Ethical Case Study Incident 9 (The Missing Needle Protector)

In their book on Principlism, Beauchamp and Childress proposed a method for guaranteeing that all clients and those under the care of others in care environments have their interests represented and cherished. They offered four bioethical principles, which have since been expanded to five with the inclusion of fidelity. Autonomy, nonmaleficence, beneficence, justice, and fidelity are the new bioethical concepts (Haswell, 2019; Melnyk & Fineout-Overholt, 2019). Autonomy refers to a client’s ability to participate in making choices that influence their management. Beneficence refers to the act of always doing what will benefit the patient. Nonmaleficence, often known as primum non nocere, refers to not causing wilful injury to the patient. Justice entails treating all patients equally and without active discrimination. Finally, fidelity sets out the ethical requirement that the healthcare staff be straightforward and honest. This paper is about an ethical situation in a clinical setting representing what would be seen as an ethical dilemma.

The Scenario Involving the Missing Needle Protector

The scenario n this case is set in a hospital in which Mr E.L. Straight is the Director of Clinical Services. At the same hospital, there is a long serving surgeon by the name of Dr. Cutrite who does full scale operations but has lately been showing worrying signs of incompetence. This is by Mr Straight’s own admission. Despite his physical and mental incapacities lately, Dr Cutrite has been allowed to still perform sensitive major procedures. Mr Straight admits that the surgeon by virtue of having worked at Hopewell hospital “for longer than anyone can remember” was well connected and politically very influential in the organization. It is for this reason that he “didn’t relish crossing swords with Cutrite”.  Ethical Case Study Incident 9 The Missing Needle Protector Essay

Concerning the matter of the missing needle protector from a syringe used during a major operation, it would appear that Dr Cutrite left it in the abdomen of a patient that he closed without confirming first with the nurse carrying out instrument count as a “time-out” component. The patient’s name was Mrs. Jameson and she had undergone a major operation in her abdomen. The needle protector that was allegedly left in her abdomen by Dr Cutrite is said to be red-pink and the color of blood and therefore would be very difficult even to see on radiography. She had not yet complained about anything and had even been discharged to go home a few days earlier.

It is the operating room supervisor that informed Mr Straight of the possible error that they had just discovered while going through instrument pack reconciliation. She told him that they had possibly left a needle protector belonging to a disposable syringe inside the belly of Mrs Jameson. When asked, the scrub nurse that was assisting Dr Cutrite during the procedure admitted to seeing the syringe but did not give much thought to the protective sheath when the final instrument count was done at the end of the procedure.

ORDER A PLAGIARISM-FREE PAPER HERE

The Ethical Considerations

After the operating room supervisor informed Mr Straight, he asked her to get the patient back into surgery and lie to her that they were just going to check her wound and her sutures. Unfortunately for him, Mrs Jameson had already been discharged and gone home two days earlier. Mr Straight told the supervisor that the patient would not know the reason for the return to surgery and that all she needed to be told was that her deep sutures and her incision wound needed to be checked. He even went further to state that the patient would never come to know that they were searching for the missing needle protector. This is a gross violation of the bioethical principle of autonomy as explained by informed consent (Haswell, 2019; OHRP, 2018; Shah et al., 2021). Autonomy requires that patients be involved in the decision making about their care. They also need to be given correct and full disclosure as to the reason for the intervention so that they may decide whether to consent or not. The requirement for this truthful information is what gives rise to the terms “informed consent.”

The other bioethical principle breached by this attitude and posture of Mr Straight is that of fidelity (Haswell, 2019). Fidelity requires that the healthcare professional be truthful, trustworthy, and honest. By intending to hide the correct information about a procedural error, Mr Straight had breached the principle of fidelity. He asked that the patient be lied to so that they could achieve their ends and protect their jobs at the expense of the patient and probably her life. It was cold and calculating of Mr Straight to do that when he knew very well that there was a chance the patient could get hurt or react to repeated anesthesia. This itself would breach the bioethical principle of nonmaleficence.

When Dr Cutrite was asked about the same, he unequivocally asked or rather warned that no staff should tell the patient anything and that they should just wait and see. Coming from the mouth of the very professional responsible for leaving the needle cap in the womb of the patient, this is a gross violation of the bioethical principle of nonmaleficence or primum non nocere (Haswell, 2019). The principle requires that healthcare professionals refrain from causing deliberate harm to a patient and instead to safeguard the interests and safety of the patients. Dr Cutrite knew very well that he was lying when he told the operating room supervisor that the plastic needle protector was not going to hurt the patient but probably only give her “a little discomfort.” This was a foreign body and chances are that it would set off an inflammatory process that would be problematic for this patient for many years to come. So apart from breaching nonmaleficence, Dr Cutrite also breached and abused the trust that the patient had for him by betraying her.  Ethical Case Study Incident 9 The Missing Needle Protector Essay

We learn that later Mr Straight approaches the Chief of Surgery but does not tell him straight that there was a breach of patient safety when a needle protector was probably mistakenly left in a patient’s abdomen. What he does instead is pose the Chief a hypothetical question about a similar scenario and ask for what would happen. The Chief of Surgery immediately knows that something is amiss but does not stamp his authority to know exactly what is happening the way he should. This can also be interpreted as collusion to defeat nonmaleficence since it is his responsibility to evaluate the quality of surgeries done at the facility. In all, the violation of bioethical principles by these professionals at this facility was total. They had no regard at all for the welfare of the patient and did not care that she may develop problems later as a result of their negligence.

Conclusion

The bioethical principles of autonomy, beneficence, nonmaleficence, justice, and fidelity are there to help safeguard the safety and ethical treatment of patients. In the above case, it can be seen how healthcare professionals may violate these and put the patient’s health and life at risk.

References

Haswell, N. (2019). The four ethical principles and their application in aesthetic practice. Journal of Aesthetic Nursing, 8(4), 177-179. https://doi.org/10.12968/joan.2019.8.4.177

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Office for Human Research Protections [OHRP] (January 15, 2018). The Belmont Report: Ethical principles and guidelines for the protection of human subjects of research. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

Shah, P., Thornton, I., Turrin, D., & Hipskind, J.E. (June 14, 2021). Informed consent. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK430827/#:~:text=Valid%20informed%20consent%20for%20research,study%20and%20its%20potential%20risks

Ethical Case Study Incident 9 The Missing Needle Protector Essay