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Unethical Leadership

Case Study

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Informed Consent

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Informed Consent

Informed consent constitutes one of the major ethical issues in the nursing profession. Bjorklund and Lund (2017) defined informed consent as the legal prerequisite in healthcare practice requiring patients and their surrogates to be informed of the benefits, risks, and available treatment alternatives. Bjorklund and Lund (2017) also noted that from an ethical perspective, consent dwells on the principle of autonomy implying that the patient accepts and understands the treatment. Notably, the patients or their surrogates could withdraw their consents and nurses are under an obligation to support and accept the consent withdrawal or refusal even in cases where their opinions differ from the ones of the patients. While the principles of informed consent require nurses to support and accept the patients’ decisions, certain cases present an ethical challenge under which the nurses find themselves in dilemmas that require rational thinking and sound decision-making (Joolaee, Faghanipour, & Hajibabaee, 2017). Such dilemmas present inherent challenges that could influence the nursing practice. The aim of the current analysis is to study the ethical issue from distinct perspectives and differing points of view.

Informed Consent Case Study

This case study revolves around a nurse experience in which the concept of informed consent is directly applied. The case commenced with the admission of a patient, a young mother and a kid to a psychiatric care unit after suffering from a medication overdose. Upon admission, the young mother was taken to the emergency room for stabilization while the kid was taken to the children protective unit. The mother suffered from distress and unrest as well as uncertainty of her own safety at the facility and, apparently, the safety of her child. Noticing the confusion and tension, the nurse kept reassuring the patient that everything was fine and that the kid was safe. Due to fear and unrest, the patient refused to sign the medication consent. As articulated in the Joolaee, Faghanipour, and Hajibabaee (2017) study, a valid consent requires that it be voluntary, informed, and the consenting party be in a position to make the decision. Subsequent explanation to the patient of the importance of treatment turned futile, as she seemed to develop more anxiety. The nurse on duty played her role in explaining to the patient the medical and nursing procedures involved in the process and let her decide whether or not to accept the treatment. Given the absence of any relative or friend to aid the patient in making the decision, the situation presented an ethical dilemma to the nurse. The nurse on duty sought help from the supervisor who responded by taking the form and coerced the patient into signing. This presents an ethical dilemma where the nurse on duty and the supervisor ran out of choices.

In the context of the above case, the condition of the patient implied a mental disorder and perhaps the patient lacked the capacity to make such decisions. The informed consent further requires the patient to make their decisions voluntarily, not under coercion or any duress, and to make sure that they have all the information regarding the treatment prescribed by the doctor. From the case described above, it is evident that the dilemma required rational decision-making. Keeping the patient in the psychiatric unit would worsen her medical condition and further cause her and her child more stress. The situation thus required urgent intervention to prevent the mother and the kid from distress. The nurse could opt to seek a close friend or a relative to aid the patient in decision-making or apply the ethical principle of beneficence. Beneficence requires the nurse to do good always by engaging in decisions and actions that aim at saving the patient’s life. In this case, the nurse would decide on the best treatment for the patient. While this option stood viable and applicable, the principle of respect for autonomy could impede its application. However, autonomy within the context of clinical ethics not only requires patients to make decisions but also grants physicians the authority to prescribe conditions for autonomous conditions among patients (Joolaee et al., 2017). The nurse could, therefore, seek more options from the physician or the supervisor to enhance her decision-making. Alternatively, she could apply the ethical principle of benevolence, proceed with the prescribed medication and ensure control of the patient situation.

Nurse Role in Handling the Ethical Issue

Given the nature of the ethical dilemma, the nurse has an inherent role in determining the outcome. Three options seem viable for the nurse in solving the dilemma. The first way is respect for autonomy in which case the doctor in charge of the patient could set conditions for both the patient and the nurse to make rational decisions regarding the patient health. The physician could engage the patient into a discussion regarding the health issue and the various concerns related to the condition. The second way is for the patient and the nurse to arrive at a consensus regarding the issue and agree on the best way forward. And the third option is that the nurse could adopt the principle of benevolence requiring them to make rational decisions regarding the health of their patients. Given the patient’s inability to make sound medical decisions, the nurse could make a choice on the ideal medication in compliance with the ethical principle of beneficence (Busquets & Caïs, 2017). The actions of the nurse supervisor in the case study could be considered prudent as the chosen option offered the best health outcomes for the patient and the kid. However, the three core requirements for informed consent are free will, ability to make informed decisions, and having full information would not have been met. Although the patient consented to the treatment methods, it was not voluntarily and therefore could trigger legal prosecution. The patient or their family member could accuse the hospital of used to compel the patient into signing the form. The nurse, on the other hand, could act in defense by citing the principles of benevolence and argue the urgency of providing the patient with the required medication.

References

Bjorklund, P., & Lund, D. M. (2017). Informed consent and the aftermath of cardiopulmonary resuscitation: Ethical considerations. Nursing Ethics, doi: 10.1177/0969733017700234.

Busquets, M., & Caïs, J. (2017). Informed consent: A study of patients with life-threatening illnesses. Nursing Ethics, 24(4), 430-440.

Joolaee, S., Faghanipour, S., & Hajibabaee, F. (2017). The quality of obtaining informed surgical consent: The case study in Iran. Nursing Ethics24(2), 167-176.

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