84. Case: Who’s Who

 

Pierre is a representative with a company that manufactures devices for use in joint-replacement surgeries.  He is often present in surgeries when his company’s products are being used.  Recently, as a patient was being wheeled into the operating suite the patient asked the surgeon who Pierre was and why he was there.  The nurse explained that Pierre was a with a device manufacturer and was there to provide support if needed.  The patient then asked, “But isn’t that a conflict of interest?”

Is there a conflict of interest?  How should the nurse respond to the patient?  And what should the hospital include in a policy designed to address these types of situations?

 


Resources:

 

Advertisements

83. Case: Strings Attached

 

A local business owner and philanthropist, whose parent recently died after living with Huntington disease for 15 years, approaches the hospital foundation to offer a significant donation in exchange for creating a new neurological research centre which would be named in memory of the philanthropist’s parent.  The hospital has identified its area of greatest need as improving access to primary care for patients in the remote communities it serves, but the donor is not interested in contributing to that mandate.

Is the hospital in a conflict of interest?  What is the nature of the potential conflict of interest?

 


Resources:

82. Case: Setting Up Shop

 

Arya is an occupational therapist who provides support for children with autism spectrum disorder.  She frequently recommends sensory integration tools to parents, but most of these are only available online through US-based websites and often that is a barrier for parents.  She is considering starting a side business importing and selling these products, but is aware that there will likely be a perceived conflict of interest.  Arya approaches her manager for guidance.

If disclosure is not enough to eliminate the perception of conflict of interest, what could Arya do?  If the perceived conflict of interest cannot be effectively managed, what should Arya do to meet her patients’ needs?

 


Resources:

81. Case: Lending A Helping Hand

 

Alison is a nurse who is working in an endocrine clinic part-time while also working on her Ph.D.  She is studying two different approaches to patient education about diabetes management.  She is putting together her research ethics application.  Alison makes a case for the logistical necessity of her being involved in recruiting patients. Her colleague and friend, Jason, will also help to recruit patients for the study.  Alison proposes that she will disclose that the research is for her Ph.D and that the patient’s decision about participation will not affect care, but Alison and Jason aren’t sure about what Jason should tell patients about their relationship.

Do you think that Jason has a conflict of interest?  If so, how should it be managed?  And does Alison’s disclosure adequately address concerns about her conflict of interest?

 


Resources:

80. Case: Less Talk

 

David is a patient waiting in a treatment room at a walk-in clinic.  He can hear the physician chatting and laughing with someone outside, and from the conversation he guesses that the physician is talking with a pharmaceutical sales representative.  David has been waiting for almost two hours with a high fever.  As the conversation outside continues, David becomes increasingly angry.

Do you think that the physician might have a conflict of interest?  If so, how should it be managed?

 


Resources:

79. Case: It’s the Little Things

 

A patient asks your colleague, Arya, “Where are you from?”  When Arya replies, “Winnipeg,” the patient says, “Oh, but where are you from originally?”  Arya, whose family immigrated to Canada before she was born, is clearly frustrated by this.  You were present during the exchange and were uncomfortable but didn’t know what to say at the time.

Discussion:

  • What are the ethical concerns raised by this case?
  • What might you say to Arya afterward?
  • How might your employer support Arya in addressing these sort of situations?

 

 Resources:

 

 

75. Case: Cultural Competence: Truth and Reconciliation in Action

 

Case 75: Cultural Competence: Truth and Reconciliation in Action

Alex Sylliboy has been referred to the diabetes clinic and this is his first appointment.  He identifies as Indigenous on the intake form.  Andrew Sullivan, the nurse, has read recently that the experience of residential schools has long-lasting, intergenerational effects on health, but isn’t sure if he should ask about it in the context of addressing Alex’s diabetes and is also uncertain about how to bring it up.

Discussion:

  • What are the ethics concerns raised here?
  • How might Andrew proceed with this encounter?
  • What are some words or phrasing that Andrew might find helpful?

