Description
- Read the case study presented at the end of Chapter 8 (Guido, p. 150)
- Is the patient correct in asserting that he has a right to know the names and status of individuals who will be performing this procedure?
- Does the manner in which the student introduced herself and the two other team members have relevance in this case?
- Was the informed consent deficient to the degree that there was a lack of informed consent by the patient?
- How would you decide this case?
- A patient is admitted to your surgical center for a breast biopsy under local anesthesia. The surgeon has previously informed the patient of the procedure, risks, alternatives, desired outcomes, and possible complications. You give the surgery permit form to the patient for her signature. She readily states that she knows about the procedure and has no additional questions; she signs the form with no hesitation. Her husband, who is visiting with her, says he is worried that something may be said during the procedure to alarm his wife. What do you do at this point? Do you alert the surgeon that informed consent has not been obtained? Do you request that the surgeon revisit the patient and reinstruct her about the surgery? Since the patient has already signed the form, is there anything more you should do?
Now consider the ethical issues that such a scenario raises. Which ethical principles is the husband in this example most portraying? Which ethical principles should guide the nurse in working with this patient and family member?
- Jimmy Chang, a 20- year- old college student, is admitted to your institution for additional chemotherapy. Jimmy was diagnosed with leukemia 5 years earlier and has had several courses of chemotherapy. He is currently in an acute active phase of the disease, though he had enjoyed a 14- month remission phase prior to this admission. His parents, who accompany him to the hospital, are divided as to the benefits of additional chemotherapy. His mother is adamant that she will sign the informed consent form for this course of therapy, and his father is equally adamant that he will refuse to sign the informed consent form because "Jimmy has suffered enough."
You are his primary nurse and must assist in somehow resolving this impasse. What do you do about the informed consent form? Who signs and why? Using the MORAL model, decide the best course of action for Jimmy from an ethical perspective rather than a legal perspective. Did you come to the same conclusion using both an ethical and a legal approach?
Explanation & Answer
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Case Study 1:
Consent may be withdrawn at any time. With that in mind, and the new
information from the husband, I would advice for the surgeon to have another sit down
with the husband and wife and give an outline of the procedure, the risks involved, the
alternatives, the medical team that will be involved in her procedure and their
qualifications as well as any side effects and what to look out for after the procedure.
This talk would settle anything that was misunderstood as well as facilitate room for any
questions and clarification needed.
Though the patient had signed the consent, it is good to clear things up even when
they emerge later and while clearly the husband is concerned, he should not be brushed
aside. This is because seeing that he is family, he has the right to sue should anything go
wrong and while his consent may not be needed, it is better to have him on board and
fully aware of what will happen in the wife’s procedure as well as reducing unforeseen
incidences that can be avoided with proper communication.
The procedure should only be carried out after the parties involved have agreed to
it and are fully aware of what they are getting into. This is despite the fact that the lady
has already s...