Intersection of Ethical, Legal, and Professional Issues in Patient Care - Case Study Example

JIGNESH CASE Introduction The case of Jignesh shows an intersection of ethical, legal, and professional issues in patient care. The operation of a healthcare professionals and their relationship to the patient is governed by high decree of ethical, legal and professional aspects that have to be observed from time to time. As will be found in the Jignesh case, ethical, legal and professionals issues surface in different ways. The problem Jignesh is brought to hospital diagnosed with septicemia. Apparently, the condition of Jignesh deteriorates and has to be admitted to the ICU after he had been admitted to the hospital for treatment of leukemia which presented red and inflamed PICC line. From the case study, it is evident that Jignesh understood his medical conditions well but at the same time he was in a dilemma because his wife also depended on his as she had cancer. There are ethical, legal and other professional issues that arise in the course of treatment of Jignesh as will be reviewed below. Ethical Medical practitioners are supposed to observe a number of ethical issues in their day to day practices (Kerridge, Low, & McPhee, 2005). Different ethical issues that may arise in the course of medical services include protection of patient rights and autonomy, minimizing risk, informed consent, caring for families who are misinformed, and many others. In the case of Jignesh, the major ethical issue that arises is Jignesh was denied his medical preferences. According to Becky, Jignesh was very much aware of his medical conditions and he wanted to the cardiac surgery so that he could live more than his wife to take care of her. It is evident that doctors had indicated a 50-50 chance of recovery from the surgery but Jignesh was ready to take the risk so long as it would give him prolonged life to take care of his wife. In addition, it is ethical to make patients become aware of medical procedures they are supposed to undergo with a good explanation of why they have to undergo those procedures. As Becky learned, Jignesh was not aware of NFR order against him. Neither Jignesh nor any of his relatives had been involved in making the NFR order against him. Legal Legal issues in patient care can be described as those issues that may result to legal implication for the medical practitioner (Kerridge et al., 2005). In the case of Jignesh, there are a number of legal issues that surfaces. First, there is evident inadequate assessment of the patient. There are conflicting reports of the patient being admitted to the ICU while he is classified as NFR. This means that there was conflicting and inadequate assessment of the patient. Second, there is inadequate communication. In this case, the case of NFR goes undocumented by the Oncologist and it is the nurse on duty who inscribes it in the report using a pencil. Third, when the patient heart rate dropped to 42bpm, intravenous atropine was not order to treat the condition because the patient had been documented NFR. These incidences could as well be treated as medical errors that could have cost Jignesh his life. Other clinical problems Other clinical problems that arise from the case include the problem of risk that Jignesh wants to take upon his life to undergo cardiac surgery. Although doctors have advised against the procedure because there are 50-50 chances of survival, Jignesh wants to undergo it to outlive his wife and take care of her. Fundamental Ethical Principles Principle Explanation Autonomy: This is the right of the patient to make their own decision regarding their medical care without being influenced by healthcare care providers (Kerridge et al., 2005) Jignesh autonomy was interfered with because he was not given the freedom to make choice his medical preferences. Becky stated that Jignesh was very much aware of his medical condition but healthcare providers were not sensitive to his medical preferences. He wanted to have cardiac surgery procedure despite the risk involved in it but doctors had denied him this procedure Beneficence: This principle outlines that it is the duty of the medical practitioner to do good for the patient (Kerridge et al., 2005) The case study reveals that Jignesh beneficence was upheld because the medical procedures that he underwent brought him back to his feet. Although there were conflicts on the medical procedure, the aim of the medical practitioners was to do good to him and this was evident after he recovered from his condition Non-Malfeasance: This principle always conflict beneficence but it stands for the need to “do no harm”. It means that an proposed medical procedure administered to a patient must do no harm (Kerridge et al., 2005) There were incidences where this principle was breached. Jignesh had earlier been admitted to hospital for treatment of leukemia but later his PICC line became red and inflamed to an extent that he had to be taken to the ICU. This means that the initial medical procedure did more harm to Jignesh than good. However, the consequential medical procedures were all found to do good which means the principle was upheld. Confidentiality/Privacy: The two principles entail how patient information is given and consequently utilized. Both principles uphold that patient information should be treated with required secrecy and should be used for medical purposes only (Kerridge et al., 2005). In the case scenario, both principles were upheld because Jignesh information was not shared to any third party. There was high level of privacy and confidentiality with his information. Veracity: