CASE SCENARIO 2: NONCOMPLIANCE VERSUS AUTONOMY

Cora is a 45 year old woman who looks year older than her stated age . She has
limited monthly income and no health insurance. Cora smoked 2 and ½ packs of
cigarette per day. She has severe COPD with constant dyspnea and frequent
exacerbations. The nurse who sees her at the local free clinic is interested in at least
preventing further problems , and speak to Cora often about the importance of quitting
smoking. The situation becomes very frustrating for all involved when Cora returns
repeatedly for increasingly sever problems, having failed to quit smoking . Cora of
course , becomes labeled as noncompliant. During a particular severe exacerbation ,
the nurse says to Cora, “ You know you are committing suicide by continuing to smoke
.”. Cora’s reply is , “ You don’t understand. I live alone. I have no money , no friends , no
family , and will never be able to work. I know the damage I’m doing , but smoking is the
only pleasure I have in life.’

THINK ABOUT IT.

Do Nurses Coerce Patients?

● In attempting to persuade Cora to stop smoking , to what degree is the nurse

disallowing Cora’s right to autonomy?

In attempting to persuade Cora to stop smoking, they disallow Cora’s freedom to

choose an act towards smoking. The freedom of every individual is innate therefore
every individual has the right to choose and decide freely.

● Does Cora have the right to choose to continue smoking?

Yes. Cora has the right to choose to continue smoking because her own
autonomy needs to be respected. According to Yusrita Zolkefli “Choice is what we all
want, as most would say. There is a growing cognisance that patients can and should
play an important role in deciding their own care, in defining optimal care, and in
improving healthcare delivery. Popular concepts such as patient-centered care, patient
empowerment, and patients as partners, shared decision making, and informed choice
illustrate the emancipation of patient.”

● If rights and responsibilities are correlative, how should the clinic respond to
Cora’s continuing to smoke? Would you suggest that the clinic continue to
serve Cora , even though she is not following the plan of care?

In Cora’s case, I suggest that the clinic needs to continue the passionate service
regardless of noncompliance and even her attitude towards the nurses are negative.
according to the the Magna Carta of Patient’s Rights and Obligations Act of 2017, “the
patient has the right to good quality health care and humane treatment. Every individual
deserves the right of continuity of good quality health care without discrimination in
terms of care, human dignity, convictions, integrity, individual needs, and their culture
needs to be respected”. The clinic must talk to Cora about the possible negative
outcomes that may occur if she does not follow the certain care plan that the clinic
made that may cause severe outcomes in the future. It will be all Cora’s responsibility to
face all the consequences if she continue to refuse all the instruction and plans of care
for her.

● To what degree is coercion employed in situations such as Cora’s? Is

coercion appropriate strategy?

The coercion must be employed in Cora's situation, she needs to have early
interventions to know what her future will be like if she does not follow all the
instructions. Positive coercion must be implied for strategy. This can help Cora to be
more educated so that her mindset can be changed and be able to follow the instruction
and certain care plan that was made for her.

● What would you do?

As a nurse, I will continue to serve Cora with compassionate care and strive hard
to convince Cora to cooperate in the plan of care made for her. In terms of Cora’s
financial problems, I will suggest that there are a lot of public health care facilities that
could attend to her needs without expensive cost and most significantly, Cora needs an
emotional and moral support so I will make sure that i’ll able to attend to her emotional
and moral needs by supporting her that she can do it and she will be able to overcome
all her circumstances and eventually she will be able to cooperate with the interventions
that her body needs in order to prevent further severe problems.

References:

Zolkefli, Y. (2017) “Evaluating the Concept of Choice in Healthcare”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771520/

Ejercito, J (2016) “An act Proclaiming The Rights And Obligations Of Patients, Providing A
Grievance Mechanism thereof And for Other Purposes”
https://legacy.senate.gov.ph/lisdata/50404429!.pdf