Nathan Miel Sabandal

4355160

When "Yes" means "No."

What are the facts of this case?

Nurse Amanda Needle, an Intravenous (IV) therapist, has worked at the Appalachian Academic

Medical Center (AAMC) for four years. She has a reputation of a "good shooter" with the

needles in her line of work. One day, 24-year-old Amanda was assigned to draw blood to one of

her previous patients named Greg. An intellectual and upbeat young man who inspires to

become a physician despite his leukemia. During the procedure, Nurse Amanda noticed that

Greg was not doing well and asked for procedural consent to let her draw the blood; however,

Greg refused. Nurse Amanda respected the patient's refusal for the procedure and informed the

third medical residents who ordered the test. However, things went south after the resident was

informed by nurse Amanda, and did not accept the reason given. Even thou, Nurse Amanda

confirmed that the patient did not consent the procedure, but the medical resident insisted and

told nurse Amanda to do her job and do what she been told. Furthermore, nurse Amanda

answered that the patient was already 17, but the situation escalated more, as the medical

resident insistent that "he is a kid, he does not know what is right for him, and he is not capable

of deciding.

What ethical dilemmas does the case illustrate?

Patient's right to refuse (Patient's right to self-determination in his/her medical care) vs.

Insubordination

It is the battle between protecting the patient's desire and autonomy in his/her medical care

against a direct order of the higher up which can result in dispute both the patient and the

system hierarchy

What should the IV therapist do?

Nathan Miel Sabandal
4355160

Maybe before the situation escalated, the IV nurse should somehow dig more in-depth on the

reason for the "NO" given by the patient towards the procedure, that way, the situation can be

presented and delivered differently to the medical resident. Furthermore, the nurse should

explain the situation the patient is in, the importance of procedure and maybe strike a bargain

like giving the patient time to rest and asking the patient that the nurse will be back for an hour

or two in that way patient still has his autonomy to decide his medical care. When it comes to

dealing with the enraged medical residents, the nurse should be aware of the situation and try to

deescalate it by adequately explaining the situation the nurse gathered, and a bargain was

struck between the patient. However, if the situation was not resolved, then inform the current

supervisor about the subject matter in that way; we can clear up things, and maybe we can

reach a compromise solution.

What should the doctor do?

In this situation, the doctor should not affront the nurse in public and try to understand the

current situation more, rather than throwing insult and implying being superior around others.

Yes, everyone indeed has a specific job around healthcare, but we, as a member of it, should

respect every colleague we worked with and try to comprehend the situation, in which, in this

case, the patient's refusal to a medical procedure. Furthermore, base on the data presented, the

patient was already 17 years old and can independently practice his autonomy with regards to

the care necessary for his health. The physician should reappraise the patient on his current

decision about the procedure while taking it as a chance to dig deeper what is the underlying

reason for the refusal, that way, both the healthcare provider and the patient could decide the

alternative actions regarding this matter on hand which can enhance patient's autonomy

towards his health care.