Consider the following case study:
An ethical dilemma
Mrs F is an 80 year old Muslim woman admitted to your ward. She has limited English and is accompanied by her husband (also with little English) and their 2 sons who speak English fluently.
Mrs F has advanced bladder cancer with urinary retention and pain score of 6/10. She requires an Indwelling Catheter (IDC) to be inserted to relieve her pain and urinary retention. She has no other medical conditions. From handover you know that she has no EPOA or ACHD and has Capacity.
Her doctor comes in and speaks to the sons who say that their culture means that there is no need to talk to their mother about the procedure and they can make the decision for her. The doctor agrees with them and orders an IDC on free drainage to be inserted.
When you come in to do her vital signs prior to the IDC being inserted and while her family are outside she tries to ask you what is happening, grabbing her lower abdomen and crying.
Q4 What would you do in this situation?
In answering the question you need to make an Ethical Decision using the following as they relate to the case study:
· Code of Ethics (ICN 2012)
· Informed decision making and Consent.
· Cultural Competency
· Ethical concepts and principles in nursing
– Autonomy – “Self-determination” – consider Mrs F’s rights.
– Beneficence – “above all, do good” – what is best in Mrs F’s interests?
– Non-maleficence – “above all, do no harm” – what is in Mrs F’s interests?
– Confidentially – who should have Mrs F’s information?
– Justice – “fairness” – what is fair for Mrs F?
– Rights – what are Mrs F’s rights?
– Veracity – “telling the truth” – what does this mean for Mrs F?
SOLUTION: Mrs F 80 year old Muslim woman admitted to ward
In this situation, several ethical principles and considerations come into play:
Autonomy: Mrs. F has the right to make decisions about her own medical care, provided she has capacity. Despite the cultural beliefs of her sons, it is imperative to respect Mrs. F’s autonomy and involve her in the decision-making process to the extent possible.Beneficence: The primary goal of healthcare professionals is to do good for the patient. In Mrs. F’s case, relieving her pain and discomfort through the insertion of the indwelling catheter (IDC) is in her best interest from a medical perspective.Non-maleficence: Healthcare providers must strive to do no harm to their patients. In this context, withholding necessary medical treatment, such as the IDC insertion, could potentially harm Mrs. F by allowing her pain and urinary retention to persist.Confidentiality: Mrs. F’s medical information should be kept confidential and shared only with those involved in her care or with her explicit consent. While her sons may be involved in her care, Mrs. F should be given the opportunity to share her concerns and preferences privately with healthcare providers.Justice: Fairness requires that Mrs. F’s cultural background and beliefs be respected while also ensuring that she receives appropriate medical care that aligns with her best interests and preferences.Rights: Mrs. F has the right to receive adequate information about her medical condition and proposed treatments, to make decisions about her care, and to have her autonomy respected.Veracity: Healthcare providers have an ethical obligation to be truthful with their patients. Mrs. F should be provided with clear and honest information about her medical condition, the proposed IDC insertion, and the potential benefits and risks associated with the procedure.
Given these ethical considerations, the appropriate course of action would be to:
- Respect Mrs. F’s autonomy by involving her in the decision-making process to the extent possible, ensuring that she understands the proposed procedure and its implications.Provide Mrs. F with culturally sensitive and linguistically appropriate information about the IDC insertion, addressing any concerns or questions she may have.Advocate for Mrs. F’s rights to receive appropriate medical care while also respecting her cultural beliefs and preferences.Ensure that Mrs. F’s medical information is kept confidential and shared only with those directly involved in her care, including her sons if she consents to their involvement.If Mrs. F is unable to provide informed consent due to language barriers or other factors, efforts should be made to facilitate communication through interpretation services or other means to ensure that her preferences and wishes are understood and respected. If necessary, involving an ethics committee or seeking legal guidance may be appropriate to resolve any conflicts between Mrs. F’s autonomy and her family’s cultural beliefs.
