Combining morphine and Ativan (lorazepam) can be deadly, making the Primary Care Physician (PCP) statement seem contradictory to medical ethics. The specific medical ethical issues addressed in this case include patient autonomy, beneficence, and nonmaleficence. However, there are other ethical issues and dilemmas raised by this case. The nurse faces professional ethical dilemmas in terms of the conflicts between Provision 2 and Provision 8 in the American Nurses Association (ANA) Code of Ethics. Provision 2 indicates that nurses have a primary commitment to the patient, followed by Provision 3, which calls for the professional nurse to actively advocate for and protect the "rights, health, and safety of the patient," (ANA, 2015). However, Provision 8 indicates that the nurse also "collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities," (ANA, 2015). This case shows how the nurse's primary obligation to protect the interests of the patients may conflict with the nurse's work as a collaborator with other health professionals with the ultimate goal of protecting human rights and promoting health diplomacy. Therefore, the nurse in this situation should confer with the PCP to discuss reasons for proceeding to the Ativan.
Crucial questions...
If that level of pain remains suitably high after the
administration of the morphine, in spite of appearances, then the nurse may need to accept that the Ativan would be necessary. The patient "appears comfortable," according to the case, but appearances can be deceiving. Plus, the patient may be saving face by avoiding the
appearance of pain to prevent worrying family members. The nurse is obliged to ask the patient directly and confidentially about the level of pain being experienced and whether the patient would like additional pain relief via
medication. Although the input from the family member is helpful, it is not necessarily relevant because the patient is the person who the nurse answers to ultimately. The International Council of Nurses (2012) also suggests that nurses advocate on behalf of patients by providing as much information as needed for the patient to make informed decisions related to
healthcare. In this case, the nurse needs to tell the patient of the potential outcomes of combining morphine with Ativan. If the patient is not in a state of mind conducive to making choices, the nurse can confer with the family member and the PCP by citing evidence showing the potential harm of the drug interactions. The possibility for harm needs to be weighed against the ethical push towards beneficence -- providing for the needs of the patient for pain relief. The patient's body weight and
medical history may also need to be taken into account when making an informed decision based on evidence rather than a knee-jerk response to the…
