Nursing Ethics and Issues

The report is a reflection on the story of Beth Bowen. It depicts the trials and tribulations faced by a parent due to their child's death caused by medical negligence and violations of ethical principles of medical practice. The story is about five-year-old child, Beth Bowen, the daughter of Sara Dawson and Richard. The couple had three children, and all had spherocytosis. Spherocytosis is a disorder of the blood characterized by the production of RBCs which are sphere-shaped rather than bi-concave shaped. It is a case of auto hemolytic anemia, and all such patients require regular blood transfusions. One of their children William had the same condition and spleen removal surgery significantly improved his quality of life. But the same operation planned for Beth Bowen proved to be a disaster for her and Beth Bowen died during operations.

On investigation of cause of death of Beth Bowen, one can find that death occurred mainly due to several negligence and violation of ethics by medical team. On inquiry by her parents, several truths about the operation came to the forefront. Firstly it was a case of pure negligence and carelessness of the nursing and medical staff. Autonomy is core ethical principles of Singapore Nursing Board which requires a nurse to respect patients or family member’s autonomy and allows them to take choices regarding treatment (Parahoo 2014). It requires the nurse the client about necessary nursing care and respect the informed decision of client to accept or refuse care. But the blunder was that during the operation the doctors decided to use a new pieces of equipment called the mocellator for surgery without informing the patient’s family members about it.

During the whole procedure of operation they never came up even once to inform Beth’s parent about sudden complications in the surgery, nor any risk assessment been done on the equipment for patients. Respecting a client’s individual value and giving informed consent regarding any procedure are also ethical values of Singapore Board of nursing practice (Judkins-Cohn et al., 2013). It involves actively involving patient or family member in planning care and considering individual values when deciding optimal treatment. But the surgeons and nursing staff operating on Beth Bowen neither came to their parents to inform about new equipments that they are using nor did they analyzed the risk of the equipment on Beth Bowen. The International Patient Safety Goal highlights evidence and expert based consensus based decision in treatment to promote patient safety. In case of Bowen no such consideration was done before using the mocellator.

Veracity and integrity are the attributes that medical and nursing staff must incorporate into their nursing practice. Veracity according to Singapore Nursing Board means disclosing all pertinent information to patient as well as respecting privacy and confidentiality of patient information. It promotes ethical standards and maintain public trust in the nursing profession. The ethical responsibility of surgeons and nursing staff in case of Beth was to inform their parents about the risk of surgery and the equipment used for surgery (Burkhardt & Nathaniel, 2013).  It would have made the parents conscious and they would have decided whether to carry forward with the surgery or not. They did not have to repent after the surgery that they could not stop the operation and save their child. Beside this the nurse could have showed integrity by being honest to Beth’s parent and realizing their error. They should have advocated in the best interest of client and provided care in a responsible and ethical manner as mentioned in Singapore Nursing Board guideline. But they never bothered to apologize to Beth’s parent or admit what mistakes they had done. They never admitted that they had failed in their duty of care (Lachman, 2014).

Another ethical principles of nursing is justice which means nurses should fairly distribute resources after analyzing all the risk and benefits of the decision. But what was done during Beth’s surgery? They decided at the last minute to use a new piece of equipment called mocellator that removes flesh through laparoscopic portholes. This instrument had never been used before and they did not analyzed the risk of this material on Beth Bowen. The instrument was the cause of death for the child because this tool was meant to be used on adult and not a child. Inspite of this they used it on the child and it caused extensive damage to Beth’s body.The nurse had no formal training about how to use mocellator but still the nurse was asked to put the mocellator together. Justice was ultimately denied to patient by this irresponsibility by nurses and medical staff. International patient Safety standard in this case would have been to monitor patients correctly before using any medical equipment (Butts  & Rich, 2012). 

Health professional’s ethical values revolve around the attribute of paternalism. It means they analyze all the possible diagnosis and therapy for the patient and then take the decision that is best for the patient (Lepping et al., 2016). But surgeons and nurse of Beth failed to follow these ethical values. Such hasty decision of using new equipment in the mid of surgery was a violation of patient safety right. Secondly, if anyone had come up with the idea, the surgeon had the responsibility to halt the operation. They would have protested that we cannot take this step as no one had formal training in using the equipment. No one even suggested that they should first do the risk assessment before proceeding with using it. This unethical attitude of the medical team took one innocent life away.

Nurses should be non-malificence that is they always ensure that they will don harm to patients by experimental treatment or use of technology. They should have the quality of beneficence meaning they should be compassionate to positive steps for patients. But it seems Beth Bowens’s medical team became an epitome of unethical behavior. It was just their action that harmed Beth and took her life away. They were the reason for cause of death. Another principle of ethical nursing practice is fidelity. It mean nurses are loyal, truthful and dedicated to the care of patients (Iacobucci et al., 2013).. In Beth Bowen’s case nurse action was against fidelity as they disposed of all the items that could have proved their negligence during surgery. It was a great breach of duty by the medical and nurses to hide necessary information that could have given clue about her death (Neil, 2015).

Thus analysis of Beth Bowen case showed us how malpractice behavior is seen in medical practice. Nurse have to follow the specific standard of care and failure of the nurse in not following this standard of practice leads to a breach of duty and causing harm to patients. There are many health professionals who have this attitude that they can never commit errors, or they can never be wrong in their medical decisions. This attitude leads to error. They should be confident in their skills, but they should also understand their limitation. It would prevent the occurrence of cases like that of Beth Bowen.

Reference

Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Cengage Learning.

Butts, J. B., & Rich, K. L. (2012). Nursing ethics. Jones & Bartlett Publishers.

Iacobucci, T. A., Daly, B. J., Lindell, D., & Griffin, M. Q. (2013). Professional values, self-esteem, and ethical confidence of baccalaureate nursing students. Nursing ethics, 20(4), 479-490.

Judkins-Cohn, T. M., Kielwasser-Withrow, K., Owen, M., & Ward, J. (2013). Ethical principles of informed consent: exploring nurses’ dual role of care provider and researcher. The Journal of Continuing Education in Nursing,45(1), 35-42.

Lachman, V. D. (2014). Conscientious objection in nursing: definition and criteria for acceptance. Medsurg Nursing, 23(3), 196.

Lepping, P., Palmstierna, T., & Raveesh, B. N. (2016). Paternalism v. autonomy–are we barking up the wrong tree?. The British Journal of Psychiatry, 209(2), 95-96.

Neil, H. P. (2015). Nursing liability and evidence-based practice. MedSurg Nursing, 24(5), S10-S10.

Parahoo, K. (2014). Nursing research: principles, process and issues. Palgrave Macmillan.

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