Patient A, who has a diagnosis of dementia, will most likely be on the receiving end of the least amount of discrimination from those around her. It’s true that she will fall foul of the prejudice (though lack of empathy might be a better phrase than prejudice) which exists against the elderly, and she may also feel some pushback for her second marriage, particularly if it was due to some error on her own part, but otherwise, her life and previous career would bring her respect. Her diagnosis does not surprise me, because at eighty-eight, patient A is quite advanced in age. Similarly, patient B will most likely not face much in the way of overt discrimination either. Cancer is known to be a disease which can strike anyone at any time, so there is no stigma associated with it. Her job as a shift worker in a casino might draw some prejudice, particularly over how it could potentially affect her children, as could her age in regards to when she had said children.
Patients C and D would both face significant discrimination, though due to different motives. HIV is something which carries a lot of stigma in and of itself, while the man’s position would bring him under fire from a certain section of the populace who might connect his illness with possible infidelity. Alternatively, his position as a husband and father in a position of authority may screen him from some of the stigma which is associated with the contraction of HIV. Indeed, his position in life is something which makes the diagnosis unusual: whether it is true or not, most people would not expect to find such a thing in a family man. Unfortunately, patient D would face discrimination because of where he is currently residing, among other things. Convicts, whether they are guilty or not, are often treated with disdain. This is a state of affairs which would not help patient D gain adequate medical care. Sadly, his diagnosis does not surprise me, since his position – being jailed for a crime he says he did not commit – would likely cause much stress and anxiety.
Dignity is a state of being where someone is seen as being worthy of respect and courtesy from the people around them. Respect is a state of having feelings of admiration for a person; treating something with respect is to treat them as a human. It might be difficult to treat some with the respect they deserve if they do not show the same courtesy in return, or if they are actively dismissive or uncaring of the care we give them as nurses.
In the scenario given for this journal piece, the patient is both a minor and not of fit mind to have a say in their own care, so the nurse should work with the parents in organiasing care (“Medical Ethics”). While it is difficult to be objective under such circumstances – a child being hurt in this manner is always hard, and the nurses may find themselves falling prey to the same feelings as the father, that if they hang on for long enough, a cure will be effected – the nurse does still have to take the patient’s welfare into account, so in that regard, any nursing staff involved in the care of the child should probably side with the mother in her attempts to organise palliative care. Even when a patient is non-responsive, as this one is, they still have a dignity as a human being which it is our duty to respect (“Medical Ethics”). Since the dignity of this patient would be best served by allowing them to die peacefully, rather than prolonging their life in the face of a scenario which offers no hope, any nursing staff should consider the mother right in her efforts to give her child some measure of dignity in a peaceful and comfortable death.
This patient, while awake and alert, is nonetheless still a minor. The scenario is a difficult one, because don’t patients have the right to know that they are going to die or not? Are the parents asking for staff to keep the information about the patient to themselves for the good of the patient, or for themselves, because they can’t stand to think about their child’s impending death? Ultimately, we as nurses are not qualified to make such calls. In this scenario, the minor is specifically stated to be of sound mind. It is my belief that the patient should be told about his condition and prognosis, even if his parents are the ones who have the power to make medical decisions. One of the foundations of medical ethics is to do no harm (“Medical Ethics”), and to keep such information from a patient would likely be very damaging indeed. Nurses act, at least in part, as an advocate for their patients, especially ones who cannot advocate for themselves. Not letting a patient know when he is dying is an unethical decision, and I would go against the parents’ wishes in this case.
The patient may not make the decision that you think is best (“Medical Ethics”). This is their right as a human being, even if you don’t agree with the course of action that they want to take.
A patient has the right to make truly informed consent.
Patients have the right to know all courses of treatment which are available to them, in order to make truly informed consent. If they are only told certain things about their illness and its treatment, they may give consent for what they think is best, but that consent will not truly be informed.
A patient should have the right to confidentiality.
Patient\doctor confidentiality is enshrined in the ethics of the medical community (“Medical Ethics”), and while it might need to be broken in some specific instances, in most cases a patient has the right to knowing that they can speak in confidence to their medical team.
A patient should have the right to autonomy.
Being ill and in hospital already means having some measure of autonomy being taken away from patients. They should be able to retain some measure of autonomy in deciding what treatment they get and when, and in what form.
A patient should have the right to the best care that is available for them.
When a patient comes under the care of a nurse, that nurse becomes their voice within the medical community, and is in a position to fight for them to receive the best treatment it is possible to give them, in the face of any arguments to the contrary.
A patient should have the right to as much respect and dignity as they would be afforded were they still of sound mind and body.
Respect and dignity are important to people, particularly in situations where they may already be feeling powerless. It is their right as human beings to be afforded as much respect as we can.
Work Cited
“Medical Ethics” Patient Info 28 Jan. 2015, http://patient.info/doctor/Medical-Ethics
