Dilemma 8

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Jessica Glaspell

Jessica Glaspell and Lee Dies Too Old for By-Pass?

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What to Consider?

Should Dr. Nicely Agree to Perform the Operation?

Should Dr. Nicely take into account that, in addition to the risks to Hannah, the procedure would generate considerable costs for the HMO?

Should the medical director take into account the costs to the HMO in deciding whether to authorize the CABG?

Works Cited ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Ethical Dilemma In the documentary The Invisible Patients, Jessica, a nurse practitioner for home-limited patients, is faced with several ethical dilemmas. For example, Jessica provides care for an elderly couple named Wink and Patty Sherrill. Both Patty and Wink are prescribed narcotics to manage their arthritis pain. During a routine urine drug screen, it is discovered that Patty does not have any trace of her pain medication in her system, yet she is still having her narcotic prescription refilled regularly. This obviously raises concerns for medication diversion. Patty is presumably giving her narcotics to her husband or selling her narcotics, which is a clear violation of her pain contract. She is banned from her primary care MD’s practice, which causes her great difficulty in finding another healthcare provider. Jessica feels that it is her responsibility to provide care for this couple. This scenario raises the ethical dilemma of beneficence versus nonmaleficence. The principle of beneficence is “the duty to do good and prevent or remove harm" (Hamric, Hanson, Tracy, O'Grady, 2014, p. 337). Prescribing narcotics to those experiencing chronic pain and disability is a necessary and beneficent act of healthcare providers. The principle of nonmaleficence is “the duty not to inflict harm or evil” (Hamric et al., 2014, p.337). Prescribing narcotics to a patient who is suspected of narcotics diversion has the potential to cause harm to the person who is taking the narcotics illicitly. Jessica must now decide which principle to follow and which principle to potentially break. Jessica decides that even though Patty is abusing her prescription, she does in fact still need her narcotics and continues to prescribe the pain medicine. My Solution In this scenario, I would not continue to prescribe Patty narcotics. Since she is not taking her pain medications but still seeking refills, she is abusing her prescription and the trust placed in her. If she is diverting her narcotics to her husband and/or selling them on the street, this places Wink and/or the narcotic abuser at risk for health complications such as respiratory depression, constipation, drug dependence, increased tolerance, and narcotic withdrawal in the future. I believe Wink has a legitimate need for pain medications, but he should be honest and open with Jessica about the need to increase his pain medications or try different modalities if his pain is not properly controlled. Regardless of motive, illegally diverting narcotics is a breach in contract and should not be overlooked. If I were presented with this scenario, I would have talked with Patty and Wink about Patty’s narcotic diversion and sought an alternative solution to continuing to prescribe narcotics. If Patty were in fact giving her narcotics to her husband to help control his pain, I would adjust Wink’s medications and pain management strategy. If they were selling their excess n.

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Dilemma 8

1. Jessica Glaspell and Lee Dies Too Old for By-Pass?

2.

3. What to Consider?

4. Should Dr. Nicely Agree to Perform the Operation?

5. Should Dr. Nicely take into account that, in addition to the risks to Hannah, the procedure would generate considerable costs for the HMO?

6. Should the medical director take into account the costs to the HMO in deciding whether to authorize the CABG?

7.