1

Running Head: ETHICAL AND LEGAL DILEMMAS

Ethical and Legal Dilemmas

Jessica D. Roberts

Athabasca University

Nursing 250

Assignment 3

February 1st, 2017

 2
Running Head: ETHICAL AND LEGAL DILEMMAS

It is Friday night in a busy emergency department, and an intoxicated patient with a head

laceration is threatening to leave without being assessed by the physician. The nurse has reported

this to the attending physician. The physician attempts to reason with the patient and encourages

him to stay because there is a high chance that he has a head injury related to his fall down a

flight of concrete steps. The patient has admitted to drinking between ten and twelve beer

tonight, and has no recollection of events leading up to the fall. It was reported that the patient

was unconscious for a period of time following the fall. The physician was very thorough

explaining to the patient why he needed medical care and the implications of refusing the care.

The patient (with a slight slur) told the physician that he understood the risks, but was still

refusing care. The patient then threatened to sue the physician for assault, unlawful confinement

and battery. The nurse caring for the patient is placed in an ethical and moral dilemma. The

patient does not appear to be in the right mind frame to refuse care. However, he is able to state

the risks associated with refusing care and still wishes to leave without being assessed. To ensure

the correct decision is made, the ethical decision making algorithm will be applied to this

situation.

Nursing Action Considerations

1. Identify the moral In this scenario, the ethical dilemma presented to the nurse is whether to

aspects. let the patient leave without being seen, or intervene. The nurse is

struggling with deciding to respect the patients autonomy and let him

make his own decisions, or stepping in and ensuring the patient gets

seen and acting on the beneficence principle to ensure the wellbeing of

the patient is taken care of.

2. Gather relevant The patient is intoxicated and has admitted to drinking between ten and

facts related to the twelve beers. He has fallen down a flight of concrete steps and has a
 3
Running Head: ETHICAL AND LEGAL DILEMMAS

issue. laceration on his head. He was unconscious for a period of time.

Involved in this situation is the patient, the nurse and the physician. The

patients motives are to go home. The nurse and physicians motives are

both on the health and wellbeing of the patient. They both feel as if the

patient may have a serious head injury and needs medical attention.
3. Determine The owner of the decision ultimately is the patient if he is deemed

ownership of the capable of making his own decisions. He is deciding whether he stays

decision. and is assessed, or goes home. However, due to the intoxication of the

patient the physician and nurse may be able to intervene.

4. Clarify and apply The nurse and doctor are both looking for the best interest of the patient.

personal values. The patient appears to be more concerned with going home than the

risks associated with refusing medical care.

5. Identify ethical The autonomy principle applies to the patient because he has the right to

theories and make his own decisions. The principles of nonmaleficence and

principles. beneficence apply to the nurse and doctor as they are looking out for the

best interest of the patient.

6. Identify applicable Due to the intoxication of the patient, he may not be mentally stable

laws or agency enough to make his own decisions. The police may be asked to become

policies. involved if the patient leaves without being assessed. The doctor could

consult with the psychiatrist on call to assess the patient to deem the

patient mentally incapable of making his own decisions under a mental

health act. If admitted, the nurse can begin an alcohol detox protocol.
 4
Running Head: ETHICAL AND LEGAL DILEMMAS

7. Use competent The nurse could consult with the social worker and psychiatrist on call.

interdisciplinary The nurse could offer to call the patients next of kin who may be able to

resources. influence the patients decision to stay. The social worker would be able

to assist with the dynamics of the situation. The psychiatrist would be

able to assess the patient to decide if he is mentally stable enough to be

making his own decisions. The nurse can consult literature to find what

clinical information can be found on intoxicated patients and refusal of

care to aid in the decision making process.

8. Develop alternative Two alternative actions, with possible outcomes follow:

actions and project 1. The nurse does not intervene and allows the patient to go home

their outcomes on the without being assessed. Possible outcomes: a) the patient has no adverse

client and family. health effects. b) the patient's condition deteriorates when he gets home

and he seeks medical attention within the next few days. c) the patient's

condition deteriorates and he becomes increasingly ill and health

complications arise, potentially death.

2. The nurse intervenes and consults with psychiatry, social work and

literature. The nurse contacts the patients next of kin. The nurse calls the

police. Possible outcomes: a) The psychiatrist deems the patient

incompetent of making his own decisions due to current mental

capacity. b) The social worker and literature provide support to the case

and resources are obtained for the nurse to support the patient staying

and being assessed. c) If the patient was to leave without being assessed
 5
Running Head: ETHICAL AND LEGAL DILEMMAS

and the police were contacted, the police could follow up with the

patient if he is at risk to his own wellbeing. d) The next of kin may be

able to speak with the patient to reason with him. The next of kin may

be able to keep in touch with the patient over the next few days if

assessment is still refused.

9. Apply nursing The nurse, as a patient advocate, can consult with members of the

codes of ethics to help interdisciplinary team and the physician to advocate for the patient's

guide actions. safety, rights and health. The nurse will contribute with the team to

resolve any ethical issues for the patient. The nurse can develop a

therapeutic relationship with the patient to promote trust.

10. For each If the patient leaves without being assessed and the nurse did not

alternative action, intervene, the nurse risks breaking the code of ethics and potentially

identify the risk and negligence. This could lead to an investigation by the health care facility

seriousness of and the nurses regulatory body. If the nurse consults with psychiatry and

consequences for the social work, she is advocating for the well being of the patient. By

nurse. researching the literature, the nurse is gaining knowledge to make the

proper ethical decision. In contacting the police and next of kin, the

nurse may upset the patient and cause tension in the therapeutic

relationship with the patient.

11. Participate Bull & Srlie (2016) have noted that on times, nurses must assume the

actively in resolving role of guardian for their patient. They compared patients to children

the issue. who do not always know what the best choice is for them. Sometimes

nurses have to use a lot of effort to persuade patients to do things that

they do not want to do, but are best for them. In this situation, the nurse

must participate in the decision making process.

 6
Running Head: ETHICAL AND LEGAL DILEMMAS

12. Implement the The nurse implements option two.

action.
13. Evaluate the The nurse must reflect on the personal choice made. Optimally

action taken. debriefing with the nurse manager, and interdisciplinary team on the

decision made as a whole to ensure the best choice was made for the

patient. If a similar situation was to occur, the team would be more

prepared.

When nurses are in a situation to make a difficult ethical decision, there are many

feelings of anxiety and apprehension felt. The nurse has a number of resources available to

ensure the appropriate choice is made. By consulting with the nursing code of ethics, the nurse

can analyze the decision of their action and the impact it will have on the patient. The nurse can

consult with the interdisciplinary team who as a whole can provide input from different angles

which will support the ethical decision making process.

References

Bull, E. M., & Srlie, V. (2016). Ethical challenges when intensive care unit patients refuse

nursing care. Nursing Ethics, 23(2), 214. doi:10.1177/0969733014560931

 7
Running Head: ETHICAL AND LEGAL DILEMMAS

Blais, K.K., & Hayes, J.S. (2011). Professional nursing practice: Concepts and perspectives (6th

ed.). Upper Saddle River, NJ: Pearson Prentice Hall.