Ethics and Legal Issues in Health Care - Case Study Example

Ethics and Legal Issues in Health Care Table of Contents Overview of Ethics in Nursing: 3 Ethical Principlism in Modern Day Nursing4 Patients Rights (Universal Declaration of Human Rights) 6 Duty Towards Dying Patients 7 The Legal Aspect 9 Ethical Aspects 10 Introduction Overview of Ethics in Nursing: In the nursing profession of today, most allied health professionals and nurses understand that the privilege of their being able to engage in professional healthcare practice is generally accompanied by both legal and moral and legal accountability for the professional judgments they might happen to engage in and any resultant actions that might arise (Grace 2013). Professional nursing practice has its origins traced back to England in the 1800s to the school that was established by Florence Nightingale where values and the various professional-shaping ethical percepts were communicated to the nursing students. By the end of the 1800s, modern nursing had already been established and the question of ethics was fast becoming a frequent discussion topic as applied to nursing (Butts 2013). In 1893, the Nightingale pledge was written under Lystra Gretter, who was a principal at a Detroit nursing school, the pledge sought to establish nursing as both a science and an art. In 1899, six years after this pledge was written, the International Council of Nurses (ICN) was established and quickly became established and emerged as the pioneer in the development of nursing codes of ethics (Butts 2013). In its earlier development, the nursing code was initially focused on physicians mainly because of the fact that it typically fell upon the male physicians to train their nursing assistants during the Nightingale era. Nurses’ obedience and technical training was seen to remain at the forefront of the set nursing responsibilities well into the 1960s, as was reflected under the nursing code of ethics set by the ICN as late as 1965 (Butts 2013). In 1973, this was to however this was to however change as the newly developed ICN code shifted the focus of nursing from the physicians to the needs of the patients where it has remained to this day (Butts 2013). Ethical Principlism in Modern Day Nursing According to Masters (2014), ethical principlism is a popular approach to health care ethics and involves a set of principles that are drawn from the widely shared and common conceptions of morality. These principles which happen to be closely associated with rule-based ethics are designed to help in providing a framework that serves to help nurses in their decision making and moral behavior. These principles are generally applied based on justifications and rules for model behavior, and it is often seen that more than one principle can relevantly be applied to an ethical situation without any conflicts (Ludwick 1999). However, in the event that relevant principles happen to be conflicting in a certain given situation, the nursing practitioner is responsible for exercising judgment to determine which principle should take precedence in guiding the actions. These five key principles according to Silva and Ludwick (1999) that help in providing a framework for ethics in nursing are: 1. Nonmaleficence: Silva and Ludwick (1999), point out the first principle of nursing ethics as being nonmaleficence, or do not harm. This principle that is seen to directly be tied to the duty of nurses that requires them to ensure that they protect the patient’s safety at all times, is born out of the Hippocratic Oath and dictates that nurses and other medical practitioners do not cause any form of injury to their patients. This principle is one of the principles that is considered before any new treatment approaches can be tried out on patients. 2. Beneficence: The principles of beneficence is seen to largely consist of various deeds that can be considered to be of a kindly, merciful or charity nature. Beneficence in nursing as a principle is seen to imply that nurses should ensure that they take any necessary actions that will benefit their patients and eventually facilitate their well-being (Masters 2014). Some of the beneficence nursing actions can be seen to include some obvious interventions such as the lifting of the side rail on a patient’s bed so as to prevent a fall, to some more subtle actions such as taking the time out to make a phone call for a patient who might happen to be too frail to do so. The principle of beneficence is often seen to conflict with the principle of autonomy that dictates that patients have a right to self determination . In the event of this conflict, nurses are required to act and make decisions in ways that they believe will be for the patient’s own good as opposed to allowing the patients to exercise their own autonomy (Masters 2014). 3. Autonomy: This third principle of nursing ethics essentially means that individuals have a right to their self determination and as such, should be allowed to make decisions pertaining to their lives without experiencing interference from others Silva and Ludwick (1999). Respecting a patient’s autonomy can include situations such as obtaining informed consent for treatment; accepting a patient’s refusal for treatment, disclosing medical information. 4. Justice: Justice is highlighted by Masters (2014) as being the fourth ethical principle in nursing. Justice in ethical nursing is seen to refer to the fair distribution of burdens and benefits. In regards to principlism, justice is seen to often refer to the fair distribution of the scare healthcare resources (Daniels, 2004). 