Questions about an Ethical Analysis

[MarquiseB]

Hello everyone,

I'm a first year nursing student (BScN) and need help with an ethical analysis for and ethical dilemma/violation.

I'm just looking for guidance on the legal side (Canadian law) of the situation.

Mr. X has advanced pancreatic cancer. He speaks very little English and refused an interpreter as he trusts his sons completely. He had surgery but has no chance of recovery. Mr. X is dying.

The team had a meeting with Mr. X and his sons to explain the situation. The team was very clear in their statements that:

- the surgery showed that the cancer was too advanced for other treatments.

- he is dying

- the health team would try to make his as comfortable as possible with palliative treatments for pain and

supportive care.

The sons listened carefully, asked lots of questions, and then turned to talk to their father. They told him that:

- the surgery removed the tumor

- he would require lots more treatment

- he was on the road to recovery

No one is aware that Mr. X has been misinformed and that he thinks he will receive medication and interventions to alleviate pain and promote healing.

*ethical dilemma or ethical violation?

*What ethical principles are involved?

*Are there any legal rules that govern the situation?

*Course of action to be taken?

Thanks

Marquise B.

[Fiona59]

You have to factor in the familiy's cultural background.

I've seen many Chinese and Vietnamese families demand that the elder not be told they have cancer.

Ultimately, the family always wins.

[linzz]

I would think the above poster is correct about the family getting their wishes. Maybe you could check your province's college of nurses website.

My aunt is an oncology RN in Toronto and they have to take culture into account when providing care.

[MarquiseB]

so the patient's right to know the truth does not necessarily come before family culture/beliefs ?

[Fiona59]

There is a stigma against cancer in these cultures. Not quite sure what it is all about, but we have always had to respect the family's wishes. I know a couple of times the hospital ethics committee got involved but the patients usually died or went home under the palliative care team's care, so we never did learn the outcome.

[dishes, BSN, RN]

How do the staff know that the patient refused an interpreter? Did the son interpret that his father did not want an outside interpreter? If so, than you do not really know if this is what patient wanted.

Did the hospital have a brochure in the patient's language explaining the role of an interpreter? I would want to be sure that the patient was given the opportunity to choose a neutral interpreter.

[Fiona59]

It's our hospital policy to find an interpreter that is not related to the family. Often the elder is old and frail and under a guardianship, or will tell the interpreter that the oldest son makes their decisions (usually when it's the aged mother).

We just don't blindly accept the family's word on everything.

[dishes, BSN, RN]

*ethical dilemma or ethical violation?

it is a violation of interpreter code of ethics because an impartial interpreter was not used and the interpreter did not accurately and completely interpret the message.

it is an ethical dilemma because the patient has the autonomy to choose a family member to interpret and the healthcare professional must respect the patients choice, the staff cannot force the patient to use the interpreter service if the patient does not want it.

*What ethical principles are involved

informed consent to treatment, autonomy, self determination the entitlement to make one's own choices about treatment

*Are there any legal rules that govern the situation?

Health Care consent Act

see informed consent document from CNO

http://www.cno.org/docs/policy/41020_consent.pdf

*Course of action to be taken?

Clarify with the son about his decision to withold information from his father. He could be witholding the information because he feels too overwhlemed to tell his father he is dying, or he maybe he wants to get a second medical opinion.

Provide support to son so that he can understand his father has right to make his own choices about treatment.