A Nurse Takes a Stand—and Gets Arrested

image via Wikimedia Commons / Jacklee

Douglas P. Olsen, PhD, RN, associate professor, College of Nursing, Michigan State University, writes about ethical issues for AJN.

On July 26, Alex Wubbels, charge nurse at the University of Utah Hospital burn unit in Salt Lake City, showed extraordinary ethical courage that will serve as an example for my students for a long time to come. She refused a police detective access to an unconscious patient so he could draw a blood sample, citing clear violation of hospital regulations, which require patient consent, a court warrant, or that the patient is under arrest. After a short, tense discussion, she was roughly handcuffed and put in a police vehicle by the detective. I recommend watching the video of the incident, although parts of it are quite disturbing. According to various analyses reported in the media, the hospital and Wubbels were legally correct and the detective’s view of her legal obligations was wrong.

All treatment, even the most minimally invasive, can be refused by a patient and therefore requires the patient’s informed consent. There are limited exceptions under which treatment can be provided without patient consent. These include:

  • When the patient lacks decision-making capacity
  • When the patient is dangerous and has a mental disorder
  • An emergency in which treatment is needed to save life or limb and the patient is unable to consent
  • A public health situation in which the intrusion to the individual (via quarantine or mandatory vaccination, for example) is outweighed by the public benefit
  • Therapeutic privilege (this is when a decision is made to not tell a patient their diagnosis)

Each exception has specific protections in place to ensure ethical decision-making. For example, when a patient lacks the capacity to make a decision, an appropriate surrogate decision-maker is identified.

In Wubbels’s case, none of the aforementioned exceptions seem to apply. Therefore, a blood draw which was not for therapeutic benefit—and which lacked consent or legal authorization—was improper.

From an ethical perspective, a nurse should not draw blood simply for forensic (not therapeutic) value without consent. In general, nurses should be careful to understand their ethical obligations whenever they are involved in procedures not being done for therapeutic value; research is one common situation.

Aside from the question of legal consent, this incident has ethical resonances. First, kudos to Wubbels, who understood her obligation to the patient, ensured that she was supported by hospital policy, and stuck to what was right despite considerable bullying—even before being physically assaulted. She did the hard thing because it was the right thing. It would have been easy to comply with the detective’s request.

Wubbels’s attorney said that the detective believed the patient’s blood could be drawn under “implied consent.” However, implied consent is an ethically dubious concept, and it certainly would not apply here. Treatment situations can be handled through explicit or substitute consent without resorting to assuming consent. One problem with implied consent is that there is no assurance that the consent is informed. Although not all nurse–patient interactions require an explicit informed consent discussion, the nurse is obligated to ensure that the patient knows what is going on and agrees to it.

This incident highlights the value of having policy in place in anticipation of such situations. (It also underscores the value of good communication, as well as the ability to de-escalate situations and to negotiate.) Wubbels’s behavior and the hospital’s policy create a forceful argument for attention to the ethical aspects of care, and for solid ethics education.

Nurses everywhere can draw inspiration from Wubbels and her confidence and use the incident as a lens for self-reflection on our own behavior in difficult circumstances—and as a model for how to behave in the future.

2017-09-02T09:55:06+00:00 September 2nd, 2017|Ethics, Nursing|11 Comments

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11 Comments

  1. Wendie Howland MN RN-BC CRRN CCM CNLCP September 9, 2017 at 4:58 pm

    I just reviewed a copy of a nurse practice act from another state. It states explicitly that a nurse ordered to draw a sample from a patient by any police officer must comply, with no exceptions, i.e, there is no requirement for warrant, arrest, or consent. I find this appalling. All RNs should go online and review their nurse practice acts to see if they are compelled to perform unethical behavior by the entities that issue their licenses. Then do something about it.

  2. Sharon Delp, CRNA September 8, 2017 at 5:59 pm

    I agree with Wendy Howland – my takeaway from this incident was one of sexism and bullying. He was assaulting a PROFESSIONAL who had obligations to sick patients. And the security guards did nothing? And those white shirt guys wimping around with “administration is on their way”?

  3. Lisa Eason September 5, 2017 at 6:18 pm

    This situation, minus the assault, with the police wanting records or a procedure, happens fairly often across the country. Some police are offended and can become quite verbally aggressive. From what I have witnessed, most often nurses don’t even know the policy and if they do, they capitulate to police without objection. This is a problem.

