Mr. Z is a visiting professor of biophysics at a large university medical center. The Z family came to the United States two years ago and will be in this country for five years. Family members include the doctor; his wife, Mrs. Z; their two children, who are four and seven years old; and Mr. Z’s mother. The family has adopted the traditions of a prominent culture in their country of origin, where the husband is conventionally the primary decision maker and the husband’s mother is in charge of the household, determining how it is organized. Mrs. Z accepts her mother-in-law’s decisions related to the household and child-rearing practices. Ethical situation:
Mrs. Z discovers a lump in her right breast. She tells her mother-in-law, who then shares the information with her son, Mr. Z. Mrs. Z, her husband, and her mother-in-law go together to a female physician, Dr. F. Mrs. Z is examined without her family in the room. This is acceptable to her culture, since only females are present. She has a mammogram. She privately tells the physician and attending nurse that she does not want her husband or mother-in-law to know the outcomes of the examination and test. She is given another appointment after the results of the mammogram are available. Dr. F and the nurse explain that she needs a biopsy. The mammogram showed a suspicious area, and a biopsy would help Dr. F establish a diagnosis. Mrs. Z chooses to have a biopsy without consulting anyone in her family. She again states she does not want her family to know more about her situation. The culture is generally family members would go with the person receiving the care but since Mrs. Z is being seen by a female physician, he would not need to be in the room. When Mrs. Z comes into the waiting room, her family asks her questions about what was done. She tells them that nothing was done, that the appointment was just a follow-up. Two weeks later, Dr. F calls Mrs. Z to tell her that the biopsy was positive and that Mrs. Z needs additional treatment. Mrs. Z does not tell her family. She is afraid of having chemotherapy, a mastectomy, or other treatment. When Mr. Z sees the medical bills, he questions his wife about the procedures. She continues to say nothing is wrong but appears unhappy. The nurse calls Mrs. Z to see if she will come into the office so treatment options can be discussed. Mrs. Z states that she will not seek additional treatment and does not want any information shared with her family. Her husband is concerned. He talks with one of his colleagues, Dr. J, who is a medical doctor, and asks Dr. J to find out what is happening with Mrs. Z. Dr. J calls the office and asks the nurse to provide him with electronic access to Mrs. Z’s records. The nurse states she will talk with Dr. F about his request. Dr. F and the nurse discuss the situation related to patient confidentiality. They use a decision-making process and review the limits of confidentiality and the good or harm in respecting Mrs. Z’s request not to share information. They base their decision making on their commitment to professional standards and their desire to ensure that Mrs. Z receives the best care possible.
Ethical decisions are made every day, by all peoples and all cultures. Ethical values are shaped by culture and can differ from person to person. Ethical dilemmas occur often in healthcare where all peoples and all cultures are thrown together for a common cause—the pursuit of health and well-being. Ethical comportment is important for professionals to insure the stability and success of the profession as well as to foster trust which is vital to all care relationships and especially to nursing. Nursing professionals have a need to recognize ethical dilemmas and to have a systematic process for navigating through ethical decisions. Making ethical decisions is a multidisciplinary process in which the nurse, as a patient advocate and medical professional,...
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