Chapter 5 : Nursing and Ethics

Section 5. Decision Scenarios

Summary of Methodology for Analyzing and resolving Cases involving moral dilemmas in Health Care:

Methodology: http://depts.washington.edu/bioethx/tools/cesumm.html

Paradigm for the Method: http://depts.washington.edu/bioethx/tools/4boxes.html

Sample Case Analysis: http://depts.washington.edu/bioethx/tools/cecase.html

Introduction to Clinical Ethics, 4th edition using the case of Dax Cowart.: http://depts.washington.edu/bioethx/tools/ceintro.html

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SCENARIOS:

For each of the scenarios you should consider how a person would reach a decision if that person were using the basic principles from EACH of the following traditions:

  • EGOISM

  • UTILITARIANISM

  • NATURAL LAW THEORY

  • KANT's CATEGORICAL IMPERATIVE

  • RAWLS MAXI_MIN PRINCIPLE of JUSTICE as FAIRNESS

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A simple case: A family wants to know the condition of a 55 year old women who has been undergoing a procedure in the hospital. They crowd into her room and in the doorway and as the nurse enters and leaves family members ask many questions. The nurse is aware that the doctor accurately reported the diagnosis and prognosis to the care recipient but has misinformed the family.

What is the nurse to do and why?

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Consider: A newly hired nurse is assigned to the recovery room of a hospital that specializes in heart surgery. She is working there for a week when one evening a man in the recovery room is being closely monitored after surgery. The signs are not good. He recovers consciousness. The doctors inform him of the situation. They leave the recovery room.

The man calls the nurse over and asks for a pen and some paper. Thinking that he might die and do so soon he informs her that he needs to write a brief letter to someone. She finds pen and paper and gives it to him. He writes his note and writes the address and asks the nurse to send it out for him. She agrees. As she is taking the pen and papers back from him the recovery room supervisor enters and observes her. The supervisor calls her over and inquires as to what she was doing. When the newly hired nurse reported that she had assisted the man in writing a letter and took it to mail it for him , the supervisor responded that :

"It is not your responsibility to do such things."

The new nurse responded that she was simply trying to help the man and had agreed to mail the letter. The supervisor replied with: "This is not a post office!"

The new nurse repeated that she was only attempting to help the man. That he might die shortly. The supervisor wrote up the new nurse for subordination. The new nurse was dismissed form the hospital as she was in her probationary period.

What was the new nurse to do and why?

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A newly hired nurse is being given orientation and training in the hospital by a senior member of the nursing staff. Assigned to a medical -surgical unit the nurse receives instructions on procedures. The nurse is instructed to "push Heparin IV" through a tube in the person's arm. The nurse when being trained in nursing program was instructed not to do so such a thing as it could have serious consequences. When the newly hired questioned the procedure that nurse was told by the senior nurse: "Look that is how we do it here, missy. We are understaffed and do not have the time to do it intravenously. If you want to work here that is how you will do it too."

What should the response of the new nurse be to this situation? Why?

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Copyright Philip A. Pecorino 2002. All Rights reserved.

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