A physician decided that a patient should have surgery on one ear. The patient agreed and provided informed consent to the surgery. However, during the procedure, when the patient was examined under general anesthesia by a surgeon, it turned out that he required the same surgery on another ear. For this reason, the doctor performed surgery on both ears. However afterward, it caused complications. The main goal of this paper is to discuss the issue, applying the bioethical decision-making model.
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Facts and Assumptions
The doctor diagnosed the patient with chronic otitis media, which is a long-standing draining perforation of the eardrum. The patient complained of hearing loss and persistent drainage from the ear. As cleaning the ear canal and ear drops, as well as antibiotics, did not result in improvements, the physician recommended ear surgery. Tympanoplasty is a surgical procedure that is performed to repair defects in the tympanic membrane (“Tympanoplasty,” 2017). It is a safe and effective technique that restores hearing and proper functioning of the middle ear. Without such surgery, very serious complications might have developed in the patient. The prognosis included such problems as chronic suppurative otitis media, postauricular abscess, facial nerve paresis, Labyrinthine fistula, Petrositis, Meningitis, Encephalocele, and Cerebrospinal fluid leak (“Middle ear infection,” n.d.).
However, tympanoplasty is associated with certain risks and complications as well. The tympanoplasty failure might include unexpected bleeding, infection, impaired sense of taste, the spread of infection to other parts of the body, dizziness, and permanent hearing loss. The procedure can also lead to such complications as the failure of the graft, nerve damage that results in partial or complete facial paralysis, and noise in the ear (“6 complications,” n.d.). The patient was explained about all the possible side effects of the procedure as well as about the complications of the disease. However, the physician failed to diagnose chronic otitis media in another ear. Therefore, the patient was emotionally prepared for complications in both ears.
However, after the surgery, he developed complete hearing loss. Unfortunately, medical practitioners and researchers cannot explain the reasons for post-operative hearing loss due to the lack of knowledge about this problem. The patient is a 56-year old Hispanic male. He works as a teacher in a high school. His close family includes a wife and two teenage children. During the examination in the doctor’s office, the patient emphasized his concerns about the possible surgery complications that could lead to hearing loss. Specifically, he said that if there was a significant chance to become completely deaf, he did not want the surgery. However, the doctor assured him that such a scenario was almost impossible as the procedure would be performed only on one ear.
This was the first assumption that had led to the situation. The doctor should have carefully examined both ears, but he did not do that because the patient complained of the symptoms only of the left ear. The second wrong assumption was made by the surgeon who decided to perform tympanoplasty on the right ear without having the patient’s permission. He assumed that it is necessary due to medical conditions. However, the surgeon did not take into consideration non-medical aspects, specifically the patient’s preferences. These two assumptions were the main factors that had influenced the wrong decision. It is important to identify such assumptions to develop a proper decision-making model. Therefore, all the decision-makers are identified. These are the physician who failed to identify problems with the right ear, the surgeon, and the patient.
However, certain aspects need to be clarified. The first aspect is the reason that led to complications. Although the real cause is very difficult to identify, as mentioned above, it is important to rule out the possibility of a medical error. The surgeon who performed tympanoplasty should provide a report on the case. Also, he should be interrogated to discuss this issue in detail. It is necessary to make sure that he performed the surgery professionally. The competence of medical specialists is crucial in such cases. Also, other clinicians who assisted in tympanoplasty should be questioned as they can provide pertinent information. Finally, it is necessary to review relevant literature to identify all the possible factors that might have led to such a complication. The second aspect is the initial diagnosis. The physician could not detect problems with the right ear. It is necessary to determine whether he adhered to the protocol of examination or not. Again, the professional competence of the involved clinicians plays a key role in resolving the issue. The reasons why the physician did not diagnose chronic otitis media in the right ear should also be documented.
Also, it is necessary to review the underlying ethical principles. Several principles might be applied to the case. The first one is beneficence (Levine-Ariff & Groh, 1990). The surgeon decided to apply this principle as he intended to improve the patient’s outcomes. Another important principle is veracity because it is necessary to make a decision that conforms to facts.
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The next step is to define alternatives. First, the surgeon could have performed tympanoplasty only on one ear as it was initially recommended. Every surgery is dangerous to a different degree, and thus should not be done without the patient’s permission. Therefore, the main benefit of this alternative is that the patient’s rights would not have been violated. However, this alternative has certain disadvantages as well. First, the disease might have been cured. Second, in case if the surgery had been successful, the patient would have been satisfied with the surgeon’s decision.
The process that might have been used with the chosen alternative could have included several steps. The first step is to explain to the patient about the problem with his right ear. The second step is to start non-invasive treatment. The third step is to assess the effectiveness of the treatment and depending on its outcomes, decide on the necessity of tympanoplasty.
The role of the nurse, in this case, is also crucial. First, the patient needs emotional support. The complications that he developed were extremely serious and undermined his spirit. Therefore, before making any decisions, the patient should restore his emotional balance, and nurses can assist in it. Second, as nurses work with patients much closer than doctors, they have more opportunities to influence their decisions. However, the most important role of a nurse is to be a patient’s advocate. The nurse can promote the patient’s interests within the medical settings. As nurses have professional knowledge and experience, they can consult patients on all the possible options and help to choose the most effective one. Also, nurses can influence the decisions of doctors as they know about patients much more than other clinical personnel. Therefore, nurses can advocate the patient’s preferences and enhance their collaboration with doctors.
6 complications related to tympanoplasty. (n.d.). Web.
Levine-Ariff, J., & Groh, D.H. (1990). Creating an ethical environment. Nurse managers’ bookshelf a quarterly series: 2:1. Baltimore, Maryland: Williams & Wilkins.
Tympanoplasty: What to expect at home. (2017). Web.