Read the two following ethical dilemma below and make comments on each of them, discuss what you think might be the problem and what you might consider doing as a solution.
Ethical Dilemma 1
The ethical dilemma I struggle with in the ED is that a patient can check in voluntarily for a chief complaint of a psychiatric issue and then not be allowed to leave due to “safety concerns”. They can be detained and held against their will even if they checked in voluntarily. This happens at hospitals all across the state and when patients ask to leave, a lot of them feel coerced into staying by staff stating that they will be legally detained if they continue to try to leave and then they will be there for a minimum of 3 days or that their insurance won’t cover it if they leave before being discharged by a provider.
I see this happen a lot in the ED and it is rather disturbing because from my research, a decent portion of those patients that check in and are evaluated, are deemed safe enough to seek outpatient treatment and are not admitted. Also, WA state law states that patients have the right to be immediately released upon request but there are constantly loopholes once you start citing safety concerns which you can do for just about anything with little to no claims to back it up.
Nurses are often the frontline when it comes to telling these patients that they can or cannot leave and what the process is for that to happen but it is often unclear what that procedure is and then the patients have to wait until the nurses can find someone else who can better help them. In no way should nurses be put in the position of guard or detainer unless the patient has been brought in by PD with paperwork stating that cannot leave. Also, patients (i.e. everyday people who haven’t committed a crime) should not be detained against their will and should have their rights regarding a behavioral health check-in explicitly explained to them.
Ethical Dilemma 2
I had a patient a few months ago, admitted to the hospital for sepsis due to multiple wounds and self-neglect. This patient is a middle-aged female and has no family, she was found in her home lying on the sofa with urine and feces for days. EMT brought her in via ambulance because she cannot walk anymore.
She is diabetic and not managing her blood glucose at home, plus lying on the sofa for a prolonged period of time; therefore, she developed wounds and ulcers all over her body and it got infected. Mental health wise, we are not sure if she has an underlying mental illness and her decisional capacity, we had a consultation with the psychiatry team and deemed her non-decisional.
During her stay at the hospital, our staff faced lots of challenges and ethical issues when providing care. She refuses blood sugar checks, all of her medications, and the most important wound care. Since she is non-decisional, the doctor had to put in an order that “the patient cannot refuse care”. However, wound care and cleaning her is very challenging for our staff, she always screams and yells at our staff, would not let anyone come near her. It requires 4-5 staff to help with care, and it takes a significant amount of time.
We cannot let her sit in her urine and feces, and we have to do wound care multiple times throughout the shift. However, the patient does not understand the importance and has no motivation.
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