Develop, in detail, a situation in which a health care worker might be confronted with ethical problems related to patients and prescription drug use OR patients in a state of poverty.
Your scenario must be original to you and this assignment. It cannot be from the discussion boards in this class or any other previous forum.
Articulate (and then assess) the ethical solutions that can found using "care" (care-based ethics) and "rights" ethics to those problems.
Assessment must ask if the solutions are flawed, practicable, persuasive, etc.
What health care technology is involved in the situation? What moral guidelines for using that kind of healthcare technology should be used there? Explore such guidelines also using utilitarianism, Kantian deontology, ethical egoism, or social contract ethics.
Say how social technologies such as blogs, crowdfunding, online encyclopedias can be used in either case. What moral guidelines for using that kind of healthcare technology should be used there? Develop such guidelines also using utilitarianism, Kantian deontology, ethical egoism, or social contract ethics.
You should not be using any text you used in a discussion board or assignment for this class or any previous class.
The Healthcare Worker: Nurse Carla, a primary care nurse case manager.
The Problem: Nurse Carla is reviewing Mr. Reyes' Electronic Health Record (EHR). The physician has ordered a new, highly effective, but very expensive SGLT2 inhibitor drug (let's call it Gliflozin) to manage his blood sugar, alongside weekly specialized wound care (a $150 per week advanced dressing kit). The EHR system contains a standard formulary check that flags Gliflozin as "Preferred," but the system is not integrated with local patient assistance programs or external pharmacy discount checks.
Mr. Reyes tells Nurse Carla he picked up the prescription and was told the copay was $300 per month—nearly a third of his monthly income—and he has not purchased the wound care supplies. He states flatly: "I paid for the Gliflozin this month. I'll just use the old gauze for the ulcer. I can't afford both." Nurse Carla knows that without the advanced wound care, his ulcer will likely worsen, leading to osteomyelitis and inevitable amputation, despite the blood sugar control.
The Ethical Dilemma: Nurse Carla is confronted with a conflict between the Physician's Principle of Beneficence (prescribing the absolute best drug, Gliflozin) and the Nurse's Duty of Nonmaleficence and Stewardship (preventing severe harm by ensuring the necessary, affordable wound care supplies are used). The system (EHR) encourages the "best" treatment without accounting for the patient's reality of poverty and resource scarcity.
Ethical Analysis and Solutions
The dilemma requires balancing clinical ideals with resource constraints.
1. Care-Based Ethics Solution (The Compromise)
Focus: Emphasizes relationships, compassion, and the context of the patient's life, prioritizing vulnerability and relationship-based care.
Solution: Nurse Carla would prioritize Mr. Reyes' immediate, palpable need and autonomy over abstract clinical best practice. The solution is not merely finding a way for him to pay, but finding a way to prevent the worst-case scenario (amputation).
She contacts the physician to advocate for a step-down approach on the diabetes medication (e.g., prescribing a less expensive, older drug like Metformin or a sulfonylurea) that is still clinically adequate.
She enrolls Mr. Reyes in a program that ensures immediate, free access to the specialized wound care dressings (the highest priority for amputation prevention).
Assessment:
Practicable: Highly Practicable. This approach leverages the nurse's existing role as a coordinator and advocate and addresses the most urgent physical harm immediately.
Flawed: Yes. It compromises the "ideal" clinical outcome for diabetes control by substituting a less potent drug, potentially slowing overall healing. It places the burden of compromise on the patient's systemic care.
Sample Answer
Ethical Scenario: Prescription Drug Use and Resource Scarcity
The scenario focuses on the conflict between clinical best practice and a patient's inability to afford necessary long-term treatment, a dilemma rooted in poverty and prescription drug access.
The Scenario: The Gaps in EHR and the Cost of Treatment
Setting: A busy, understaffed Federally Qualified Health Center (FQHC) serving a high-poverty urban neighborhood.
The Patient: Mr. Reyes, a 68-year-old uninsured man with severe, poorly managed Type 2 Diabetes and a newly diagnosed Diabetic Foot Ulcer (DFU) on his right foot. He lives alone and relies on Social Security for income.