GENETIC ENGEERING

1. Locating an organism with a specific trait and extracting its DNA.

2. Cloning a gene that controls the trait.

3. Designing a gene to express in a specific way.

4. Transformation, inserting the gene into the cells of a crop plant.

5. Cross the transgene into an elite background.

INFORMED CONSENT

1. Describing the proposed intervention,

2. Emphasizing the patient's role in decision-making,

3. Discussing alternatives to the proposed intervention,

4. Discussing the risks of the proposed intervention and

5. Eliciting the patient's preference (usually by signature).

RIELLE ANTONETTE I. MATAS BSN-2B

I. ETHICAL ISSUE: INFORMED CONSENT

Scenario/Case:

Mr. Thomas is a 68-year-old male with a history of diabetes and peripheral hypertension.
Because of vascular changes and uncontrolled blood sugar, Mr. Thomas developed ulcerations
on his right heel. Treatment of the wounds has been unsuccessful, and Mr. Thomas' physician
suggests the next step is amputation. Mr. Thomas agrees with the doctor, but his wife does not.
Mrs. Thomas voices concern to the nurse that her husband is being tricked into having his foot
amputated because the doctor is tired of treating the wounds.

Ethical Dilemma:

The concept of informed consent is a common ethical dilemma in nursing. Informed

consent to treatment is the process whereby a patient or their designated representative grants
healthcare providers permission to administer treatments or perform procedures. Informed
consent requires healthcare providers to advise patients of potential risks and benefits of
suggested treatments and inform them of any alternative treatment options.

How to Deal with this Ethical Dilemma:

It is common for patients or their loved ones to confide concerns or ask questions of
nurses before talking to doctors, especially when they are worried or stressed. In this scenario,
Mrs. Thomas seems to feel more comfortable talking with the nurse. It is crucial that the nurse
try to understand Mrs. Thomas' concerns and offer her comfort. Additionally, it is essential for
the nurse to notify the charge nurse and the physician regarding Mrs. Thomas' statements and
concerns. While the decision for treatment is up to Mr. Thomas, concerns from his spouse should
not be ignored.

II. ETHICAL ISSUE: END OF LIFE CARE/ASSISTED SUICIDE

Scenario/Case:

Mrs. Douglas has metastatic lung cancer. Her physician has advised about treatment options that
may prolong her life by six months to a year. However, to the dismay of her family, Mrs.
Douglas has chosen comfort measures only. Mrs. Douglas has prepared an Advanced Directive,
including signing a DNR (Do Not Resuscitate).
Ethical Dilemma:

Decisions about end-of-life care is one of many examples of ethical dilemmas in nursing.
Nurses can easily become overwhelmed when trying to comfort loved ones while honoring
patient wishes.

How to Deal with this Ethical Dilemma:

Nurses are invaluable resources of help for patients and their loved ones during end-of-
life transitions. If Mrs. Douglas is of sound mind and clearly understands her prognosis with and
without treatment, she has the right to decide what treatment she does or does not want.
Although the situation may be difficult, the nurse's primary responsibility is to her patient.
Nurses must advocate for the autonomy and rights of patients. Because the patient in this
scenario prepared an Advance Directive, the responsibility of following her wishes may be
easier.
PAULEENE KAYE B. PACULDAR BSN-2B

I. ETHICAL ISSUE: ALLOCATION OF LIMITED RESOURCES

Scenario/Case:

Nurse Judy is the wound care nurse for a home health agency. She stopped by the office
to pick up additional wound care supplies for her weekend visits. However, the charge nurse told
her the wound care supplies delivery did not arrive. As a result, there are not enough supplies on
hand for the visits Nurse Judy has scheduled.

Ethical Dilemma:

Nurses may face situations that require them to determine which patient needs supplies or
treatment more than another. While this is not an ideal situation, it happens more often than most
people care to admit.

How to Deal with this Ethical Dilemma:

This situation requires the nurse to use her triage skills and determine which patients if
any, could safely have orders changed or amended. The nurse should review nurses' notes and
get a report from the last person who saw the clients for whom she is scheduled to give weekend
care. If any patient has a wound that is resolved or improving, she should report these changes to
the nurse supervisor, primary care provider, or physician on call to determine if orders can be
changed. By doing this, the nurse may now have enough supplies to care for the patients who
require wound care services until supplies are delivered.

II. ETHICAL ISSUE: INFORMED CONSENT

Scenario/Case:

Nurse Gloria is instructed by the attending physician to have Mr. Isaacs sign a consent
form before a scheduled colonoscopy. As Nurse Gloria goes over the form with the patient, she
notices he seems confused and is unsure where or how to sign the paperwork.
Ethical Dilemma:

It is common for nurses to be the ones to get signatures on consent forms, especially for
procedures like the one described in this scenario. When faced with a situation like the one here
when the nurse is not sure that the patient understands what he is being told or if he can read, the
decision of whether to delay a busy schedule to have the doctor come back and talk to the patient
or explain to the best of her knowledge and get the patient's signature may seem difficult to
make.

