Ethical Decisions

Ethical Decisions

Cheryl M. Moultrie

HCS/335

August 22, 2015

Robert Vella

Ethical Decisions

Mr. ABC, an elderly African American gentlemen, presented to the clinic as a new patient for Internal Medicine.  As the assigned Medical Assistant, I was responsible for his initial intake. This included getting a complete medical, social, sexual, and psychological history and PHQ status.  Not only did Mr. ABC divulge that he was having hopeless feelings and often thought of hurting himself, he explained these feeling were due to his living situation and his health.  In addition, his medical history divulged that he was hypertensive and diabetic. This was confirmed by his blood pressure reading of 250/120 and a blood glucose level of 500 plus.  Furthermore, his lower right extremity exhibited edema, and was bandaged.  As required, I informed my provider of his vitals as well as his psychological status and returned to the room.  I requested that Mr. ABC remove his shoes so that the provider can evaluate what if any wound care would be required of his lower extremity.   He was reluctant, as was I, because clearly Mr. ABC was homeless and there was a necrotic odor emanating from the lower extremities as well as visible leakage.  

        During his visit, I gathered that Mr. ABC was a very proud and noble gentlemen, but clearly, delusional about the severity of his situation because he asked me to marry him several times.   What makes this situation stand out in my memory so much is the fact that this 68 year old African American gentlemen was accompanied by a middle age Caucasian woman.  That in itself wasn’t a flag, but the fact that the patient was so evasive in divulging information and stated several times that he was ready to die made me question his companion, who clearly was not a family member.  In doing so, I found out that the patient was a member of her church who has diligently come to service every week.  The congregation was concerned about his wellbeing and ultimately got him to schedule and keep his medical appointment.   Once his visit was over, the provider clearly knew his diagnosis was not good and scheduled appropriate labs to confirm.  The obligatory 6 week follow up appointment was made, however, two days later, we received his lab results which basically said the gentlemen was septic and needed to either go to the ER for aggressive antibiotic treatment or risk losing his lower limb.    As the Medical Assistant, it was my responsibility to contact the patient and schedule the appropriate follow-up, but my dilemma was he had no phone.  I, again, made the decision to contact the companion and divulge the severity of Mr. ABC’s situation.  I had to subsequently establish transport for the gentlemen to ensure his return to clinic as the companion would not be available, as well as, get a confirmation from his companion that he would keep his follow up.  Thankfully, the gentlemen kept his appointment on the assigned day.  When he showed up, he was still in denial and, adamantly, refused to go to the ER and seek the treatment he so desperately needed.    The provider felt that since I had developed a rapport with patient, it should be I to I tell this man the detriment of him not going to receive the much needed treatment- if he did not admit himself to ER and receive the antibody therapy, he would die.  I drew the line there, and acquiesced the situation to my Nurse.   The clinic attempted to put Mr. ABC on a 72 hour psychiatric hold, but again, the gentlemen refused.  Ultimately, after all was done, we had to allow this man his right to refuse treatment.  Mr. ABC is one of many clients that I periodically think about, but at the end of the day, I know each and every decision I made regarding this patient, was ethical and correct. By utilizing proper ethical problem-solving techniques, I was able to not only help this patient to the best of my ability (beneficence), but also ensure that he was properly counseled   and made aware of his situation, thereby allowing this gentlemen to keep his autonomy.