    Second, this type of aggression is just a spill over from the types of police aggression that some police have been exhibiting across the country. The ANA is in a perfect position to influence the conversation about about police aggression, since we are often the ones dealing with the fall out from it, as it relates to patient defensiveness and self protection in the hospital. It takes patients a long time to build trust with staff when they have been abused and it is our obligation to speak up when we see it, no matter who the recipient is.

    Lisa Eason RN

  4. Barbara Cwik September 3, 2017 at 7:51 pm

    This nurse was physically assaulted and the policeman should be arrested.

  5. Wendie Howland MN RN-BC CRRN CCM CNLCP LNCC September 3, 2017 at 8:13 am

    I have posted this elsewhere but it bears repeating: not one other hospital employee or security guard lifted a finger to help her even as they heard the hospital policy clearly explained to the assaulting officer, nor did his partner who had pointed out no probable cause for warrant and that this “arrest” would not stand. Would he have assaulted a hefty male charge nurse or demeaned him as “young man”? Doubtful. Shameful that this officer received no discipline whatsoever until this video came out. Sexism is apparently still a police value in Utah. Wendie Howland MN RN-BC CRRN CCM CNLCP LNCC

  6. Gilbert James September 2, 2017 at 11:20 pm

    Congratulations and commendations to the courageous and dutiful nurse Wubbels. You are a bulwark, example and model for ethical nurses universally! This cops actions and the actions of his ilk who act above and beyond the law without respecting life and limb will result in anarchy and non-cooperation with good, ethical and law-abiding cops!

  7. Robert Martin September 2, 2017 at 11:06 pm

    So far, I have not seen ANYone defend the officer’s actions in the incident? Does that tell us something?

  8. Leslie Kern September 2, 2017 at 5:01 pm

    This is a wonderful article to read. Thank you. Unfortunately as a nurse we still have to cope with violence, bullying, and abuse while providing care and protecting our patients. Alex is a beautiful role model for all nurses. I am hoping she wins a national award in nursing. She maintained a professional environment while attempting to protect her patient. Unacceptable behavior from the ‘officer’ could have surely made her lose her composure. I feel badly she had to suffer this, however she did persevere and reminded us all as to how important our patients rights are. Leslie Kern, RN in Pa.

  9. Marcia Levin RN September 2, 2017 at 12:19 pm

    As a nurse who works with trauma patients I at first thought this story to be fake news. I could not understand how anyone who is not a hospital employee could barge into a critical care floor to do a procedure that is without a RX. Where were the hospital administrators, doctors and security when this occurred? Something is missing in this story.

    I hope this story continues to surface and nurses discuss it. Too often I see many types of individuals in the icu obtaining consents and providing services to folks who should not be available

  10. Robert L. Abare Jr. September 2, 2017 at 11:34 am

    To be very honest I would hope she would be able to sue this cop (not to be confused with other police officers who have a brain) to the point of, forever being on the street and penniless for the rest of his life. If he does not have the education to understand that, what he is about to do is WRONG, He is in the WRONG Uniform and can never be educated enough to do his job properly, without giving REAL police a bad rap.

  11. Beth Anne September 2, 2017 at 10:59 am

    Thank you for this insightful commentary. I am very proud of Nurse Wubbels. She embodies the spirit of nursing. Something else related to Patient Rights that has bothered me my whole career: What about the patient who has decision making capacity, but is unable to verbalize or write? There was almost always at least one in my ICU on any given day. They were either intubated with peripheral lines and/or edema, injury, illness or other reasons. Nurse staffing ratios left us little time to use alphabet boards, use them for their participation in their plan of care or even assess location and type of pain. Were we meeting spiritual concerns? There is now a company that makes the eyegaze technology used throughout the world for ALS and similar patients that is making one for facility use, complete with a real time eye-follower that stays focused on the patients’ eye while the patient is sliding down in bed. The patient can choose to look at phrases, or type on a keyboard just using their eyes. If we fail to provide access of this device to patients with decision making capacity but inability to write or verbalize, isn’t that a violation of Patient Rights? http://www.eyegaze.com/users/

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