Hello! I have not visited this forum in awhile, and I have missed it!
I live in Canada, and have a ethical dilemma/question:
I work for an assertive community treatment team (outpatient/community psychiatry). We currently have a patient who has not been medicated for 2 years (as they refuse any and all medication), and has gradually worsened since then; However, at this point, is still considered capable to make treatment decisions.
My dilemma is this: One of the social worker's on the team approached me and asked how I would feel giving our patient money in exchange for allowing me to give them an antipsychotic injection. I told her that I felt it was unethical to essentially bribe a patient to take an injection, and that I would not feel comfortable participating in this.
Well, she consulted with our psychiatrist and our psych resident and our resident went out with the social worker and gave this patient $20 in exchange for receiving the IM (typically it is only nurses who give IM's on the team, we are just lucky to have a resident right now who is very hands-on!).
So now I feel I have been forced into this difficult situation where I do not feel comfortable bribing our patients, but this patient's IM has been restarted and the only way they would accept it is by me giving them $ (which, I should mention, this patient will end up spending on crack).
My question is: Can anyone link me to some standard of practice, or nursing regulation that will help support my standpoint when I am sure to get blow back from my co-ordinator/other team members? I couldn't find anything in the CNO standards, and would appreciate some guidance!
If I were you, I would be reporting to the Canadian Medical Association and the Canadian Nursing Association. There are so many Ethical Violations in bribing a patient in order to promote and maintain medication compliance, it give me a headache thinking about it.
When prescribing a medication, the patient needs to be provided informed consent. Informed consent involves the patient being educated about side effects, benefits of treatment, alternatives to treatment, treatment interventions, necessary follow-up care etc. An argument could be made that the patient is not receiving informed consent. The patient could say, "I am being given money to take a drug and no one told me anything about the drug." Of course the patient could be lying, but is their actual teach back shown and documented that the patient really understands.
The patient is knowingly using money for illegal drugs, crack! Medical professionals are actively giving money to a patient and know that patient is buying drugs with the money! You are promoting a habit, a habit that affect the medically prescribed drugs uptake, half life, and impaires the patient's mental status. If the patient insisted on drinking alcohol with each medication administration, would you document and administer as the patient wished?
The physician and the nurse must disclose financial bias when providing medical treatment. If you, or the doctors have any financial incentive towards prescribing a medication, and you are bribing a patient, if the patient had a negative outcome, how would you show that your judgement was not compromised by the financial incentive?
How is your treatment team providing consistent medical care? If the patient was hospitalized for an infection, would you expect other medical professionals to bribe him to take his antibiotics? Are you setting a standard of care that is not the standard? If it was a child, would you give them money?
I believe you are correct to not agree with this treatment plan. If you coworkers support this practice I would hope management would not, and if they do, finding a new place to work at would be your only option.
RNGummy40
43 Posts
Hi Michelle.
If I were you, I would be reporting to the Canadian Medical Association and the Canadian Nursing Association. There are so many Ethical Violations in bribing a patient in order to promote and maintain medication compliance, it give me a headache thinking about it.
When I first read your problem, I decided to look at the Canadian Medical Association Ethics guidelines. http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf
When prescribing a medication, the patient needs to be provided informed consent. Informed consent involves the patient being educated about side effects, benefits of treatment, alternatives to treatment, treatment interventions, necessary follow-up care etc. An argument could be made that the patient is not receiving informed consent. The patient could say, "I am being given money to take a drug and no one told me anything about the drug." Of course the patient could be lying, but is their actual teach back shown and documented that the patient really understands.
The patient is knowingly using money for illegal drugs, crack! Medical professionals are actively giving money to a patient and know that patient is buying drugs with the money! You are promoting a habit, a habit that affect the medically prescribed drugs uptake, half life, and impaires the patient's mental status. If the patient insisted on drinking alcohol with each medication administration, would you document and administer as the patient wished?
The physician and the nurse must disclose financial bias when providing medical treatment. If you, or the doctors have any financial incentive towards prescribing a medication, and you are bribing a patient, if the patient had a negative outcome, how would you show that your judgement was not compromised by the financial incentive?
How is your treatment team providing consistent medical care? If the patient was hospitalized for an infection, would you expect other medical professionals to bribe him to take his antibiotics? Are you setting a standard of care that is not the standard? If it was a child, would you give them money?
I believe you are correct to not agree with this treatment plan. If you coworkers support this practice I would hope management would not, and if they do, finding a new place to work at would be your only option.