Case 1:

An 82-year-old female patient with congestive heart failure and moderate dementia requires elective hip replacement surgery. Surgeon A and anesthesiologist A, however, considered her to be too high of a risk for surgery. Later in the week, surgeon B, who practices with surgeon A, has an anesthesiologist approve the patient for surgery even though the patient’s attending physician expresses extreme concern regarding the patient. On the morning of surgery, the patient suffers premature ventricular contractions, which the nurse in the preoperative waiting area notes in the chart. The nurse also notes that the patient’s husband is wary of the entire surgical process, stating that “everything had better go okay.” After speaking with the patient’s husband, the nurse realizes that he is unaware of the conflict between the surgeons involved with the case. Surgeon B is scheduled to leave town for a month the next day, so he is adamant about performing the surgery before leaving. The nurse discusses the patient’s unstable cardiac status with the surgeon. The surgeon listens attentively, but proceeds with the surgery anyway. The patient suffers a cardiac arrest during surgery. She is resuscitated and transferred to the intensive care unit, but she dies two days later.

What are some of the ethical issues in this case?

  • What is the obligation of the nurse in this case?
  • Was consent informed?
  • Who decides if the surgery is too risky?
  • Is the patient capable?
  • Has information only been disclosed to the appropriate people?

 

Case 2:

Video monitoring offers the possibility to provide better care for the patient being monitored, for example, by helping to detect and prevent falls or self-inflicted harm. It may also permit better care for other patients by freeing up staff resources or help hospitals to address other staffing challenges. Your organization is considering a proposal for a pilot program that adds video monitoring options for patients at risk for safety (falls, self-harm, etc.) and needs your recommendations.

What are some of the ethical issues involved in video monitoring patients?

  • What are the clinical ethical issues?
  • What are the organizational ethical issues?
  • How would you justify monitoring? Or not?

 

Case 3:

A worker (who we will name Sue) approached a friendly work colleague (who we will name Donna) and asked to have a “confidential conversation.” Donna agreed to keep the conversation confidential. During that conversation, Sue disclosed to Donna that she feels she is being harassed by an ex-boyfriend, who is also an employee, and that she believes her personal safety may be at risk.

Donna tried to convince Sue to report the issue to her supervisor, but Sue did not agree.

Worried about her colleague’s safety, Donna took it upon herself to report the matter to Sue and Donna’s supervisor. The supervisor initially agreed to keep this information confidential, but is now having second thoughts and is not sure what is “the right thing to do” in this situation.”

What are some of the ethical issues in this case?

  • Do you agree with the actions Donna took? Why?
  • What do you think the supervisor should do next? Why?

 

Case 4:

A patient is brought to your local Emergency Department after police found her in the middle of the street striking herself in the abdomen. She presents at 8 months pregnant and an underlying mental health issue has her believing that there is a tumour, rather than the fetus, inside of her. Additionally, the treating physician is unsure that the patient is being completely honest in her responses to his assessment questions regarding drug use (so that he may try to avoid any adverse drug interaction in his recommended treatment), and upon believing that he has heard her name in the local media as being charged with possession of illicit drugs, decides to ‘google’ her. Despite this, the team determines that the patient does not fit the criteria for a Form 1 (Mental Health Act) and thus decides to discharge her since her behaviour has stabilized and she no longer has an acute need. The team continues to be concerned about the patient’s well-being, and considers informing the police or local shelter in her area just to keep an eye on her.

What are some of the ethical issues in this case?

  • Should you ‘google a patient’? Are there ethical concerns with doing so?
  • Where does respecting patient privacy become ‘muddy’ in your experience?
  • Are there ever situations in which it might be ethical to violate privacy even though that may contradict the law?

 

Case 5

Mr. Jameson is a former patient of yours who has recently deceased. Several days after his death, his son, who you have met on several occasions before and who had a good relationship with his father, comes to the unit to thank you for taking such good care of his father when he was under your care. The son does not have a good relationship with his sister, who was their father’s Power of Attorney (POA), and thus has not received any details on how his father died. He requests this information from you.

What are some of the ethical issues in this case?

  • Even though the son is not the POA, can you provide information on his father’s death to him?
  • Is consent required to release Personal Health Information after death?