Read the case study presented at the end of Chapter 8 (Guido, p.133) which begins, “The patient was hospitalized for extreme low back pain

Read the case study presented at the end of Chapter 8 (Guido, p.133) which begins, “The patient was hospitalized for extreme low back pain

• Was there informed consent for the initial medications given to the patient?
• How would you determine that informed consent had been given for the MRI and the medications needed for sedation for the test?
• Was the informed consent deficient to the degree that there was a lack of informed consent for the patient for the second dose of medications?
• How would you decide this case?

Read the case study presented at the end of Chapter 9 (Guido, p. 150) which begins, “Jimmy, a Floridian, has undergone two liver transplants.”:

• What questions would you anticipate the judge to ask Jimmy to ascertain his level of maturity, understanding of the full consequences of his lack of action, and possible alternative reasons for requesting that he be allowed to make his own medical decisions?
• How should the judge evaluate the mother’s response to her son’s request?
• Does the state of residency factor into the judge’s decision?
• Are there additional issues that should be addressed prior to deciding the outcome of this case?
• How would you decide the case?

Jimmy Chang, a 20- year- old college student, is admitted for additional chemotherapy. Jimmy was diagnosed with leukemia 5 years earlier and has had several courses of chemotherapy. He is currently in an acute active phase of the disease, though he had enjoyed a 14- month remission phase prior to this admission.

His parents, who accompany him to the hospital, are divided as to the benefits of additional chemotherapy. His mother is adamant that she will sign the informed consent form for this course of therapy, and his father is equally adamant that he will refuse to sign the informed consent form because “Jimmy has suffered enough.”

You are his primary nurse and must assist in somehow resolving this impasse.

• What do you do about the informed consent form?
• Who signs and why?
• Using the MORAL model, decide the best course of action for Jimmy from an ethical perspective rather than a legal perspective.
• Now decide the best course of action based on a purely legal perspective.
• Did you come to the same conclusion using both an ethical and a legal approach?

Please combine all of these responses into a single Microsoft Word document for submission. Submit only completed assignments (not partial or “draft” assignments). Be thorough in your responses to adequately address all aspects of each question.

Submit only the assignments corresponding to the module in this section.

Assignment Expectations

Length: 1500 words; answers must thoroughly address the questions in a clear, concise manner.

Structure: Include a title page and reference page in APA style. These do not count towards the minimum word count for this assignment.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).

File name: Name your saved file according to your first initial, last name, and the assignment number (for example, “RHall Assignment 1.docx”)

M6 Assignment UMBO – 4

M6 Assignment PLG – 4, 6

M6 Assignment CLO – 1, 2, 3, 7

The case study for Chapter 8: ”  The patient was hospitalized for extreme low back pain

so intense that he could not be scheduled for a magnetic resonance imaging (MRI) until his fifth hospital day. His physician explained to him that the Dilaudid and Ativan he would receive the next day to numb his pain for the MRI could cause respiratory depression or arrest in patients like himself who were on high doses of opiates. The patient agreed to be given the medications. At 8:15 A.M. the next day, a nurse gave the patient the medications, but the MRI had to be postponed.

With the physician’s new orders and the patient’s verbal consent, the nurse gave a second dose of the same medications at 11:30 A.M. About 5:00 P.M., the patient became stuporous. Vital signs were taken, oxygen was initiated, and Narcan was prepared for injection. At 6:00 P.M., the critical care code team was called, as the patient was in full cardiopulmonary arrest. The patient was successfully resuscitated and was discharged the next day. The patient then sued, claiming residual psychologi-cal symptoms and failure to obtain valid informed consent for the second dosage of medications administered at 11:30 A.M.”

The case study for Chapter 9: “Jimmy, a 15-year-old Floridian, had undergone two liver transplants. An only child, he lived with his mother, a sin-gle parent. He was prescribed immunosuppressant drugs that caused severe debilitating side effects in an attempt to prevent his body from rejecting the second liver transplant. Understanding that his life expectancy was limited and that the medications were causing the debilitating side effects, Jimmy elected to stop taking the immunosuppressive medi-cations.

When his attending physicians discovered that he was no longer taking the prescribed medications, they instituted court proceedings against his mother for child endan-germent. Jimmy was readmitted to the hospital at the same time in an attempt to ensure that he restarted the immuno-suppressive mediations.A juvenile court judge held separate meetings with

Jimmy, his mother, and the health care team in an attempt to resolve the issue. His mother, at her meeting with the judge, expressed anguish as she felt that not taking the medications would hasten her son’s death, but she was also resolved to the fact that she felt he was mature enough to fully under-stand the consequences of his non-actions.

