Analysis of an 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

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which may exacerbate the depression diagnosis. While withholding the additional medication may be a good decision, the making of this decision without patient, family, and other consultation may not be a good decision. The nurse must enter into an honest relationship with the patient, which includes truthful communication. In this case, while a lie has not been told to the patient, the exclusion of the patient and CNS in the decision-making process, did not allow for all of the relevant information to be considered, and thus the conclusion that the decision was a good one, may be a lie. The patient has the right to personal choice and this must be respected. This right was not considered in this case. Institutional policy was not an issue regarding the medication decision or the process, since the doctor had the qualified right to make the decision and the institution regulations did not demand discussion with relevant parties for decision-making. Family members were a consideration, even though they were not identified as decision-makers, since they were also distressed by the decision and the patient's resulting condition. Family member feelings and views were not considered or discussed and this resulted in heightened
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Approximate Word count = 1516
Approximate Pages = 6 (250 words per page)