What is the case that presents an ethical dilemma to the nurse?
It is quite true that people from all walks of life and people from different professions experience a moral dilemma of some sort in their lives. The question of different ethics can affect and can determine certain actions in a person’s life — work ethics, personal ethics, and even law ethics. It is unquestionable that in due time, a moment will come when the different aspects of a person’s ethics and principles will be questioned. This moment or situation will challenge a person as he or she will be faced with an issue of great deliberation and debate —an issue concerning ethics. There are different issues concerning these ethical issues, and everyone is somehow bound to think and ponder on the different things concerning the issue they are involved in.
A person from the medical field is also bound to be faced with such ethical issue. In fact, it can even be most applicable to a person from this field as they are concerned with a life of a person. A nurse of the medical profession can be also faced with such an issue of the ethics as he or she will be bound to choose what course of action to take based on which is right or wrong from the perspective of every aspect of the field — laws concerning the issue, the practice or procedure of the hospital, etc.
One of the more known forms of an ethical issue is that concerning the consent of the patient and/or the consent of the family of the patient. One example of such case is that of Amanda (taken from the book Ethical Issues in Nursing) who is the patient of the story. Amanda is pregnant who unknowingly discovers that she was tested for an HIV test which she turns up positive. There comes a dilemma when there was no consent from her otherwise while a very confidential information about her is made known to other people. Ann Kennedy (1994), the author of the article and of the case, is a nurse who feels that there is a great dilemma happening or a conflict of some sort when clearly, there was something “off” with having to give information or tests for the sake of medicine without the consent of the patient. The ethical issue surfaces when the problem of the patient is left in the dark about the whole procedure and when he or she has absolutely no idea that information about her was already given to other people — information that was clearly confidential and personal. As a nurse, will Kennedy stand still and watch the whole process unfold? However, as what Kennedy (1994) has written, sometimes, even the act of questioning those people who are higher than the nurse serves no purpose at all. For example, a friend of Kennedy had a quite common experience concerning this issue: “when one of my nursing colleagues tried to discuss with the doctors the issue of patients consenting to their personal details being reported to the surveillance center, she was simply told, “If you don’t want to do it, we’ll just have get someone else to do it” (Kennedy, 1994, p.109).
Therefore, the problem of whether the situation is an ethical issue or not arises when even the superiors make it a point to say another thing when clearly, the nurse is trying to resolve the issue or do something which is right. As what Kennedy (1994) wrote, the nurse should know better whether to follow his or her superiors. However, the situation is proven very difficult when the code of ethics of the nursing profession versus the code of ethics of the medical profession is generally bound to be in conflict with each other: Will the nurse consent to his or her superiors for the advancement of the medical knowledge, or will he or she protect the patient and the patient’s privacy, personal life, and rights?
From whom did you learn about such a case?
There are numerous books and resources available wherein the ethics of the nursing profession is put into question; or rather, the nurse is put into a position wherein he or she faces an ethical dilemma. The particular situation or case which is appearing on this paper is from the book of Geoffery Hunt entitled “Ethical Issues in Nursing” which was published in 1994 by Routledge. As what is most obvious regarding the title of the book, there are ethical issues contained therein. The most fascinating and intriguing, perhaps, is the one presented by Ann Kennedy entitled “Ethical issue in HIV/AIDS Epidemiology: A Nurse’s View.” The case of HIV/AIDS is most prominent in the contemporary times, and it is without a doubt one of the most researched and studied medical cases. Thus, it is not surprising why such a particular case can be regarded as an ethical dilemma of the nurse.
Who are the stakeholders, and what are their interests?
In this particular case, there are three parties which are to be considered — one is that of Amanda and her baby who are tested for HIV when clearly, she had no consent and absolutely had no idea that it was even taking place. The others are the people who are more superior than that of the nurse and involved in the testing and analyzing of the blood of Amanda and her baby — the midwife, the General Practitioner or the GP, and the people themselves from the central laboratory. The final person involved is of course, the nurse. Each party has different interests; the patient is a mere pawn and tool used by the medical staff — the midwife, GP, and the central laboratory staff were clearly doing it for the advancement and further information for the medical profession — while the nurse was there to protect the patient and the patient’s rights and privacy.
a) What are the ethically relevant factors?
The ethically relevant factor is mainly about the right and privacy of the patient. Amanda and her baby were stripped of the “right” of the consent to be even tested in the first place. Thus, the nurse felt that there was a need to tell the patient, but as such, she was frustratingly chastised for even suggesting the fact that there should be informed consent from the patient.
b) What principles relate to these factors?
