If A Caregiver Disagrees With A Physician’s Written Orders

If a caregiver disagrees with a physician’s written orders and is sure that he or she is right, should that caregiver violate the order?

In healthcare, the relationship between caregivers and physicians is founded on mutual trust, professional standards, and legal obligations. When a caregiver encounters a situation where they believe that a physician’s written orders are inappropriate or potentially harmful, they face an ethical dilemma: should they adhere strictly to the orders or consider violating them to uphold patient safety? This dilemma warrants a comprehensive discussion considering legal, ethical, and practical perspectives, emphasizing the importance of professional responsibility, patient advocacy, and institutional protocols.

Legally and ethically, caregivers are bound by the doctrine of patient advocacy and their professional code of conduct, which prioritize patient safety and well-being. According to Pozgar (2016), healthcare professionals must act in the best interest of the patient, which sometimes involves questioning or clarifying physician orders. The principle of nonmaleficence — “do no harm” — compels caregivers to prevent harm, even if it means challenging a physician’s decision if it appears detrimental. For example, if a nurse notices that an ordered medication might cause adverse interactions with a patient’s allergies, they are ethically obligated to speak up, seek clarification, or escalate the concern.

However, the question remains whether violating a written order is permissible. Legally, caregivers must follow the chain of command and institutional policies, which typically require reporting concerns through proper channels. Violating a physician’s order without authorization can lead to legal repercussions, such as charges of assault or professional sanctions, unless the violation is justified by patient safety concerns. For instance, if a caregiver administers medication contrary to written orders due to urgent safety reasons and documents thoroughly, they might protect themselves legally.

Institutional policies and ethical guidelines generally promote communication and collaboration. Open dialogue between caregivers and physicians is encouraged to resolve disagreements professionally. Ethical frameworks, such as those outlined in Pozgar (2016), advocate for caregivers to first seek clarification, express concerns, and document issues. If disputes persist, consulting with the healthcare team, supervisors, or ethics committees is advisable. In some cases, refusing to adhere to orders without following these steps might be considered negligence or insubordination, risking disciplinary actions.

Despite these considerations, there are scenarios where a caregiver might ethically justify disobeying orders. For instance, if the physician’s directive plainly contradicts accepted standards of care or violates patient rights, the caregiver must prioritize patient safety over obedience. An example would be administering a medication known to be contraindicated for a specific patient condition, despite the physician’s written orders. In such cases, documenting concerns and acting in the best interest of the patient aligns with ethical obligations and legal protections.

Overall, the decision to violate a physician’s orders should not be taken lightly. Caregivers are ethically compelled to advocate for their patients by ensuring that care provided aligns with current standards, best practices, and patient safety. When disagreements arise, professional communication, thorough documentation, and escalation through institutional channels are essential. Ultimately, the priority is safeguarding the patient’s well-being while remaining within legal boundaries and professional standards.

References

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