5. Privacy and Confidentiality: The fifth ethical nursing principle is cited by Silva and Ludwick (1999) as relating to confidentiality and privacy. Privacy is a right that belongs to every person and it cannot be taken away for a person unless the person wishes to share it. Confidentiality on the other hand is seen to mean that the information being shared will not be wrongly spread abroad and will only be specifically used for the intended purposes. By sharing private information with a healthcare provider, a duty of confidentially is imposed on the healthcare provider which necessitates that the provider only shares the information on a need-to-know basis. In order to be able to effectively tackle the ethical and legal dilemma issue in this paper, it is of critical importance to first highlight a number of key ethical nursing principles and theories that will help in laying up of the necessary foundation that will be of key importance in the building up of a proper discussion. Rights and Principles Patients Rights (Universal Declaration of Human Rights) The notion of patient rights was developed under the Universal declaration of human rights and is designed to help in the determination of what exactly is owed to a patient as a result of their being human beings by the state or physician. There continues to be a number of enormous debates pertaining to how best to conceive the relationship between the physician and the patient. In this debate, some parties are seen to be advocating for the patients to be positioned as being consumers who are deemed to be best positioned to judge exactly what is in their own interests with the doctors being viewed chiefly as being providers of information (Leino-Kilpi et al. 2000). On the other hand, some parties are seen to be actively opposing this position and are advocating for more rights to be granted to physicians to allow for their judgments about what is in the best interest of the patients to be valued above the decision-making power of the patients. There however is growing international consensus that all patients have a fundamental and inherent right to privacy, to refuse or even consent to any of the available lines of treatment provided by the doctor, a right to the general confidentiality of their medical information and a right to be informed about their medical condition in addition to any relevant risks that they might potentially face as a result of medical procedures (WHO 2014). Duty Towards Dying Patients Nurses and physicians have a professional duty to try and alleviate the suffering of their terminally 9ill patients, In the event that a physician is no longer able to cure a patient, the duty of nurses and physicians is seen to shift from that of preventing them from dying of the terminal illness to that of preventing both pain and suffering . There are a number of ethical and legal guidelines that guide nurses on how to treat patients that might happen to be facing some form of terminal illness. I. Legal Aspects – The law is seen to completely support the principle of autonomy. According to Swanson and Cooper (2005), nurses and physicians have a duty to inform patients that they are dying. However, these professionals should ensure that they are compassionate when performing this duty (Bernat 2008). II. Ethical Aspects – Some of the ethical aspects that may be seen to apply to this particular scenario include the principles of beneficence, nonmaleficence as well as the principle of patient autonomy. Ethical Dilemma Problem: Madam Tan a 40 years old patient was aware that she happened to be suffering from some very severe illness although she was not aware of exactly which disease she was suffering from. While Madam Tan was admitted at the hospital, her husband who was already aware of the diagnosis of her disease asked all the hospital staff and various authorities not to disclose the details of this diagnosis which showed that Madam Tan was suffering from HIV/Aids. The withholding of this information about Madam Tan’s terminal illness was not an easy decision for the various hospital authorities and it is as a result of this that these authorities explored the option of consulting the expert opinion of an ethics consultant. The ethical dilemma in this case pertained as to whether Mr. Tan’s request was to be accepted and exactly what would be the best course of action to take so as to ensure that a positive outcome was eventually achieved. Discussion In the above case study, there are a number of several parties involved which are seen to primarily be the concerned patient, the patient’s family as represented by the husband and the hospital staff and authorities. It is imperative that the patient’s family and hospital staff and authorities make a decision that will be perceived as being in the best interests of the patient. In order to come to come to a proper conclusion as pertaining as to which is the very best decision that should be made, it is important to undertake a step by step analysis that will seek to establish the concerns of the various parties involved, legal rights and ethical principles that need to be observed. I. Patient: The patient in this dilemma is mentioned as being a 40 year old lady who although aware of the fact that she is suffering from some chronic illness, is not aware that the illness is actually a HIV/Aids infection. II. The Patient’s Family (Husband): The patient’s family, which in this instance is represented by her husband, had prior awareness of the fact that Madam