Ruby: A Fourteen Year Old Girl - Case Study Example

Running head: Case Study Case study Ruby: A fourteen year old girl Table of contents Page 3 2. Introduction Page 4 3. Problem : Page 4 4. Facts about the problem : Page 4 5. Principles related to the problem : Page 5 a. Autonomy : Page 5 b. Beneficence : Page 6 c. Non- malfeasance : Page 6 d. Justice : Page 7 6. Ethical conflicts : Page 7 7. Legal concepts about the problem : Page 8 8. Making the ethical decision : Page 9 9. Conclusions : Page 10 10. References : Page 12 Abstract Healthcare professionals often come across with difficult situations in which they were confused with taking proper decisions about the treatments of a patient. As per medical ethics, the health care professionals should do everything possible to save the life of a patient as life is supposed to be the most valuable thing in the world. But the medical ethics allows a patient to know about his medical condition and to decide upon the further treatment. Some of the ethical theories are also giving contradictory interpretations about ethical standards. As per the Utilitarian theory, the moral validity of an action is determined by the outcome of the action and hence the healthcare professional need not reveal the treatment options and to consider his/her opinions since the doctor or the nurse is working towards a utility. As per Kantian ethical theory the purpose of morality is not to make others happy, but to do the right thing just for the sake of doing. This paper analyses the case of a 14 year old girl who was brought to the hospital in a critical condition with the help of different perspectives of ethical theories. Introduction The given case study explains the case of Ruby, a 14 year old girl, who has had asthma since she was a young child and regularly uses beclomethasone and salbutamol inhalers. She was brought to the hospital because of a suspected flu. She was worried about whether her asthma may become worse or not because of the flue she was suffering from. She was keen in taking an important examination coming up; but her condition was not so good to participate in the examination. The doctor has advised her few days of bed rest after watching her critical condition. The doctor gives her a choice of taking oral antibiotics and steroids but tells her “she has to stay in sick bay for a few days to get some rest” and the nurse will check on her regularly. Problem The major problem involved in the above case is that at what age a person can be considered to be taking independent decisions. Ruby is fourteen years old and the healthcare professional cannot completely avoid her demands citing her as a child. Up to what extent, the doctors and the nurses need to consider the opinions of Ruby? What is the role of parents of a competent minor in healthcare decision making? These are the problems needed to be answered by the healthcare professionals in Ruby’s case. Facts about the problem Ruby’s condition was so critical that it was not wise for her to take the examination rather than taking rest at the hospital bed. She was suffering from asthma and the current flu has worsened her condition. The help of inhalers are necessary for her because of the severe breathing problems. Moreover, antibiotics and steroids are needed for the complete recovery of her current problems and that also needed to be supervised under a hospital environment. Principles related to the Problem Autonomy Autonomy is state in which one person is free from any external influences. In such a condition, the person would be able to take decisions and act independently (Pantilat MD, 2008) The healthcare professionals in the above case may face situation in which how much balance can be obtained between patient autonomy and the doctors own values. The question of what should be respected and up to what extent is another worrying factor for the healthcare professionals. If the demands of the patient may not do any harm to the medical conditions of the patient, then the healthcare professional can allow such demands, but in other cases it is impossible for them to advice or allows such things which are threatening to the life of the patient. ‘Patient autonomy cannot be considered as unlimited. It should be restricted for the safe treatment of the patient. The following instances for example can be considered as situations in which the patient autonomy needed to be restricted; when the patients demanding non- medical methods for their treatment; when patients demand treatment that is scientifically valueless and when the patients demand treatments that is inconsistent with the purpose of medicine and the medical profession – in other words, treatments that are outside the boundaries of accepted medical practice’ (Patient Autonomy vs. Medical Values, 2009) In Ruby’s case the third point seems to be more relevant; patients cannot demand treatment that is inconsistent with the purpose of medicine and the medical profession. If the doctor allows Ruby to take part in the examination, the purpose of his treatment will be lost. On the other hand, even if the Ruby was unable to attend the examination she could have attempt is later. So in this case the patient autonomy need not be considered much as far as