Chemical Restraints and Patient Rights: an Ethical Issue Essay Example
In a secure psychiatric ward a psychotic patient has abruptly become violent shortly after his last scheduled dose of Ativan. It is three in the morning and the night shift nurse has a decision to make. Should she wake up the psychiatrist and request that he come and assess the patient, or should she administer the PRN medication of
Zyprexa that the physician had previously authorized in the patient's chart? According to a strict interpretation of the published HCFA rules, chemical restraints or inappropriate use of medication is defined as "A medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychological condition." It goes on to specifically mention that this would specifically include "No PRN orders" (Federal Register, 1999). If the nurse were to administer the Zyrexa in addition to the scheduled dose of Ativan, she would be using a form of chemical restraint and thus be trampling on the patient's rights. According to protocol, this could only be done if the patient was observed by a physician within an hour of the dispensing of the drug. Yet, how is one able to control the situation otherwise? Where do the rights of the patient as defined by law end and right of the clinicians to observe safety for them and the patient begin? It is a difficult question. The moral considerations in this situation can have two directions. On one hand, there is the right of the patient to be protected from unnecessary chemical restraint by the use of multiple anti-psychotic drugs in various combinations that would result in him being totally in the control of the clinicians responsible for this care and therapy. On the other hand, those very clinicians have their own rights to protection from violence, as well as being able to discharge their duty to prevent the patient doing harm to himself. Balancing these two seemingly opposing moral directions can be tricky. The border of
Zyprexa that the physician had previously authorized in the patient's chart? According to a strict interpretation of the published HCFA rules, chemical restraints or inappropriate use of medication is defined as "A medication used to control behavior or to restrict the patient's freedom of movement and is not a standard treatment for the patient's medical or psychological condition." It goes on to specifically mention that this would specifically include "No PRN orders" (Federal Register, 1999). If the nurse were to administer the Zyrexa in addition to the scheduled dose of Ativan, she would be using a form of chemical restraint and thus be trampling on the patient's rights. According to protocol, this could only be done if the patient was observed by a physician within an hour of the dispensing of the drug. Yet, how is one able to control the situation otherwise? Where do the rights of the patient as defined by law end and right of the clinicians to observe safety for them and the patient begin? It is a difficult question. The moral considerations in this situation can have two directions. On one hand, there is the right of the patient to be protected from unnecessary chemical restraint by the use of multiple anti-psychotic drugs in various combinations that would result in him being totally in the control of the clinicians responsible for this care and therapy. On the other hand, those very clinicians have their own rights to protection from violence, as well as being able to discharge their duty to prevent the patient doing harm to himself. Balancing these two seemingly opposing moral directions can be tricky. The border of