Clinical Ethics

So, I know I’ve been very bad about posting on this blog lately. But between work, class, and clinical there hasn’t been a lot of time. I finally have a few days off this week. Anyway, I thought you might like to see what I’m “learning.” One of the classes I am taking is Clinical Ethics. Yesterday in class we had to discuss the following scenarios. For each one assume you are a doctor/nurse practitioner and ask yourself: What should be done and why?

1) A patient with a family history of colon cancer and other risk factors refuses your best efforts to encourage scheduling a colonoscopy.

2) An 18-year-old woman requests a cesarean delivery for an uncomplicated pregnancy because she fears labor. You are concerned because there are no medical indications for the cesarean delivery, which has more risks. At the same time she requests a prescription for an antibiotic because “this cold is a drag and antibiotics always seem to help.” You believe her “cold” is viral and not bacterial.

3) You are a medical or graduate nursing student working in a clinical setting and your observe one of your peers falsifying patient-related information in a chart note.

4) As a resident, you are ordered to obtain consent for a procedure from a patient whose decision making capacity appears to be adversely affected by medication.

5) You are part of a team caring for a patient who preferences for a Do Not Resuscitate/Do Not Intubate order are ignored by the attending physician. The patient suffer a cardiac arrest.

6) A nursing colleague confesses to you that an unintentional error he made in a patient’s medication may have been responsible for hastening the patient’s death.

7) You overhear a fellow student using derogatory language to describe a patient with HIV.

8) The family of a patient with metastatic, end-stage breast cancer, who is no longer able to communicate her own preferences, demands that she receive treatment that is “futile” in the judgment of her professional care givers. You are one of the patient’s caregivers.

9) The parents of a 13-year-old boy with limited mental capacities, impaired judgment, and new tendencies to act out sexually with girls, demand a vasectomy for their son.