Ethical Issues

[supertrooper8900]

Hi. I am wondering what the biggest nursing ethical issue is that you had to face and how you handled it. Thanks.

[Pudnluv, ASN, RN]

I've run into several and have actually had to report a few to our ethics committee. The ethical dilemmas I see most frequently are related to DNRs, tube feedings and pain control. I've seen families come in and rescind a DNR on a patient who clearly state in their living will and on their MOLST form that they with for DNR status. Unfortunately for them, if they are unable to make a decision, the family can try to reverse it. I was also ordered to place a NG tube down one gentleman to start tube feeding. The family was adamant but the patients living will clearly stated he did not want any kind of feeding tube. I notified the doctor and told him I would not place the tube until morning when the doctor could speak with the family. The patient had continually pulled out his NG tubes previously and that was enough evidence for me to hold it. The worst case I've seen though (and one we still talk about today) was the case of an 84 year old woman with metatstic bone ca. The tumor was pushing though the skin on her hip and oozing out continually. The poor woman was in excrutiating pain, crying and moaning all night. The daughter absolutely did not want this woman medicated for pain. She said that when she visited her mom during the day, mom was too doped out on pain meds. So every day they would d/c the pain meds and every night we would call and get a one time order. It was so bad that the doctor actually threatened to sign off the case because he was so upset with the daughter. The daughter also insisted that mom be place on antibiotics (the cure all for everything) and eventually convinced the doc to move her to the ICU because her respiratory status was failing and she wanted mom tubed. The poor woman cored soon after moving to the ICU, after the daughter left. From what I heard, it was a "slow core" and the woman finally got her peace.

[nb623]

Hello Everyone,

I apoligize for not directly addressing the particular issue you were previously discussing. I am new to site and haven't figured out how to start a post. I am a nursing student and am working on an ethical assignment. I was looking for some insight. Recently I witnessed a nurse faced with an ethical delimma. She had tried to administer insulin to her post op surgical patient. Upon entering the room the patient refused to allow the nurse to give her the injection.The problem was that the patient followed a sliding scale at home different from the doctors orders in the chart. The nurse respected the patient's wishes and called the doctor immediately. The doctor's response was to switch the patient to NPO status. The nurse hung up the phone and disucssed the issue with her collegues. The nurse was upset that the doctor would do such a thing and following the advice of her fellow coworkers worked up the courage to call the doctor back to change the order.

Does anyone have any experience in this type of situation? I find it troubling that the doctor would want to put a diabetic on NPO status in order to get the patient to take the prescribed medication. Am I wrong to view this as punishment. I could be missing something since I was merely an observer and was not directly involved in the patients care.

Let me know what you think and what you would have done in this situation.

Thanks :wink2:

[wanderlust99]

Not honoring a pt's DNR status because the family wants all measures taken to revive him.

Aggressively treating a pt whose prognosis is very poor.

Doctors not giving a clear cut explanation of how poor the pt's outcome is.

Taking or doing tests/procedures that I feel are unnecessary. For example, my previous job, my patients would get labs drawn q6h, head cts daily, etc... Just too much done that wasn't necessary and too costly.

But, mostly treating pts who will live the rest of their lives in a nursing home, bedridden, and basically a vegetable is my biggest issue. I see the wrong and the right withdrawing care in pts. So, not sure which one is right.

The example you gave about the insulin & npo status, well that just wasn't the best thing for the patient, so the nurse did the right thing by calling back the physician. I don't believe an md would actually make a pt NPO just so they would take the medication. That doesn't really make since to me.

[nb623]

Thank you Nuerorachel for responding to my post. I agree with you that it doesn't really make sense for a doctor to change a patient to NPO status because she has an issue with her sliding scale. I feel that this would be even more harmful to a diabetic patient since she is also not recieving any insulin. Like I said, I could also be missing a little info since I wasn't directly involved with the patient care.