The primary function of nurses is the treatment of diseases, but advocacy is also part of their job. As a patients’ advocate, the nurse protects their rights and promotes their health and safety. Thus, a registered nurse (RN) helps to advocate for the patients’ right to informed consent. Reporting the case of the denial of the latter puts the nurse in a moral dilemma but through the use of the bioethical decision making model, one can solve the issue.
Description of the Clinical Situation
The RN had to advocate for the right to informed consent of a 32-year-old woman, Anna, who had a tumor in the pulmonary artery of her heart. There were two options for treatment, surgery and medication. In the first case, there was a chance that the tumor would be totally removed and the woman would get cured. However, there was the likelihood of a complication that would lead to a sudden death. Ann opted for a surgery and signed the consent form. She went to the operation room, but was pronounced dead after the surgerical intervention. It is a situation of the breach of informed consent. One element of fully informed consent is information containing relevant risks and benefits regarding various alternatives to treatment (Grace, 2018, p. 84). The doctor did not tell Ann about the possible effect of surgery and let her believe she could be cured, and she believed. Reporting the malpractice posed an ethical dilemma to the RN, and it can be approached using the bioethical decision making model shown below.
Definition of the Dilemma
The nurse is confronted with the decision-making problem of whether to report the cause of death of Ann to the administration or stay silent about it. The one chooses to be an advocate for the patient by reporting the incident. The nurse is however afraid that the doctor may make her work difficult in the hospital or that the facility administration may fire her if she chooses to report the incident to the board.
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Identification of Medical Facts
The dilemma here relates to the inappropriate conduct of the doctor who chose not to give Ann all information regarding the heart surgery, and she ended up dying immediately, which was against her wish. The healthcare provider did chest X-rays twice and discovered that the woman had a mass on the coronary artery of her heart. Ann was not satisfied and sought a more specialized diagnosis with an electrocardiogram. It was discovered that the patient had the same problem. Ann had limited years to live. Surgery could have lengthened her life if it had gone well or if she had had a heart transplant. On the other hand, medication could have helped to relieve pain temporarily but she would have finally succumbed. Thus, the doctor was to perform a surgery but his practice required him to disclose possible effects to Ann, which included minimal chances for survival.
Non-Medical Facts
The patient has the right to safe and quality care. Ann was a Christian who believed that God would not let her die yet because she had children to take care of. The woman had a five-year-old son and a ten-year-old daughter. Her husband left her for other woman, and she raised the children on a salary of a high school teacher. She had a very supportive family who wanted her to live. They supported the decision on surgery that Ann had taken after she had signed the consent form by herself.
External Influences
State laws provide clear evidence of punitive measures that follow medical negligence. Maryland laws state that medical malpractice must be reported not later than five years from the time when it happens. Besides, the Maryland Board of Physicians is another body that is concerned about this matter because it can revoke the license of a doctor who does not adhere to ethical codes. The general public, who are patients that deserve quality care, is also interested.
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Facts
1. The first fact is that Ann had a tumor in her heart.
2. The second fact is that she had surgery as one of her options and treatment through pills as another one.
3. The nurse witnessed an immediate death after surgery.
4. The doctor had not disclosed the information needed to Ann before she signed the consent form.
Assumptions
1. The doctor assumed that Ann would survive.
2. The nurse assumed that refusing to report the case would save her job and relationship with her colleagues in the hospital.
3. If not reported, the case will be forgotten, and next time, there will not be a greater duty of care from the doctor.
Facts That Need Clarification
1. Why did the doctor insist on surgery but not medication or any other procedure like a heart transplant?
2. What weight did Ann place on various treatment options and why?
3. Did the nurse try to question the doctor about the issue? What was the response of the latter? Was he remorseful?
4. Why did the doctor fail to disclose the information regarding the surgery to Ann making her make a rushed decision when the code of ethics guiding his job is clear to him?
Decision-Makers
Ann had the capacity to decide. As a high school teacher, she was competent enough to make informed decisions. She was in the right physical condition to do so because she had gone to the hospital. The patient was clear that she wanted a procedure she would afford and which would prolong her life. She questioned its effect, and the doctor assured her of full recovery following a heart surgery.
The Underlying Ethical Principles
The beneficence of patient care is applicable to this case. As an advocate, the nurse practices this principle and fidelity by reporting the incident (Charlotte, 2018, p. 4). On the other hand, non-maleficence cautions against causing extra harm to the patient. The doctor chose to ignore this and went ahead to perform a surgery that instead killed the patient. The former was also not just in his actions because he chose to hide the truth from Ann. The autonomy of the woman was respected in this case but under misguided information. If the nurse chooses not to report the case, she will have justice in relation to her colleagues but against Ann.
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Alternatives
The best option was to report the incident, and it would comply with the ethical principles of beneficence and justice towards the patient. Reporting the case would advocate for nurse-patient integrity as well as maintain high standards of care within the hospital (Hatmaker & Tomajan, 2015, p. 44). Another option would be to stay silent and choose justice towards colleagues than beneficence in relation to the patient. Effects of this decision would be guilty feelings, which might force the nurse to resign because she chose to compromise her professional integrity.
The Chosen Alternative
The chosen alternative is to report the case. The best way to do it is to be as secretive as possible. It is because since there were many people in the surgery room, it would not be possible to tell who reported the case. The nurse does not have to fear to report. Besides, having surveillance cameras that record voice and procedures will force nurses to advocate for reporting such instances because there is evidence on surveillance cameras.
Conclusion
Nurses act as patients’ advocates in hospitals, communities, and the nation in general. In their place of work, they should provide all necessary information that promotes healing and report malpractice involving patients. In the community, they advocate for better health conditions and dignified human care. The best way to do the job is to stay informed and act under the guidance of the professional code. When faced with an ethical dilemma, a nurse can use the bioethical decision-making model to address the situation and pick the best alternative possible.
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