Question

Hello, I have another case study to ask. Thank you.

Question. For the last few days, you have been taking care of Mr. Smith, a 30 years old patient with end stage cystic fibrosis. You have developed a caring relationship with Mr. Smith and his wife. They are both aware of the prognosis of his disease and realize that he has only a short time left to live. When Dr. William made rounds with you this morning, she told Mrs. Smith that Mr. Smith could be discharged today if his condition remains stable. They were both excited about the news because they had been urging the doctor to let him go home to enjoy his remaining time surrounded by things he loves. When you bring in Mr. Smith's discharge order to his room in order to review his medications and other treatments, you find Mrs. Smith assisting Mr. Smith as he coughs up bright red blood. When you confront them, they both beg you not to tell the doctor or chart the incident because they do not want their discharge to be delayed. They believe that it is their right to go home and let Mr. Smith die surrounded by his family. They said that they know that they can leave against their physician's wishes and go home AMA( against medical advice), but if they do, their insurance will not pay for home care.

(1) What is your duty in this case?

(2) What are Mr. Smith's right?

(3) Is it ever justified to withhold information from the physician?

(4) Will you chart the incident and will you report it to anyone?

(5) Solve this case, justifying your decision by using ethical principles( Veracity, fidelity, beneficence, etc.). Need reference cited.

Answer 1

1

To protect you and other health care providers caring for the patient and your facility if problems were to arise from an unapproved discharge, you should have the patient sign an AMA form. This form should clearly document that the patient knows he's leaving AMA, that he's been advised of and understands the risks of leaving, and that he knows he can come back. Use his own words to describe his refusal to stay for further treatment.

Here's what to include on the AMA form:

• explanation of the risks and consequences of the AMA discharge, as told to the patient, and the name of the person who provided the explanation
• other places the patient can go for follow-up care
• names of people accompanying the patient at discharge and the instructions given to them
• patient's destination after discharge.

If the patient leaves without anyone's knowledge or if he refuses to sign the AMA form, check your facility's policy; you'll most likely have to fill out an incident report.

2

Mr smith has well oriented and mentally stable so he has right to refuse for further treatment from the doctor

3

It is never justified to withold information from doctor as a care taker as if some further severity occur it can become a legal issue

As patient witholding information from doctor can lead to faulty treatment.

4

I would inform this to the physician dr . Williams and will chart the detail of event . This would prevent medicolegal problems in future .

5

Autonomy

As a modern health care professional you are obligated to recognize patients’ right to make decisions (good and bad) for themselve

Beneficence: This principle states that health care providers must do all they can to benefit the patient in each situation. All procedures and treatments recommended must be with the intention to do the most good for the patient.

Veracity is defined as being honest and telling the truth and is related to the principle of autonomy. It is the basis of the trust relationship established between a patient and a health care provider. Veracity is what binds the patient and the clinician as they seek to establish mutual treatment goals. Even between care taker and doctor

fidelity is the keeping of promises. For nurses, that means remaining true to the professional promises made to provide quality, competent care to their patients

So i would insist patient fir further treatment and inform the doctor about event and make a chart of incidence.