Daniela Quiza

HS 2050 - Cultural, Legal,

and Ethical Issues for the Health Sciences
December-07-2016
Professor: Jeff Zealley

Patients With Suicidal Attempts

Introduction:
Mrs. Velasco was a 45 year old female patient with final stage Breast Cancer and who
was taking care by the Nursing team in the oncology department of a local general hospital. She
was diagnosed with this type of cancer six years ago but she refused any kind of medical and
surgical treatment at that time. Nurses deal with often ethical dilemmas at their job, and
sometimes they are taking care of a patient with a terminal disease that it may consist with a end
of their life stage. In this case it is described when Nurses are taking care of a patient with end
life stage Breast Cancer Mrs. Velasco who it has showed suicide thoughts to one of her Nurses
and it has asked her to keep it as a secret for her.
Thesis:
The debatable claim in this cases consist of the Nursing staff should share with other care
team about the suicidal thoughts of Mrs.Velasco without out her consent. In Mrs. Velascos case
the Nurse chose to share the information about this patient suicide thoughts with other care
professionals and as result the Nursing team decided to follow the suicide protocol of the
Hospital. In Mrs. Velascos case the choice of keeping her secret can be classified as assisted
dying defined that the principle of autonomy is not to support euthanasia and assisted suicide as

because people do not have the right to be assisted to die at any time they chose. Meaning that
Mrs.Velascos autonomy can be overrule in order to avoid her suicide attempt.
Body:
Medical Indications: After identified the factors that it may cause patients suicide
attempts it is really to provide the appropriate Nursing care to be able to act the right way to deal
with the risk factors and work together with other care professionals to give the proper care to
this kind of patients. Mrs. Velasco had several admissions, on the last admission Mrs. Velasco
was told that she may only have 3-7 weeks to live when previously was 6-12 months, after a
cystoscopy showed extensive spread of the Breast Cancer, at this time it was determined that any
more extensive surgical/medical intervention would not be appropriate in this case.
Patient Preferences:. She chose to look for other kind of treatment as for example
alternative treatment and she did not follow up any of the urologist treatments over those six
years. Mrs. Velasco medical condition has become worse, she is now presented with anemia
and the cancer has spread more through her body. The goal of Nursing is to care for people with
respect and dignity, they would be confronted with some ethical dilemmas when they are doing
their job meaning that they will face some difficult moral problems where in some cases the
principle of autonomy has the meaning that people have the right to determine their own actions
based on their values and beliefs
Quality of Life: The Nursing staff decision it may cause the patient to actually commit
suicide, If the Nursing staff chose to tell other care providers about this patient's suicide attempt,
the health care team will intervene by monitoring to prevent and avoiding suicide, but the
patients autonomy confidentiality would be violated. The possible results of this action may be

resulting in lengthens Mrs. Velascos life and maintaining her safe which can make her family
and care providers more with peace of mind. Life with end stage Breast Cancer can be difficult,
Mrs. Velasco has been familiar with the quality of life with breast cancer as she has been battling
this disease for some time and for the results of denying medical treatment her condition had
been declining in the last weeks/months
Contextual Features: The behavior of Mrs. Velasco put the Nursing staff in a difficult
situation, which can be identified as an ethical dilemma. When Mrs. Velasco reveal her suicide
attempt to the Nursing staff has two morally correct choices, if the Nurse decide to keep the
patients secret this will respect the patients own decision and if the Nurse chose to tell other
health care member more close care will be provided to Mrs. Velasco. While the patient has a
legal right to refuse treatment, there are also certain emergency room obligations to treat this
kind of patients
Alternative Options: Some Emergency physicians do not permit suicidal patients to
refuse treatment, because most of this patients are suffering from some mental illness like
depression or some kind of substance abuse, so some alternative options which this patients can
be treated with psychological therapy or medications that can reverse suicidal ideas. The goal of
this medical treatments is to maintain, restore and improve the quality of life of the patient. In
other cases when a patients life seems to be almost in the end some medical staff members with
the best morally approach will be to try a new intervention, continue with all the treatments just
to keep doing something.

Conclusion:
Ethical dilemmas are essential in the Nursing care and it is important for nurses to realize
that that they make ethical decisions and they have to be able to identify which decisions are
theirs to make and which ones require collaboration from other medical staff members. In the
case of Mrs.Velasco the ethical dilemma of which the nursing staff face put their patient
autonomy at risk, about the patient sharing her thoughts about suicide with her Nurse this put the
medical staff in a position to make the decision on sharing this information or not.
By sharing this information with other medical staff this Nurse will violate this patients
autonomy but is she doesnt keeping her secret can be classified as assisted dying an ethical
issue that the majority of the medical staff face in cases like this one. In my opinion facing this
kind of dilemmas can be hard because a healthcare provider like a Nurse have to follow some
rules and protocols but in the other side is the Ethical dilemma of what to do? And if the Nurse
will be executing the correct choice
This case it may can reflect the same or similar dilemma when it comes to patients with
suicidal attempts and the way any Nurse or medical staff should act if he think their patient's life
can be a risk but they have to always respect the patient's rights and Hospital protocols. The
information that is provide by this case can be used to analyze the different ethical issues that can
come with different kind of patients and cases or even medical procedures the are going through
and Nurses are more often to deal with them for the reason that in most cases are the one who are
more connected with the patients.

Bibliography

Lin Jie (2015).The patient suicide attempt An ethical dilemma case study.Retrived
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Jos VM Welie and Henk AMJ ten Have (2014). The ethics of forgoing life-sustaining
treatment: theoretical considerations and clinical decision making. Retrived from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995268/
Pamela Chally(2014).Ethics in the Trenches: Decision Making in Practice. Retrived
from:https://www.researchgate.net/publication/13655618_Ethics_in_the_Trenches_Decision_Ma
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