Thursday, February 18, 2016
Case 8 Nursing Autonomy/Subservience :) (23 & 25 Feb)
Collectively, address the questions at the end of the case (read what the people ahead of you have written and join in the conversation, rather than just responding to the prompt). Incorporate your ethical theories, and the readings on Nursing (that we discussed to today in class) and on informed consent in your posts. After you've made an initial post (due by 23 Feb), critically respond to the post of a classmate's (due by 25 Feb). Be charitable but challenging.
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1. Was Nurse L acting in a morally correct way when she gave Michael G the information?
ReplyDeleteAccording to Kant, Utilitarianism, the principle of Biomedical Ethics, and Ross' Principle of Bioethics all can be used to say that Nurse L was acting in a morally correct way. Kant's perspective of the categorical imperative states that a person cannot use a person as a means for their own benefit and can rationally believe is the rational law of nature. Nurse L was giving Michael G information that would in no way help her and she believed it was the right thing to do in that situation. The Utilitarianism perspective says to maximize goodness and minimize harm. Nurse L is trying to maximize the goodness of Michael G's life by letting him know of the other options that are available to him. In turn she is minimizing the amount of harm, such as Michael G possibly dying because he didn't know about a treatment that could have saved him. The principle of Biomedical Ethics was being followed by showing autonomy, beneficence, non maleficence and justice. Nurse L was respecting the patient's autonomy, doing good by giving him all possible options, trying to not do more harm to the patient, and being fair by not making chemotherapy the only option he has. Finally Ross' Principle of Bioethics shows that Nurse L was showing fidelity, justice, non maleficence, and beneficence. The fidelity she was showing was telling the truth and being honest to Michael G.
2. Should the physician in charge have the final word about the information a patient receives?
I do not thing the physician should have the final word in the information a patient receives because sometimes the physician will be thinking in their best interest and not tell the patient about the other options because they don't want them to leave and spend their money elsewhere.
3. If Michael G did not know about the alternative therapies, was his agreement to the chemotherapy informed consent?
If Michael G did not know all options that were available to him, then I do not believe that he was fully informed before consenting to chemotherapy therefore his agreement was not informed consent.
I agree with you Megan because it is wrong to not tell someone all of their options especially when used for your own benefit. In order to completely have consent, each of the options need to be clearly listed out. The face that they were not means this doctor is acting immorally.
Delete1. Was Nurse L acting in a morally correct way when she gave Michael G the information?
ReplyDeleteI believe the nurse was acting morally on the idea of Virtue. Edmund Pellegrino talks about how physicians need to make decisions in the most virtuous mindset they can have. He also believes that they should act like they have virtue even if they lack it. Nurse L felt like the patient was not given all of the options that he deserved and she knew she needed to be virtuous enough to help. She took to action what was right for the patient, even if that meant losing money for the doctor.
2. Should the physician in charge have the final word about the information a patient receives?
No because the physician is not the one who has to go through the pain. The patient knows what they need to do to minimize the pain and maximize their own pleasure. Maybe taking the more natural route is more cost-efficient for them then the hospital.
3. If Michael G did not know about the alternative therapies, was his agreement to the chemotherapy informed consent?
I do not think this should be considered consent off the fact that he was not informed of all his choices. It is hard to make the right decision when you are only given one ultimatum.
Your response to the third question hits the nail on the head. How can we make a decision if we are only given/presented one option? I don't even think it can be called a decision.
DeleteYour second respond has be a bit confused: I believe it was asking who between the nurse and the physician should have the final say on what information the patient receives.
I really liked your last comment about the fact that there can't be a decision if there is only one option. It's like asking someone what ice cream they want but only having one flavor to choose from. It just doesn't make sense. I also agree that Nurse L was acting morally, I thought the same. She was trying to give him all the options to make an informed decision about quality of life moving forward.
DeleteI agree that he did not have informed consent, but I disagree with your view on the other two questions. From a utilitarian perspective the nurse may have caused more harm than good. She quite possibly eroded the trust between the doctor and patient, and she may have given the patient an option that is not actually an effective treatment. The nurse does not have sufficient knowledge of proper treatments and should have consulted with the doctor first. Also, the doctor is not making more money by giving out chemo so he is not biased in regards to compensation.
