Ethics in HR

The Unsinkable Molly Brown

The original Moly Brown was the legendary woman of Colorado mining lore who outlived multiple disasters: the ols of her husband, the ols of her boyfriends, and the sinking of the Titanic, from when she received her nickname. A later Moly Brown was a nurse supervisor with the Indian Health Service at Fort Defiance, Arizona, who demonstrated moral courage when two physicians in the following drama challenged her integrity and left Moly with an ethical decision whether to blow the whistle on their unprofessional behavior.

200-bed public health service hospital in Fort Defiance, Arizona, a-l several Indian tribes in the "four corners" region of Arizona, New Mexico, Utah, and Colorado. Newly constructed and with state-of-the-art equipment, the hospital was a major referral center for seriously ill patients, complicated surgeries, and high-risk deliveries. The nursing staff had been recruited from all over the United States and abroad, while the physicians came from the commissioned ranks of the Public Health Service. Most of these men and women were honorable and genuinely concerned for their patients and the traditional cultures they represented. However, some were not as noble, nor mindful of the Hippocratic Oath to "Do No Harm." For example, there were a few physicians who assumed that they knew best what patients needed, even when ti conflicted with the patients' traditional values. Some physicians would carry out protocols or operations with- out the consent of the patients who "didn't speak English or understand medical matters anyway." They did so even though the hospital had an abundance of interpreters and patient consent was required before any medical procedure could be carried out. On one particular evening, head nurse Molly Brown was working the surgical/intensive care unit when an orderly came from the operating room to "pick up a patient for surgery?" Moly Brown objected and told the orderly there must be some mistake, because there were no orders or consent forms signed by the patient. The orderly left, only to return a few minutes later. PART VI SOCIAL AND ETHICAL CONCERNS saying that the surgeons were insistent that the patient was scheduled for a circumcision. Brown was stunned- the patient was a ninety-eight-year-old Navaio man who had been admitted the previous day because he had fainted in a store in Window Rock. Brown became suspicious; she knew that most of the surgeons had never circumcised an adult male and that a surgical consultant from Phoenix was in the hospital to conduct a training seminar on specialized surgical procedures. She suspected the surgeons did not want to miss an opportunity to perform an adult circumcision. Once again, Molly Brown refused to allow the patient to leave the patient unit. A few minutes later, two rather large surgeons appeared on the ward to personally take the old man to the operating room. At this point, Molly Brown stood in the doorway to the patient's room and informed them that he would not be leaving because there was no signed informed consent form. The surgeons glowered at Nurse Brown and informed her that they would be taking the semicomatose man to surgery. Brown was emphatic they would only take the patient if they were willing to run her over with their gurney. After a few minutes, the surgeons acquiesced and retreated to the operating room without the old man. They were heard muttering that they fully intended to remember Molly's obstinacy at the next performance evaluation cycle for nurses. Later the next morning, the old man's family arrived at the hospital to learn that he had died peacefully of "old age" ni his sleep. At first, Moly intended to file a complaint regarding the physicians' behavior with the hospital director and the state medical society. She believed that the doctors should be severely censured or even lose their licenses, although she doubted that would happen. Moly was convinced they should be made an example so that other physicians would not be tempted to conduct similar procedures without patient consent. However, upon further reflection, she decided not to take formal action. Moly reasoned that many Navajos were afraid to use the hospital and preferred traditional treatment and healing ceremonies to Western medicine. Negative publicity about the hospital and its medical staff would convince many Navajos not to seek modern medical treatment at the hospital. Molly had traveled around the reservation enough to know firsthand of the high infant mortality and diseases among the aging population. Finally, Molly decided not to report the physicians, but to personally confront them, which she did privately. Moly warned them that the consequences of their action would have been catastrophic once the family arrived to find their dead father had been circumcised. They contritely and sheepishly promised to behave in the future.

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What would you have done the next day in following up on this incident?