Resources: Rosenthal L. D. Burchum J. R. 2021 Lehnes Pharmac

Resourcesrosenthal L D Burchum J R 2021lehnes Pharmacoth

Review the scenario involving an 18-month-old boy with severe gastrointestinal blockage and pain, whose parents refuse treatment due to religious beliefs, trusting in prayer for healing. The assignment requires analyzing the legal and ethical implications of prescribing medication, disclosure, and nondisclosure. It involves examining laws and standards specific to your region related to prescription practices and medication errors, and considering ethical responsibilities for all involved stakeholders, including prescribers, pharmacists, patients, and families. Additionally, you must identify two strategies to guide ethically and legally responsible decision-making as an advanced practice nurse in this scenario, including whether medication errors should be disclosed.

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In the complex and sensitive scenario involving an 18-month-old boy suffering from severe gastrointestinal impaction and pain, the critical role of legal and ethical considerations in healthcare practice becomes highly evident. As an advanced practice nurse (APN), navigating this situation requires a comprehensive understanding of prescriptive authority, medical ethics, legal statutes, and cultural competency. The primary challenge lies in balancing the obligation to provide life-saving medical intervention with respect for the parents' religious beliefs and autonomy. This situation presents a profound ethical dilemma, particularly concerning informed consent, potential harm, and the duty to prevent suffering in a pediatric patient who cannot advocate for himself.

Legal and Ethical Frameworks in Prescribing and Disclosure

The legal protocols governing prescription practices vary across states but generally include statutes that specify the scope of practice for advanced practice nurses, including prescribing authority, medication management, and reporting obligations (DEA, 2021). In most jurisdictions, APNs possess the legal authority to prescribe medications within their state-licensed scope, provided they adhere to regulations concerning documentation, collaboration with physicians, and patient safety standards (American Geriatrics Society [AGS], 2019). Ethically, prescribers are bound by principles of beneficence—acting in the best interest of the patient—and nonmaleficence—avoiding harm. Respect for autonomy is balanced against the child's best interests, especially when parental decisions conflict with medical recommendations.

When it comes to disclosure, the healthcare provider has an ethical obligation for transparency about medication errors, per standards outlined by the Institute for Safe Medication Practices (2017). Transparency fosters trust, promotes patient safety, and aligns with ethical standards that advocate for informed decision-making (Sabatino et al., 2017). However, in pediatric cases involving parental refusal, providers must consider how disclosure and intervention intersect with legal mandates and ethical duties, often requiring delicate communication strategies to navigate cultural and religious sensitivities.

Legal and Ethical Implications in the Scenario

The parents’ refusal to accept treatment raises significant legal questions about the authority of healthcare providers to override parental decisions in life-threatening situations. Laws pertaining to child protection and mandatory treatment vary, but generally, healthcare providers have a duty to act in the child's best interest, including seeking court intervention if necessary (DEA, 2021). Ethically, the provider must weigh the respect for parental religious beliefs against the child's immediate health needs, which, if unmet, could lead to irreversible harm or death.

The ethical principle of beneficence supports intervening to save the child's life. Conversely, respecting the parents' religious autonomy respects familial cultural values, which are core to holistic patient-centered care. In some jurisdictions, courts have granted healthcare providers the authority to provide necessary treatment against parental wishes to prevent imminent death or serious harm (AGS, 2019). The decision-making process must incorporate legal statutes, institutional policies, and ethical guidelines, emphasizing the child's welfare and considering least restrictive means of intervention.

Regarding disclosure, transparency about potential risks, benefits, and the severity of the child's condition is essential. Although the parents prefer prayer, the healthcare team has a duty to inform them of the medical implications of refusing treatment, including potential outcomes. Ethical principles advocate for truthful communication, delivered with cultural sensitivity, to empower the family to make informed decisions, even if they choose to refuse medical intervention (Sabatino et al., 2017). If a medication error occurs during treatment, the provider must disclose it fully, as withholding information violates ethical standards and can undermine trust (Institute for Safe Medication Practices, 2017).

Strategies for Ethical and Legal Decision-Making

To navigate the legal and ethical intricacies of this scenario, two strategies are essential. First, employing culturally sensitive, compassionate communication is paramount. Engaging in open dialogue with the parents about the child's condition, possible outcomes, and treatment options helps foster trust and mutual understanding. This approach aligns with the ethical principle of respect for persons and supports shared decision-making (Sabatino et al., 2017). Active listening, empathy, and providing clear information tailored to the family's beliefs and values can facilitate acceptance of necessary treatment or, at least, an informed refusal that considers the child's welfare.

Second, consulting with the institutional ethics committee and legal counsel is vital. These resources provide guidance grounded in law and ethics when parental refusal poses a risk of severe harm or death to the pediatric patient. By documenting all interactions, recommendations, and efforts to educate the family, the APN upholds legal standards and demonstrates due diligence. If parental refusal persists, and the child's life remains threatened, pursuing legal intervention—such as seeking court orders for treatment—may be necessary. This ensures that the healthcare provider acts within the legal framework and prioritizes the child's safety while respecting legal protocols.

Regarding medication errors, full disclosure aligns with ethical standards and can mitigate harm by ensuring appropriate follow-up care. When errors occur, transparent communication with the family about what went wrong, potential consequences, and corrective actions are crucial. This approach fosters trust, promotes a culture of safety, and adheres to professional ethical guidelines (Institute for Safe Medication Practices, 2017).

Conclusion

Managing this ethically and legally complex scenario requires a nuanced approach that balances respect for parental religious beliefs with the imperative to preserve the child's health and life. As an APN, employing culturally sensitive communication and leveraging institutional resources like ethics committees are key strategies for responsible decision-making. Transparency and honesty, particularly in disclosing medication errors, further uphold ethical standards and promote trust. Ultimately, prioritizing the child's welfare while respecting family values, within the boundaries of legal statutes, embodies the ethical practice essential to advanced nursing care in such sensitive situations.

References

• American Geriatrics Society (2019). American Geriatrics Society 2019 updated AGS Beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767
• Drug Enforcement Administration. (2021). CFR - Code of Federal Regulations Title 21. https://www.ecfr.gov
• Institute for Safe Medication Practices. (2017). List of error-prone abbreviations, symbols, and dose designations. https://www.ismp.org/resources/list-error-prone-abbreviations-symbols-and-dose-designations
• Sabatino, J. A., Pruchnicki, M. C., Sevin, A. M., Barker, E., Green, C. G., & Porter, K. (2017). Improving prescribing practices: A pharmacist-led educational intervention for nurse practitioner students. Journal of the American Association of Nurse Practitioners, 29(5), 248–254. https://doi.org/10.1002/.12446
• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.