Ethical Decision Making Exercise - Essay Example

A RETROSPECTIVE ETHICAL ANALYSIS OF THE CASE Ethical issue/Problems in the case: From an analysis of the case it emerges that the patient, Mr. James,who sought pain relief, was administered an overdose of Morphine which hastened the process of his death instead of mitigating his pain. The sequence of events pointed at culpable dereliction of duty of care not only on the part of Nurse Clark but also from the side of Nurse Ng and the Medical Officer. Death, a universal truth, is the final portion of life cycle for all of us. Providing prompt care to “patients near the end of life,” when curative means are no longer possible, is the most essential part of medical profession (AGS Ethics Committee, 2002). It is the responsibility of health care providers to ensure that “alleviation of pain and management of other physical symptoms of suffering” are high priority in their agenda. Though Mr. James had outlived a three months prognosis by two weeks, his health was deteriorating and his pain had aggravated. Hence he deserved the highest quality of committed duty of care from medical professionals. Unfortunately, the dose that was intended to alleviate his pain ended up in taking his life. Perspectives of the people involved Nurse Clark: Though an experienced agency nurse, Nurse Clark had not worked on the ward and was assigned the responsibility of four patients which looked a bit hard on her. Her orientation was brief, besides the handover being unclear. When the patient asked for medication for pain relief she acted promptly with bona fide good intent of helping him cope up with the pain, and followed the procedures like donning gown and gloves correctly. Nurse Clark, honouring the patient’s privacy, ignored the requirement of exposing the full site for determining the correct route. She injected 5mg Morphine into the Y catheter. Though her concern for “professional ethics” was evident to some extent from her actions, dereliction of duty was also forthcoming (Taboad, Paulina. IAHPC: Ethics Article, 2006). The unclear, taped handover couldn’t absolve her of the blame because the call of duty required her to seek clarification if the handover was not clear to her. When she realised her mistake, she panicked and administered the remaining 5mg through the SC port though she was aware that the patient has already received too much Morphine. This, again, hinted at the unprofessional manner in which she handled the situation. The duty of care required her to foresee the effects of her action. She had received relevant education and training to make her capable of doing this. It was also not clear why she didn’t ventilate the patient to counter the respiratory depression when the patient was a known case of emphysema. Nurse Ng Being a Charge Nurse it was incumbent upon Nurse Ng to orient a new inductee properly and adequately to the duties and responsibilities in the ward. She should have gone inside to identify the patient, and to make sure that the drug was administered through the right route. Apparently, she stayed at the door to avoid the extra bother having to wear appropriate attire. Thus she failed to stand up to her responsibility of adhering to the five rights of medication administration viz. RIGHT PATIENT, RIGHT DRUG, RIGHT DOSE, RIGHT ROUTE, RIGHT TIME. Her inaction to ventilate the patient and the non-availability of Narcan in the ward also pointed to her lack of concern for ethical values. Medical Officer The medical officer was unsure of the dosage and he didn’t bother to consult a drug book which necessitated the intervention of pain specialist at a later stage. This resulted in wastage of time. Further, he seemed to have taken no follow up action like ventilating the patient, etc. Hospital Management The administrative machinery of the hospital seemed to require overhauling. The absence of Narcan, emergency trolley etc in the ward pointed to poor management and inadequate supervision. The fact that Nurse Clark wasn’t given proper orientation and the poor quality of the tape also suggested laxity on the part of the management. Ethical, Legal, and Professional concepts When evaluating the negative consequences of the nurse’s action it comes to fore that though there is no element of bad intention, her action entailed the death of a patient. “Agents are not considered morally responsible for all the consequences of their voluntary action. Rather, the standard is that any agent can justifiably be held morally responsible only for the reasonably foreseeable consequences of an action.”(Austin, J.L., 1961). From her education and experience it is evident that Nurse Clark was knowledgeable enough to gain the foresight into her action. The complicity of several individuals, whose roles have been more detrimental to extending a proper duty of care to the patient, may absolve Nurse Clark of her involvement from a legal point of view. But she cannot escape the ethical obligations bestowed upon her as a nurse. Nurse Clark failed to ensure that she is administering the right amount of medicine through the right route. Thus, despite the existence of good intentions, the ideal of promoting human well being has not been achieved because of a moral negligence on the nurse’s part. “Moral negligence occurs when the power to choose to act as the moral rule requires (such as non malfeasance) lies within agent’s ability but they fail to: recognize the act as morally wrong; regard all the relevant moral features of the act; or act in accordance with their moral deliberation and judgement dictates.”(D’Arcy, 1963).So, the ethical ideal of promoting human wellbeing cannot be seen as fulfilled in this case. Choice of the Course of Action Under the circumstances, with her professional acumen, Nurse Clark shouldn’t have panicked. Instead, it would have been appropriate if she immediately administered a suitable dose of anti-dote with the aid of her team. Further, they could have hyper ventilated the patient to correct the hypoxemia. Also it appeared that before administering Narcan they failed to provide a high flow of oxygen for few minutes. The episode has been quite unfortunate for both the patient and Nurse Clark. But the complacency of others involved in the incident leaves one wondering, “Are we the true professionals we claim ourselves of being?” Reference American Academy of Family Physicians: Ethics (2006). Ethics: Core principles for end of life care. Cited August 18, 2006 from AGS Ethics Committee: The case of dying patients (November 2002).Cited August 19, 2006 from Austin, J.L. (1961). A Plea for Excuses. C.A: Standard University Press. D’Arcy, E. (1963). Human Acts: “An essay in their moral evaluation.” Oxford: Oxford University Press. Taboad, Paulina: International Association for Hospice and Palliative Care (2006). Ethics Article: “Systematization of the Ethical Analysis of Clinical Cases.” cited August 20, 2006 from Read More