Hi Seth,

This is a very interesting case and I believe that I understand deontological ethics a lot better
now.  Although the nurse in the Mercy hospital case was doing her duty by going up the chain of
command to get the patient treated, I believe that she made a huge error by speaking to the
patient's family about the physician who overlooked prescribing the medication for the patient.
As a nurse, as in many professions, it will be important to present or represent someone else
within the organization, including their opinion, their actions, or their lack of actions.  There will
be many times when a unit is running short handed on staff and a physician or a nurse may not
be a thorough or may have missed something due to the situation.  In those cases, being a good
team member with providing support in actions without negative verbal input for the team would
be the best way to behave professionally.  I agree with you that the nurse in this case was doing
the right thing for the patient, as the physician clearly did not follow through.   But instead of
allowing the hospital protocol to handle the fallout of the error, she added fuel to the error by
speaking unprofessionally about the physician to the family.  She should have not only been fired
but, she also could be sued to slander, the oral form of defamation of character.  (Pozgar, 2020,
p. 162)  

Had the charge nurse just not made that one extra comment, the physician may have ended up on
the firing end of the situation as the hospital would have done more research on the issue and
how it unfolded. In fact, according to ANA’s Code of Ethics for Nurses, the charge nurse was
doing the right thing according to 3.5 Protection of Patient Health and Safety by Acting on
Questionable Practice, the nurse has an obligation to report the questionable practices. (ANA,
2015, p. 12) However, it also says that even when handled properly that reporting the
questionable or impaired practice poses a threat to the nurse, but this does not eliminate the
nurse’s responsibility to do so. (ANA, 2015, p.13) I believe that the charge nurse was not
terminated for doing the right thing but saying the wrong thing. A lesson for us all.

My personal morals and ethics frequently have put me in these politically charged situations
throughout my career. Gratefully, so far it has not involved the threat of someone’s life.
However, for far less at stake I have seen individuals’ careers ended due to the political and
public things that they have done. So, I believe it is best to follow protocols to ensure that the
administration can manage the fallout and not become part of it and hopefully help the change
for the better in the long run.

References
American Nurses Association. (2015). Code of ethics for nurses with interpretive
statements. Washington, DC: Nursebooks.org. - https://www.nursingworld.org/practice-
policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/
Pozgar, G.D. (2020).  Legal and ethical issues for health professionals (5th ed.).   Sudbury, MA:
Jones and Bartlett.
Hi Kaligya,

Thank you for providing your summary and explanation on the legal aspects of this case. There
are many interesting aspects of this case that I had to do a little more research. I agree with all
your analysis of both a doctor’s and a nurse’s clear errors and delay in treatment. However,
there is another area which I believe should also be explored is the fact this happened to a person
who was incarcerated at the time.

Questions that come to my mind are: What is the law that pertains to the health care of those in
custody? What is the normal or acceptable time for a person without an acute issue to be able to
see a physician? Does this vary according to the facility or state, or is this a standard for all
those incarcerated? Is there prejudicial thinking about the prisoner on the part of the health care
providers?

I was able to learn that prisoners are protected upon admission under the Eight Amendment
which guarantees them specific rights including health care for preventative, routine, urgent, and
emergency care. There are landmark cases (Estelle v. Gamble) that further pushed the neglect
of medical treatment while in prison under this amendment to be labeled cruel and unusual
punishment. (Oyez.org 2021) There are many websites in support of prisoners’ rights where
they note a reduction in the amount on onsite availability of health care, medical supplies, and
medications in general. Further, some of the sites mentioned lower wages for the medical staff.
Concerning the prejudicial thinking, I would only guess if someone were making less money to
care for individuals where there is a lack of staff and resources, that they may also allow
themselves to show less care. This is not a fact overall but was apparent in this case.

In addition to the ethical legal aspects that you mentioned, I would also add that both the
physician and the nurse were also guilty of Nonfeasance – failure to act. Neither of them
provided care or arranged diagnostics as a “prudent person” would do. (Pozgar, 2020, p. 155)

Could the patient’s breast have been saved? That was not the point, one hundred fifty-three days
after she initially requested to be seen, is a very long time. Back in 1989 there was surely less
technology, but there was surely enough knowledge that sooner treatment would provide a better
outcome.

References:

Constituteproject.org, 2021. Retrieved from:

https://www.constituteproject.org/constitution/United_States_of_America_1992

Oyez.org, 2021. Retrieved from: https://www.oyez.org/cases/1976/75-929

Pozgar, G.D. (2020).  Legal and ethical issues for health professionals (5th ed.).   Sudbury, MA:
Jones and Bartlett.