Case
You are a nurse that works in the cardiac unit of a major hospital. A 52 year old woman who has had a heart attack 4 days ago, is admitted into your ward, showing signs of acute mitral regurgitation, a condition that occurs when the heart’s mitral valve doesn’t close, which allows blood to flow backward in the heart. After running some tests, the physician in charge of this patient’s care thinks that the patient needs a mitral valve replacement, a diagnosis that you agree with.
But the patient refuses the operation. The patient says that her grandmother who died came to her in a dream, and told her not to have any operations, because it would kill her. The patient also does not want to be scarred from incisions in surgery. You and the physician attempt to reason with the patient, but to no avail.
Frustrated, the physician decides to call in a psychiatrist, who also happens to be the physician’s close friend. After an extremely short meeting with the patient, the psychiatrist decides that the patient has a personality disorder that makes her incompetent to make medical decisions. You know that this patient does have an abrasive and confrontational personality, but do not recall any signs of a personality disorder. However, you do acknowledge to yourself that you are not an expert in mental health conditions, and may be wrong.
Nevertheless, the physician is satisfied with the psychiatrist’s decision, and decides to book the patient in for mitral valve surgery, without asking your opinion of what was done. He tells you to make the arrangements.
Is there something wrong with what happened here? What should you do in this situation?
She Adapted from: Kleinman, I. (1991). The right to refuse treatment: ethical considerations for the competent patient. CMAJ: Canadian Medical Association Journal, 144(10), 1219.
Marking criteria:
1. Identifying the central ethical issues raised by the dilemma, and applyingethical principles and the framework to analyzing the case- 5 marks
The Ethical Principles : 3+1
Autonomy, Beneficence, Justice, the Law
2. Discussing relevant and factually accurate background information that applies to your case (i.e. standards of practice of the profession, similar cases that you know about from class or your own general knowledge; statistics that apply to your case; medical or scientific information about the health issue in your case, etc.) – 5 marks
3. Providing a resolution to the dilemma that indicates a clear understanding of ethical principles and legal considerations that apply to the case – 5 marks
4. Demonstrating understanding and empathy for the perspectives of all participants in the case (the patient, the family, the health professional, society at large, etc.) – 5 marks
5. Engaging the class in meaningful discussion about the case – 5 marks
6. Organization, flow and clarity in presentation style – 5 marks
7. Originality and creativity in presentation style – 5 marks
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