Tan actually happened to be suffering from an HIV/Aids infection. However, Madam Tan’s husband chose not to disclose this information to his wife for some reason and has also gone ahead to ask the hospital staff and authorities to also not disclose this diagnosis. III. The Hospital Staff and Authorities: While hospital staff and authorities are ethically required to ensure that they always respect the inherent autonomy of all their patients, they have in this case received a request from Mrs. Tan’s family to withhold information from Madam Tan concerning her HIV/Aids diagnosis. While a number of nursing principle considerations will potentially be violated by their accepting of this request, there are also a number of ethical aspects that will potentially be of great benefit to Mrs. Tan if she is not made aware of the fact that she is suffering from HIV/Aids status. The Legal Aspect Some time back, physicians regularly dispensed a series of oracular commands to their patients and attending nurses and rarely had any of the judgments get questioned. Doctors could be able to take it upon themselves with relatively very few ethical qualms to keep the news of a terminal illness from a patient. Other than the ethical mandate of ensuring that they always tell the truth to patients, hospital staff and authorities are currently legally obligated to ensure that they disclose all of the relevant health information to their patients (Day and Brunner 2009). Under the patient’s rights provided under the Universal Declaration of Human Rights, it is important for physicians and hospital authorities to ensure that they share a patient’s diagnosis with the patient as withholding this information can be deemed as being a violation of these human rights (Freeman and Pathare 2005). Madam Tan’s husband has no legal right to withhold this information from her and although the hospital not informing Madam Tan of her HIV/Aids status might arguably be perceived as being a case for compassion, the hospital would inadvertently open up itself for legal action as Madam Tan could possibly sue it for withholding this crucial health information. It can also be legally argued that the hospital would be legally liable for additional criminal charges if it withholds this information from Madam Tan as Madam Tan could potentially and unintentionally infect other individuals with this chronic illness. Ethical Aspects I. A Case for Compassion? According to Shwartz (2010), while cases of physicians lying to patients are quite rare, it is quite common for many physicians to fail to answer questions in a direct manner, give compete information about the benefits of a treatment and otherwise avoid imminent death discussions with patients that might happen to be suffering from an advanced disease. Shwartz (2010) further points out that the most common argument that is cited against obligatory truth telling is the impact that the truth might have on a patient’s emotional and physical state; this might potentially be the main reason for Mr. Tan requesting for Madam Tan’s health information to be withheld from her. Healthcare providers in some parts of the world such as the former Soviet Union and Central Asia are usually still found to censor information from patients with terminal illnesses on the grounds that the information will cause depression and earlier death. In contrast to this position most patients usually want to know exactly what it is that they are suffering from, their options as well as what is going to happen to them. II. The Patient’s Autonomy Patient’s have a right to make informed decisions pertaining to their healthcare. The process of balancing the benefits and risks of a treatment and informed consent are fundamental ethical nursing principles. The principles are found to be no less relevant for patients with terminal illnesses and it is important that these patients have an awareness of the life-limiting and incurable nature of their underlying medical conditions as these will be essential in their decision making. By being fully informed, patients are found to be fully empowered and this serves to give them adequate time to put all their affairs in god order. This might include making critical decisions pertaining to their eventual end-of-life care, guardianship, finances, power of attorney and where to die. According to Lowry (2013) the withholding of information from patients with the view of not causing them emotional distress or prompting their early death is a flawed supposition. Patients are rarely found to be surprised to learn that they are actually terminally ill and it is extremely unusual for this information to come to them as a surprise. Most terminally ill patients are usually found to already be fearing the worse and it normally comes as a relief to them to have an open discussion about their anxieties and fears as well as have the opportunity of being able to make realistic choices affecting their future (Patel and Rushefsky 2002). Sensitive and honest discussions with patients are highly unlikely to take away a patient’s hope or cause any emotional distress and can instead help to allay fears and support realistic hopes on the part of the patient. In order for the hospital’s medical staff and authorities to ensure that they adequately respect Madam Tan’s autonomy the nurses at the hospital should ensure that they. Provide the patient with all the information necessary to enable Mrs. Tan to make relevant decisions on their the course of treatment to be adopted and any suitable changes to her lifestyle to help argument