the healthcare professional’s perspectives are concerned. Beneficence ‘Beneficence can be defined as the actions performed for the benefit of others. It can be used to prevent or remove harms or to improve the situation of others. Healthcare professionals should refrain from actions which may cause harm to the patients. At the same time they have the obligation to help their patients whenever possible. Beneficence can be classified into two broad categories; obligatory and ideal. Ideal beneficence comprises extreme acts of generosity or attempts to benefit others on all possible occasions whereas obligatory beneficence are acts which are not compulsory, but performed because of the obligations towards the patient (Pantilat MD, 2008) In Ruby’s case, even though she will be benefitted if the doctor allows her to write the examination, the same action may result in spoiling or worsening her health condition. So it the healthcare professional must compare the outcomes of his actions before taking decisions about whether allow her to appear in the examination or not. The main objective of the medical profession is the welfare of the patient as far as his medical condition is concerned. It doesn’t mean that the doctor has the obligation to fulfill all the demands of the patient. Non- malfeasance Non- malfeasance is the duty to do no harm to the patient (Ethical concepts, n.d). Knowingly no healthcare professional engage in any activities which may harmful to the patient. In Ruby’s case, allowing her to take part in the examination is a risky decision as far as the healthcare professionals are concerned. Sometimes she might be able to complete the examination without many problems, but there is every chance that the problem may be worsened because of her hard works for the examination. Under such conditions, the healthcare professionals may not allow Ruby to try her luck, giving her life to her destiny. Justice There is no hidden agenda for the doctor to prevent Ruby from appearing in the examination. Doctor is trying to regain her physical health condition. So the interests of doctor is always directed towards saving her life rather than thinking about the benefits associated to Ruby by allowing her to participate in the examination. On the other hand, Ruby should realize that the doctor was trying to save her life rather than spoiling it. It is difficult for a healthcare professional to think in terms of the material benefits of the patient by undervaluing the health benefit of the patient. Ethical conflicts In the above case the major ethical problem involved is how far the healthcare professional can allow Ruby to take independent decisions and also how far they need to obey the demands of the Ruby’s parents. As per the ethical principles, a person has the right to decide upon his actions to shape his life. But the person should be matured enough to take independent decisions. In Ruby’s case, she has not attained the major status and still she could be considered as a minor. ‘In order to determine the consequences of an action, Utilitarianism uses the theory of intrinsic value which states that something is held to be good in itself apart from further consequences. All the values derived from this intrinsic good will also be good in nature (West, n.d). As per the arguments of utilitarian, actions are right in proportion as they tend to promote happiness (Mill, 2004,p.6) The questions like “What ought a man to do?” is answered by utilitarianism. The answer to the above question is simple; man should act so as to produce the best consequences possible (Utilitarianism, 2009). When we analyze Ruby’s case based on utilitarianism, Ruby will get more benefit (saving her life) if she agree to stay in the hospital than what she may achieve through the examination. In that respect, the doctor’s stand is right as he was not sure about her conditions if she might be allowed to participate in the examination. Life is precious compared to all other things and hence the utility of life is more than anything else in the world. But as per the Kantian views of ethics, there is a difference between the questions; what a person should do and what a person wants to do. Allowing a person to act as per his desire would usually bring immediate gratification/happiness, but might not benefit the person in the long run. On the other hand, the answer to what one should do may cause immediate discomfort/unhappiness, even if it is good for the person in the long run (Maccarelli, 2006). Kant identifies imagination as the very root of finite reason. He believed that reasons are subjective in most of the cases (Rockmore, 2000). Applying Kantian ethical theory in Ruby’s case, we can see that by allowing her to participate in the examination, the doctor may achieve the short term goal of her immediate gratification/happiness. But the same action may damage her health and may lead to discomfort/unhappiness in future. Legal concepts about the problem As per the western Australian nurses and midwives act 2006, disciplinary action can be taken if the nurse acted carelessly; acted incompetently; or acted improperly. (Australian nurses and midwives act 2006). So the cases like Ruby’s must be taken seriously by nurses to protect their