For this assignment, consider the following case and then using the internet, course materials, and the Library, compose reasoned responses to the questions that follow. In the mid 1970s, a nursing educator in Idaho had contact, through a student, with a female client who had chronic myelogenous leukemia. This form of leukemia can often be managed for years with little or no chemotherapy. The woman had done well for about twelve years and ascribed her good condition to health foods and a strict nutritional regime. However, her condition had turned worse several weeks before and her physician had advised her that she needed chemotherapy if she were to have any chance at survival. The physician had also advised her of the potential side effects of the therapy including hair loss, nausea, fever, and immune system suppression. The woman consented to the therapy and signed the appropriate forms, but later, she began to have second thoughts. The nursing educator and student had given the patient one dose of the therapy when the woman began to cry and express her reservations about the therapy. She questioned the nurse about alternative treatments to the use of chemotherapy. The patient related that she had accepted the therapy because her son had advised her that this was the best treatment. She related that she had not asked about alternate forms of treatment as the physician had indicated that chemotherapy was the only treatment indicated. The nurse did not discuss the patient's concerns with the physician, and later that evening, she talked to the patient about alternate therapies. In the discussion, rather nontraditional and controversial therapies were covered including reflexology and the use of laetrile. During the talk, the nurse made it very clear that the treatments under discussion were not sanctioned by the medical community. The patient's feelings toward alternate therapies were strengthened by the evening's conversation; however, she continued with chemotherapy. The treatments, however, did not bring remission to her crisis and she died two weeks later. Upon hearing about the conversation between the off duty nurse educator and his patient, the physician brought charges against the nurse for unprofessional conduct and interfering with the patient-physician relationship. (In re Tuma, 1977). 1. What, if anything, did the nurse do wrong? 2. Had she moved beyond her scope of practice? 3. Could the nurse's conduct be justified under the patient advocate portion of her role? 4. If you were a member of the state board for nursing and had to decide the issue of unprofessional conduct and interference with the patient-physician relationship, would you sanction the nurse? Support your responses with evidence and cite your sources. Length 4 pages not counting the case. At least 4 references; scholarly sources COURSE MATERIAL INFORMATION : Ethical Principles and Dilemmas of Confidentiality, Veracity, and Fidelity Health care .

1. For this assignment, consider the following case and then using
the internet, course materials, and the Library, compose
reasoned responses to the questions that follow.
In the mid 1970s, a nursing educator in Idaho had contact,
through a student, with a female client who had chronic
myelogenous leukemia. This form of leukemia can often be
managed for years with little or no chemotherapy. The woman
had done well for about twelve years and ascribed her good
condition to health foods and a strict nutritional regime.
However, her condition had turned worse several weeks before
and her physician had advised her that she needed chemotherapy
if she were to have any chance at survival. The physician had
also advised her of the potential side effects of the therapy
including hair loss, nausea, fever, and immune system
suppression.
The woman consented to the therapy and signed the appropriate
forms, but later, she began to have second thoughts. The nursing
educator and student had given the patient one dose of the
therapy when the woman began to cry and express her
reservations about the therapy. She questioned the nurse about
alternative treatments to the use of chemotherapy. The patient
related that she had accepted the therapy because her son had
advised her that this was the best treatment. She related that she
had not asked about alternate forms of treatment as the
physician had indicated that chemotherapy was the only
treatment indicated. The nurse did not discuss the patient's
concerns with the physician, and later that evening, she talked
to the patient about alternate therapies. In the discussion, rather
nontraditional and controversial therapies were covered
including reflexology and the use of laetrile. During the talk,
the nurse made it very clear that the treatments under discussion
were not sanctioned by the medical community.

