You are working on a transplant unit. Patients on your unit are usually in their 20's and 30's and receive the transplant as a result of a long-term congenital condition. Prognosis is good for a "normal" life expectancy with a variety of expensive medications and medical follow-up. Because of the nature of their chronic condition, prior to transplant, many of your patients live on a fixed income with limited health care benefits.
A group of physicians on the unit are researching a new drug to enhance the quality of life of these individuals, post-transplant. The research protocol states that participants in the experimental study group will receive all their medications free for the remainder of their life.
Individuals in the non-experimental groups will receive free medication only for the duration of the study.
All patients on the unit are approached by an individual hired by the MD researchers and are invited to participate. If patients agree to participate, they will receive IV medication for the first week and then be switched to an oral form. Both the experimental and the control drugs are clear IV fluids, which are administered every 4 hours. The medication is not identifiable by either the nurse administering it or the MD caring for the patient.
You enter Mr. Smith's room. He agreed to be in the study yesterday. As you prepare to hang the IV medication, Mr. Smith comments, "This whole transplant process is so expensive. Without that study drug, I don't know how I would pay for the medicine I need. Do you think this new drug is really better?"
1. How would you respond?
3. What are the ethical responsibilities of the nurse?
1. How would you respond?
Clearly, since the nurse does not know whether she is giving the patient control or experimental drug, she has no cause to respond in the affirmative or in the negative. Any other value judgment would be biased and unethical. She should explain the experimental protocol to the patient, explain what he agreed to, and encourage him in his decision. She could discuss with him the opinion of the MDs since they are hypothesizing that the experimental drug may work better, but there is no way to know of its effectiveness until the experimental protocol is concluded.
2. What are the ethical issues (specific to research ethics and scientific integrity) inherent in this nursing situation?
Ethics should always be guided by an overriding principle. The best one that I've come across is the Golden Rule, "Do unto others as you would have them do unto ...
Ethics in nursing are evaluated in a case study.