Healthcare professionals are constantly confronted with situations in which they have to make decisions with legal and ethical ramifications. They are constantly confronted various options to choose from, leading to dilemma (de Casterle et al, 2008, p. 540). The choices made by a health professional may lead to conflict with the decisions of others in the same team. This paper presents an analysis of a case in which medical professions are confronted with a situation in which they are required to make crucial ethical decisions regarding the treatment of a patient.
Problems identified in the case study
| Ethical Issues |
|
This is evidenced by the conflict regarding the appropriate treatment to be provided to Emily. This is evidenced by the extent of care and support provided to Emily by Sue. Derogatory comment by Sue about oldies people to let them die when it’s their time. |
| Legal issues |
|
There lacks specific documentation of patient’s stages of illness. Failure to observe a patient and take vital signs at appropriate interval. There is limited attention to emotional aspects of end-of-life care evidenced by lack of communication of patient’s health status with patient and family members. Sue delegated Ben to give Emily’s medications. |
Adherence to the fundamental ethical principles
| Principle | Explanation |
| Autonomy Autonomy implies the ability to make own decisions without infringement or coercion from others to make those decisions. (Woodward, 1998, p. 1049). |
In this case, it is evident that Sue breached this principle by failing to provide Emily with such information. She decided to treat her with painkillers and never took time to listen to what she wanted. That way, she breached the principle of autonomy. |
| Beneficence According to Finkelman & Kenner (2012, p.181), beneficence it refers to doing something good and taking care of the patient which by all means is far beyond physical care and encapsulates awareness of patients situation and needs. |
Evidently, Sue did not act in the best interest of Emily in this case. After realizing that her temperature and pulse rate had risen, she advised Ben to give her panadol, a pain killer. She excused herself as being too busy to be able to make further examinations. Despite Emily’s deteriorating health condition, Sue did not take steps to inform June or the doctor. She dismissed her as being suffering from cold. Only after doctor’s examination that it was realized that Emily was diagnosed with urinary track infection and septicaemia. Generally, it is clear that Sue failed to act in the best interest of Emily and thus, violated the medical principle of beneficence. |
| Non-maleficence This principle is summarized by the famous doctrine ‘primum non nocere’ which when translated means ‘above all, do no harm’ (Kerridge, Lowe & McPhee 2005, p.52). |
Sue violated the principle by assuming that Emily was suffering from cold and then prescribed panadol, a pain killer to her. The painkillers were difficult for Emily to swallow and could harm her. |
| Veracity According to Finkelman & Kenner (2012, p.181), this means truth. Pertinent information regarding the patient is more crucial for ultimate treatment (Finkelman & Kenner, 2012, p.181). |
Sue lied to the doctor that she had taken observations on Emily in the morning and that she was well. However, Ben, who was around most Emily most of the morning confirmed to June that Sue had not taken the observations. By giving false information, Sue violated the principle of veracity. |
| Advocacy States that a nurse should stand for patients in ensuring that they get what they are entitled to get and their rights are well addressed (Kerridge, Lowe & McPhee 2005, p.285) |
In this case, the principle of advocacy was upheld. June advocated for Emily when she asked Sue about Emily’s recent condition. |
Adherence to law and professional nursing standards
Laws and professional nursing standards in Australia are developed by a national nursing and midwifery organization known as the Australian Nursing and Midwifery Council (ANMC), in conjunction with the state organizations. The performance of medical personnel is assessed against these standards in order to obtain or retain license. Among other issues, professional standards require nurses to fulfil duty of care by performing nursing interventions in accordance with the recognized standards of practice (ANMC 2005).
The Code of Ethics for Nurses in Australia, Value Statement 5, requires nurses to always “conduct a comprehensive and systematic nursing assessment of a patient’s health status. Value statement 7.2, requires them to “provide nursing care according to the documented care or treatment plan” (ANMC 2005). Additionally, value statement 1 requires nurses to fulfil duty of care for all patients by providing them with quality care and preventing harm on them (ANMC 2008). According to value statement 6 requires nurses to plan nursing care in consultation with patients, family members, significant others and the relevant health care team.
In this case, Sue breached the above standards by failing to conduct comprehensive and accurate assessment of symptoms of Emily’s illness. She did not record observations of stages of her illness. She also failed to inform June and the doctor regarding Emily’s deteriorating health condition. On top of that, Sue administered wrong treatment to Emily, which could cause harm. She ignored informing the family members of Emily about her health status. Generally, Sue’s conduct constitutes negligence and malpractice and may be sued in a court of law.
How the problem would look from another perspective
In this case, Sue believes that Emily is in the face of inevitable death given her age and thus, further medical care is futile. She believes that Emily only requires comfort and pain killer to keep her alive. The professional standards of care allow for futile medical care for patients who are in the face of inevitable death, but some guidelines are provided (Curtin, 2005). In such situation, choosing and informing the patient and the family members or significant others is not easy and may require procedure. This may justify the conduct of Sue by withholding information from the other health professionals, Emily and her family members.