This is the principle of truthfulness essential for informed consent and respect of autonomy (Kerridge et al., 2005). This principle was breached because not all truth was revealed to Jignesh. As Becky learned, Jignesh had not been informed of his NFR order that had been given against him. It means that some information about his treatment had not been revealed to him or to his relative. Advocacy: This principle is held in the belief that many patients do not have a voice in their own healthcare and therefore healthcare care professionals should look for the wellbeing of the patient (Kerridge et al., 2005). In this case scenario, there are instances where the principle was upheld and others breached. Becky comes out as an advocator of Jignesh healthcare. Becky clearly outlined that other healthcare practitioners were not sensitive to his medical preferences. However, one of the nurses breached this principle arguing that they were following doctors’ orders whether they were right or wrong. Law and professional nursing standards In this case scenario, there were a number of law and professional nursing standards that comes into surface (Ferrell et al., 2001). One of the legal and professional nursing standards that come into surface is the issue of NFR. There were conflicting ideas on the NFR status of Jignesh because he had been admitted to the ICU while it was evident that he was NFR. In the discussion between Sue and Becky, it becomes evident that Sue was upholding the NFR status just because the doctor had indicated so, which means as a nurse, he cannot make any decision regarding the patient and just want to follow orders even when the orders given are likely to be incorrect. Furthermore, when Jignesh heartbeat dropped to 42bpm the resident and clinical nurse on duty did not give intravenous atropine because the patient was indicated NFR even though they questioned why the patient had been transferred to the ICU. This shows professional conflict for the nurses. How the problem could look from another perspective The main stakeholders in this case were the patient, the hospital, nurses and doctors. The interest of the patient was to get well and go back to take care of his wife. This means that Jignesh would have liked to undergo cardiac surgery so that he can live longer and take care of his wife despite the slim chance of a successful cardiac surgery. On the other hand, the interest of the hospital was to take care of the Jignesh so that he can recover and go back home. He has more to lose in this case including his life. Although law empowers him to make decision about his treatment, this is limited by the limited information he gets. His problem is urgent because he needs to recover and go back to hospital. The hospital is also interested in the financial income it will get from Jignesh but also wants to uphold the quality of healthcare services offered. The main interest for nurses here is to take care of the patient according to the instruction given by the doctor. This means that their interest in this case is limited by the medical prescription to be given by the doctor. Nurses are powerful in that they determine the success of the care plan given by doctors. Their urgency is to see the patient stabilize. The other players are doctors who are treating the patient. Their interest is to see the patient recover and improve in health. They are the most powerful stakeholders here because they determine the direction treatment will take. Their power is legitimate in that their treatment plan is taken to be final. Ethical conflicts in the study There is an ethical conflict in the scenario regarding Jignesh treatment. He has been proposing to have a cardiac surgery to prolong his life. From an ethical point of view, he feels that he needs this surgery in order to live longer and take care of his wife. However, doctors think that the surgery is quite risky as it has 50-50 chances of success and therefore they have denied him the services. This conflict may be resolved by explaining to Jignesh the risk associated with the surgery and allow him to make his final decision whether to take on the surgery or not. From ethical and legal perspective, the patient has the right to make decision regarding the services he receives but at the same time the principle of Non-Malfeasance states that doctors must always do well (Johnstone & Turale, 2004). This means that the procedure to be recommended by the doctors must not do harm to patients (Wakefield, 2007). These principles can give guidance on the need to allow patient to make the decision under informed consent. Ethico-legal decision The main ethico-legal decision to be made here is whether to allow Jignesh to undergo cardiac surgery or not. The decision not to allow him undergo the procedure was made in light of the risk involved in the procedure under the guiding principles of beneficence and non-malfeasance. To help the stakeholders make an action plan, I would communicate this decision through giving stakeholders information about the condition and the guiding principles that pertains to the issue. Bibliography Ferrell, B., Novy, D., Sulivan, M., Banja, J., Dubois, M., et al. 2001, Ethical dilemmas in pain management, The Journal of Pain, 2(3), 171-180 Johnstone, M. & Turale, S 2004, Registered and enrolled nurse experiences of ethical issues in nursing practices, Australian Journal of Advanced Nursing, 22(1) Kerridge, I., Low, M. & McPhee, J 2005, Ethics and law for the health professions, The Federated Press, Annandale Wakefield, J 2007, Patient safety: from learning to action, Queensland Health, 2007 Read More