late and you enter the patient’s room to find that she has climbed out on the window ledge. She appears to be crying and tells you to leave her alone.

In the abovementioned scenario, the woman on the ledge offers another ethical consideration, contrasting the autonomy of the patient’s wishes to be left alone against the provider’s responsibility for offering care. The patient exhibits clear signs of lacking the necessary components of autonomy. Her actions are clearly not rational and arguably not competent as they are likely indications of mental illness, risk of self harm or even suicide. In this matter, the clear decision is to not fulfill her wishes to be left alone. However, staying in the room or climbing out on the ledge is not a sufficient answer to this situation. This situation needs immediate response: security and police/EMS services need to be notified. Any and all possible means to prevent harm need to be taken.

Beyond the ethical considerations, it is necessary to consider the legal impact of inaction. Had the provider observed the patient’s wishes, he or she would have been liable for any harm that came to the patient (Jenner & Welch, 2001). When a patient is under professional care, it is important for the provider to protect them from harm, even if the harm is caused by themselves as in the case of psychiatric disorders. If the provider fails to reasonably safeguard against actions of self-harm or suicide, he or she will likely be civilly liable for malpractice and negligence (Jenner & Welch, 2001).

Your elderly patient hates to have the bed rails up and tells you to leave them down.

Ethically, this scenario does not offer enough information to conclude if there is a legitimate dilemma: whether or not the patient is autonomous is unclear. The indication of age does not necessarily indicate any potential harm. There is no mention as to whether there are physician orders regarding the matter of the bed rails. The setting of the situation is unclear. More information needs to be obtained before any actual ethical determinations may be made