This study examines a specific scenario in which a patient needs an experimental study and the hospital administrator expresses their intention to provide teh surgery due to a very significant monetary donation that the hospital will receive if they do the surgery. The nurse examines the issue and renders a decision according to hospital organizational ethics policy and law.
¶ … ethics issues presenting in this scenario. First, the patient who is to be admitted has cancer and a tumor which involves several major organs of the patient's body. The chances for the patient's survival are already greatly reduce in addition to the hospital already having a reputation for incompetence and the patient's chances of surviving the surgery are very low. The hospital administrator's decision to conduct the experimental surgery is more focused on the large donation that is promised if the surgery is performed presenting an ethics issue related to placing more importance on hospital funding than on saving the life of the patient or on doing the right thing for the patient. Finally, this case should have undergone the review of the hospital ethics committee before a decision was made to admit this patient.
How to Resolve the Issue
Ethics committees are reported to have "a long history of serving as a useful resource for hospital staff addressing ethical challenges." (Nelson and Elliott, nd, p.1) the role of the ethics committee in the hospital organization includes: (1) consultation; (2) education; (3) policy and (4) hospital self-evaluation. (, p.2) the ethics consultation is prospective in nature with open access to physicians, nurses, social workers, the patient and the patient's family. The administrative authority of the ethics consultation is the medical staff and administrative staff committees. The ethics consultation involves analysis of the issue which is presented by the physician and the identification of the ethical conflict. The patient's preferences and best interests are identified and the possible alternative or resolution is discussed and justified.
The ethics consultation provides a forum for ethical dilemma or conflict consideration so that any ethical issues relating to social values, law and institutional policy can be considered. The hospital policy and the law must be identified and the question of what is ethical according to the law and the policies of the hospital. (Donovan, nd, paraphrased) Therefore, with this information applied, in this case it is not possible to determine what is ethically appropriate without the review of an ethics committee. The ethics committee has the knowledge and expertise to weigh the facts of the case with the applicable hospital policy matter and the relevant state and federal laws relating to hospital ethics. Therefore, in order for an ethical decision to be made in this case, it is necessary that the hospital ethics committee be contacted on the issue and that the ethics committee call a meeting on this case in order to determine the ethical issues as they relate to hospital policy and relevant and applicable laws. Murphy (1989) examines the role of the nurse on hospital ethics committees and states that the appropriate involvement of the nurse on the ethics committee is one that has a part is "assuring adequate information, multiple perspectives, sufficiently deliberate thought, emotional support for all decision makers and legal acceptability" in that the nurse assists by "helping to assure patient, family and professional participants that they have done their best under difficult constraints." (Murphy, 1989, p.1) the role of the nurse is that of patient advocate." (Murphy, 1989, p.1) an ethics committee is critically important in the hospital organization in that as noted in the work of Leavitt having a hospital ethics committee "can allow the ward staff to let others take the responsibility for hard decisions." (p.1) it is related that no two hospitals have the same ethics and that this is as it should be because "life and death are too complicated for ethical uniformity, let alone universalism." (Leavitt, 2000, p.1) the American Medical Association, Council on Judicial and Ethics Affairs states that the hospital ethics committee should be voluntary, educational and advisory" in nature and that these committees should be used or consideration and resolution in cases that are "unusual, complicated ethical problems involving issues that affect the care and treatment of patients." (1984) the American Nurses' Association Committee on Ethics reports that nursing professionals should be included in the "development, implementation and evaluation of ethical review on ethics committees." (1985) it is the conclusion of this writer that in the absence of an ethical committee review, that no decision on the ethics of this patient being admitted and treated through surgery can be determined in a conclusive manner.
Why the Decision Was the Ethical Decision
Because the ethics issues in this case are complex and because there are multiple ethical issues that have arisen in treating this patient, the only ethical decision that can be made in this instance is that a hospital ethics review committee meet and discuss and debate the issues of this case, research the ethical conflicts, and then collaboratively to consider the issue and render an appropriate decision however, it is certain that at no time should the promise of a donation take precedence over doing what is best for the patient.
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