Chapter 11: The ethical mental health nurse

Case Study: Community mental health nurse

Sean lives with Joanne and their three young children, Zac, Lucy and Ben. You are Sean’s community mental health nurse and have been supporting Sean and his family since his discharge from hospital. Sean had been admitted to hospital on section 2 of the MHA following a period of psychotic depression which commenced after he was made redundant from the insurance company he had worked for since leaving school 15 years earlier. He had been treated with antipsychotic medication but states that he feels better wants to stop taking the tablets as he feels that he is ‘over it’. Sean’s partner, Joanne, intercepts you as you get out of your car. She tells you that Sean hasn’t been taking his tablets and has been reluctant to go to bed at night because he is fearful that somebody will break into their house and murder them all in their beds during the night. She pleads with you not to tell Sean that she has told you this and asks you to persuade him to start taking his medication again. Joanne is aware that a major side effect of the medication is tiredness, but asks you to keep this information from Sean, otherwise he will refuse to take it and he is scaring the children by his behaviour. What do you do?

There are a number of ethical principles at stake here – what do you think that they are? 

› Possible answer

We, as nurses have a duty to care. We also have to tell the truth and remain professional. Sean is our ‘patient’, but we need to care for the family.

Think about the ethical issues. Here are three, but there are many mores:

Autonomy: For Sean to be able to make autonomous and self-determining decisions, he needs to have the information that enables him to consent to treatment, (informed consent).  

Confidentiality:  Should you ‘let on’ that Joanne has told you that Sean is not taking his medication?

Safeguarding: Sean has three very young children who are frightened that they will be murdered in their beds when they go to sleep. However, Sean is a loving and protective father, who loves his children.

Paternalistism: could you and Joanne be accused of overprotecting Sean? It’s important to help him to make healthy choices her himself.

Consequentialism: Consequentialist moral theories are concerned with assessing the consequences/outcomes of actions and omissions (e.g. Pettit, 1991; Hooker, 2000). Broadly speaking, a typical consequentialist holds that an action/omission is morally right if it produces good consequences. Hence, could it be said that telling a lie/omitting to tell Sean that his medication would make him sleep could be justified as the good consequences of such an action outweigh the perceived dishonesty?