DQ 3-2

DQ 3-2 Responses

2.

According to AHC Media, “A 63-year-old woman with pneumonia was admitted to a hospital and rendered brain damaged before her discharge. The failure to appropriately monitor the level of oxygen she was to have received resulted in acute respiratory arrest and hypoxia, which ultimately led to brain damage. She now requires 24-hour care and ultimately settled with the hospital for $2.7 million” (AHC Media, 2001).

The facts of this case appear to be relatively clear cut in that the nurse failed to properly monitor the patient. If the nurse was unable to monitor the patient as per the specific physician orders and intervene when the patient was beginning to deteriorate, the nurse had a duty to the patient to report through the chain of command that she needed help.

It is not clear in this overview as to whether the nurse attempted to obtain help and was unable to so, or whether the nurse was negligent in not recognizing how compromised this patient was and taking appropriate action. However, in cases such as these it is important to have health care professionals with integrity whom exude ethical behavior at all times. In this case, one would hope the health care staff in this situation exemplified veracity and beneficence. “Veracity is based on the virtues of truthfulness, candor, and honesty” (AOTA, 2015).

 References

AHC Media. (2001). Failure to monitor oxygen levels leads to brain damage. Retrieved from https://www.ahcmedia.com/articles/72950-legal-review-amp-commentary-failure-to-monitor-oxygen-levels-leads-to-brain-damage-2-7-million-settlement-in-kansas on November 16, 2017.

American Journal of Occupational Therapy. (2015). Occupational Therapy Code of Ethics. Retrieved from  https://ajot.aota.org/article.aspx?articleid=2442685 on November 16, 2017.

3The case study that I chose for this assignment focuses on conducting research with the elderly population. 

Case Study: Sociologists at a nearby university are doing a study to determine if the local community could benefit from the addition of an assisted living center. Ms. Mildred, 66 years old, was contacted and asked to participate in the study. Ms. Mildred is currently employed full-time as a book keeper for a small office, and has stayed on past retirement age since her husband’s unexpected death two years ago. She enjoys her job, but looks forward to the time she can spend with her daughter and her family in a nearby state. (Walsh, 2009)

After initial telephone contact at home, the lead researcher asked for Ms. Mildred’s work phone number for contact during the day, and asked to meet Ms. Mildred during her lunch break at a nearby cafe to explain the study. Ms. Mildred agrees, but states it is important that she returns to work on time. Ms. Mildred listens to the presentation provided by Dr. Snow, the researcher, looks at the detailed pamphlet offered, signs the consent, and completes the survey before returning to the office at the end of the lunch break. Ms. Mildred’s participation in the study ends at this point with no further researcher contact. (Walsh, 2009)

There are many ethical concerns regarding this case study.  The researcher contacted Ms. Mildred at her place of employment and agreeing to meet her in a public place could have been a violation of her privacy.  Conducting a survey during the participant’s lunch hour may have impinged on the time the researcher had to fully explain the details of the research.  The pamphlet offered by the researcher may have been printed in a font that was too small for the participant to read and may have contained material that was coercive in nature.  “While we do not know if the researcher presented the study with fewer details and straightforward language, unless this was purposefully done, there may not have been comprehension of the material” (Welsh, 2009).  It is essential that the research participant fully comprehend the material, especially with a vulnerable population.  “This group mainly represents vulnerable people and requires more sensitivity” (İlgili et al, 2014).  Ms. Mildred was vulnerable in several ways and should have been adequately protected; therefore, the research may have been unethical.

References:

İlgili, Ö., Arda, B., & Munir, K. (2014). Ethics in Geriatric Medicine Research. Turk Geriatri Dergisi, 17(2), 188–195. Doi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257472/

Walsh, Susan A. (2009). Conducting Research with the Elderly: Ethical Concerns For a Vulnerable Population. Southern Online Journal of Nursing Research (SOJNR), Volume 9, Issue 4. Doi: http://www.resourcenter.net/images/snrs/files/sojnr_articles2/Vol09Num04Art03.html

4.

