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Education And Debate

An Ethical Dilemma: A nurse is suspended

BMJ 1996; 313 doi: (Published 16 November 1996) Cite this as: BMJ 1996;313:1249
  1. John M Kellett, consultant geriatriciana
  1. a Department of Geriatric Medicine, St George's Hospital Medical School, London SW17 0RE

    A day hospital sister was suspended and given a final formal warning for obeying the request of her consultant to give a patient tranquillising medication in disguise. Though a disciplinary inquiry exonerated the consultant, the action on the nurse has not been rescinded. This case questions the authority of the multidisciplinary team and the role of nursing managers. We asked two geriatricians and forensic scientists to comment on the case.

    The case

    WP was a 91 year old widower recently admitted to an old people's home. Although normally pleasant, he showed unpredictable aggression. Some days he was unusually bombastic but returned to normal the next day after a long sleep. Doctors thought that this might indicate temporal lobe epilepsy, but as he correctly pointed out he had never had a fit, and he refused electroencephalography or anticonvulsant drugs. He was cognitively intact and physically strong, although arthritis meant that he needed a Zimmer frame to walk.

    He was near to being expelled from the home when he was persuaded to attend a day hospital for elderly people. He spent the first two weeks making model houses to collect money for charity. On 14 August he arrived at the day hospital in buoyant mood. During the day his mood varied from determined volubility and grandiosity to irritability and impatience. At 3 pm he was invited into the ward round, when he firmly declined the offer of admission or a tranquilliser. The team felt he was hypomanic and unsafe to return to his home without treatment, and …

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