A 27 year old nursing student has just graduated and developed a rare and life threatening

illness, a progressive muscular degenerative disorder which causes significant pain. A new
procedure or therapy has been found to improve life expectancy. The physician feels this may be
the best hope for his patient and refers patient for treatment. The patient is low income and has
government assisted health insurance. The medical insurance denies coverage for this procedure
as it is new, experimental, and not covered under the stated policy. It is expensive and although
the company who has this "cure" has discounted the cost, it is still unaffordable for this patient.
The patient states, "I can't believe I am going to die from this because I'm poor." The hospitalist
stabilizes his condition and writes for patient to be discharged. The family is seeking legal advice
to sue the medical insurance, hospital, and physician.
According to the ANA Code of Ethics, the ethical principles that are involved in this case
are as follows: 1.4 The Right to Self-Determination : Patients have the moral and legal right
to determine what will be done with their own person; to be given accurate, complete, and
understandable information in a manner that facilitates an informed judgment; to be assisted with
weighing the benefits, burdens, and available options in their treatment, including the choice of
no treatment.; 2.2 Conflict of Interest for Nurses Nurses must examine the conflicts arising
between their own professional values, the values and interests of others who are also
responsible for patient care and health care decisions, as well as those of patients. Nurses strive
to resolve such conflicts in ways that ensure patient safety, guard the patients best interests and
preserve the professional integrity of the nurse.; and 3.5 Acting on Questionable Practice
When the nurse is aware of inappropriate or questionable practice in the provision or denial of
health care, concern should be expressed to the person carrying out the questionable practice.
Attention should be called to the possible detrimental affect upon the patients well-being or best


interests as well as the integrity of nursing practice. So the nurses job in this case, is to make
sure that she advocates for the patient, and always puts the patients safety first.
Some of the options that apply to this patient are: 1) Talk to the doctor about a possible
payment plan where funds could be raised somehow and paid over a period of time, 2) Find out
if the clinical trials sponsors could cover some of the costs, or 3) Appeal to the insurance
companys decision and write a letter requesting that the case be reviewed again. According to
the Affordable Care Act, you now have the right to ask that your plan reconsider its denial of
payment.If it is eventually turned down, an external review could be done by a third party, and
whatever decision they make will override the insurance companys decision. When speaking
specifically though, Hawaii is amongst the few states that currently do not have any existing laws
or agreements in place regarding clinical trials.
So the ethical dilemma here is autonomy of the patient, because he does want to go ahead
with the treatment procedure, but does not have the financial support to; beneficence on the
Doctors part because all he wants to do is treat the patient; and nonmaleficence on the insurance
companys part because they may cause harm (in this case, death) to the patient, by not covering
the payment of the treatment. The nursing value that could apply to this situation is the value of
Social Justice, which is acting in accordance with fair treatment regardless of economic status,
race, ethnicity, age, citizenship, disability, or sexual orientation. Because our patient in this case
is suffering financially because of just getting out of college and now having to have his own
insurance, he should be treated just as equally as other patients.
In conclusion, our group decided that our patient should appeal to the insurance
companys decision because it is a matter of life or death. He may get approved depending on
how strong his viewpoints are, especially one of them being the fact that his life depends on


whether the insurance will pay or not. Whatever the case may be, this is an ethical dilemma that
needs careful consideration.

Reference
Cherry, B. & Jacob, S. (2011). Contemporary nursing: Issues, Trends and Management (5thed).
St. Louis: Elsevier.



(Attached is our groups powerpoint presentation, which goes more into detail about statistics on
HMSA, medicare, and clinical trials. The powerpoint also contains our list of references, in
addition to the one I have listed above).