Gastrointestinal (GI) bleeding

Mr. L is a 50-year-old man admitted for gastrointestinal (GI) bleeding. After a couple of days his hematocrit is still low and his physician tells him that he is not ready to be discharged today. Mr. L becomes angry and tells the team he wants to leave against medical advice (AMA).

His nurse, Susan, and his physician outline the risks of leaving, including the risk of rebleeding, but he insists and leaves the hospital. That night, Mr. L ends up back in the Emergency Room with profuse GI bleeding. While leaving AMA is often viewed as a patient right based on the principle of autonomy, it is also necessary to consider whether the patient is putting himself at undue risk for harm.

When the risks of a situation outweigh the possible benefits, the provider’s obligation to promote the patient’s best interests may outweigh the patient’s desire to act autonomously (Grace, 2014). Thus, the ethics worry in this case relates to the potential conflict between Susan’s ethical obligation to promote good (beneficence) and Mr. L’s right to autonomy.

To promote Mr. L’s ability to act autonomously in the future, it is necessary to minimize the potential harm to which he exposes himself in the present. Ethical awareness would help Susan recognize this responsibility. To address this obligation, Susan could try to talk through the situation in greater depth with Mr. L in an effort to uncover the reasoning behind his desire to leave.

There may be additional factors of which Susan is unaware that are contributing to Mr. L’s anger. If these reasons are explicated, perhaps they can arrive at a compromise to appease Mr. L, while keeping him medically safe.

Additionally, Mr. L’s clinical picture includes a low hematocrit. This factor may be negatively impacting his decision-making abilities. Susan may wonder whether Mr. L is truly making an autonomous decision, which would require that he fully understands and is able to use reason to determine the potential long-term outcomes of leaving the hospital.

Susan could further explore these concerns to ensure that Mr. L’s decision to leave is actually fully informed. Should she reach an impasse, she may consider seeking additional resources to keep Mr. L safe, including involving psychiatry and possibly an ethics consult.

1) Based on the scenarios in the article list at least 3 changes in our society that have contributed to the prevalence of ethical dilemmas in healthcare?

2) summarise an event, real or fiction, where you faced an ethical dilemma in healthcare. this can be something you have heard about in healthcare or experienced at your job. if you chose a fictional event, it cannot be one of the scenarios from the article

3) what did you learn from the event you summarised above?