DeleteI would also say the doctor does have the final say in the information a patient receives if the doctor is giving sufficient information for the patient to make an informed decision. The doctor has the responsibility to present all viable treatment options. If the doctor does this, then the doctor is informing the patient correctly. He has the right to withhold info only if the alternative options have unknown effectiveness.
I agree Katrina, I think I may have misread the question. I believe whoever is making the most ethical and reliable decision should make the final decision rather it being the nurse or physician. The decision should be the same anyways to make it the right one, so either one I feel is capable of helping the patient regardless of status.
Delete1. Was Nurse L acting in a morally correct way when she gave Michael G the information?
ReplyDeleteAccording to Lisa Newton in her article on traditional nursing, Nurse L was in the wrong in that she acted autonomously and not in a subservient nature. By taking it upon herself to tell the patient about alternative therapies she was undermining the physician and going against her traditional role. However, if you interpret Newton's theory in a different way and focus on the maternal aspect, Nurse L took this upon herself in order to act as a caretaker for Michael G in order to get him the best care possible. I personally believe that Newton's theory is wrong in this case and I believe Nurse L should have taken her opinions and consulted Michael G's entire medical team to discuss letting him know about alternative therapies.
2. Should the physician in charge have the final word about the information a patient receives?
I believe that it is the physician in charge's final decision about the information a patient receives. But, as a physician they should know that patients must be informed of all possible treatments and side effects. The job of the physician is to make a person better but they should do this in a way that also takes into consideration the wishes and goals of a patient.
3. If Michael G did not know about the alternative therapies, was his agreement to the chemotherapy informed consent?
No, in order for informed consent to be valid a patient must know all options for treatment and all possible outcomes for this treatment. If a patient is not given a full list of treatments this may cause them to choose a treatment that they would not have previously. Just as Josh said, how can someone make the correct decision when they are only given one option.
I agree with you Abby on your response to the second question. The physician should be able to make that final decision with the exception of making sure the patient has all the information and that the decision made is respectful of the wishes of the patient.
DeleteAs for question three, i truly think this is also the correct thing to do. It always happens to older patients or patients that might not know much about what is going on with treatments or surgeries, to get the minimum about of information just to get the procedure done. And i also agree with Josh that someone can not make a reasonable decision if they do not have all the information and are only limited to one option.
I completely agree with you Abby. Newton believes nurses should act in a subservient nature towards the physician so Nurse L would be acting in an immoral way when she went behind the physician and told Michael G alternative therapies. I don't agree with this. Just like you said, I think Nurse L was right to tell Michael G of the alternative therapies because I think he deserves to know all possible treatments that are available to him before he decides what he wants to do. Since he didn't know about all options for treatment, it wouldn't be informed consent. I also agree with Josh that someone can't make the right decision when only given one option.
Delete1. Was Nurse L acting in a morally correct way when she gave Michael G the information?
ReplyDeleteIf one were looking at the situation from Newton’s point of view, the nurse definitely acted in an immoral way. She was not fulfilling her subservient duties. Instead, she was acting out of her own autonomy and disregarding the physician. Depending upon interpretation, one could also argue that the Nurse acted morally and was exercising her motherly role by presenting alternatives. In the case of a traditional nurse quite some years ago with significantly less training and education, I would support Newton’s view; however, I believe Newton’s argument is outdated. Today, there would be a whole medical staff that she could consult and present alternatives to. She should have gone to them to verify possible alternatives.
2. Should the physician in charge have the final word about the information a patient receives?
I believe that the physician should have the final say. Of course, it should be required as a part of their job to present all of the options regarding treatment to a patient. A patient should be well-informed, and a decision should be made together.
3. If Michael G did not know about the alternative therapies, was his agreement to the chemotherapy informed consent?
No, a patient must know all of the options, risks, and outcomes. If they are not given all of the information in an understandable manner, then they are not truly informed.
1. Was Nurse L acting in a morally correct way when she gave Michael G the information? Nurse L was not acting in a morally correct way because she told Michael G about a therapy that her and her team did not consult. When informing a patient of other therapy options, the hospital team of physicians and nurses need to discuss them before presenting them to a patient.
