You are caring for a 17 year old female African American patient with sickle cell disease

You are caring for a 17-year-old female African American patient with sickle cell disease who has been admitted for treatment of sickle cell crisis.  Sickle cell disease is a genetic abnormality that affects hemoglobin in the red blood cells. The defect is found primarily in African Americans.  In a sickle cell crisis weakened red blood cells clump together and impede blood flow, causing extreme pain.   To prevent stroke and manage pain of the crisis, your patient needs aggressive fluid and comfort management.  Even though she is receiving pain medication around the clock, she continues to report acute pain, a level of 10 on a scale of 0-10.  In her distress, she complains about almost everything:  her roommate, the food and even the intravenous line that delivers the fluids and pain medications.  Her home is far from the hospital, and neither her parents nor her friends are able to visit.  She has an older brother who has been convicted of possession of illegal drugs.

1.  Examine and describe your values and opinions about pain, pain management, and addiction. 

2.  Describe any ethical concerns you might have about this patient’s autonomy. 

3.  How can you apply the principals of beneficence and fidelity in this situation?  What about         nonmaleficence?