Sarah is a fortytwoyearold woman has been battling breast ca

Sarah is a forty-two-year-old woman, has been battling breast cancer for the past four years. It has spread to her lungs. She underwent an operation to remove several tumors a year ago. New tumors have now appeared. Her oncologist, Greg, is recommending that she take part in an experimental protocol. There is a new drug that promises to significantly check the development of new metastatic tumors.

Greg explains to Sarah the hoped for benefits of the new therapy. These center primiarly on slowing the development of new tumors. However, there is little evidence that the new therapy can eradicate the metastatic cancer. Thus, it is not a cure. Rather, it may give her more time to live. He also explains that there are some risks - the extent of which have not been entirely documented (thus the need for more research). These may include severe fatigue and reduced immunity to other infections. These could leave her so tired that she could not carry out normal activities and/or more vulnerable to additional complicated infections and illnesses. He also explains that she will be part of a double blind trial - meaning that neither Greg nor Sarah will know whether she is receiving the new experimental drug or the conventional drugs used to treat metastatic breast cancer.

Sarah has been very despondent about her condition, so he does not share with her that in the light of past response to conventional therapy, she would probably not do well unless she got the experimental therapy. He also brushes over another possible side effect of the new therapy - possible loss of cognitive functions. Sarah is a writer - and her ability to think and express her thoughts is very important to her. He is worried that even though this is a minimal risk (20%), she will decide against the experimental therapy for fear of being cognitively disabled. In his opinion, this is her only hope to prolong life. To cover himself legally, he explains there is a slight risk of some disorientation.

Greg works at a teaching hospital and, as part of a prestigious group of research oncologists, he would like to see Sarah participate in the trial. She fits the perfect profile of a candidate for the protocol. He\'s anxious to see how someone with her past history would respond to the new drug. Without the experimental drug, he knows she will deteriorate quickly.

One of Sarah\'s nurses, Jennifer, who has worked on the oncology unit for eight years, is surprised to hear that Greg has recommended this experimental protocol to Sarah. She\'s even more surprised to hear from Sarah that Greg didn\'t mention cognitive risks - something Jennifer has actually witnessed with other patients in the trial. Although she knows Sarah is at risk for a quick decline on conventional therapy, she believes Sarah alone has the right to make a decision about entering a research protocol or not.

Questions for discussion/posting:

Drawing from professional codes, what are Greg\'s and Jennifer\'s obligations to Sarah? Make sure you demonstrate your familiarity with multiple obligations in these professional codes and how they could come into conflict or tension.

What does our text say about conflicting roles - such as between clinical and research roles? How are these conflicts managed?

Would a consequentialist look at this case different from a deontologist? How so?

What do the professional codes say (if anything) about the relationship between Greg and Jennifer?

How should Jennifer handle what seems like a breach of professional ethics on the part of Greg?

Solution

Familiarity with multiple obligations in these professional codes

1)Primary bond between the practices of medicine and nursing is mutual ethical concern for patients, One of the duties in providing reasonable care is fulfilled by a Jennifer who carries out the orders of the attending Greg. Where orders appear to the nurse to be in error or contrary to customary medical and nursing practice, the physician has an ethical obligation to hear the nurse’s concern and explain those orders to the nurse involved The right of patients to be informed of all pertinent medical information must be reaffirmed by the medical profession, and individual physicians must continue to uphold their ethical obligation to disclose such information.

2)The Greg has a responsibility to inform Sarah about important health information or abnormalities that he or she discovers during the course of the examination. In addition, the physician should ensure to the extent possible that the patient understands the problem or diagnosis.

3)Greg have stronger obligations to patients with whom they have a patient-physician relationship, especially one of long standing; when there is imminent risk of foreseeable harm to the Sarah or delay in access to treatment would significantly adversely affect the patient’s physical or emotional well-being; and when the patient is not reasonably able to access needed treatment from another qualified physician.

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Conflict between research and clinical roles are Financial relationships, with pharmaceutical, medical device and biotechnology companies  may create conflicts of interest and risk of undue influence on judgment both for entities that sponsor the development of clinical practice guideline and for the individuals who participate in their development.

In research side are medical research, education and practice.  They build on medical research and serve an education function.  In Clinic, they may influence patient and physician about heal care interventions, health plan coverage for medical services, and assessments of the performance of individual physicians and institutions that provide health care.

Clinical roles guidelines are based on valid scientific evidence, critical assessment of that evident, and objective clinical judgment that relates the evidence to the needs of practitioners and patients.  Clinical roles is not having proper research knowledge.

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Chemotherapy for breast cancer, as considered different from a deontologist.

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Relationship between Greg and Jennifer, Primary bond between the practices of medicine and nursing is mutual ethical concern for patients. She have to obey Greg order, in case Greg  order is wrong, Jennifer have right to tell that truth to doctor.  There is no superior concept  here because medical professionals has to save the life of patient.