Contemporary Issue Position Essay: Is the
Surgery Necessary Now?
purpose of this paper is to evaluate the ethical issues of the case “Is the
Surgery Necessary Now? The Surgeon’s Conflicts of Interest” (Brody &
Zientek, 2007), and to state my ethical position. I will define my position
with legal, ethical, and professional evidence and propose strategies and
solutions to address the issues in this case. Lastly, I will discuss how this
case impacts my role as a future nurse practitioner.
The Issue and My Ethical Position
case is about Dr. Hendry, a neurosurgeon, who has been in his first year of
practice. Dr. Hendry met his patient, Ms. Davis, who has been experiencing back
pain in her right leg for more than a month that started when she bent down to
pick up her grandson. Dr. Hendry examined Ms. Davis and noticed that her right
leg is slightly weaker than her left with right foot drop. On Ms. Davis’ MRI,
it showed that she had ruptured L5-S1 disk and mild degenerative changes (Brody
& Zientek, 2007). Dr. Hendry explained the MRI results to Ms. Davis and
gave her options to either have the surgery now or wait longer to see if her
symptoms will resolve on their own. Ms. Davis’ response was that she thought
she might need surgery and asked Dr. Hendry if surgery is what he recommends.
Hendry is the newest member of the three-surgeon practice and has the fewest
patient and fewest surgeries done. The week before Dr. Hendry met Ms. Davis, he
had a group meeting and one of the surgeons said to him that it takes a few
months for young surgeons, like Dr. Hendry, to build his practice. He also
noticed indirect comments that his practice is moving slower than the others.
And another joking reminder that surgeons in their practice are paid to do
surgeries and that office visits does not pay their rent.
issue in this case is whether Dr. Hendry would recommend patient to have surgery
done or wait it out for the symptoms to resolve on its own. Dr. Hendry felt
confident that he could remove the extruded disk material and that Ms. Davis,
who was 58 years old and in good health – would have a favorable outcome (Brody
& Zientek, 2007). When Ms. Davis visited the office she seemed to believe
that Dr. Hendry would recommend for her to have surgery done. On the other
hand, Dr. Hendry explained to Ms. Davis that some patients recover with the
same medical problem without surgical procedure. According to Brody &
Zientek (2007), the disk fragment can be resorbed by the body and relieve the
pressure on the nerve. But Dr. Hendry also knew that it was impossible to
predict if or when the symptoms might resolve, and, as he told Ms. Davis, the
longer they were allowed to persist, the greater the chance of doing lasting
damage to the nerve (Brody & Zientek, 2007). Whenever Dr. Hendry thought of
considering not to operate, he remembered one of his partner’s joking reminder
that office visits does not pay their rent.
ethical positions in this case are patient advocacy and human dignity. In the
Code of Ethics for Nurses with Interpretive Statements, the ANA continues to
support patient advocacy by elaborating on the “primacy of the patient’s
interest” (Butts, 2016). According to Butts (2016), nurses are called upon to
ensure that all appropriate parties are involved in patient care decisions that
patients are provided with the information needed to make informed decisions.
In respect to human dignity, it requires recognition to patients’ rights. Patients
have the moral and legal right to determine what will be done with and to their
own person; to be given accurate, complete, and understandable information in a
manner that facilitates an informed decision (Butts, 2016). In this case, it is
Dr. Hendry’s duty to fully explain to Ms. Davis, within her capability of
understanding, the pros and cons of proceeding to surgery and the “wait-it-out”
option. He should not rush to surgery unless he is certain that Ms. Davis understands
My Role as a Nurse Practitioner
case has a great impact to my role as a future nurse practitioner. The issue in
this case is that Dr. Hendry is conflicted about how to answer Ms. Davis’
question, if they should schedule surgery. To me, this question is screaming
for more information. This is when nurses and nurse practitioners’ role of
patient advocates come into play. I truly believe that nurses and nurse
practitioners are patient advocates, which have been an essential part of
nursing for so long. As patient advocates, we protect our patients from harm,
we communicate their preferences, we provide them important information to make
informed decisions, and we support our patients regarding their choices and
Legal, Ethical, and Professional Evidence
dignity and patient advocacy are my ethical positions in this case. According
to ANA Code of Ethics (Butts, 2016), the nurse must respect patients’ dignity
by recognizing patients’ rights. Patients have the right to know about their
care and they need to be provided with truthful, entire, and clear information
in a way where they can draw their informed decision from. In this case, it is
Dr. Hendry’s duty to explain to Ms. Davis, in details, about the pros and cons
of the surgery and other options, such as to “wait-it-out” or nonsurgical. In
the ANA Code of Ethics (Butts, 2016), this is to minimize unwarranted,
unwanted, or unnecessary medical treatment and patient suffering. Ms. Davis
must fully understand her choices or options before she and Dr. Hendry can
proceed with her care.
concern in this case are the comments Dr. Hendry received from his partners.
These comments are that his practice is moving slower than the others and the
joking reminder that he is paid to do surgery and that his office visits does
not pay for their rent. Dr. Hendry is facing conflict of interest and must make
a decision whether he should improve his financial productivity and his reputation
within his group or risk his patient, Ms. Davis, to the pain, suffering, and
cost of unnecessary surgery. According to Brody & Zientek (2007), a
conflict of interest occurs when the physician’s action is likely to compromise
the patient’s trust by serving his or her own interests before those of the
patient. In the ANA Code of Ethics, the primary commitment is to the patient
and one must practice with compassion and respect for the inherent dignity,
worth, and unique attributes of every person (Butts, 2016). In Dr. Hendry’s
group, his partners need to treat him with dignity and respect. This standard
of conduct includes an affirmative duty to act to prevent harm (Butts, 2016).
My Proposed Solution and Other Ethical
For the dilemma
that Dr. Hendry is facing on how to answer Ms. Davis’ question of, “Do you
think we should schedule for surgery?” he must explain fully to Ms. Davis the
pros and cons of the surgery and the option to “wait-it-out” or nonsurgical.
After Dr. Hendry explains the risk of surgery and the benefits of waiting and
no matter what decision Ms. Davis makes, he has to abide by her decision.
addition, Dr. Hendry is experiencing conflicts of interest. If Dr. Hendry
encounters more situation similar to Ms. Davis and he feels torn in between
doing the best for his patients or what is best for his group, then he must
begin to consider going or transferring to a different group. Possibly his
partners have different values than Dr. Hendry and prefers their income rather
than the care they provide for their patient. It may be a difficult and unruly
to consider such option, but in the end it is the best thing to do.
In conclusion, if Dr. Hendry follows
his principles, he will gain Ms. Davis’ trust and the trust of his future
patients. It will definitely upset his partners but he will become a preferred
surgeon in his community. As care providers, our duty is to keep our patient
safe and to provide the best quality of care. Our personal interest must be put
aside and the patient’s best interest must always comes first.