ReplyDelete2. Should the physician in charge have the final word about the information a patient receives? A physician should have the final say about the nursing staff explaining other options and treatments to a patient. It is not professional for a nurse to suggest another therapy treatment while the hospital team is planning to treat Michael with the best treatment option they have on site.
3. If Michael G did not know about the alternative therapies, was his agreement to the chemotherapy informed consent? Michael G is not told all options for his treatment, so he doesn't necessarily give consent to chemotherapy when that is the only option given to him.
Hi Marissa!
DeleteI agree with you about Michael not receiving all the information about the other treatments. Since he didn’t receive all the options and information, he didn’t inform consent to the chemo. Do you think we could argue that he also wasn’t able to consent since he might not be competent to give consent? Due to the chemo and the pain.
Marisa, I don't completely agree with your response to question two, only because I do not believe the physician would recommend something different to the patient enough to turn the patient away from the hospital he or she is working at. I believe the physician would guide the patient on the right path that the doctors or hospital have them on already, because why would a physician push away business rather than keep the person there and give them the best treatment?
DeleteKayla, I was explaining that the nurse shouldn't discuss other options with the patient before she discusses them with the physician. The physician and his team are guiding Michael on the right path, but they did not explain all treatment options to him.
DeleteZai, It is also possible that due to Michael's treatment of chemo, that he may not be competent to give consent to a treatment he truly wants and knows all the facts about.
1) Was Nurse L acting in a morally correct way when she gave Michael G the information?
ReplyDeleteYes, Nurse L was acting morally when she informed Michael G of the alternative treatment options. From a Kantian perspective, she was working through the Categorical Imperative, which would hold that a universal reaction to patient treatment would be to inform the patient of all the options that are available for their illness. She also was treating Michael G as a person, not merely as a means, by preserving his autonomy as sentient human being. From the perspective of Biomedical Ethics, she was preserving his autonomy as a patient by providing him with the information he required to make an informed decision about his treatment and therefore provide informed consent to what he wanted done. She was also practicing beneficence, whereby giving him the information allowed Michael G to choose the treatment he wanted, as opposed to the treatment the doctor wanted him to take.
2) Should the physician in charge have the final word about the information a patient receives?
I do not think that physicians should have the final say in what information the patient receives, if only because such a system violates the patient's autonomy by possibly restricting access to pertinent information, as seen in this scenario. Instead, I feel that doctors should be required to supply the patient with all of the pertinent information to their treatment, allowing them to, by extension, make an informed decision.
3) If Michael G did not know about the alternative therapies, was his agreement to the chemotherapy informed consent?
No, because informed consent requires the patient to be informed not only of the benefits, risks, and side effects of the treatment they choose, but also of all of the options they have for treatment. Informed consent requires the patient make and autonomous decision about what treatment they want, which requires them to be completely informed to the best of their understanding in order to provide a decision on what they want.
Hi Keith,
DeleteI agree with you that the physician shouldn't have the final say because it does violate the patients autonomy. It also violates that patients right to informed consent. The patient needs to be away of all available treatments and not just treatments that benefit himself. This would be violating Kant because the doctor would be using the patients as means for himself
1. An article we read and discussed in class discussed how nurses are subservient to doctors. Therefore, it would be morally wrong for Nurse L to discuss other options with the patient, before asking the doctor for permission. The medical field has changed a lot in the last few decades. Personally, I think doctors and nurses should be partners, with the doctor making the final decision, unless a rare event occurs (ex: Doctor is drunk). In this case, I don’t think Nurse L was acting in an immoral way. The doctor withheld information from Michael, for some reason. Nurse L had a duty to tell Michael, since the doctor didn’t. I do think that Nurse L could have handled it better. She could have talked to the doctor first, because he might not have known about the natural therapy.
ReplyDelete2. From what I have learned in class, doctors/physicians have the final say in decisions. In this case, I don’t think the physician should have the final say. He withheld other treatment from Michael, for whatever reason. My assumption is money, since chemotherapy is way more expensive than natural therapies, which translates into more money for the physician/doctor. Even if the other treatment isn’t in the best interest of the patient, doctors/physicians should still tell their parents the other options they have and let them decide.