the chosen course of treatment (Day and Brunner 2009). One of the most sacred aspects in the patient-healthcare provider relationship is the element of trust. Honest and open dialogue on both sides is considered to be critical for effective care. While patients are required to be truthful so as to ensure that an accurate diagnosis is made and an appropriate treatment plan is effected, nurses and doctors on the other hand are required to provide full disclosure about the patient’s health irrespective of whether the news is good or bad so as to help the patient make informed decisions. In light of this aspect being considered as the cornerstone of the modern day medicine and patient-centered care, it is important that the nurses ensure that they are truthful about Madam Tan’s medical condition. The nurses should also not try to force Madam Tan to make any decisions on her health. She should be free to make decisions on her health without any coercion on the part of the nurses. Of note however is that a patient’s right to respect for autonomy is not unqualified and can at times be denied as is the case in the event that granting the patient autonomy could harm or endanger other as is the case when the patient is suffering from communicable diseases or can potentially be violent to others. Shwartz (2010), makes the observation that recent years have seen lawsuit being filed against physicians by patients because of the physicians informing the spouse of a patient about the patient being diagnosed with a life threatening sexually transmitted disease. However, there are some courts that are now beginning to consider that in some specific circumstances, a patient’s autonomy could be overlooked and the doctor be allowed to go beyond the patient – physician relationship and disclose medical information to another party if they judge the party to be in possible danger. Conclusion Not disclosing Madam Tan’s medical condition to her can be seen to have a number of attributes that will affect her in both positively and negatively. In this instance, the optimal solution to the dilemma is for the nurses at the hospital to choose the option that will serve to minimize a negative outcome as much as possible while maximizing the chances of a positive outcome being realized. Regardless of the arguments posed by both Madam Tan’s husband and the hospital staff and authorities supporting or opposing the request by Mr. Tan to not disclose Madam Tan’s medical diagnosis to her, the ultimate decision should be based on its impact on Madam Tan as she is the single person who stands to be most affected by the decision. In this instance, while Madam Tan’s husband is seen to have some credible grounds for withholding her HIV/Aids diagnosis from her, based on the effect that disclosure of the information might have on the quality of her remaining life, and the possible distress that might result from this disclosure, it is however important for the hospital to ensure that it discloses this information to Madam Tan as the hospital medical team is both legally and ethically bond to do so. Not disclosing this information to Mrs. Tan would result in the hospital flouting Madam Tan’s right to autonomy that requires that the hospital discloses all of Madam Tan’s medical information regardless of whether this information is good or bad news. Not disclosing this information by to Madam Tan could also potentially leave the hospital staff and authority open to legal action if Madam Tan were to discover that this information was wrongfully withheld from her by the hospital in collusion with her husband. Madam Tan’s husband has no legal ground to force or coerce the hospital into withholding this information from Madam Tan. The only legal grounds that Mr. Tan would have had to have his request to withhold Madam Tan’s medical condition from her would have been if Madam Tan’s medical condition was too advanced and was affecting her faculty to make decisions pertaining to her health. However, this option is not available to Mr. Tan as Madam Tan’s decision making faculties are not recorded as being affected by her medical condition. In informing Madam Tan of her HIV/Aids medical condition, it is important for the hospital’s medical staff to ensure that they are compassionate and humane. They should also ensure that they formulate measures through which they will be able to handle any negative outcomes that might potentially result from informing Madam Tan of her Medical condition. Some of these possible measures might include: I. The hospital medical team can organize counseling services for Madam Tan, to help her deal with any possible depression that might potentially result from her learning about her medical condition (Snyder 2003). II. Using Mr. Tan to inform Madam Tan of the medical condition as Mr. Tan would be better placed to break the news to his wife. Mr. Tan will also be able to mobilize some family members and friends of Madam Tan who would offers support for Madam Tan as she gradually accepts her health condition. The hospital staff and authorities should talk with Mr. Tan and explain why they are obligated to inform Madam Tan of her medical condition. After this, the two parties should consult as to the best way in which to inform Madam Tan of her diagnosis. References Bernat L. James. 2008. Ethical issues in neurology. Philadelphia : Lippincott Williams & Wilkins. Butts, Janie. 2013. "Ethics in professional nursing practice." Nursing ethics: Across the curriculum and into practice. 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