2. The patient's feelings toward alternate therapies were
strengthened by the evening's conversation; however, she
continued with chemotherapy. The treatments, however, did not
bring remission to her crisis and she died two weeks later. Upon
hearing about the conversation between the off duty nurse
educator and his patient, the physician brought charges against
the nurse for unprofessional conduct and interfering with the
patient-physician relationship. (In re Tuma, 1977).
1. What, if anything, did the nurse do wrong?
2. Had she moved beyond her scope of practice?
3. Could the nurse's conduct be justified under the patient
advocate portion of her role?
4. If you were a member of the state board for nursing and had
to decide the issue of unprofessional conduct and interference
with the patient-physician relationship, would you sanction the
nurse?
Support your responses with evidence and cite your sources.
Length 4 pages not counting the case. At least 4 references;
scholarly sources
COURSE MATERIAL INFORMATION
: Ethical Principles and Dilemmas of Confidentiality, Veracity,
and Fidelity
Health care providers and patients both enter a health care
relationship with a set of ethical principles and moral
expectations. While both patients and providers are aware of
underlying assumptions, the rules for practicing ethical health
care can be conflicted, and at times, impenetrable. In this

3. presentation, we focus on the ethical principles and dilemmas of
confidentiality, veracity, and role fidelity as they are applied or
emerge in modern health care.
Confidentiality and Veracity
Confidentiality, an important element of respect for persons,
requires caregivers and executives to keep secret what they
learn about patients and others in the course of their work.
Patients have a right to expect that information regarding their
care and treatment will be kept confidential. Information
received by a physician in a confidential capacity relating to a
patient's health should not be disclosed without the patient's
consent although disclosure may be made under compelling
circumstances (e.g., suspected child abuse) to a person with a
legitimate interest in the patient's health. In short, all health
professionals who have access to medical records have a legal,
ethical, and moral obligation to protect the confidentiality of
the information in the records.
Truthfulness, like confidentiality, is an ethical principle that
guides patient-provider relationships. In fact, truth-telling is at
the core of the patient-physician relationship and crucial for the
information exchange process. Patients generally have a right to
accurate medical information. It is a rare occasion when lying to
a patient is justified. Veracity, like confidentiality however,
does not function well as a moral absolute. Telling the truth in
the patient-physician relationship is not always in the best
interest of the patient's mental or physical health. Whereas
providers are bound to veracity, they are also bound to
nonmalefience.
Role Fidelity
A major problem with applied ethics is that many written and
unwritten codes influence or guide human behavior. In the
health professions of licensed caregivers, codes of ethics that
define acceptable and unacceptable behavior are general with

4. vague performance standards making enforcement difficult, if
not impossible. Even vigorous enforcement, however, only
guides those seeking to do the right thing but who need help
determining what that is. Someone at the fringe of a profession
is dissuaded neither by principles of ethical conduct nor by
legal requirements. Discretion in this context is one who has the
authority to act according to his or her judgment. The public
trusts the licensed caregiver to not abuse his or her exercise of
discretion and cause harm. Because the discretion that
accompanies nurses, physicians, therapists, and other licensed
caregivers in their jobs is most often under their control, they
face a variety of ethical issues. These issues range from
uncaring behavior, patient sexual abuse, self-referral, to
permitting peers to practice medicine while impaired.
The first image I remember once I gained consciousness was my
reflection in the mirror; I had a laceration in my ear and blood
pouring down my face. I could not feel anything,my entire body
was numb. Even though I was in serious danger, the only thing
that came to my mind was that if I had been severely injured I
could not become a physician.
My friend will never let me live down that night. He always
emphasizes that when I regained consciousness my first words
were, "I can't move my neck, I can't be a doctor." As foolish as
that sounds, it was my first thought, even before I even felt
pain. After finally turning toward my friend, the look of fear
and nausea on his face caused me to panic.
It was October 31st and my friends and I were in our costumes,
ready to enjoy Halloween. As the night progressed, a friend of
mine was approached by a man looking for a fight. After I
thought he had successfully diffused the situation, I turned and
faced the other direction. Unfortunately, I had actually put