Personally, I think nurses and doctors need to work together as partners. Nurses spend more time with the patients. They get to know them more. Doctors have more experience and knowledge. Together, they have all the information they need, to help do what is truly best for the patient.
3. From reading the information provided in the case, I would argue that Michael’s agreement to the chemotherapy was not informed consent. For starters, if the doctor didn’t explain the other treatments to Michael, it is safe to assume that he also didn’t discuss the risks and benefits about chemotherapy with him. Michael wasn’t given sufficient information, therefore, his decision cannot be an informed on. Also, Michael may not be capable of making important decisions autonomously, since he is in pain from his illness and treatment. Plus, he could be in shock from the whole experience. If he can’t make a decision autonomously, than he can’t and didn’t give informed consent.
I agree that these nurses and Doctors need to work together as a team and make these tough decisions. The better the team work and the more voices means he more opinions will help for the team of doctors to make a decision that everyone should be comfortable with.
Delete1. Was Nurse L acting in a morally correct way when she gave Michael G the information?
ReplyDeleteI think that morally she was trying to give him a better option than the invasive treatment he might undergo, I think her intentions weren't terrible. Doctors and nurses should work as a team and it is both of their jobs to inform the patient.
2. Should the physician in charge have the final word about the information a patient receives?
I do think that the Physician in charge should have the final word. Key phrase in that question is "in charge", so it has been answered for us. We should give that right to the physician but the nurse should have a say in the matter. They should speak with each other before letting the patient believe he has only ONE option.
3. If Michael G did not know about the alternative therapies, was his agreement to the chemotherapy informed consent?
I don't think it was informed consent, the doctor neglected to inform him of all the possibilities and if you can't make an informed autonomous decision than you are not getting the full knowledge of the informed consent. It does say in the book that they believe giving too much information to a patient will make them understand less and giving them minimal information makes them focus on the important information. It is tricky but I think that Michael was not capable of making the decision fully because he was not given the necessary knowledge.
I never really payed attention to that it does say physician "in charge". Usually the person in charge does make the decisions, but what if this person is being immoral? I'm sure we have all met someone who is "in charge" but abuses their power. Do you feel that power can be overruled if needed? I do. Still, I do agree with what you mentioned about the patient and physician to be in agreement. The more they can agree the more ethical and right decision can be made.
Delete1. I do not think she was acting in a morally correct way when she gave Michael G the information. She should have approached the doctor first about her thoughts, and as a team they could decide what to do. There may have been a very good reason the doctor did not share this information with the patient. For example, these natural therapies may have no real scientific research done on them, and thus the effectiveness is unknown.
ReplyDelete2. A physician should have the final word about what info a patient receives as they are experts in their field. However, they do have a responsibility to give them all pertinent info.
3. I would say if the alternative therapies were known to elicit positive results, then Michael G did not have informed consent. He deserves to know about these options even if the doctor does not agree with them. By not knowing about these other options, it cannot be said that he voluntarily chose chemo as his options were limited by the doctor. However, if the alternative therapies were not proven to have positive results then Michael G did have informed consent as they were not valid medical options. In this situation, Michael G had sufficient understanding of the situation in order to make his decision.
Brycen,
DeleteI disagree with you because the patient has a right to know what all of his options are. The doctor should have told him in the first place all options that are available. Michael G did not have informed consent even if the alternative treatments didn't work. Since he did not know all options available, he was not technically informed.
1) Was Nurse L acting in a morally correct way when she gave Michael G the information? Michael G deserves to know all possible treatments before making his decision so I believe Nurse L was morally correct to tell him about these options. Newton believes nurses should act in a subservient nature towards the physician so according to her, Nurse L would be acting in an immoral way when she went behind the physician and told Michael G alternative therapies. I don't agree with this. I think Nurse L was right to tell Michael G of the alternative therapies when the physician failed to inform him.
ReplyDelete2) Should the physician in charge have the final word about the information a patient receives? I believe the physician in charge has the final word about the information a patient receives. However, it is their job to inform the patient on all treatments and side effects to help them with their decision. Physicians are supposed to help their patients get better but also need to keep their goals in mind.
