87. Case: Considering Alternatives

Jessie Rockford is an 8-year-old with a history of developmental delay, significant cognitive deficits, and symptoms of cerebral palsy. She is her parents’ only child and they are very loving, attentive, and concerned–they never miss a medical appointment and have carefully followed the care plan drawn up for their daughter.

However, with the passing of time they have grown increasingly concerned about her muscle spasms and contractions that seem to be causing her significant discomfort. They have consulted a local homeopath as well as a massage therapist who have both become involved with Jessie’s ongoing care.

At a regular clinic visit her parents tell the clinician about these new developments and add that they believe the treatments are helping. When the sessions are explored with Jessie, she shows no concern and seems quite content.

The health care team has some questions about this development and has called you to find out how they should respond to Jessie’s parents. Should they be supportive or discouraging of the parents’ decision?


36. CASE: Fee-For-Service Care (Complementary/ Alternative Practices)

A registered nurse is also a registered massage therapist and runs a private practice out of her home.  Physicians often refer patients to her privately for massage therapy, but have also begun asking this RN to provide massage services while on duty in the hospital. She feels uncomfortable about this and after speaking with her manager and director, requests an ethics consult.

  • What are the main ethics issues to think about in this situation?
  • What other issues need addressing in this case?
  • How would your committee respond to this request?

Some Values and Ethics Issues to Consider

  • Compliance with policy
  • Resource allocation
  • Health care provider relationships
  • Organizational culture
  • Overlapping roles and responsibilities
  • Professional boundaries