The licensed practical/vocational nurse is caring for a client at a clinic who reports his concern that three of his brothers died from a brain aneurysm
His physician has ordered a computed tomography (CT) scan but his insurance will not authorize this test to determine if he has an aneurysm because he does not have any headaches. The client believes this is an ethical dilemma because if he lies, he gets the treatment paid and possibly waste insurance money to find out it was not necessary. He could go along with the insurance's rules and wait until he has a headache with the risk of dying from an aneurysm. Which should the nurse suggest to the client?
A) "Discuss the situation with your physician and have him write an appeal to the insurance underwriters stating the reasons why you should have the procedure and e-mail the form to them to expedite the process."
B) "You should take the situation to the hospital board of ethics and let them make a decision, and if they believe it is wrong for insurance to withhold treatment, they will permit you to receive the treatment."
C) "You should just lie and say you are experiencing the worst headache in the world, and insurance will cover the CT scan, and you will find out if you have an aneurysm or not, and if you have one, the physician can repair it."
D) "If you are not experiencing a headache, then you don't have an aneurysm, and the insurance company knows this based upon statistics, and they would never try to harm an individual and refuse treatment to save costs."
Ans: A
Feedback:
The client is facing an ethical dilemma he identified: having to lie to get diagnostic testing that may not be needed or waiting until he has a headache and risking his life if the aneurysm ruptures. The nurse should have the client discuss the situation with his physician so an appeal may be made because the client has not had any headaches, and the insurance company needs to be made aware of the high probability that the client may have an aneurysm, so he may receive the diagnostic test before having a headache. The client does not need to take the matter to the hospital board of ethics because they have no authority to make insurance pay, and the hospital will administer the test without insurance paying for it, if the client wants. The nurse should not tell the client to go against his moral convictions and lie. The client would not have brought up his ethical dilemma if he believed it to be alright to lie and get the procedure. The nurse gives false assurance by stating that statistics is what drives insurance underwriters' decisions, so the client not having a headache equals no aneurysm.
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