Now that the process and evaluation of ethics consults have been fully explained in the earlier chapters, we look at some case examples in this chapter. These practice consults can be used for individual studying or in a group discussion format to facilitate learning. The questions embedded throughout the cases help foster critical thinking and reiterate the recommended process of conducting an ethics consultation.
CASE 1: AN UNCONVENTIONAL BIRTH
A 22-year-old pregnant female presents to the hospital 33 weeks and 4 days gestation after spontaneous rupture of membranes. The pregnancy was a result of an acquaintance rape that she did not report. She did not find out she was pregnant until a few months after the sexual assault, when she was already in a new relationship. The patient's family and boyfriend assume the baby is his, and the patient has not divulged the truth. The medical plan is to admit her to the hospital and induce labor at 34 weeks gestation. The patient's family and boyfriend assume the baby is not viable based on the belief that the pregnancy is still in the early stages. The patient expresses to her attending OB/GYN that she wants to deliver the baby, give it up for adoption, and inform her family that the baby has died. The healthcare team is concerned about the patient's request to lie to her family and boyfriend. An ethics consult is placed by the physician to evaluate the case.
After the ethics nurse discusses the case with the primary nurse and physician, in addition to performing a chart review, the ethics nurse and the clinical nurse specialist (CNS) on staff in the labor and delivery unit meet with the patient.
What parts of the chart would be the most pertinent to review?
How would you introduce yourself to the patient? What words would you use to open the conversation?
The ethics nurse explains her role as a member of the ethics committee and that she was consulted by the attending obstetrician, who was concerned about the patient's request to lie about the circumstances of the baby's birth. Along with many members of the healthcare team, the ethics nurse and the CNS advise the patient to reveal the truth to the boyfriend and her family. In addition, they discuss the potential ramifications of not disclosing the truth. The patient remains firm in her decision. The ethics nurse explains that from an ethical standpoint, all healthcare providers involved in her care must be true and authentic in their medical record documentation and in their interactions with fellow hospital team members. The discussion also includes that both the hospital and its employees are obligated to protect her privacy, and that no information would be given to anyone else other than the patient. All inquiries about the patient and the ...