Reference no: EM133911637

Question 1.

Patient was hospitalized for extreme low back pain so intense that he could not be scheduled for a magnetic resonance imaging (MRI) until his fifth hospital day. His physician explained to him that the Dilaudid and Ativan he would receive the next day to numb his pain for the MRI could cause respiratory depression or arrest in patients like himself who were on high doses of opiates. The patient agreed to be given the medications. At 8:15 A.M. the next day, a nurse gave the patient the medications, but the MRI had to be postponed. With the phy-sician's new orders and the patient's verbal consent, the nurse gave a second dose of the same medications at 11:30 A.M. About 5:00 P.M., the patient became stuporous. Vital signs were taken, oxygen was initiated, and Narcan was prepared for injection. At 6:00 P.M., the critical care code team was called, as the patient was in full cardiopulmonary arrest. The patient was successfully resuscitated and was discharged the next day. The patient then sued, claiming residual psychologi-cal symptoms and failure to obtain valid informed consent for the second dosage of medications administered at 11:30 A.M. Questions

1. Was there informed consent for the initial medications given to the patient?

2. How would you determine that informed consent had been given for the MRI and the medications needed for sedation for the test?

3. What type of role should nurses have in securing informed consent? In assisting with research studies? In assisting with genetic testing? 3. Was the informed consent deficient to the degree that there was a lack of informed consent by the patient for the second dose of medications?

4. How would you decide this case?

Question 2.

Jimmy, a 15-year-old Floridian, had undergone two liver transplants. An only child, he lived with his mother, a sin-gle parent. He was prescribed immunosuppressant drugs that caused severe debilitating side effects in an attempt to prevent his body from rejecting the second liver transplant. Understanding that his life expectancy was limited and that the medications were causing the debilitating side effects, Jimmy elected to stop taking the immunosuppressive medi-cations. When his attending physicians discovered that he was no longer taking the prescribed medications, they insti-tuted court proceedings against his mother for child endan-germent. Jimmy was readmitted to the hospital at the same time in an attempt to ensure that he restarted the immuno-suppressive medications. A juvenile court judge held separate meetings with Jimmy, his mother, and the health care team in an attempt to resolve the issue. His mother, at her meeting with the judge, expressed anguish as she felt that not taking the medications would hasten her son's death, but she was also resolved to the fact that she felt he was mature enough to fully under-stand the consequences of his non-actions. Jimmy assured the judge that he understood the consequences of his non-actions, but he was tired of taking medications that merely increased his pain and suffering and wanted, as stated in his final comment, "some time to be free of pain. I am go-ing to die anyway." The health care team were unable to assure the judge that taking the medications would greatly increase Jimmy's longevity.

1. What questions would you anticipate the judge to ask Jimmy in order to ascertain his level of maturity, under-standing of the full consequences of his non-actions, and possible alternate reasons for requesting that he be al-lowed to make his own medical decisions?

2. How should the judge evaluate the mother's response to her son's request? Is she really supportive of his decision?

3. Does the state of residency factor into the judge's decision?

4. Are there additional issues that should be addressed pri-or to deciding this outcome of this case?

5. How would you decide the case.