Jimmy assured the judge that he understood the consequences of his non-actions, but he was tired of taking medications that merely increased his pain and suffering and wanted, as stated in his final comment, “some time to be free of pain. I am go-ing to die anyway.” The health care team were unable to assure the judge that taking the medications would greatly increase Jimmy’s longevity.”

Required resources:

• Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Prentice Hall. ISBN: 9780134701233. Read Chapter 8 & 9.
• Pozgar, G. D. (2020). Legal and ethical issues for health professionals (5th ed.). Jones and Bartlett. ISBN: 9781284144185. Read Chapters 12, 13, & 14.

Expert Answer and Explanation

Informed Consent

This paper will give an insight into various issues surrounding informed consent. Three case studies will be used to provide context on the subject under discussion.

Chapter 8 Case Study

Informed consent is a critical component when discussing ethics in care provision. Informed consent is a process that allows the patient to be informed about the benefits, risks, and alternatives to a given procedure, allowing them to make an informed decision without being forced by any secondary party (Guido, 2014). It is a way of ensuring that the patient has all the facts before deciding on how their care is to be provided. By getting valid informed consent, the health care worker is absolved of any known adverse outcomes that can occur from a therapy, which has been made known to the patient prior to the intervention.

Based on the merits of the case presented, there are two things that are to be assessed. The first being, whether oral consent is considered valid consent, and whether the patient was in the right state of mind to give the informed consent. As to whether the oral informed consent was valid, the answer is yes. Informed consent according to Guido (2014) can either be written or oral. Likewise, if it was proven that the patient was in the rights state of mind, (not under duress, in that case, extreme pain or under the effect of opiates), then the informed consent would be considered valid (Kalina, 2020)

To ascertain whether informed consent had been given, the following are some of the factors that need to be met. One is an explanation of the intervention, the name, and qualification of the person performing the procedure, an explanation of the benefits and risks of the procedure, and the right to refuse or stop the intervention even after being initiated (Guido, 2014). However, there are certain circumstances where informed consent becomes implied, especially when the procedure has low risk, for example, imaging procedures like MRIs and standard medication (Reeder et al., 2017). From the case, the patient also gave a second verbal consent for the procedures to be undertaken.

Having been explained the implications and risks attached to the medication given to the patient, then the informed consent could not be said to be lacking to the degree that no informed consent was given. However, the physician, to eliminate and benefit of doubt, should have reinformed the patient of the attached risks of the medication, and reiterate to the patient whether he intends to continue receiving the medication or not. Having done so would have absolved the hospital and the concerned parties from any liabilities that could occur thereafter.

Based on the merits of the case, it can be said that the patient gave oral consent on the procedures that were being undertaken. This was after being explained the risks attached to the procedure. While written consent would have been better evidence (Guido, 2014), oral consent is still considered valid before the court, so long as it is proven that it was given.

Chapter 9 Case Study

Using orthodox means, minors are not permitted to give consent on medical procedures on interventions to be prescribed by the health care provider. This is a mandate specifically meant for the parents and guardians of the minors, unless under special circumstances. However, a new concept of matured minors, borrowed from family law, has gained acceptance in many states. A matured minor can be termed as a teenager between 14 to 17 years who can make informed independent decisions after understanding the nature and consequences of those decisions (Guido, 2014).

Using the presented case, the judge is expected to ask Jimmy, whether he first understands the implications of the choice he is making, and whether those decisions are based on emotions or analysis of facts. The judge will also want to ask Jimmy whether it was common for him to make independent decisions without his mother’s input. Another question that the judge would likely ask Jimmy is the reason why he didn’t seek approval from his parents before making the decision.

From the mother’s response, there are two ways in which the judge can make his evaluation. The first approach is that the judge can look at Jimmy’s mother from the perspective that she is irresponsible and uncaring on the decisions made by her son. As such, the mother can be considered as having endangered Jimmy for lack of supervision when taking the prescribed medication, which could lead to a shorter lifespan for Jimmy.

Another way the judge could evaluate the response made by Jimmy’s mother is that she trusts her son is mature enough to make competent decisions on his own, maybe based on his previous decisions. As such, Jimmy can be considered a mature minor who can make independent decisions on his health without the input of his mother.

