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UNRS496: Ethics and Issues in Health Care
Transcript of UNRS496: Ethics and Issues in Health Care
The Ethical Dilemma of Withholding Opioids in the Pain Management of Substance Abusers
A Case Study
Ted is a current substance abuser that recently underwent an emergency appendectomy; Ted has recently awoken in the recovery room and has complained of abdominal pain, rating the pain as a “ten out of ten” – this rating implies that Ted believes he needs the strongest medication to appropriately manage his pain. Ted’s nurse, Tina, knows that morphine sulfate is most effective at treating postoperative pain, but is also aware of the patient’s history of substance abuse. The patient’s physician has prescribed both morphine sulfate and high-dose ibuprofen to be given as needed.
Impact to the Field of Nursing
The Code of Ethics for Nurses
Autonomy is the right of the individual to make decisions [actual or implied] about their own health care despite the opinions of others (Evans, 2000).
"Justice is concerned with the equitable distribution of benefits and burdens to individuals in social institutions, and how the rights of various individuals are realized" (Feinsod & Wagner, 2008).
To promote beneficence is to "do or promote good; prevent evil or harm; and remove evil or harm" (Burkhardt & Nathaniel, 2008)
Refraining from doing harm to an individual or
“There is neither Jew nor Gentile, neither slave nor free, nor is there male or female, for you are all one in Christ Jesus” (Gal. 3:28).
Providing the first line of pain treatment to the general population whilst withholding it from known substance abusers is a violation of justice, as this is an unequal distribution of benefits.
Standard Definition of Pain: whatever the patient says it is, existing whenever the patient says it is does (McCaffery, 1968).
In responding to the patient's subjective pain level rather
than treating the pain based on the nurse's objective
beliefs, the nurse is respecting the autonomy of the
“When adequate pain relief is withheld because the patient has a history of substance abuse, the nurse has not given ‘good’ care to the patient”; Bernhofer goes on to state that “the principle of beneficence is upheld when the appropriate amount of medication or other treatment is administered to the patient in a timely fashion resulting in the best pain control with acceptable side effects” (Bernhofer, 2011).
Bernhofer, E., (October 25, 2011) "Ethics and Pain Management in
Hospitalized Patients" OJIN: The Online Journal of Issues in Nursing Vol. 17 No. 1.
Evans, J. (2000). A sociological account of the growth of principlism.
The Hastings Center Report, 30(5), 31-38.
Feinsod, F. M., & Wagner, C. (2008). The ethical principle of justice:
The purveyor of equality. Annals of Long-Term Care, Retrieved from http://www.annalsoflongtermcare.com/article /8210
McCaffery, M. (1968). Nursing practice theories related to cognition,
bodily pain, and man- environment interactions. Los Angeles, CA.
Burkhardt, M.A., & Nathaniel, A.K. (2008). Ethics & issues in
contemporary nursing. 3rd ed. Clifton Park, NY: Thomas Delmar Learning.
Many believe that by withholding opioid medications from substance abusing patients, the nurse would be preventing potential harm by keeping the patient from becoming addicted to yet another substance
"It is imperative to understand, however, that pain itself may be more harmful to the patient than the side effects of the drugs used to control it . . . untreated pain can have detrimental physical and emotional effects on a patient”
"The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems” (ANA, 2001).
All of mankind was created as one in Christ, free from any form of hierarchical value system
“Equality in Christ is the starting point of all truly biblical social ethics … any expression of social class superiority or gender superiority violates the truth of the gospel” (Hansen, 1994)
American Nurses Association. (2001). Code of ethics for nurses with
Hansen, G. W. (1994). The ivp new testament commentary series:
Galatians. Downers Grove, IL: InterVarsity Press.