Charge Nurse: An Ethical Dilemma

The Ethical Dilemma

I was tasked with the following case from a charge nurse as part of an ethics consult. A 68 year old man was admitted to the medicine unit from Denver International Airport for altered mental status and aggressive behavior. The patient, from this point forward to be called Mr. Johnson, was found to be acutely infected from a septic wrist joint, but was also found to have frontotemporal dementia. Once the infection cleared, it was hoped that Mr. Johnson’s mental status would improve, but he remained aggressive and lacking in capacity. After much investigating, outside hospital records were found on Mr. Johnson but neither the providers nor case managers were able to find any family or interested parties, and Mr. Johnson
The good effect would be that Mr. Johnson would be satisfied and deescalate. The bad effect would be that nurses and providers would knowingly and purposefully be deceiving Mr. Johnson with a pill that is not clinically indicated. The provider’s intention isn’t entirely benevolent in this situation. Though the provider knew the folic acid wouldn’t harm Mr. Johnson, he was not planning to order the pills to improve his health but was instead doing so to placate him. Also, the bad effect (deceiving the patient) would be a means to the good effect (satisfying Mr. Johnson), which automatically determines this to be an immoral act. However, even if one were to continue on to the fourth step of proportionality in the rule of double effect, it is not proportional to knowingly deceive and administer folic acid that isn’t clinically indicated with the goal of calming down an aggressive and confused patient.

The Role of the Ethical and Religious Directives
The third directive states that one should advocate for those in society who are on the fringes. Stating, “In particular, the person with mental or physical disabilities, regardless of the cause or severity, must be treated as a unique person of incomparable worth…” (United States Conference of Catholic Bishops, 2009, p.11-12). Thus, Joe’s mental fragility and illness should not preclude him from receiving the same respect and dignity as anyone else. The thirty-first directive discusses rules surrounding experimentation and while Joe was not being experimented on in the most literal sense, the provider’s decision to give folic acid as a placebo pill is an experiment of sorts in that the provider is doing so without the patient’s consent. The directive states, “the greater the person’s incompetency and vulnerability, the greater the reasons must be to perform any medical experimentation, especially nontherapeutic” (United States Conference of Catholic Bishops, 2009, p. 21). And most true to the basis of this case is the second directive which states that, “Catholic health care should be marked by a spirit of mutual respect among caregivers that disposes them to deal with those it serves and their families with the compassion of Christ, sensitive to their vulnerability at a time of special need (United States Conference of Catholic Bishops, 2009,