Law &. Ethics for Medical Careers 5th Edition by Karen Judson,Carlene Harrison

تمرين 5

Medical Records and Informed Consent
A basic tenet of medical law and ethics is that patients have the right of self-determination. That right, however, can be effectively exercised only if patients have enough information to make an intelligent, informed choice about medical treatment. Health care practitioners do not have the right to withhold information, because full disclosure might prompt the patient to forgo needed therapy.
Dr. Carmen Paradis, a bioethicist with the Cleveland Clinic, says the following to health care practitioners regarding informed consent:
"Make information relevant to how the patient thinks. For example, '3 percent' may mean nothing to a patient, where '3 out of 100' will. You may also want to say, '97 out of 100 will not have this problem.'
"Benefits must be weighed against risks for the patient. How risky is the treatment under consideration? Is the benefit marginal? In addition, make the information available over time, so the patient is not overwhelmed with information all at once. And in addition to verbal explanations use alternative methods of giving information, such as videos, CDs, written material, and so on."
Medical providers at the Cleveland Clinic are fortunate, in that the clinic has an international center practitioners can call on for translations of medical documents into languages other than English, and for translators who can relate to a patient's native culture and language.
ETHICS ISSUE 1 : A nurse working in a physician's office is helping the physician explain a medical diagnosis and proposed treatment plan to a middle-aged woman who is a recent immigrant from Thailand. The woman speaks no English, and her daughter is attempting to translate the conversation. The woman has metastasized lung cancer, and her prognosis is not good. The nurse notices a pronounced hesitation in the daughter's translation of this news to her mother, and she suspects the daughter has not relayed the information correctly, because the patient seems undisturbed by the news.
DISCUSSION QUESTIONS
1. As the nurse helping the physician in this scenario, what would you do?
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2. Assume that the nurse and the physician must obtain informed consent from the patient in the above scenario. Should they rely solely on the daughter's ability to translate? Explain your answer.
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ETHICS ISSUE 2: You are an LPN in a reproductive services clinic, and a pregnant patient is suffering a medical condition wherein the pregnancy threatens her life. Her physician suggests that she undergo an abortion.
DISCUSSION QUESTIONS
1. Will your personal values allow you to assist with the procedure? Explain your answer.
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2. If your answer to question number 3 is no, what are your alternatives?
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ETHICS ISSUE 3: You have observed an LPN with whom you work in a hospital attempting to erase an entry she has made in a patient's medical record. She asks you not to tell that you saw her attempting to erase the entry.
DISCUSSION QUESTION
1. What will you do next?
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ETHICS ISSUE 4: You have faxed a patient's medical record to another physician's office and discover you have used the wrong fax number.
DISCUSSION QUESTION
1. What will you do next?
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