Ethical and Legal Courses of Action – Case Studies
In each case, answer the questions at the end of the case
and also give researched references to support your assertions and explain what
would be the ethical course of action and the legal requirements for action in
the case.
Case One
Mrs. Lewis was head nurse on a medical surgical floor in a
community hospital with 250 beds. Over the course of six months, she noticed
that all patients admitted from the shady Rest Nursing Home had signs of severe
injuries other than those connected with the admitting diagnosis. There
appeared to be patient abuse in the nursing home. Mrs. Lewis investigated
discreetly and found no explanation possible except abuse. In accord with the
obligations of the law in her state, she reported the matter to the Department
of Welfare Bureau of Inspection.
The Welfare Department investigated immediately, found proof
of abuse, and threatened to close down Shady Rest if there were any more
recurrences. Mrs. Lewis was overjoyed until her hospital administrator,
bypassing the director of nursing, called her in and warned her that she would
be fired if she reported any other instances of abuse. Shady Rest sent the
hospital a lot of business, and good relations had to be maintained.
Mrs. Lewis was even more shocked when she discovered that
the administrator was a golf partner of the owner of Shady Rest and was doing
an old buddy a favor. Despite fears of retaliation, Mrs. Lewis consulted a
lawyer, who threatened the hospital with exposure and with penalties that would
follow if one of its employees failed to follow the reporting provisions of the
law on abuse in nursing homes.
Did Mrs. Lewis act correctly? What should she have done if
she could not have afforded to consult with a lawyer? In what ways can
whistle-blowers protect themselves? Must the art of intimidation be part of the
toolbox of health care professionals in order to protect their patients? Is
power an appropriate consideration in health care ethics?
Case Two
On a July weekend, Mrs. Allesfertig, nursing supervisor of
the whole hospital, discovered that the intensive care unit was seriously
understaffed. She pulled two nurses with previous ICU experience off other
floors to bring the unit up to strength in view of the extreme level of acute
care needed. On the following Monday, Dr. Bestknabe, who has overall
responsibility for the ICU unit, closed the unit for further admissions until the
staffing had been worked out on a permanent basis.
Should the new staffing policy give the nurses authority to
refuse to admit patients when the staff is not sufficient to handle them? (In
some hospitals, nurses have this authority.) Can any policy take precedence
over the professional judgment of trained ICU nurses?Ethical and Legal Courses of Action – Case StudiesIn each case, answer the questions at the end of the case
and also give researched references to support your assertions and explain what
would be the ethical course of action and the legal requirements for action in
the case.Case OneMrs. Lewis was head nurse on a medical surgical floor in a
community hospital with 250 beds. Over the course of six months, she noticed
that all patients admitted from the shady Rest Nursing Home had signs of severe
injuries other than those connected with the admitting diagnosis. There
appeared to be patient abuse in the nursing home. Mrs. Lewis investigated
discreetly and found no explanation possible except abuse. In accord with the
obligations of the law in her state, she reported the matter to the Department
of Welfare Bureau of Inspection.The Welfare Department investigated immediately, found proof
of abuse, and threatened to close down Shady Rest if there were any more
recurrences. Mrs. Lewis was overjoyed until her hospital administrator,
bypassing the director of nursing, called her in and warned her that she would
be fired if she reported any other instances of abuse. Shady Rest sent the
hospital a lot of business, and good relations had to be maintained.Mrs. Lewis was even more shocked when she discovered that
the administrator was a golf partner of the owner of Shady Rest and was doing
an old buddy a favor. Despite fears of retaliation, Mrs. Lewis consulted a
lawyer, who threatened the hospital with exposure and with penalties that would
follow if one of its employees failed to follow the reporting provisions of the
law on abuse in nursing homes.Did Mrs. Lewis act correctly? What should she have done if
she could not have afforded to consult with a lawyer? In what ways can
whistle-blowers protect themselves? Must the art of intimidation be part of the
toolbox of health care professionals in order to protect their patients? Is
power an appropriate consideration in health care ethics?Case TwoOn a July weekend, Mrs. Allesfertig, nursing supervisor of
the whole hospital, discovered that the intensive care unit was seriously
understaffed. She pulled two nurses with previous ICU experience off other
floors to bring the unit up to strength in view of the extreme level of acute
care needed. On the following Monday, Dr. Bestknabe, who has overall
responsibility for the ICU unit, closed the unit for further admissions until the
staffing had been worked out on a permanent basis.Should the new staffing policy give the nurses authority to
refuse to admit patients when the staff is not sufficient to handle them? (In
some hospitals, nurses have this authority.) Can any policy take precedence
over the professional judgment of trained ICU nurses?