The privacy and well-being of the patient are unquestionable — they should be both considered no matter what. If the patient did not consent to the testing for HIV, then she should never have been tested in the first place. Yet, when the circumstance arrived that she was tested for the HIV and the midwife had no information about the whole thing — the moment that the midwife knew, she should then have informed the patient right away. Not only would this save the patient from further and a prolonged moment of being kept in the dark, this would also readily informed the patient that she is in such a condition and she tested positive for the HIV.
Identify ways in which sensitivity toward (consideration of) some of the ethically relevant factors mention above conflicts with sensitivity toward others (also mentioned above).
As what was mentioned in the answers to questions number three and four, the conflict of the whole situation happened when the patient felt like her privacy was invaded and that she had the thinking that if people who she did not even know had the information regarding her condition, what were the chances that the news about her will spread further? Thus, the medical professionals were not sensitive toward the feelings of Amanda.
With regard to the conflicting ethically relevant factors mentioned above, are there some factors that clearly take precedence over the factor(s) with which they conflict? If so, explain which factors weigh more than which, and provide (to the extent possible) your reasons for weighing the factors as you do. If your reasons include any absolute principles, identify them.
Referring to the answer to the letter b of question number four, it is unquestionable that there are certain things which affect the issue tremendously — one is that of the patient’s right to privacy, and the other is that of her well-being.
Are there any laws or institutional policies that should influence how the nurse is to respond to the dilemma(s)? If yes, identify them.
According to an article by Jennifer M. Sims (2008), there are legal laws regarding the consent of the patient. In the article, she wrote:
The Joint Commission on Accreditation of Healthcare Organizations has regulations concerning informed consent. The regulations include the following: (1) the patient and family are involved in the consent process; (2) the consent form is a legal doctrine; (3) the informed consent must explain all procedures and treatments, including risks and benefits; (4) the patient must have the right to refuse; and (5) consent must be obtained in a timely manner. (Sims, 2008)
What specific action(s) ought the nurse to take in response to the case? How is this response justified in light of the ethically relevant factors you have identified?
Since the incident has already happened and the nurse cannot do anything about something which has already been done, then there is nothing to be done except to care and support the patient in her endeavor. However, if the nurse was present before or during the whole situation, then it is important or suggested to talk to the people concerned about the ethics and legality of the whole thing — after all, it is not only the health of a patient which should be taken care of but his or her well-being as well, and this includes the privacy and protection of personal matters of the patient.
• If the response includes/risks “infringing upon,” or showing some insensitivity toward, certain factors, explain how this is justified.
The problem with the case was the GP and the midwife felt that it was “ethical,” and what they did was legal since it is done all the time — that of blood tests or blood samples being sent to central laboratory units for study and analysis which could contribute to research and some other things. However, it was the patient herself who had qualms and doubts about the whole thing because people knew of her condition (that she was HIV positive) without knowing how and why they were able to obtain the information. The whole thing may be justified in the eyes of the people from the medical team, but it was not comfortable and “right” for the patient.
What objections could a reader of your analysis raise against your proposed solution or way of reasoning?
While it indeed true that the patient should give consent, there could be factors affecting a patient’s decision to consent. For example, there could be diseases or illnesses which targets the mental activity of the brain and prohibits the person of properly making decisions. In simple terms, they are incapacitated to think clearly for themselves. In addition, the whole point of the testing (as shown in the case of Amanda) was to advance information of the medical profession. Moreover, the testing was anonymous, and it was only people from the medical field who know of her condition; thus, there is really no ethical issue present in fact.
How do you respond to the above objections?
What should be pointed out regarding the whole case is that although the blood sample is anonymous, the time came when the anonymity of the patient was lost since she was tested positive for the HIV antibodies. Also, as for the objection that the information is used for the advancement of the knowledge of the medical profession, the patient should still be informed that such testing took place. In fact, if she was informed earlier, she could have known that she was HIV positive even before her baby was born, and necessary precaution and assistance could have been given to her before hand. Thus, there is no excuse regarding the existence of the ethical issue. There is the presence of the ethical issue.
Kennedy, A. (1994). Chapter 6: Ethical issue in HIV/AIDS epidemiology: A nurse’s view. In G. Hunt (Ed.), Ethical Issues in Nursing (pp. 109–117). New York: Routledge..
Sims, J. M. (2008). Your role in informed consent, part 1. Dimensions of Critical Care Nursing, 27 (2), 70–73.