interests and to avoid possible disciplinary actions. There are various medical laws related to the treatment of a patient like Consent to Medical Treatment, General Principles, Capacity to Give Consent, Refusal of Medical Procedures, Conditions of Admission etc. (Pelliccioni, J.D., M.P.H., Ph.D, n.d). But in Ruby’s case, since she was a minor the parents’ opinion is more important as far the legal aspects are concerned. Since she was not independent enough to take critical decisions, her parents must take proper decisions about her in order to avoid future legal problems. The healthcare professionals must ask the opinions of her parents while taking decisions about allowing her to participate in the examination. ‘Clinical Governance assumes that all health professionals should share responsibility for safe and ethical professional practices. Ethical issues are considered as the part of their profession. Health professionals, patients and their carers may have differing values which may impact upon clinical decisions and behaviours in healthcare settings. Clinical ethics is clearly an important part of effective Clinical Governance (Clinical Ethics, n.d). When we think of patient’s rights, it means that health care providers have an obligation to respond to that right. These rights might be negative, positive or moral. In any case, there is a contrast between negative rights (the right to be left alone) and positive rights (the right to be assisted in some way) and between moral rights (common to all humans) and legal rights (variable among societies) (Kaldjian MD et al, 2005) Making the ethical decision The nursing profession values the human rights of people and the responsibility to safeguard dignity of everyone which includes recognizing, respecting and, protecting civil, cultural, economic, political and social rights that apply to all human beings (code of ethics for nurses in Australia, p.3, n.d). So a health care professional should think of above things before taking any decisions. It is important that one should learn lessons from the past experiences he faces directly or from the incidents happening around him. It is not necessary that all the people respond to an incident in similar fashions because of differences in their experiences and intellectual levels. So the healthcare professionals must take a decision about Ruby’s case and it should be conveyed to both the patient and her parents. The doctors and nurses should explain why they are not allowing Ruby to take part in the examination in detail so that Ruby and her parents must realize the seriousness of the situations. If they are still adamant the healthcare professionals can allow them to participate in the examination by their own risk. Conclusions It is difficult for the healthcare professionals to take decisions based on the opinions and interests of the patients always. Healthcare professionals need to value the medical ethics more than anything else. The primary responsibility of a healthcare professional is to take necessary step to regain the health of the patient and all other things might be of secondary importance for them. It is not necessary that the patients know much about their health conditions. Under such circumstances, the healthcare professionals who have an assessment about the health conditions of the patient based on the examinations, should be allow to take decisions as far as one’s health aspects are concerned. Ruby’s case was so critical that allowing her to take part in the examination may result in playing with her life. Since Ruby was only 14 years of age (legally a minor), allowing her to take decisions which may jeopardize her life is not advisable. Ruby’s parents should be allowed to take a wise decision on behalf of her by the healthcare professionals in order to avoid future legal and ethical consequences. It is impossible to succumb to the demands of a minor because of immaturity in their opinions. Morality and ethical principles are different under different circumstances. In the given case study of Ruby, she was connected to so many things in the society. She is a daughter to her parents, a sister to her brothers, a friend to her classmates etc. Moreover she is a minor and may not be able to take wise decisions. In those circumstances, it is unwise to allow Ruby to take independent decisions even though as a person she as the every moral right to decide upon her actions. References 1. Australian nurses and midwives act 2006, Retrieved on 15 October 2009 from http://www.slp.wa.gov.au/legislation/statutes.nsf/main_mrtitle_2498_homepage.html 2. Clinical Ethics, Retrieved on 15 October 2009 from http://www.hnehealth.nsw.gov.au/cg2/clinical_ethics 3. 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Mill John Stuart, Utilitarianism,(2004), Retrieved on 15 October 2009 from http://books.google.com/books?id=9PE1LARQNV8C&dq=Utilitarianism&printsec=frontcover&source=bl&ots=54VwimSZ8i&sig=7f2q1be-7t6ih4pHPFsnmXT0qTs&hl=en&ei=kSeKSsL-G8OOkQXzv6gr&sa=X&oi=book_result&ct=result&resnum=5#v=onepage&q=&f=false 13. Utilitarianism (2009), In Encyclopædia Britannica. Encyclopædia Britannica Online: Retrieved on 15 October 2009 from http://www.britannica.com/EBchecked/topic/620682/Utilitarianism Read More