Cleo Swimmers, a 70-year-old diabetic, developed a small ulcer on a toe (left extremity)Â following a recent below-knee amputation (BKA) of the right extremity. Because of his depression and sense of hopelessness prior to the BKA, the nursing staff decided not to tell him the results of the wound culture report of pseudomonas (it was unclear whether the culture report referred to the BKA wound or the toe). They placed an “infection control” sign over his bed and told him that he had “an infection.” They reasoned that because he had been through a great deal of stress, they did not want to contribute to his fears of losing his other leg. It soon became apparent that the infection was definitely in the toe of the left extremity. The nursing staff wondered if and when they should tell him the truth. They decided not to tell him anything. Eventually his left toe became gangrenous and required amputation. Several months later, the nurses decided to present the incident to the ethics committee. Mr. Swimmers was invited to tell how he felt once he learned that the nurses had withheld information from him. The patient described how his nurses and doctors had reacted when he asked them direct questions about his left extremity and the infection. He claimed that they “hid behind their medical authority” and that he experienced fear and false impressions about what was really going on. He stated, “If I had been told, ‘Yes, there is some infection in the toe of your left foot but we are going to treat it,’ it would have been easier for me.” Instead, he worried that he had a terrible infection throughout his body that was going to get progressively worse. He understood that the nurses were keeping the truth from him out of a desire to help, but their actions were not helpful. They just made him feel alone and scared.
1- Determine all the facts of the situation: WHAT, WHEN, WHERE, WHO, WHY.
2- Determine the exact ethical issue involved.
3- Determine the rules, laws, principles, or values that are involved.
4- List all viable options or courses of action.
5- Determine all the advantages and disadvantages of each option.
6- Determine all the possible consequences and who would be affected by the options.
7-Determine which decision is best and act on that decision.
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