1. Use the following case study/ethical issue that is significant and relevant to patient care and/or nursing practice:


 Michael is a sixteen-year-old who was diagnosed with a sexually transmitted infection (STI). Although the doctor examined Michael and told him about his diagnosis privately, Michael’s mother is in the waiting room and wants to know what the doctor said. Michael told the doctor and nurse that he does not want anyone to know about the STI, including his mother.

Ethical Dilemma:

 Perhaps one of the most common examples of ethical dilemmas in nursing occurs when nurses must determine if it is appropriate to discuss a patient’s medical information with a parent or guardian. For years, parents and guardians were allowed access to medical records for any patient under the age of eighteen. Today, every state has some laws allowing minors to consent to care under certain conditions without parental knowledge, consent, or access to their medical records.

How to Deal with this Ethical Dilemma:

 In most states, when an adolescent is old enough to give consent for healthcare, information pertaining to that care is typically considered confidential. Violating a patient’s confidentiality can result in serious repercussions, including loss of job or licensure. Therefore, it is necessary for nurses to be aware of their state laws and to work closely within those laws and with supervisors to adhere to their organization’s guidelines. It is always appropriate to defer to your facility’s policies or to ask for a supervisor’s intervention or guidance if you are unsure.

  • Introduced the topic and purpose of the paper in a clear, complete, and logical manner, in a half page length.  5 Points
  • Used current, evidence-based literature (a minimum of 6 references from relevant, peer reviewed journals and/or text-books – at least 5 from sources outside course text). 10 Points
  • Summarized data in a clear, logical, and organized manner. 15 Points
  • Delineated relevant health care issues that impact the ethical issue within the context of current professional/political and /or financial situation. 20 Points
  • Implementation of a method of ethical analysis – 4-box used, possible solution/outcome alternatives, and resolution / plan of care (what action or alternative did you choose and why).  May include your opinion on the topic, however, balanced arguments are required. 20 Points

How to Use the 4 Box Method video https://www.youtube.com/watch?v=OcrgbOiyXHo

  • The conclusion clearly summarizes relevant points of the paper and provides adequate closure to the topic. 10 Points

The Principles of Beneficence and Nonmaleficence
The Principle of the Respect for Autonomy
The Principles of Beneficence and Nonmaleficence and Respect for Autonomy
The Principle of the Respect for Autonomy and Justice

Jonsen, Siegler, Winslade Clinical Ethics:  A Practical Approach to Ethical Decisions in Clinical Medicine

Text Box: Medical Indications:
1.	What is the patient’s medical problem? History? Diagnosis? Prognosis
2.	Is the problem acute? Chronic? Critical? Emergent? Reversible?
3.	What are the goals of treatment?
4.	What are the probabilities of success?
5.	What are the plans in case of therapeutic failure?
6.	In sum how can this patient be benefited by medical and nursing care, and how can harm be avoided?
Patient Preferences:
1.	Is the patient mentally capable and legally competent?  Is there evidence of incapacity?
2.	If competent, what is the patient stating about preferences for treatment?
3.	Has the patient been informed of benefits and risks, understood this information, and given consent?
4.	If incapacitated, who is the appropriate surrogate? Is the surrogate using appropriate standards for decision making?
5.	Has the patient expressed prior preferences, e.g. advance directives?
6.	Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
7.	In sum, is the patient’s right to choose being respected to the extent possible in ethics and law?
Quality of Life:
1.	What are the prospects, with or without treatment, for a return to normal life?
2.	What physical, mental, and social deficits is the patient likely to experience if treatment succeeds?
3.	Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
4.	Is the patient’s present or future condition such that his or her continued life might be judged undesirable?
5.	Is there any plan and rationale to forgo treatment?
Contextual Features:
1.	Are there family issues that might influence treatment decisions?
2.	Are there provider (physicians and nurses) issues that might influence treatment decisions?
3.	Are there financial and economic factors?
4.	Are there religious or cultural factors?
5.	Are there limits on confidentiality?
6.	Are there problems of allocation of resources?
7.	How does the law affect treatment decisions?
8.	Is clinical research or teaching involved?
9.	Is there any conflict of interest on the part of the providers or the institutions?  4-Box Method of Ethical Analysis

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