The state residency plays a major role in the judge’s decision. There are some states that do not recognize the aspect of matured minors (Guido, 2014). In case the judge is presiding the case in such a state, then Jimmy’s mother can be held culpable of endangering the wellbeing of her son and, as a result, charged by the court.

Before the court makes a decision, various issues must be addressed. The first issue is a show of proof from the medical experts that continuing with the prescribed immunosuppressive medications has a positive impact on the longevity of the patient. Likewise, the court has to assess the relationship between Jimmy and his mother to understand the motive behind the mother’s response. From there, a more informed decision can be made.

For the case, I would base my decisions based on the laws of the state, specifically laws concerning matured minors. Similarly, I would also base my decision on whether Jimmy was mature enough to make the decision he made. Otherwise, if found that he was not mature enough, then his mother would be found culpable of endangering her son.

Case study for Jimmy Chang

Getting informed consent from the concerned parties can end up being complicated. For example, in the provided case, where both parents have a conflicting opinion on the best method to deal with their child’s care.

After assessing the facts presented, the wisest decision would be to hold on to the patient’s consent form to give time for either parent to amicably come to an agreement. Likewise, in case the parents fail to agree on the issue, it would be prudent to also seek the input of Jimmy on what action he wants to take, given that he can be considered to be an adult capable of making his own decisions (Guido, 2014).

The choice of who signs the documents is dependent on the decision made by the patient. The reason for this is because Jimmy’s age considers him mature enough unless proven otherwise, to make competent decisions about his healthcare. Another consideration is what the best interests of the patient are from a clinical perspective.

Therefore, if chemotherapy is considered to be helpful to Jimmy in the long term, then his father will be allowed to sign the consent. According to Lang and Paquette,(2018), the right to refuse consent or to ignore non-consent can be made after a court order has been taken to indicate that the decision made can injure the health of the patient.

The MORAL model is a decision-making tool that can be applied in the context of the case to make ethical decisions. The first course of action that can be taken is to massage the dilemma (M). This involves the identification of issues surrounding the case from the various stakeholders, including both parents, in this case, Jimmy, and health care providers.

Using the collected information, an outline of options (O) can be made. This involves the identification of options based on the facts presented, including conflicting options (Ramos et al., 2016). At this stage, it is wise to list the pros and cons of each option. The third step in the model is to resolve the dilemma (R). this is done by using the basic ethical guidelines when assessing the available options and deciding the best option to take in resolving the dilemma (Guido, 2014).

The next step is the act of applying the chosen option (A) which involves implementing the decision made, whether it is to continue or desist from taking the therapy. The last stage is looking back and evaluating (L) whether the decisions made were to the benefit of Jimmy or not. Engaging Jimmy and his parents during the evaluation process is important. In case the first option failed to improve his health outcomes, then the alternative options will be implemented, taking the same approach again.

Based on a purely legal perspective, subjecting Jimmy to chemotherapy, in case he consents would be the best course of action. The legal standpoint indicates that the intervention to improve the health outcomes of the patient should be given priority and that court orders can nullify lack of consent if it is deemed to endanger the life of the patient.

Both ethical and legal approaches led to the same conclusion, which is to try and help Jimmy using chemotherapy to increase his longevity. However, for both approaches, his decision will be regarded as a primary factor using the ethical principle of autonomy and by law.

Conclusion

This paper has discussed various aspects of informed consent and some of the ways in which issues concerning informed consent can occur in the health care setting. Some of the pertinent issues that have been discussed include seeking consent from matured minors and application of legal and ethical principles in the event of a dilemma.

References

Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall.

Kalina, P. (2020). Ethical and Legal Manifestations of Informed Consent. Technium Social Sciences Journal, 8, 753-758.

Lang, A., & Paquette, E. T. (2018). Involving minors in medical decision making: understanding ethical issues in assent and refusal of care by minors. In Seminars in neurology (Vol. 38, No. 05, pp. 533-538). Thieme Medical Publishers.

Ramos, F. R. S., Barlem, E. L. D., Brito, M. J. M., Vargas, M. A., Schneider, D. G., & Brehmer, L. C. D. F. (2016). Conceptual framework for the study of moral distress in nurses. Texto & Contexto-Enfermagem, 25(2). https://doi.org/10.1590/0104-07072016004460015

Reeder, S. B., Kimbrell, V., Owman, T., Steckner, M., & Calamante, F. (2017). Guidelines for documentation and consent for nonclinical, nonresearch MRI in human subjects. Journal of magnetic resonance imaging: JMRI, 45(1), 36–41. https://doi.org/10.1002/jmri.25333

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