A nurse discovers that an excessively large intravenous dose of an opiate analgesic has been prescribed by an attending doctor. Based on her knowledge of pain management regimens and a clinical assessment of the patient, the nurse is concerned that if the prescribed dosage is administered as ordered, the consequences to the patient could be dire. (Specifically, it would, in all probability, hasten the patient’s death.) She checks with the prescribing doctor, who confirms that the medication is to be administered as prescribed and that, even though its administration will probably result in hastening the patient’s death, this is not the intended outcome. He explains that the dose prescribed is ‘in the best interests of the patient’ and is ‘necessary to alleviate the patient’s pain and suffering’. He further states that the prescription in question is ‘good medical practice’. The doctor upholds this view despite knowing that the patient has requested ‘everything possible be done’ to prolong her life and has expressed a preference not to be medicated in a manner that would render her unconscious. To answer the following questions, it is necessary to have some understanding of what an ethical issue looks like. In other words, the characteristics of what constitutes a moral/ethical issue need to be clarified

1. In which of these three scenarios does the medication order constitute an ethical issue, as opposed to, say, a clinical (practical) issue or a legal issue?

2. Discuss the elements of the case that you believe indicates the elements of the ethical issue and identify which aspect of the Code of Ethics is at risk of being breached.

Mrs. Reveres is an 82-year-old new patient at the medical office and has come for her first appointment. When you inquire about her current medications, she pulls out a brown paper bag, full of pill bottles, some prescription, some over the counter and some loose pills. She is a poor historian. How can you determine which medications the patient is using? What could you suggest to help Mrs. Reveres keep track of her medications?

When would the clinician be most concerned with suicidal tendencies, once the patient start taking antidepressant medication? What factors are related to antidepressant medications that affect medication adherence? Explain why.

What is the potential cause of altitude and why it might occur? What possible problems could it cause? What is the possible impact of outcome on the human body?

Read the Medication Guide that comes with HUMIRA medicine before you start taking it and each time you get a refill. There may be new information. This Medication Guide does not take the place
of talking with your doctor about your medical condition or treatment. What is the most important information I should know about HUMIRA? HUMIRA is a medicine that affects your immune system. HUMIRA can lower the ability of your immune system to fight infections. Serious infections have happened in people taking HUMIRA. These serious infections include tuberculosis (TB) and infections caused by viruses, fungi or bacteria that have spread throughout the body. Some people have died from these infections.
• Your doctor should test you for TB before starting HUMIRA.
• Your doctor should check you closely for signs and symptoms of TB during treatment
with HUMIRA.
You should not start taking HUMIR A if you have any kind of infection unless your doctor says it is okay.

After reading the practice exercise below, answer the following questions:

1. Identify techniques used to target laypersons?

2. Would you suggest any revisions?