CARN Ethical and Legal Principles 3 — Questions and Answers
Question 1: A patient in a methadone clinic is also prescribed benzodiazepines by an outside psychiatrist. The addiction nurse's ethical duty regarding this information is to:
- Ignore it since the psychiatrist is responsible for that prescription
- Inform the patient of the interaction risk and coordinate care with the prescriber (Correct answer)
- Discontinue the methadone without consulting the patient
- Report the psychiatrist to the licensing board immediately
Correct answer: Inform the patient of the interaction risk and coordinate care with the prescriber
The nurse has a duty to educate the patient about potentially dangerous drug interactions and facilitate interprofessional communication to ensure safe care.
Question 2: Which statement best describes the ethical concept of 'therapeutic privilege' in addiction nursing?
- Nurses may withhold information if they believe it will cause patient harm (Correct answer)
- Patients forfeit privacy rights when entering court-ordered treatment
- Nurses can override patient preferences based on clinical judgment alone
- Treatment providers have legal immunity for clinical decisions made in good faith
Correct answer: Nurses may withhold information if they believe it will cause patient harm
Therapeutic privilege is the controversial and generally disfavored concept that clinicians may withhold information believed to be harmful to the patient.
Question 3: A patient discloses current active child abuse during a substance use treatment session. The CARN's legal obligation is to:
- Maintain confidentiality per 42 CFR Part 2 since it relates to addiction treatment
- File a mandatory report with child protective services immediately (Correct answer)
- Discuss with the patient first and report only if they agree
- Refer the matter to the program's ethics committee before reporting
Correct answer: File a mandatory report with child protective services immediately
Mandatory child abuse reporting laws supersede 42 CFR Part 2 protections, requiring immediate reporting to child protective services.
Question 4: An addiction nurse is aware that a patient's insurance company is denying coverage for residential treatment using outdated clinical criteria. The ethical principle guiding advocacy for this patient is primarily:
- Fidelity
- Justice (Correct answer)
- Veracity
- Nonmaleficence
Correct answer: Justice
Justice requires fair and equitable access to treatment; nurses should advocate when systemic barriers prevent patients from receiving appropriate care.
Question 5: A CARN who is in personal recovery from alcohol use disorder begins working at a substance use treatment center. Which action is MOST ethically appropriate regarding disclosure?
- Disclose personal recovery status to all patients to build rapport
- Never disclose personal recovery status under any circumstances
- Use professional judgment to determine if selective disclosure serves therapeutic goals (Correct answer)
- Disclose only to supervisors but maintain confidentiality with patients
Correct answer: Use professional judgment to determine if selective disclosure serves therapeutic goals
Self-disclosure of personal recovery should be guided by whether it serves the patient's therapeutic interests, not the nurse's own needs.
Question 6: Informed consent for medication-assisted treatment requires that patients receive information about all of the following EXCEPT:
- Benefits and expected outcomes of the medication
- Risks and potential side effects
- Available alternatives to medication
- The nurse's personal opinion about the best treatment choice (Correct answer)
Correct answer: The nurse's personal opinion about the best treatment choice
Informed consent requires objective information about benefits, risks, and alternatives; the nurse's personal opinion is not a required component.
Question 7: A patient who is HIV-positive and in addiction treatment refuses to disclose their status to sexual partners. The nurse's ethical tension exists between:
- Beneficence and justice
- Patient confidentiality and duty to protect third parties (Correct answer)
- Veracity and fidelity
- Autonomy and nonmaleficence only
Correct answer: Patient confidentiality and duty to protect third parties
The nurse faces a conflict between protecting patient confidentiality under 42 CFR Part 2 and the ethical/legal duty to protect identifiable third parties from harm.
CARN Ethical and Legal Principles 3
A patient in a methadone clinic is also prescribed benzodiazepines by an outside psychiatrist.
The addiction nurse's ethical duty regarding this information is to: