it. Thank you so much!

    Rain
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  3. 11 Comments so far...

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    In patient care of the non compliant patient who has no insurance and would die if discharged.
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    Pediatrics is FULL of them.

    A frequently encountered one... Jehovah's witnesses and blood transfusions. Can the Jehovah's Witness parent refuse blood transfusion for their child based on their religion even if the child will die without the transfusion? In my state, the answer is no and the hospital will get a court order to administer blood despite the parents' refusal.

    HIV in children and disclosure. I have seen this one many times. If a child has HIV, it's likely that they got it via vertical transmission which means that at least the mom if not both parents also have HIV. Young children cannot understand what having HIV means and are likely to walk around announcing it to people who perhaps shouldn't know... and then those people infer that the parents also have the virus. At what age should disclosure happen? Do the parents have the right to privacy for as long as they desire or is there a point in adolescence where the health care worker needs to step in above the parents' protest and disclose to the child?

    Pre-implantation genetic testing to create a sibling as a bone marrow or kidney donor.

    Genetic diseases that we can test for before symptoms onset. Things like Huntington's and ALD come to mind. I've seen it with a child with ALD (X-linked). When he was diagnosed, the question of whether or not to test and then TREAT the brother (with experimental stem cell transplantation) prior to symptom onset was discussed.

    Children with severe congenital defects that would lead to long term disability... to treat or not to treat? We CAN prolong their lives but do nothing to reverse their disabilities: http://www.nursingcenter.com/lnc/Jou...ssue_ID=934467

    Parents who do NOT want to treat their children for various illnesses and then on the flip side, those who do despite a terminal diagnosis. Should we be able to force a parent to treat their child for, say, leukemia (something like a 90% survival rate with current treatment) even though the child could suffer long term effects from the treatment? Should we trach and vent a child with a terminal high grade brain stem tumor who is on death's door?

    The mature minor rule. If a 16 or 17 yr old doesn't want to proceed with treatment for whatever they have, whose decision is it? Should a parent be able to force a 17 year old to have his leg amputated due to osteosarcoma or is it the 17 yr old's decision? If a 16 or 17 year old patient wants to terminate treatment for cancer, do they have the right to do so?

    A famous case from many years ago: The Ashley Treatment, Ashley Treatment - Wikipedia, the free encyclopedia
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    Resuscitation of neonates on the very edge of viability - around 23 weeks. Sure, some of them survive....but it is rare that they do so with no deficits that will prohibit them from ever living a normal life (CP, severe brain bleeds, etc).

    Allocation of resources, specifically organ donation. There are only so many kidneys, hearts, livers... available. Who gets them? Those who are the sickest and will quickly die without them? Or someone who is less ill and may live many quality years after transplant?
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    Here's an ethical dilemma that I have personally seen. There is a family that I lived near once that had 4 kids with osteogenesis imperfecta. They did not see why that they shouldn't keep having kids. Those poor kids suffered through years of broken bones, surgeries and at times, full body casts. They were always in pain. So here is the dilemma. Should parents that know they will continue to have children with severe illnesses keep having children?

    Here is the next part of the dilemma, neither of the parents had jobs that had insurance. So those children's medical expenses were paid for by the state. I can't even imagine the cost of 4 kids with that crippling disease.
    DeLanaHarvickWannabe likes this.
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    Thank you all so much for all of these great suggestions! Now to pick just one! Cerriwen, I actually have some very dear friends who had their little boy at 23 weeks. He is now a very happy 4 year old. He does have some delays, and has just barely started walking on his own, but they are so thankful for him and would not rather that he had been let go.
    Last edit by RainzRN on Oct 2, '12
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    I watched a TV program where a drug addict came into the ER and had methamphetamines stashed somewhere private. The police had brought him in. The nurses found it and ended up hiding his drugs to save him from further legal problems. I can't remember why It was beneficial to the client to have the drugs hidden from the police. I believe it had something to do with a long prison sentence.
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    Blood transfusion, Jehovah witnesses.... Advance directives, DNR.... A few cool topics
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    The homeless, family-less developmentally-delayed person who has a terminal condition and is no longer able to talk to you, and you have a physician or physician team who wants to go all-out doing everything even though it's painful and sure to be futile (teaching hospital, it's all about the practice), and the patient can't understand why you're torturing him. (Hint: Google substituted judgment)

    The old lady who is occasionally not lucid and getting less so, but who is adamant that she does not want more treatment, the amputation that will save her life, or anything else...against the wishes of her daughter, who wants it all. (Hint: Google Candura)


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