Statement & Assessment of the Ethical Dilemma
A patient at the VA Hospital on a Psychiatric unit for chronically mentally ill veterans requested additional medication. The patient was a 75 year old man suffering from chronic depression, who was seen on an outpatient bases. He was currently taking one medication for depression and complained that it was not effective, and he therefore wanted another medication. The doctor was consulted by the patient's wife; she was told that the medication would not be changed at this time. The doctor did not consult the patient, the Clinical Nurse Specialist (CNS), or others involved in the case. Thus the patient and relevant health care professionals were not permitted to participate in the decision-making process and ethical efficacy was not considered. The patient's condition became worse following the decision. If the CNS had decided to ignore the fact that the client had not been consulted, she would be in violation of her duty to care for and be responsible to the client, since a fair and just decision for the patient had not been made. The CNS decided therefore, to challenge the decision and the process with which it was made.
Ethical principles for nurses are difficult to understand since code requirements conflict, are not exhaustive, do not provide rationale, and are devised by minority nurse groups (Edwards, 1997). The International Code of Ethics for Nurses provides elements that pertain to: nurses and people, nurses and practice, nurses and the profession, and nurses and co-workers (ICN Code of Ethics for Nurses, 2000).
Code elements related to nurses and people, that are relevant to this case, include the following: the nurse has the primary responsibility to people requiring nursing care; the nurse insures that human rights and values are respected, and the nurse ensures that the individual receives sufficient information on which to base consent for care. A code...