Giving Narcotics to Known Addicts - Essay Example

? Ethical Dilemma: Doctors Giving Orders for Nurses to Carry Out to Addicts Even Though the Doctors Know Their Patients Are Addicted to the NarcoticsYour Name School Affiliation Abstract This paper denotes the ethical responsibilities of nurses carrying out doctors’ orders with which they disagree. The specific topic is doctors giving narcotic orders for nurses to carry out to addicts even though the doctors know their patients are addicted to the narcotics. Rules of proper conduct will be discussed, situations presented, and laws cited in relation to this dilemma. The conclusion will be evident that nurses must keep the patients’ best interests at heart as they seek to be the patient advocate and do no harm. Ethical Dilemma: Doctors Giving Orders for Nurses to Carry Out to Addicts Even Though the Doctors Know Their Patients Are Addicted to the Narcotics There are many documented instances where nurses have been placed in ethical situations when it comes to following doctors’ orders. One of these situations is whether or not to carry out those orders if they mean giving narcotics to known addicts. Revised over the years, the Nurse’s Association’s Code of Ethics for Nurses with Interpretive Statements strictly conveys the importance of accountability and patient advocacy. Primary to the subject matter of this article are several Provisions directly stated in the Code. In Provision 2, “The nurse’s primary commitment is to the patient, whether an individual, family, group or community.” Provision 3 states, “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient,” And Provision 4 reads,“The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.” To gain a clearer understanding of the scope of ethics in relation to the subject matter, a definition of some terms would be beneficial. “Ethics” is defined by Merriam-Webster as “a set of moral principles: a theory or system of moral values” (ethics, 2011), while the American Heritage Dictionary defines a “narcotic” as “ an addictive drug, such as opium, that reduces pain, alters mood and behavior, and usually induces sleep or stupor” (narcotic, 2011). In the article “Nurses Struggle with Ethical Dilemmas,” Christine Mitchell (RN, MS, FAAN, Director of Ethics at Boston Children’s Hospital and Associate Director of Clinical Ethics at Harvard Medical School in Cambridge, Massachusetts) is quoted as saying, “The important thing is for nurses to listen to their inner voices and ask themselves, ‘Are we doing the right thing?’ Pay attention to that voice.” (Boivin, 2009) In seeking to do the right thing, the nurse must minister to the whole person, as Marg Hutchison quotes Joyce Travelbee in “Unity and Diversity in Spiritual Care,”A nurse does not only seek to alleviate physical pain or render physical care - she ministers to the whole person. The existence of suffering, whether physical, mental or spiritual is the proper concern of the nurse.” (Hutchison, 1998) In adhering to this principle, the Hospice Patient’s Alliance focuses on five rights of drug administration that apply to nurses employed in any medical setting. These rights, as listed in the article “Dangers of Leaving Medications Out” include the right patient, drug or medication, dose of medication, route of administration, and time (frequency). (The Hospice Patient’s Alliance) The nurse must, therefore, forever be aware of the patient’s best interests. It is obvious that serious consequences could occur if either of these rights was violated. In the process of giving medication to patients, the nurse might question why the doctor would prescribe narcotics to a known addict. There lingers the possibility that the nurse may be unaware of the total reasoning behind a doctor’s orders. Perhaps the patient is seeking chronic pain relief. Perhaps it is a situation where the doctor is treating an addict with a drug such as buprenorphine in order to prevent withdrawal’s interference with treatment for an unrelated medical condition. Neither the Drug Addiction Treatment Act of 2000 (Amendment to Controlled Substances Act, 2000) or the Drug Enforcement Agency’s regulation 21 CFR 1306.07(b) and (c) (Administering or Dispensing of Narcotic Drugs, 2005) prevent a doctor from treatment of this sort in such an instance. However, nurses are taught to be responsible as far as doctors’ orders are concerned. In the textbook, Foundations of Nursing Practice: A Nursing Process Approach, the nurse is taught that, if there is some question as to a doctor’s orders, he or she should first clarify the orders, then if there is still a question, he or she should contact the nurse manager or supervisor. (Foundations of Nursing Practice: A Nursing Process Approach, 1998) In another textbook, Illustrated Manual of Nursing Practice, this point is further emphasized and is expanded to address the issue of liability on the nurse’s part. (Illustrated Manual of Nursing Practice, 2002) Some well-documented legal cases have been cited in regard to nurses questioning doctors’ orders, including the well-known 1965 Supreme Court’s Darling v. Charleston Community Memorial Hospital, where a patient ultimately lost his leg below the knee due circumstances that followed when a nurse followed a doctor’s orders instead of her own medical training and instincts. In Berdyck v. Shinde (1993), the nurse followed the doctor’s orders on a misdiagnosis that could have been prevented if she had done more than follow those orders without question. The Court held that the nurse, in this case, could have followed the chain of command and consulted with a supervisor or other physicians on staff when the question arose regarding the misdiagnosis and subsequent treatment of the patient. In Meloy v. Bachmeier (2002), a nurse’s statement that she was simply following doctors’ orders did not hold up in court in defense of her negligence charge. The nurse’s liability is on the line and perhaps she is afraid of a lawsuit of negligence or even a malpractice suit if she should be wrong in questioning doctors’ orders. Ultimately, the nurse should always remember that she is the patient’s advocate and should keep the patient’s best interests and medical care from jeopardy. According to “Medical Authority and Nursing Integrity,” the nurse gives medication by doctors’ orders because that is his or her job. However, even as the orders are being carried out, he or she must believe that the doctor also has the best interests of the patient in mind and that the doctor is fully capable to fulfill his duties as a physician. (L de Raeve, 2002) References Administering or Dispensing of Narcotic Drugs, Title 21. CFR 1306.07(b)(c) (2005). Amendment to Controlled Substances Act, 42 USC §3502(a)(2000). American Nurses Association. (approved 1985, revised 2001). Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses Publishing. Berdyck v. Shinde, 613 N.E. 2d 1014 (Supreme Court of Ohio, 1993). Boivin, Janet (2009, May 25). Nurses Struggle with Ethical Dilemmas. Retrieved April 29, 2011, from Nurses.com Web site: http://news.nurse.com/article/20090525/NATIONAL01/90520001. Darling v. Charleston Community Memorial Hospital, 211 N.E.2d 253 (Supreme Court of Illinois 1965). Ethics. (2011). In Merriam-Webster Dictionary. Retrieved April 30, 2011, from http://www.merriam-webster.com/dictionary/ethics Hospice Patients Alliance, Inc. Dangers of Leaving Medications Out. Retrieved April 29, 2011, from Hospicepatients.org Web site: http://www.hospicepatients.org/hospic68.html. Hutchison, Marg (1998, September). Unity and Diversity in Spiritual Care. Retrieved April 29, 2011, from Web site: http://members.tripod.com/~Marg_Hutchison/nurse1.html. Kizilay, Patricia & Leahy, Julia M. (1998). Foundations of Nursing Practice: A Nursing Process Approach. Philadelphia: Elsevier Health Sciences. L de Raeve. (2002). Medical Authority and Nursing Integrity. Journal of Medical Ethics, 28, 353-357. Meloy v. Bachmeier, 302 F.3d 845 (8th Cir. 2002). Narcotic. (2011). In The American Heritage Dictionary. Retrieved April 30, 2011, from http://education.yahoo.com/reference/dictionary/entry/narcotic Springhouse. (2002). Illustrated Manual of Nursing Practice (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. Read More