3) If Michael G did not know about the alternative therapies, was his agreement to the chemotherapy informed consent? His agreement was not informed consent because he did not know all possible forms of treatment. He was only given one option and so was not able to make an informed decision. He needs to know all possible information to make a truly informed decision.
Well my browser deleted EVERYTHING, so I'm starting over with a simpler explanation of each.
ReplyDeleteWas she acting morally? Yes. She wasn't thinking with her wallet, she was thinking about the patient and the money and pain he was suffering often found in chemo.
Should he have the last word? Yes and no. He is a doctor for a reason but he is only human. He should have his professional input heard and heavily considered, but in certain situations, it should be discussed amongst his entire team.
Was it consent? Once again, it depends on the circumstances. What were the alternative therapies? Was it a new procedure with a low success rate, but cheaper and less painful? Or was it a brochure to a sweat lodge found in the plains of Arizona? Was it a new experimental drug, free of charge for human trial participants? Or was it a formulated diet, comprised of recipes for açaí and kale smoothies with a dash of, I dunno, frog's foot that witch doctors used to magically heal people? If the alternative therapies are things that can be carried or by medical professionals and are viable procedures, then they should be told to the patient. But, if they are "holistic" hippy cures, then they shouldn't be required to be told because that kinda stuff is a dime a dozen and can be found when searching google and Reddit.
I believe that nurse L was actict morally because if a patient like Michael G wants to know all options for treatment then it is the moral right for the nurse to do so.
ReplyDeleteEven the though the nurse has talked with the patient the most and is around the patient a lot more. The head physician still should be the one to have the final say in what the treatment will be.
Michael G would not have been informed consent if he was not notified of the multiple options of treatment. In order for him to make a decision that is percent informed ], then you have no choice but to tell him everything in detail.
I am in agreement in your answer to the second question since the physician is the boss in this situation. But I also believe that if the boss is making a mistake that the subordinates should check and balance that decision.
DeleteKant would say that Nurse L was acting accordingly on moral grounds because all people deserve the right to their respect and in this case involves disclosure of information. His informed consent is also at risk if the information is not available to him. If the physician has the last word about the information a patient receives then all the information should be disclosed to ensure that the patient could make an informed decision on his treatment. Michel's agreement to the chemotherapy would not be informed consent if he did not know about alternative pathways.
ReplyDeleteI believe that overall, Nurse L was acting morally. From the standpoint of virtue ethics she did not give him the information to go against the doctor she gave it to him because she was trying to do whats best. However, I do believe that she should have consulted with the doctor first, this would have been best because it would have preserved the relationship between the doctor and nurse and I believe that the doctor is overall in charge of the patient's care and if something were to happen, the doctor would be held accountable. Michael was not fully informed if he was not given all the information.
ReplyDeleteI agree that she should have discussed with the doctor to find out why the doctor did not bring this up in the first place. If the doctor even after discussing it with the nurse and still decides to not tell the patient, Do you think she should morally inform the patient anyways?
DeleteI believe that Nurse L was acting on moral grounds to ensure that the patient was truly was informed. Through theory of Ethics of Care, Nurse L was ensuring that the patient was receiving all of his needs by telling him the other alternatives he could use. Also by taking the time and sitting down with the patient and going over it with him this also goes along with the Ethics of care by handling the patients needs in a personalized manor. The doctor should have talked about all the options from the beginning because by not doing so he did not give Michael the option of truly informed consent.
ReplyDelete1. I do believe that the nurse was acting morally, but the way she did it was wrong. She should have told the patient that these therapies were there, and then set up a joint counseling session with the doctor to explain to the patient the treatments. The way she went behind the doctors back was unprofessional. That being said, the doctor was also unprofessional by not telling the patient about the alternative natural therapies.
ReplyDelete2. The physician in charge should not always have the final word about the information a patient receives. The patient should get all the information, not just what the doctor considers relevant. That is one of the main premises behind informed consent.
3. I do not believe that the patient had informed consent when he started chemo. He did not know his alternative options, which could have influenced his decision.