I have a question on ethics.
I work in a CD treatment center. From what I understand, they are considered vulnerable adults. Pt has a history of psoriasis...patient point out healed scars on legs to show how bad it had been before he was put on Humira.
The patient complained of abdominal pain at history and physical, so the nurse practioner put a hold on the next dose of Humira, which was due in 1 day, until liver panel could be done. This was to 'do no harm, because the side effects had the possibility of causing death. Also, the CNP stated that though the condition was disfiguring, and bothersome it was not terminal. To the CNP, the risks outweighed the benefits. The CNP explained to the patient, all of this. Also that the psoriasis wouldn't 'erupt' all of a sudden in a few days. The patient felt that the benefit of the medication outweighed the risks. He was told by the prescibing doctor that there were no side effects ( pt's claim that is what was said).
The patient did not have insurance or MA and county pay for treatment wouldn't cover the lab work. Management was looking into funding options, but in the meantime, the patient was begging for his medication. He had brought 2 doses in with him on admission...each dose to be given 2 weeks apart. The patient stated that he was already getting some white spots, indicating to him that the psoriasis was becoming less suppressed. The patient also expressed that to him, it was a self esteem issue, that he was presently experiencing a lot of stress and anxiety because of the fear of how bad the psoriasis would become without the medication, and also that it was not a narcotic medication, so he didn't see why he couldnt' have it.
As a nurse, I am supposed to be advocating for my patient. In this instance, is it autonomy, nonmalificence or benificence that are the higher ethical issue? Should the pt be able to get the medication, because he wants it...it has been prescribed and he does have the right of refusal, so why not be able to get the med?
Should he not get it because of do no harm? Or get it because it benefits him the most? Can I advocate that he see another doctor for a second opinion....or send him to the ER so he might be more apt to get the med there? Is sending him to another doctor, putting me in the role of doctor shopping for him?
So my question is, since nurses are supposed to be advocating for their patients...what seems to be the best option for the patient?