Week 7 db

To allow all members of the class sufficient time to respond to peer’s postings, students must initially post the response to the instructors question by Wednesday 11:59pm of each week. Students must post the responses to peers posts by Sunday 11:59pm of each week. Students are referred to the course syllabus and to the BSN Student Handbook regarding late assignments. You must post at least two different days in the week. You are referred to the syllabus for Guidelines for Discussion Board Posting expectations on critical thinking in discussion questions. In 200 words respond to the following question using two resources. One source may be your text and a minimum of one English peer-reviewed nursing journal article (less than 5 years). Include a Permalink to the references so that faculty can easily access the articles (see library database page). Articles from non-nursing peer-reviewed journals, including those published outside the United States, and websites ending in .gov, .org and .edu may be used as a third resource if published within the last five years. Choose one of the Ethical Scenarios in Chapter 8: 8-1, (p. 118) 8-2, (p.127) Answer the questions in the scenario. Be sure to write the questions in your post. Chapter 8 Ethical Scenario 81 Limitation on Informed Consent Mr. and Mrs. Urkovitsch had their two-year-old daughter admit-ted to the hospital for evaluation of her continuing breathing problems and blue finger-tips. They have recently moved from their native country to the United States and speak limited Eng-lish. After diagnostic tests were completed, a diagnosis of se-vere cardiac cardiomegaly and aortic stenosis has been made. The pediatric cardiologist and the cardiovascular surgeon car-ing for the child feel that the parents do not have the needed education to fully comprehend the severity of the childs diag-nosis, and that only minimal informed consent is needed as they will not understand anyway. Through an interpreter, the two physicians have informed the parents of the fact that the child requires surgery, but that everything will be fine after the surgery. The parents are asking the nursing staff additional questions, such as what type of surgery their daughter is about to have, how long she will be in the hospital, and when she will be able to play with the other children again. Additionally, the parents have told the nursing staff that they understand their daughter is quite ill and are very worried about her future. Discuss the ethical principles underlying this situation, from the aspect of the parents, the nursing staff, and the physicians. Is there a realistic ethical outcome for this situation? Exceptions to Informed Consent The courts recognize the following four exceptions to the need for informed consent in circumstances in which con-sent is still required: 1. Emergency situations 2. Therapeutic privilege 3. Patient waiver 4. Prior patient knowledge From a practitioner standpoint, consent is still needed to prevent charges of battery, but the informed consent requirements are eased. Emergencies give rise to implied consent. Courts in some jurisdictions have recognized that if there is time to give information, a limited disclosure may be valid. If no time exists or the patient is incapable of understanding by virtue of the physical disability, then no information need be given. To bring a successful malpractice suit based on informed consent, the plaintiff must be able to show, by a preponderance of the evidence, all of the following: 1. There was a duty on the part of the health care pro-vider to know of a risk or alternative treatment. 2. There was a duty on the part of the health care pro-vider to disclose the risk or alternative treatment. 3. There was a breach of the duty to disclose. 4. If the health care occurs in a state where the reason-able patient standard is used, a reasonable person in the plaintiffs position would not have consented to the treatment if he or she had known of the outstanding risk. 5. The undisclosed risk caused the harm, or the harm would not have occurred if an alternative treatment plan was selected. 6. The plaintiff suffered injuries for which damages can be assessed. EXERCISE 81 Explore your own state requirements for standards of informed consent. How did you go about discovering these standards? Do elective procedures and emergency situations use the same standard of informed consent? Are ethical principles evident in these standards for informed consent? Which of the standards gives the most ethical rights to patients? Therapeutic privilege, sometimes referred to as ther-apeutic exception, has its origins in the common-law defense of necessity. Therapeutic privilege allows primary health care providers to withhold information based on sound medical judgment that the patient is too emotionally or mentally unable to fully understand and that revealing the information would potentially harm the individual. The detrimental nature of the information must be more than fear that the information would lead to the patients refusal. The disclosure of the information should pose seri-ous and immediate harm to the patient, such as prompting suicidal behavior (van den Heever, 2005, p. 420). In using this defense, the primary health care provider justifies its use based on actual danger or patient incompetence, not merely on the principle of beneficence. Therapeutic privilege is not favored by the courts, as it is a form of intentional nondisclosure. Courts have held that a relative must concur with the decision to intervene medically and that this relative must be given full disclo-sure, whereas other courts have held that no relative need give concurrent consent. Once the risks of patient harm have abated, the primary health care provider must then fully disclose the previously withheld information to the patient. The patient may also agree to a waiver of the right to full disclosure and still consent to the procedure. The caveat to be avoided in this instance is that the health care provider cannot suggest such a waiver. The waiver, to be valid, must be initiated by the patient. Such a waiver may be seen when patients tell the primary health care provider that they do not want to know the potential risks or com-plications associated with a specific procedure. Prior patient knowledge involves the patient to whom the risks and benefits were fully explained the first time the patient consented to the procedure. Liability does not exist for nondisclosure of risks that are public or common knowledge or that the patient had previously experienced. Often prior patient knowledge is encountered in patients