Resources:

 

46. CASE: Team Work?

Judy, who had worked as a senior social worker in a mental health setting for 12 years, was hired as a team social worker in a community health care organization. Shirley, one of the team RNs, perceived Judy as hesitant and ineffective in patient care planning meetings. Other team members also found Judy to be too hesitant in making decisions, often rolling their eyes when Judy asked team members for their opinions. Despite their concerns about Judy’s hesitancy, team members also complained when Judy did not consult them before making a patient care decision. As Judy experienced these mixed messages, she became more guarded in her social work assessments.

The inter-professional team on which Judy was placed had a culture of socializing together after work. Initially, team members invited Judy to join them, but she did not have time due to the care that she was providing for her mother after work and also was uncertain about how much to socialize with her colleagues.

When the team was together after work, they discussed Judy’s behaviour, often noting that her mode of dress was out of style. Carol, the team facilitator, would occasionally join the rest of the team for a drink after work. During one of these nights, Shirley complained to Carol that Judy was not doing her job. She also mentioned that the team did not like Judy because she did not socialize with them and wouldn’t disclose information about her personal life as they all had done with each other. The nursing assistant and dietician on the team told Carol that they saw Judy as being very unfriendly. The following week, Carol spoke with Fran, the social work supervisor, stating that Judy was a problem and she wasn’t sure that Judy would work out with this team.

In her monthly supervisory meeting, Fran asked Judy how things were going with her team. As Judy’s eyes began to tear she said that she was thinking of leaving. Judy said that that she hadn’t realized how hard it would be to work with a team, and commented that the team members kept comparing her to a former team social worker who was not liked by them.

Judy told Fran that the team seemed fairly uncomfortable with mental health issues and that she was shocked when the team made derogatory comments about patients – i.e., that some were dirty and smelly or that the team couldn’t stand certain patients. And, in terms of the team, Judy wasn’t sure what to do because someone had told her that once you were on Shirley’s bad side that you were always on her bad side.

[Case modified from: P.G. Clark, C. Coot, T.J.K. Drinka, 2007, Theory and practice in interprofessional ethics: A framework for understanding ethical issues in health care teams, Journal of Interprofessional Care 21(6): 591-603.]

  • Is this a human resources issue or an ethics one?
  • How would you handle this situation?
  • Are there underlying and/or competing values that should be considered?

 

Some Values and Ethics Issues to Consider

  • Care for the vulnerable
  • Community health ethics
  • Health care provider relationships
  • Moral distress
  • Organizational culture
  • Overlapping roles and responsibilities
  • Professional competence
  • Professional boundaries
  • Respect for privacy and confidentiality
  • Respect for professional integrity
  • Staff morale

43. CASE: What’s My Responsibility?

You’ve been a physician at the local hospital for a number of years and greatly enjoy your practice. You get the chance to see a range of patients and have worked closely with a variety of community members to facilitate the development of support networks for patients after they leave the hospital. Recently, in response to the perceived need to build better relationships between your hospital and the community, a council on “improving relationships for improving health” was created. Many of your colleagues felt that you were a natural fit for this council and nominated you for it as one of the hospital representatives.

After the first few meetings, you realize that there are a couple of issues that need to be sorted out if you are going to continue participating on this council. One is that a council member, who you know is waiting for a liver transplant, had a drink at the dinner meeting last evening. It was just one, and the council member asked you to keep quiet about it as this was his first and only “transgression”.

  • Is this something you should keep confidential?
  • Should you tell your colleague, the transplant coordinator, about this occurrence?

The other issue is that one of the community members on the council has information about staff at the hospital – information that you believe should only be available in the staff’s personnel files – and is sharing this information at the meetings to emphasize her points about the need to take a closer look at the qualifications of those who work at the hospital.

  • What should you do about the sharing of staff information?
  • Does anyone at the hospital need to know about this sharing of information?
  • You are also aware there are internal processes at the hospital already looking at the issue of qualifications. Can you mention this at the council meetings?

 

Some Values and Ethics Issues to Consider

  • Honesty, trust and truth-telling
  • Overlapping roles and responsibilities
  • Community relationships
  • Compliance with policies and procedures
  • Respect for privacy and confidentiality
  • Organizational culture
  • Professional boundaries

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