Top ethical concerns to RNs

KelRN215, BSN, RN · Nov 13, 2015

I agree that pediatrics is full of ethical concerns.

I had an interesting one that came up this week. I actually think the kid's case may be heading towards an ethics consult. 17 9/12 year old. Relapsed Ewing's Sarcoma. Having symptoms of disease progression-specifically delusions that has led his oncology team to think that he may have new mets to the brain. They want to do an MRI of the brain. They have not shared with the patient that the reason he needs this scan is because they are concerned his disease may be progressing. I think that's ethically questionable.

He has also begun expressing that he doesn't want more chemotherapy and doesn't feel like he has any fight left in him. When he requested to stop this cycle, the team did honor his wishes. But if it gets to the point where he wants to completely stop and his parents want to continue, it is ethically complicated. Legally it is their decision, the patient is a minor, but children over a certain age (I think 11 in my state) have to assent to treatment. In similar situations, I have always seen the ethics team side with the child. Forcing a competent 17 year old to accept treatment that he doesn't want and isn't likely to change his prognosis would be unethical in my opinion.

And then you have the never ending Jehovah's Witness/Blood transfusion issue. I recently had a patient whose cardiac surgery was delayed because of this. The surgeon wouldn't take him to the OR without consent for blood and they needed a court order first.

SarahMaria, MSN, RN · Nov 13, 2015

As a forensic psych nurse, an ethical concern is forced medications. Also, restraints, and the insanity defense.

ComeTogether, LPN · Nov 13, 2015

I mis-typed. She was gone within 45 minutes of her first morphine dose. I think the morphine kindly pushed her over the edge. We all were grateful for this.

I understand what you're trying to say, but as others have tried pointing out, morphine given to a terminal patient doesn't push them over the edge, it simply makes it easier. Just take the time to read the other posts, and reflect, and you'll learn a lot here.

allnurses Guide · Nov 13, 2015

I understand what you're trying to say, but as others have tried pointing out, morphine given to a terminal patient doesn't push them over the edge, it simply makes it easier. Just take the time to read the other posts, and reflect, and you'll learn a lot here.

I agree.

LDAthleteNurse, BSN, RN · Nov 13, 2015

I understand what you're trying to say, but as others have tried pointing out, morphine given to a terminal patient doesn't push them over the edge, it simply makes it easier. Just take the time to read the other posts, and reflect, and you'll learn a lot here.

Okay, gotcha. Thank you for the clarification. I appreciate your comment.

Simonesays, BSN, RN · Nov 13, 2015

Interesting discussion! For me, one of the big ethical dilemmas that I often find hard to deal with are the way code statuses are addressed in our health care system. It seems to me that there has to be a better way. What exactly that entails, I wish I knew. But as others have mentioned, calling a code on a frail elderly patient can be incredibly traumatic for everyone involved.

Another ethical dilemma is the two-tiered health care system that seems to exist here when it should be universal and equitable coverage for all (in Canada). You have to be a strong and articulate self-advocate, or have someone else who can be that for you, oftentimes. And marginalized populations tend not to have that capacity and can easily fall through the cracks. It can be disheartening to see how even within a well-intentioned system homeless, mentally ill, substance-addicted, etc. populations suffer disproportionately adverse health outcomes.

Jensmom7, BSN, RN · Nov 13, 2015

I understand what you're trying to say, but as others have tried pointing out, morphine given to a terminal patient doesn't push them over the edge, it simply makes it easier. Just take the time to read the other posts, and reflect, and you'll learn a lot here.

Ah, but she blocked me awhile ago because I told her something she didn't want to hear. If that's how she responds to differing opinions, she's missing out on a lot of opportunities to learn.

roser13, ASN, RN · Nov 13, 2015

Another thread was just posted, asking RN's for their help in researching ethical issues. The 2nd poster flat-out acknowledged that it was a homework assignment.

LDAthleteNurse, BSN, RN · Nov 14, 2015

Welp, looks like OP got some good answers. I'm happy to help, honestly.

LDAthleteNurse, BSN, RN · Nov 14, 2015

And the other poster asked about ethical issues internationally.. Not exactly the same, but close enough I guess.

CathySweeney · Nov 19, 2015

Athelet2bnurseBSN If your niece died 4 hours after the morphine was given, it was not a factor in her death. The morphine was probably not working any longer. She died of the pneumonia as it was meant to be. As a hospice nurse I feel I can say this from experience.

ljmasse · Nov 19, 2015

Wow ? You and everyone who liked this post call yourself care givers ? Where is the caring in any of you ? Way to help out a fellow nurse ! You should have just ignored the post instead of adding your 2 cents only to put someone down ! Hope you don't approach your patients in the same condescending manor !