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:

 

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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?

 


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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?

 


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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?

 


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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?

 


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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?

 

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77. Case: Accommodating Requests: Which Differences Make a Difference?

 

Michelle Yoder is 8 months pregnant and a member of the Amish community.  She requests that only female health care providers and staff be involved in providing her care during labour and delivery.

Michelle Federov is 8 months pregnant.  She requests that only white health care providers and staff be involved in providing her care during labour and delivery.

 

Discussion:

  • What are the ethical concerns raised by these cases?
  • How are your responses different to these two scenarios?
  • How do you think health care organizations should respond to requests like these?

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55. CASE: What is My Obligation?

A family physician in a small, remote community assesses a patient, who is a local schoolteacher, as developing a post-partum psychosis. He feels he lacks adequate training or experience to manage her care.

He recommends she seek treatment at a distant large mental health centre but she refuses to travel to the centre because of the distance involved. He feels uncertain about caring for the patient when the treatment is outside his area of competency.

  • How should the physician proceed with the patient’s care? Should he treat the patient when he feels it is is outside his area of competency?
  • If the patient is unwilling to disclose her health issues to her employer, as a healthcare professional and/or a member of the community, should the physician report them to school authorities?
  • What ethics issues are at play here?
  • What resources could the physician seek to assist with this situation?

Some Values and Ethics Issues to Consider

  • Community and family relationships
  • Respect for privacy and confidentiality
  • Patient-provider relationships
  • Professional boundaries
  • Honesty, trust and truth-telling
  • Patient safety
  • Equality of access
  • Resource allocation
  • Duty to provide care
  • Intellectual honesty
  • Respect for professional integrity
  • Professional competence
  • Overlapping roles and responsibilities

54. CASE: Professional Role

While doing a weekday home visit to an elderly patient, a VON nurse in a small community finds the patient’s son at home. The patient has mentioned that her son teaches at the local elementary school, but he has never been present during any of the nurse’s previous visits to the house.

On a weekday visit he appears to be drinking heavily and the patient seems uncomfortable and ill at ease.  During the next few weeks the son is there on several more occasions and appears to be either drunk or “hungover”. The nurse is also a member of the town’s school board.

  • What is this health professional’s responsibility to her patient? To her patient’s son?
  • What should her immediate concerns be?
  • What is her responsibility as a member of the school board?
  • How should she proceed in this situation?
  • Can/should this individual segregate her role as a nurse with her role as a school board member?
  • Should she mention what she knows about the son/teacher to her colleagues at the school board?
  • How are the ethics issues at hand affected by the rural setting?


Some Values and Ethics Issues to Consider

  • Professional boundaries
  • Duty to provide a safe work environment
  • Living at risk
  • Duty to accommodate
  • Duty to provide care
  • Community and family relationships
  • Respect for human dignity
  • Respect for professional integrity
  • Compliance with policies and procedures
  • Respect for privacy and confidentiality
  • Overlapping roles and responsibilities
  • Patient safety

52. CASE: Community Values

A patient in your rural community that you have treated for COPD for several years missed her last two appointments. When you speak with her after church, she indicated her husband lost his job as a logger and no longer has family health insurance to cover the cost of the treatments. She refuses to accept charity but does indicate she will be willing to clean your home and office as “payment” for your healthcare services.

  • Should a healthcare professional accept bartering as payment?
  • What ethics issues should be considered here?
  • How are these ethics issues affected by the rural context?
  • Should the health of the patient take precedence over compliance with your organizational policy and/or your professional code of conduct?
  • What other creative solutions are there that will allow the patient to receive the treatments?

 

Some Values and Ethics Issues to Consider

  • Social justice
  • Professional boundaries
  • Duty to provide care
  • Community and family relationships
  • Respect for human dignity
  • Respect for professional integrity
  • Compliance with policies and procedures
  • Respect for privacy and confidentiality
  • Overlapping roles and responsibilities
  • Patient-provider relationships
  • Equality of access