Emily, a nurse on Six East, was hoping that she could combine her clinic work with a re-search project needed for her master’s degree. A large part of her job is to take complete medical and sexual histories, as well as perform physical exams, on patients referred to the colposcopy clinic. In this clinic, a colposcope is used to evaluate patients who have an abnormal Papanicolaou (Pap) smear, and a punch biopsy is taken together with an endo-cervical curettage. Emily follows up with many patients, explaining the results to them—normal or varying degrees of dysplasia. In cases of severe dysplasia or invasive cervical cancer, she helps the patient schedule surgery. In collecting her information and following the patients, Emily has observed that several things in their history appear to be related to cervical cancer. Some of the more significant factors appeared to be early first intercourse, multiple sexual partners, being young at marriage, a young or early pregnancy, smoking, and having a partner who has had multiple sexual partners. She wondered if her perceptions were accurate and if there may be other precursors to cervical cancer that she was missing. As a research project, Emily decided to review patient records for the last six months and to collect data for another six months. At that time, she would look at all of her data and do a multiple regression analysis of those risk factors. Since this was part of her work, Emily knew this project would save her time and would not require informed consent. While this wasn’t a perfect project, it came very close”. (Neutens & Rubinson, 2014, pg. 46)

Informed consent is an act of explanation of the task at hand, in this case a research study, which makes the subject of the task fully aware of the study and in turn gives their permission to the researcher. (Neutens & Rubinson, 2014) Details included are time frame, risks and benefits to the subject, purpose to the study, and how the subject’s personal information will be made confidential. In this case study Emily did not reveal to the patients her intention on using their information for a research project for school. Emily went on assumption that it would be ok since she was an employee of the clinic. The patient still has to give consent for their personal information to be used in a different context other than for reference and documentation for their physician.

The University of Missouri-Kansas City describe beneficence as “human subjects should not be harmed, research should maximize possible benefits and minimize possible harms”. (University of Missouri-Kansas City, 2017) Many people see the word “harm” and think physical harm, however, this can also include emotional and mental harm. Emily is putting the patients at risk for both mental and emotional harm by using their personal information as part of a study that they have not consented to. Medical and sexual histories is a very personal area to discuss and uncomfortable for many people so therefore they wouldn’t easily give permission for someone to use their information for public use.

“Truth telling in medicine is a broad area and often encompasses several ethical issues. These issues include the right of patients or their families to receive information about their diagnosis and illness”. (Sullivan, Menapace, & White, 2001) Emily was not being truthful by not informing the physician and patients that she was using personal health care information for her personal use for school. This is also an example of deception. She was being deceptive by not divulging her intent.

Neutens, J. J., & Rubinson, L. (2014). Research techniques for the health sciences (5th ed.). San Francisco, CA: Pearson Benjamin Cummings.

Sullivan, R. J., Menapace, L. W., & White, R. M. (2001). Truth-telling and patient diagnoses. Journal of Medical Ethics, 27(3). doi:10.1136/jme.27.3.192

University of Missouri-Kansas City. (2017). Research and economic development. Retrieved November 17, 2017, from http://ors.umkc.edu/research-compliance-(iacuc-ibc-irb-rsc)/institutional-review-board-(irb)/history-of-research-ethics

5.

Assisted suicide (medical term Euthanasia) studies is a huge controversy.  There are beliefs that participants self elect themselves or doctor persuade them to do it.  The basic ethical consideration would be autonomy.  Verbakel and Jasper (2010) stated, “euthanasia is something that people should have the right to decide on their own life and death.  This right of self determination is a central component in the wider concept of personal autonomy” (p.113).  In another article that I read my understanding of the message was that some participants of Euthanasia are manipulated into participating.  Patients that may want to end their suffering are offered this service as an alternative to stop their pain.  According to Emanuel J (1997), “Physicians who performed Euthanasia or assisted suicide found that only 35% of cases did a pain figure in the request” (p. 124).  “Treatment decisions must be consistent with the basic ethical principles of beneficence and non-maleficience” (p. 13) says Stenson and McIntosh (1999).  This is something that happens on a daily basis and before anything is done to a patient I think the doctor should thoroughly explain to the patient and be honest with them; but they also have to respect autonomy.

 

Emanuel, E.J. (1997). The painful truth about euthanasia. The human life review, (1). 123

Stenson, B., & McIntosh, N. (1999). Some ethical considerations in the neonatal intensive care area. European Journal Of Pediatrics. Supplement, -17.

Verbakel, E., & Jaspers, E. (2010). A comparative study on permissiveness toward Euthanasia: religiosity, slippery slope, autonomy, and death with dignity. Public Opinion Quarterly, (1), 109.

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