5. myself in the line of fire as the man smashed a large glass bottle
over my head, unprovoked.
I was rushed to the ER where I first encountered a nurse who
informed me that if the cut on my neck was a few centimeters
lower I may not have lived. After waiting nervously, a man
rushed in and introduced himself as a plastic surgeon. As he
wiped the blood off of my neck and began to prepare for the
procedure, he struck up a casual conversation with me. After I
had told him about my interest in medicine, he informed me, "I
am going to debride the wound edges of your ear and then begin
to suture both your ear and neck to achieve appropriate
anatomy." He then positioned a mirror so that I would be able to
watch the procedure. At that moment, my fear had escaped and
was replaced by intrigue and excitement. I no longer felt like a
patient, but rather as though I had gone back to 11th grade when
I was a volunteer shadowing a surgeon.
My initial interest in medicine began working at my father’s
office. For such a small town in upstate New York, my father’s
office was always packed. Even though I had worked there for
many years, when I reminisce of those times, only one memory
comes to mind: Shirley, my father’s previous employee, running
into my father’s room giving him an enormous hug. Afterwards
I asked her why she was so happy to see my father. She told me
that a couple of months ago she had gone to the hospital
because she had not been feeling well. However her initial
cough and shortness of breath got much worse in the ER and she
was put onto a ventilator and admitted. Shortly her lungs
improved but she became completely paralyzed. As this
persisted, many of the doctors and her family was thinking of
ways to make her comfortable, losing all hope that she would
get out of her current vegetable state. However, after my father
heard of what had happened, he took her case. He refused to let
the family lose hope and constantly reassured them. Eventually
my father found the problem, and took her off her current

6. treatment and treated her for steroid myopathy. Within weeks
she began to regain activity in her limbs. She later was taken off
the ventilator and is now completely healthy and is able to walk
and live a happy life. She thanks my dad for not giving up and
for giving her more time to live, when even her family had
thought her time was up. From this experience, I really was able
to see the effect medicine had first hand and it solidified my
interest in medicine.
Wanting to enter a profession in which I could both help and
interact with people led me to my first position in the medical
field. Volunteering at a hospital in high school was very
educational, but there was something important missing from
the experience-I had only viewed the physician operate after the
patients were put under anesthesia, never having the chance to
interact with them. As I entered college I found a position at the
NYU School of Medicine Center for AIDS Research. The
clinical aspect of my job was to assay the blood samples of
patients for the progression or regression of HIV andAIDS.
However, I only worked with the blood that was delivered to
our lab from the nurses, so once again I was unable to interact
with patients. As time went on and I gained more experience, I
was able to move on to more complex research. My last project
involved methods to detect the cause of T cell anergy and AIDS
pathogenesis. I am highly aware of the tremendous amount of
people that this research may help in the future, and have a
great interest in research, however this role had been very
technical and I have a strong desire for an area of medicine that
is more relationship based.
My experience in the ER, however, had finally completed the
picture because it allowed me to fully comprehend the
significance of the doctor-patient interaction in medicine. My
physician's ability to converse with me as a person calmed me
down and made me feel comfortable before he proceeded. After
being able to view the many dimensions of the medical field, I
became certain of my decision to become a physician.

7. Having seen the effectiveness of my physician's interaction with
me in the ER, I decided to implement a similar tactic of
interaction with my students at the Youth Employment Services
(Y.E.S.) program. This program was set up to aid at-risk young
adults with Axis I diagnosis in preparation for their GED exam.
I was able to quickly set myself apart from the other volunteers
by personally connecting with each of my students before
proceeding to teach them the material. I found that they became
more responsive after establishing trust in me rather than if I
tried to introduce new material without creating a comfortable
atmosphere.
I realize now how important it was that the doctor was able to
allay my fear by connecting with me and how that made for a
more positive treatment. I know my experience at the Y.E.S.
program is very different from what I will encounter as a
physician, but hopefully I will have the opportunity to transfer
my experiences with these students to my patients in the future.
I am thankful to this day not only because my physician did an
amazing job suturing my wounds and probably saving my life,
but also because through that experience I finally understood
the emotions and gratidtude Shirley had felt as she
enthusiastically hugged my father. I know I want to help people
and perform life altering procedures, allowing people to live
better lives. I just hope that one day I will be able to bring the
same joy to my patients as my father had done for Shirley.