Introduction
Jane Doe is a 74-years old oncology patient. She is suffering from a near-terminal stage bladder cancer, and has been admitted to chemotherapy by her physician. The process is extremely long and uncomfortable for the patient. She constantly complains about pains, vomiting, and other side-effects associated with the procedure, to the nursing team. The nurse brings the patient’s complaints to the physician, and suggests that the procedures should stop, and the chances of success are minuscule, while the patient’s suffering worsens with each day. The doctor dismisses these concerns, and prods the patient to continue, despite initial protests. When the nurse protests about the doctor’s decisions, he tells her to fall in line and follow the chain of subordination. The nurse has a decision to make – to bring the matter to the higher-ups, essentially undermining the doctor’s authority and failing to cooperate with their requests, or follow suit despite the patient’s increasingly alarming objections and complaints.
Relation to the Nurse’s Code of Ethics
The situation relates to several provisions within the Code of Ethics for Nurses. Namely, it concerns points 1-4, which state that the nurse should treat patients with compassion and respect, have a primary commitment to the patient, promote and advocate their rights, and make decisions to provide optimal healthcare (Bedzow, 2018). The concern for compassion and respect relates to the patient constantly stating their discomfort and pain. Not bringing up these concerns with the doctor and fellow nurse members would be a breach of the provision. The doctor chose to ignore these points, facilitating further action on the part of the nurse. The second provision regards commitment to the patient and promoting their rights (Bedzow, 2018). The situation describes how the doctor continued to emphasize the need for chemotherapy despite little chances of it being effective. On the other hand, the consequences of this therapy for Jane Doe were immediate, obvious, and severe. Thus, the nurse is required to act out of commitment to the patient.
The patient’s rights were obviously infringed, as the doctor effectively bullied her into continuing the treatment, despite the vocal demands to stop whenever he was not around. He used his authority and knowledge to pressure the patient, thus resulting in an uninformed decision-making on the latter’s part. Since the nurse is the primary advocate for a patient’s rights, it behooves her to act in their best interest (Bedzow, 2018). Finally, the point of contention is the necessity to provide optimal care (Bedzow, 2018). Here, the nurse’s assessment of the situation is different from that of the doctor, resulting in a conflict. The nurse must decide whether her noncompliance or her failure to report the incident would harm the patient more.
The Situation and Ethical Nursing Principles
The ethical principles as outlined in the Nursing Code are those of Autonomy, Justice, Beneficence, and Nonmaleficence. The situation presents three of these principles being questioned. The patient’s right for autonomy is being infringed by the doctor, who thinks that the therapy is needed, even if there is even a slight chance of success (Bedzow, 2018). The patient’s vocal complaints about the aftermath could be considered a reason enough to stop the procedure, and a revocation of consent (Muller & Schaber, 2018). The principle of beneficence is also being put into question for that reason (Bedzow, 2018). If a treatment has a very low likelihood of succeeding, it may be considered pointless in purpose and harmful to the patient both from a psychological, physical, and financial points of view.
Finally, the principle of nonmaleficence is closely related to these concerns as well. The nursing oath demands not to induce any harmful treatments. Chemotherapy is a very hazardous option, as it can provoke vomiting, internal hemorrhaging, pain, and disrupt sleeping patterns, among many other side-effects (Muller & Schaber, 2018). Thus, utilizing it on a terminal-stage patient would be directly harmful to them and result in a reduction in a quality of life. At the same time, the latter two principles can be interpreted from the doctor’s perspective. If the patient is not given treatment that has a small, but feasible likelihood of success, they are effectively refusing care and allow the patient to die. Doing so violates the ideas of beneficence and nonmaleficence both, which is why many doctors are apprehensive about refusing treatment.
What Can a Nurse Do to Lessen the Impact of the Situation?
The situation effectively revolves around whose call is correct – that of the doctor or the nurse. If the treatment is pointless, as the nurse perceives it to be, then everything the doctor does is only pointlessly hurting the patient. If the doctor’s chosen course of treatment is correct, then all the nurse accomplishes is undermining the faith of the patient and the nurse staff in the doctor (Rainer et al., 2018). This effectively prevents him from accomplishing his task of saving the patient.
In order to avoid personal perceptions and biases to affect the goal of finding optimal treatment, the nurse should seek counsel from other doctors higher up in the hierarchy. An independent observer could evaluate the situation without risking biases present in either side (Rainer et al., 2018). Doing so would allow discovering the most appropriate course of action. It also helps avoid some of the issues with the chain of command and personal authority to the doctor. It is not uncommon for nurses and doctors to disagree on a course of treatment. However, these disagreements should not come at the expense of the patient.
One issue that should be remedied immediately, however, is the doctor’s breach of consent practices. It is the duty of any medical worker to explain the treatment options and chances of success for the patient, prior to administering or continuing them (Muller & Schaber, 2018). The patient’s autonomy must be respected, especially considering that Jane Doe is in the right mental and emotional state to make such decisions (Muller & Schaber, 2018). She should be explained the options she has without any attempts at manipulation, and the healthcare clinic should then respect her decisions in regards to the treatment (Muller & Schaber, 2018). Accurate estimations on how successful chemotherapy would be should be done involving a third party.
Conclusions
The ethical situation presented revolves around opposition and noncompliance of a nurse with a doctor’s intended course of treatment. The patient’s autonomy, health, and long-term state are on the line. The nurse should act in accordance to the Code of Ethics, and seek to report the situation to higher medical authorities. The price of the patient’s well-being is worth getting into a discussion with the superior clinician, as they are to be held accountable by their peers.
References
Bedzow, I. (2018). Giving voice to values as a professional physician: An introduction to medical ethics. Routledge.
Müller, A., & Schaber, P. (Eds.). (2018). The Routledge handbook of the ethics of consent. Routledge.
Rainer, J., Schneider, J. K., & Lorenz, R. A. (2018). Ethical dilemmas in nursing: An integrative review. Journal of Clinical Nursing, 27(19-20), 3446-3461.