LeAnna Ceglia

Professional Ethics
Paper #2
April 30, 2013
When Lack of Professional Ethics Fails a Patient
The feeling of having a right or freedom taken away is something that is unbearable and
hopefully never experienced. Unfortunately, seventy-year-old Mr. Jones experienced this. His
autonomy was taken away when Dr. Smith threatened to get his license revoked if he did not
agree to a procedure. Mr. Jones visited the doctor after experiencing severe light-headedness due
to his medication diltiazem. Diltiazem is taken either for cardiac arrhythmias or hypertension in
which Mr. Jones has neither. Mr. Jones does have a right bundle branch block that, according to
Dr. Brown, does not indicated treatment. However, Dr. Jones, on the other hand, insists that Mr.
Jones suffers from a third-degree AV block and needs to continue taking the diltiazem as well as
have a pacemaker inserted. Tracy, one of the nurses, recognized and informed Mr. Jones that he
only suffered from a right bundle branch block and did not need to take the medication or
undergo surgery for a pacemaker. However, Dr. Smith insisted otherwise and threatened to get
Mr. Joness license revoked if he did not do as he was told. This was a problem for the patient
because he made his living by driving and was not financially able to retire. With his job being
at stake, Mr. Jones underwent the procedure to get a pacemaker and continued taking the
diltiazem.
There were a couple of issues that concerned me throughout this case study. The biggest
issue was taking away patients (Mr. Jones) autonomy. In Samuel Gorovitzs Good Doctors,
Dr. Smith violates the characteristics of what it takes to be a good doctor. This includes having
and maintaining a high level of technical competence in his field. The reason I feel that Dr.

Smith is lacking in this area is because he diagnosed Mr. Jones with a third-degree AV block and
prescribed him for the medication of diltiazem which is for hypertension and cardiac
arrhythmias. However, at the hospital, Mr. Jones was diagnosed with a right bundle branch
block that is benign and found out that it is unnecessary for him to be taking diltiazem because
he does not show any signs or symptoms that this medication treats. Three other good doctor
characteristics that go hand-in-hand that Dr. Smith lacks are being diversely sensitive to factors
that can influence a patients view of what the best solution is, has the humility to respect a
patients autonomy, and the sensitivity to recognize moral conflict where it exists and
understanding/considering it with intelligent reflection where it is faced as well as the judgment
to decide wisely after such consideration (Gorovitz, 425). Dr. Smith did expressed none of these
mentioned characteristics, but, instead, did the opposite. Rather than considering Mr. Joness
feeling and respecting his autonomy, Dr. Smith decided to make the decisions on his own and
threatened the patient if he should disagree with him.
The other issue that caught my attention was why the nurse (Tracy) did not do anything
other than tell the patient (Mr. Jones) that he did not have to go through with the procedure.
According to Michaels, nurses have certain obligations under the Code for Nurses, which include
protecting and advocating for their patients. However, Tracy did not follow under these duties.
Yes, she informed Mr. Jones that he did not need a pacemaker and that he should not be taking
the medication diltiazem, but that is all she did. With Mr. Jones having his autonomy taken
away by the doctor, his confidence to ask questions and stand up for himself is shot. That is
where Tracy needed to step up and inform the doctor that what he is doing to Mr. Jones is not
right and to inform higher management of his doing as well as inform higher management of
these other diagnoses made by Dr. Smith that are not found to be true. The nurses primary

commitment is to the health, welfare, and safety of the client (Michael, 244). Tracy knew that a
pacemaker was neither needed nor necessary and yet she let the final decision be made by the
patient whose job was threatened by the doctor. Undergoing any procedure is dangerous with
many risks, therefore, ones that are not necessary should not done. In other words, dont fix
whats not broken. Over all, the nurse could have done more for her patient.
If I were in the shoes of Mr. Jones, I would have done things differently. I would have
told the doctor that I am no longer taking the medication since I do not have the signs or
symptoms that are treated by it. I would also ask him what my other options are rather than
undergoing a large procedure such as having a pacemaker put it. Also, if he would have threaten
me by having my license revoked, I would have told him that I still do not want the pacemaker
and I would either talk to upper management and let them know that my doctor is threatening me
or I would tell the doctor to tell that to my lawyer. However, it is also easy for me to make these
decisions from my stand point because I am an outsider looking in and I do not have anything at
stake.
According to this case study, what had occurred simply was that the patients autonomy
was taken away. However, throughout the case study, there were some conflicts. The first
conflict was that Dr. Smith believed that he knew what was best for Mr. Jones in which coercion
was implemented. The second conflict was that the patient (Mr. Jones) lacked the knowledge of
why he was taking diltiazem or needed a pacemaker, but, at the same point, did not want to lose
his truck drivers license. The third conflict was that Tracy, the nurse, did not see it necessary
for Mr. Jones to be taking diltiazem or to have a pacemaker put it. However, this could have all
been solved or avoided if Dr. Smith did not practice medical paternalism and use coercion, but,
instead, provide Mr. Jones with all of the necessary information so that he could make a rational

informed decision on his own (Villanueva, 4). All in all, according to Villanueva, Dr. Smith
tried to make what he thought was the best decision for Mr. Jones. However, what he ended up
doing was cross the legal and moral boundaries by threatening his patient, taking away and
violating Mr. Joness autonomy and legal rights.

Villanueva, Manuel. A Case Study in Coercion. Oakland University, Michigan. 2000. Web. 19
April 2013.