How to Deal with this Ethical Dilemma:

The language used in healthcare and on healthcare documents is complicated to most

patients. It can be even more challenging for patients with poor literacy levels. Nevertheless, all
patients have the right to be fully informed about and understand treatment options and
procedures before they are provided. It is ALWAYS right to err on the side of a patient's
vulnerability. The nurse should provide information in a way the patient understands, allowing
him to ask questions and have the option to allow or refuse treatment. If the patient does not fully
understand what the nurse is saying, the nurse should notify the doctor and ask him to explain the
procedure, including anticipated outcomes and risks again.
ANNA MAE S. DEGUZMAN BSN-2B

I. ETHICAL ISSUE: PRIVACY

Scenario/Case:

Michael is a sixteen-year-old who was diagnosed with a sexually transmitted infection

(STI). Although the doctor examined Michael and told him about his diagnosis privately,
Michael's mother is in the waiting room and wants to know what the doctor said. Michael told
the doctor and nurse that he does not want anyone to know about the STI, including his mother.

Ethical Dilemma:

Perhaps one of the most common examples of ethical dilemmas in nursing occurs when
nurses must determine if it is appropriate to discuss a patient's medical information with a parent
or guardian. For years, parents and guardians were allowed access to medical records for any
patient under the age of eighteen. Today, every state has some laws allowing minors to consent
to care under certain conditions without parental knowledge, consent, or access to their medical
records.

How to Deal with this Ethical Dilemma:

In most states, when an adolescent is old enough to give consent for healthcare, information
pertaining to that care is typically considered confidential. Violating a patient's confidentiality
can result in serious repercussions, including loss of job or licensure. Therefore, it is necessary
for nurses to be aware of their state laws and to work closely within those laws and with
supervisors to adhere to their organization's guidelines. It is always appropriate to defer to your
facility's policies or to ask for a supervisor's intervention or guidance if you are unsure.

II. ETHICAL ISSUE: END OF LIFE CARE AND INFORMED CONSENT

Scenario/Case:
The patient Mr Green is a 57 year old gentleman with aggressive prostate cancer who is
took care of by the nursing team in the oncology department of a general hospital in Brisbane,
QLD, Australia. Mr Green was diagnosed with prostate cancer seven years ago but refused
medical and surgical treatment at the time. He chose to seek alternative treatment and did not
follow up with the urologist over that seven year period. Mr Green has now presented with
anemia and hypoproteinemia. After several diagnostic tests over a period it was discovered that
the cancer had metastasized to his bones, it had spread locally to his lymph nodes and the
primary tumor was invading the bladder and partially obstructing the left kidney. Mr Green had
several admissions over a two month period for various reasons. On the last admission Mr Green
was told that he may only have 4–6 weeks (previously it was 6–12 months) to live after
a cystoscopy showed further extensive growth of the tumor, it was determined that any further
surgical/medical intervention would not be appropriate in this case and that a palliative
care regimen was the next step. At this point the patient reported to the health care team that he
had resigned himself to the fact that he was going to die. Mr Green pulled one of the author's
colleagues aside and confided to the nurse that he planned to kill himself and that is was a secret
that the nurse was not to tell anyone.

Ethical Dilemma:
In Mr Green's case, after the patient confided the suicide attempt, the nursing staff has
two exclusive, morally correct choices. If the nurse chooses to keep secret as patient required,
this behavior will respect patient's own decision. However, the nursing staff's decision may cause
the patient actually commit suicide without any healthcare intervention. If the nursing staff chose
to tell other health care team members about patient's suicide attempt, the health care team would
be involved in monitoring, prevention and avoiding suicide, but the patient's autonomy,
confidentiality would be violated. Therefore, the major ethical dilemma of this case can be
identified as ‘if the nursing staff should tell other health care team members about patient's
suicide attempt without patient's consent.

How to Deal with this Ethical Dilemma:

In the Mr Green's case, the ethical principle autonomy and beneficence can be applied
equally, but none of them can be chosen without violating other one. The significant logical
incompatibility between autonomy and beneficence in this case is the major reason which causes
the ethical dilemma about ‘if the nursing staff should tell other health care team members about
patient's suicide attempt without patient's consent’. In addition, the ethical principle non-
maleficence is considered in this moral situation which infringes autonomy principle but gives
support to beneficence principle. Therefore, when considering Mr Green's case, three ethical
principles are in conflict: respect for autonomy, non-malefience and beneficence.