Thursday, February 21, 2013
Case 9 Informed Consent
As a class, analyze this case. Whoever starts should pick a theoretical perspective (Kant, utilitarianism, Principles of Bioethics, etc.) and analyze, and then everyone else follows suit to either refine the analysis or add in a different theoretical perspective. At least one person should argue that the nurse should give the information, and at least one other person should argue the opposite.
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I guess I will start this by using the Principles of Bioethics to dissect this case. Following this set of principles, I believe the nurse should inform the patient that there are other options. The nurse should recommend the patient to ask for a second opinion with the doctor to discuss a few other main therapy options. If the patient wants to know a bit about the other therapy options, the nurse should feel free to talk to her about those. Bioethics stands on the principles of autonomy, justice, nonmaleficence, and beneficence. If there are multiple legitimate therapy options, the patient should be able to make an autonomous decision based off the information the doctor provides. Justice can be seen as being truthful and fair by being thorough in discussing therapy options, and not witholding useful information. It is possible that the negatives for the current therapy will be something less desirable for the patient than another therapy. Seen in this sense, nonmaleficence (do no harm) and beneficence would say inform the patient that there are other options. The nurse may be preventing the patient from undergoing side effects she may otherwise trade off for a more tolerable side effect.
ReplyDeleteI believe the nurse should give the information to John. The patient has the right to be informed about all possible forms a treatment that are available. In informing the patient of all the choices he is freely allowed to choose what treatment he wants with the help of a medical professional. For the principle of beneficence i feel that telling the patient the information that the doctor failed to inform him of is beneficial to the patient because it will allow him to make a better well informed decisions about the different spectrum of treatments. Lastly the principle of justice comes into play by the nurse being fair in the sense of feeling the need to inform the patient more about the treatment options. Since the nurse should give the information to John then the principle of justice plays a big role because the doctor should have informed the patient of all the treatment options not just one and should have explained the good and bad aspects of them.
ReplyDeleteVirtue ethics is all about compassion, justice and things of that nature right? So wouldn't the just and right thing for the nurse to do would be to tell the patient this information. She should probably mention it to the doctor first though since part of justice is following the chain of command and the doctor is kind of like the nurses boss. In showing compassion, another virtue, the nurse might mention or ask joan how her visit went and if they discusses other options ( in casual conversation). But i think if the nurse is truly concerned she should go to the doctor first and discuss it with him in private so as to not offend the doctor or the patient by stepping out of line or on anyones toes. I think the nurse should discuss her concerns with the doctor. If she is a caring, kind, individual ( virtues) she should approach the doctor. She should do this in his office away from the patient, so that they can properly.
ReplyDeleteI agree that the nurse should inform the patient of all the options but I do think that from the virtue ethics theory,the nurse or the doctor needs to inform the patient what they think is the best option for the patients situation. It is the patients right to know what other treatments are available, but they are most likely not as familiar with the treatments as the physician so i believe that he needs to inform the patient with what he thinks will benefit he/she the most.
DeleteI guess I will be the one to make the argument here (even though I find the nursing telling the patient to be the better choice by far). Anyway, I will argue against this claim that it was a good thing that the nurse told the patient this information, by her telling the patient these other options for a cure she could cause negative side effects. I will use the Utilitarian approach and say that by the nurse going behind the doctor's back and telling the patient about other cures, there is a large possibility that the patients suffering may increase due to the nurse acting in this way. As we all know Utilitarianism is about maximizing happiness and decreasing suffering. By the nurse doing this the patient may have a negative side effect to the matter (depending on how she goes about saying it). This can cause the patient to have second thoughts about the procedure that the doctor suggested, which was most likely the procedure that is most likely to save his life. In doing this, if the patient decides to try something else that is less effective, the patient could continue to feel pain, be ill, and possibly progressively get worse, which would cause the patient to not be as happy in the long run. Second, the simple possibility of the patient questioning a doctors authority and knowledge on the issue at hand alone will lead to confusion and mistrust in not just the doctor, but possibly the entire office or hospital that the patient is attending.
ReplyDeleteThe patient could have thoughts of, "why did the doctor not discuss these other cures and procedures?" "does the doctor know what he is talking about?" "why is the nurse just now telling me this?" "is the doctor just trying to take my money?" "can I trust the doctor and his staff?" "why are the nurse and doctor not on the same page?"
The last thing that this patient needs on his mind before a serious procedure or when making a possibly life changing decision is questions on trust. By the nurse telling him this information, many negative thoughts can occur not that will only stress the patient out, but greatly decrease his happiness, which is not the utilitarian way of doing things.
Really good point about this ruining the trust between the patient and doctor.
DeleteI definitely see what you are saying by Utilitarianism, but couldn't it also be argued in this way:
DeleteBy the nurse telling the patient that there are more treatment options, the patient may decide to choose to undergo treatment that could increase the health of that patient, which is promoting health. Also, the nurse will maximize benefits because the nurse will be confident in his/her work and so they will hopefully use that good work ethic to help other patients. Also, this will maxmize benefit for the family of the patient because they will not have to worry about his suffering. As for the physician, he will be minimizing harm to the patient in this new treatment, so that would be Utilitarian too, I think.
Just a different side of this theory.
Jimmy, I think you make a really good point. If there is any argument to be made here against the nurse sharing additional options with the patient, it is that this could undermine the doctor's authority. Furthermore, as you said, it could spark Joan's distrust in the doctor. This runs the risk of Joan being afraid of making any decision at all out of fear of which person to trust. It is important that the medical staff as a whole remains on the same page when sharing information their patients. Thus, in this situation, it may be best for the nurse to share his/her concerns with the doctor and see if he/she would be willing to go over the options again with the patient. Michael is correct in saying that by the Principles of Bioethics, the patient should be able to make an informed autonomous decision. However, the nurse being the one to share information may not be the best route to go.
DeleteI agree with Kelsey, the Utilitarian way is to minimize harm and maximize good for the greater amount. Although the nurse is giving the patient more information on the options, that doesn't mean that the patient would do the other options. The patient would just have more information and could then make a better judgement. Maybe the treatment that the doctor thinks is best and only suggest could put the patient in more pain than an alternative treatment, therefore going against the utilitarian belief. Just because the physician feels the treatment option is the right choice for the patient, that does not mean the patient will agree, and therefore should be given more options to minimize the harm of the patient and their family.
DeleteI didn't even think of that Kyle, I remember discussing that in class now that you say that. That is definitely something that needs to be considered in these kinds of situations. Not following the chain of command gives the patient even more of a reason to not trust the medical facility she is attending.
DeleteI agree that the Nurse-Doctor relationship needs to be protected and that is not possible if the Nurse goes behind the Doctor's back. According to the Utilitarian view what is best for all patients is to maintain trust for all physicians and medical staff. The only way to maintain the trust is for Doctors and Nurses to maintain a strong relationship.
ReplyDeleteWell, at this point I can only regurgitate information like a parrot. The Nurse should have told the doctor about the possible options and had him tell the patient about them, or atleast had him present. Going behind his back and offering the patient a painless alternative not only undermines the doctors authority, it also instills distrust in the doctor for the patient. Why should she trust someone who isn't willing to give her all her options?
ReplyDeleteYou really have to place yourself in the patients position for this case. The patient is probably nervous, scared, and confused. therefore, it is essential that you keep a professional relationship with the whole staff. This means the nurse and doctor working together. You dont want the patient to have to worry about their caretakers as well as themselves.
ReplyDelete