Apart from Sue, there are other stakeholders who have interest to Emily’s health condition. They include Emily herself, her family members, nurses and doctors. All of them are interested to understand cause of the deteriorating health condition of Emily. Their concerns are significant since they have right to be informed. They are also legally allowed to access information about Emily’s health condition. From an ethical point of view, the conduct of Sue would be acceptable to the extent that she plan the procedure to inform other health professional involved in her care and family members.
Ethical conflicts identifiable in the case study
In the case study, June faces ethical conflict from Sue, who holds different values regarding the care and support that should be provided to Emily. As well, there is ethical conflict between Ben and Sue regarding the quality of overall care administered by Sue to Emily. There is also ethical conflict between treatment options, whether to provide Emily with medical care of futile medical care. This is brought about by the conflicting values of the care providers.
These conflicts may be resolved if all the parties involved accept to be guided by the ethical principles of nursing including beneficence, autonomy, non-maleficence, advocacy and veracity (Toren & Wagner 2010, p. 393). These principles can guide nurse managers to make solutions when nurses collide and to ensure that the rights of patients and those of nurses are respected.
The relevant legal concepts in the case study are negligence and malpractice. These concepts are expressed by the tort law, the law of contract and in the criminal law, both at federal and state level. These laws can help nurse managers to ensure that the rights of patients to care are observed and the rights of nurses are also observed (Toren & Wagner 2010, p. 396).
Ethical-legal decisions
In the case study, the decision that needs to be made is to compel all health professionals in the nursing home to respect and conform to the ethical, legal and professional standard guidelines of medical practice (Curtin, 2005). In this case, the guidelines were balanced eventually. Sue’s conduct in her care for Emily seemed to completely contradict these guidelines initially but this perspective changed after it was realized that Emily has a serious disease that can lead to her death.
According to Queensland Health Clinical Incident Management Implementation Standard, Severity Assessment Code 1 the first step in communicating such decision is to open a formal open disclosure meeting with the patient and her family members and to discuss with them about the clinical incident report (Queensland Government, 2009, p. 13). This should be followed by a formal open disclosure meeting with the clinicians involved to debrief them about the report. A third meeting should be planned, which should include the patient, family members and the clinicians involved to discuss the same issue.
The meetings’ debrief should be documented and communicated to other relevant stakeholders such as the management personnel. The documented report on the meetings’ debrief should be communicated back to the selected open disclosure team which should summarize any commitments given and how they should be followed up., The lessons learned from the clinical incident should then be communicated to the patient, to family members and to clinicians involved. There should be a follow up on the outcomes agreed. Finally, the patient, family and the clinicians involved should be provided with additional support where necessary (Queensland Government, 2009, p. 13).
Conclusion
In conclusion, the case study demonstrates how health professionals are confronted with situations in which they are bound to make choices among various ethical decisions. They are faced with dilemma due to the huge impact of any decision made. Some times, they make decisions that are contrary to ethical, laws and professional standards of care. This may lead to conflicts with the stakeholders involved. In such situations the requirements of ethical legal and professional standards should prevail.
References
Australian Nursing & Midwifery Council 2005, National Competency Standard for the Registered Nurse, Dickson ACT, viewed 20 October 2012, <http://www.anmc.org.au/userfiles/file/competency_standards/Competency_standards_RN.pdf>.
Australian Nursing & Midwifery Council 2008a, The Code of Ethics for Nurses in Australia, Dickson ACT, viewed 20 October 2012, <http://www.nrgpn.org.au/index.php?element=anmc+code+of+ethics>.
Curtin, L 2005 “Patient wishes and futile interventions”, viewed 20 October 2012, <http://healthcaretraveler.modernmedicine.com/healthcaretraveler/FAQs+about+Healthcare+Travel/Patient-wishes-and-futile-interventions/ArticleStandard/Article/detail/154100>
de Casterle´, D B; Izumi, S; Godfrey, N S & Denhaerynck, K 2008, “Nurses’ responses to ethical dilemmas in nursing practice: Meta-analysis”, Journal of Advanced Nursing, Vol. 63, Issue 6, Pp. 540–549.
Dempsey, J, French, J, Hillege, S & Wilson, V 2010, Fundamental of nursing and midwifery a person-centred approach to care, Lippincott Williams & Wilkins Pty Ltd, Broadway, NSW.
Finkelman, A & Kenner, C 2012, Professional Nursing Concepts: Competencies for Quality Leadership, Johns & Bartlett Publishers, Massachusetts, Vol. 2, Issue 3, pp 171-180.
Kerridge, I, Lowe, M & McPhee, J 2005, Ethics and Law for the Health Professions, Federation Press, Australia.
Toren, O & Wagner, N 2010, “Applying an ethical decision-making tool to a nurse management dilemma”, Nursing Ethics, Vol. 17. Issue 3, pp. 393-402.
Woodward, V M 1998, “Caring, patient autonomy and the stigma of paternalism,” Journal of Advanced Nursing, Vol. 28. Issue 5, pp. 1046-1052.
Queensland Government, 2009, Queensland Health Clinical Incident Management Implementation Standard, viewed 20 October 2012, http://www.health.qld.gov.au/qhpolicy/docs/imp/qh-imp-012-1.pdf
