There is no doubt that now everyone has a full access to various resources about medical problems and their possible decisions. As a result, patient’s awareness of etiology, pathogenesis, treatment and especially side effects has increased dramatically last decades. Actually nowadays, it is quite typical when a doctor orders a patient with a GI disorder a cleansing enema and the patient turns it down because this procedure seems irrational to him. The next aspect of this problem is that a nurse has legal responsibility for doing this manipulation.
Nevertheless, in a New Hippocratic oath it is said that medical staff will not provide treatments which an informed and competent patient refuses (Longmore, Wilkinson, Turmezei, & Cheung, 2009, p. 1). Moreover in 1973 the American Hospital Association worked out and introduced a pattern of Patient’s Bill of Rights which has been revised and used as a pattern for many clinics and hospitals. The last version of this paper was approved on October 21, 1992. Subsequently each patient has the right to make his or her own decision about the plan of treatment prior to and during the course of this treatment and to refuse recommended procedures, drugs, etc. (Joint Comission on Accreditation or Healthcare Organizations, 1998, p. 24). So if a nurse wants to administer an enema to the patient he has all rights to refuse this procedure and this right is regulated by the administrative law.
The next important point is that people who decide to leave against medical advice should be advised of the risks, if possible, and should be urged to rethink if further care is needed (Trandel-Korenchuk, 1997, p. 121). In our case (when the nurse despite the wish of the patient made the enema without giving any explanations to her patient) the patient’s relatives can apply to the Department of Health and Human Services and claim a defense of their civil rights. This organization includes many agencies such as the Administration on Aging which the main function is to focuse on the protection of senior citizens. This nurse’s action has to be considered as an administrative tort and she can be punished for the negligence in performing her duties because she did not obtain the permission for doing the enema. In other words the nurse violated the principle of informed consent so this patient did not have possibility to determine what can be done with his body or parts of his body. She also forgot about her other responsibility to provide all patient’s needs which are not restricted by hospital regimen. In addition there is moral dimension of this occasion that illustrates a thoughtless and insensitive nurse with ask of tact who does not respect an elderly patient. This nurse forgot that she had to listen to the patient, to be honest, respectful, and compassionate towards all and provide the best care she can (Longmore, Wilkinson, Turmezei, & Cheung, 2009, p. 1).
On the other hand this nurse had to inform the doctor about the case and he could solve this problem without any negative consequences. Moreover it is her potential liability to inform doctors about any conflicts.
However there are some situations when health care professionals have to view their obligations to a patient different from the patient’s own assessment (Pozgar, 2007, p. 333). Therefore if this nurse had had patience, tact and had explained all the procedures in a calm manner with simple and understandable arguments the patient would have confided in the nurse and her actions.
It is obvious that the caregiver should try to find compromise between compulsive and persuasive strategies when it concerns various medical very often-unpleasant procedures such as an enema because only mutual understanding between the patient and medical staff will lead to the recovery.
Joint Comission on Accreditation or Healthcare Organizations. (1998). Ethical Issues and Patient Rights across the Continuum of Care. Oakbrook, IL: Joint Comission on Accreditation or Healthcare Organizations.
Longmore, M., Wilkinson, I., Turmezei, T., & Cheung, C. K. (2009). (7th ed.). Mini Oxford handbook of clinical medicine. Oxford, O: Oxford University Press.
Pozgar, George D. (2007). (10th ed.). Legal Aspects of Health Care Administration.
Ontario, M: Jones and Bartlett Publishers.
Trandel-Korenchuk, Darlene M., & Trandel-Korenchuk, Keith M. (1997). (5th ed.). Nursing & The Law. Gaithersburg, M: Aspen Publishers.