Ethics and Legal Issues in Health Care - Research Paper Example

Ethics and legal Issues in Health Care Introduction The essay will be dedicated to assessing an ethical topic area whichwill be discussed throughout the paper by the researcher and ended by a conclusion from the researcher who will incorporate the facts and finding from the case study. The specific topic chosen by the researcher deals with confidentiality and illustration is made by a case consideration in which a married woman who is terminally ill asks the hospital authorities not to disclose her health condition to her husband on the basis of continuing with the sexual relationship that they have. The challenge to the case is that the woman is suffering from HIV/AIDS and puts her husband at risk of getting infected if they continue having a sexual relationship without taking any form of precaution or safety measures. In-depth description of the ethical case scenario will be provided in the next section of the study with the main discussion coming after it and finally a conclusion of the entire study. In addition, the researcher will also incorporate relevant examples from practice in illustrating the ethical issue. Ethical Situation The ethical situation for discussion is the case of one Madam Linn who is a 30 years old patient. Linn is suffering from HIV/AIDS and is fully aware of her health condition. Madam Linn falls sick and is brought to hospital by her husband for treatment. She asks the hospital staff and various hospital authority not to disclose the details of her health condition to her husband ad family members because she wants to continue the sexual relationship she has with her husband. The withholding of such vital information about the terminal illness of Madam Linn is not an easy decision for the involved hospital authorities. The situation requires the involvement of expert opinion and consultancy of an ethics personnel to establish if the ethical dilemma that pertains to the case of Madam Linn’s request or right was to be accepted and what exactly would be the best course of action to be taken so as to ensure that a positive outcome was eventually achieved. The next section of the study will be a discussion of the ethical consideration and legal implications of the said case. In this part of the study, the researcher will tackle various legal, ethical and professional aspects of practice in regard to the considered case. My rationale for choosing the said ethical situation is based in the fact that HIV/AIDS is real health concern in the 21st century that has continued to affect many individuals both directly and indirectly. Moreover, in the case scenario chosen, there exists an ethical dilemma that requires intricate handling by a professional in line with the various ethical and legal principles that constitute the nursing profession to ensure that the best positive outcome is achieved in the end. Discussion The case scenario presents an ethical dilemma to the nurses and various hospital authorities. The request of Madam Linn to keep her HIV/AIDS status unknown to her family members and husband is a tough one and puts the hospital authorities in a tight position on whether to inform the family members and husband of the status of Madam Linn or to honor her wishes and keep her status confidential. The doctors and hospital authorities are supposed to ensure that the treatment of patients is done in a manner that ensures their care as well as offers them with respect, integrity and better protection while maintaining the rights of the patients (Schneider, & Levinson, 2005). Hiding the truth of Linn’s status to her husband can be considered as an ethical issue. Nursing ethics should be considered in arriving at a conclusion as to whether the hospital authorities should honor Madam Linn’s wishes or override her request and inform her husband and family members of her HIV status. An analysis is thus required to determine the power of the several parties involved in the ethical dilemma so that the various moral principles that pertain to the case ca be taken into consideration. The patient, Madam Linn is a 30 year old woman who is married. She is suffering from HIV/AIDS and requests the doctor not to disclose her health condition to her husband and family members as she wants to continue the sexual relationship with her husband. The hospital authorities are responsible for treating Madam Linn and should perform various functions in line with the ethical and legal guidelines that bind the doctors, nurses and entire hospital authorities. However, there are instances when it is appropriate for such personnel to breach confidentiality and such will be discussed in-depth with reference to Madam Linn’s case. Ethical, Legal and Professional Aspects of Practice In the nursing practice, there exists certain professional boundaries in which the caregivers are required to follow to ensure that they deliver quality treatment and care to patients (Benjamin & Curtis, 2010). The ethical and legal concerns that relate to this include; moral courage, respect, confidence, cultural sensitivity and openness (Butts & Rich, 2013). The legal and professional aspects are responsible for making up the essential elements which comprise the several important concepts within the nursing practice. Law is defined as being a standard conduct which one must not fall into (Sim, 1997). Law applies to all humans in all societies. By law, doctors and nurses are bound to act in manners that remain acceptable in the field of medical practice. For Madam Linn’s case, however, the nurses and hospital authority are presented with an ethical dilemma on whether to report the health status of Madam Linn’s status to her husband and family members or to honor the wishes of Madam Linn. The correct course of action in this case may be derived by looking at the law and what is legally allowed in line with the said concern. Non-disclosure of one’s HIV-positive status to their spouse or sexual partner may hold criminal implications for the party that fails to disclose the status as they put the other partner under imminent danger of contracting a terminal disease (Casterlé et al., 2008). Westrick & Dempski (2009) define law as being the formalization of a body of conduct, or rules of action which is enforced by a binding legal authority. Once the law is broken, an individual should be punished by a relevant authority figure. Thus, in the case of Madam Linn, failure to disclose her HIV-positive status to her husband with the intention of continuing with the sexual relationship that they have may have legal implications on her part and call for legal action. The hospital authorities are also legally bound to disclose such vital information to Madam Linn’s husband and override the wishes of Madam Linn to keep her HIV-positive status private. This is because the intent of Linn in the non-disclosure of her HIV-positive status is based on continuing with a sexual relationship with her husband which may ultimately put her husband’s health in danger. Ethical principles act as a guide to moral action and decision making for professionals in various fields, nurses and doctors included. Furthermore, they play a fundamental role in the formation of sound moral judgment in professional practice (Butts & Rich, 2013). Ethics and moral are often used synonymously but are words which are not derived from the same root. According to Casterlé et al (2008), moral is frequently used in describing a standard form of behavior while ethics refers to the study of morals and moral behavior. The importance of applying ethical principles and using moral guidelines in the healthcare profession is gaining increasing recognition across the globe. This is because the public is more concerned with the morality associated with the healthcare and treatment. As with the case scenario of Madam Linn, it is evident that healthcare professionals are constantly confronted by ethical dilemma on a daily basis while dealing with different patients at the hospital. Bioethical Principles and Philosophical Theories in the Case Scenario The four major bioethical principles that govern the nursing practice include; beneficence, respect for autonomy, justice and non-maleficence (Hamric et al, 2008). It is important to note that the four principles are non-hierarchical. This means that no principle routinely “trumps” the other in terms of importance. Other ethical rules such as confidentiality, honesty, and professional behavior are derived from the major ethical principles aforementioned (Kälvemark et al, 2004). It has been observed by researchers over time that ethical responsibilities possess more stringent aspirations as compared to legal responsibilities (McCormick, 2012). As with the case of Madam Linn, the doctors, nurses and hospital authority are not stringently bound by the law to confide the status of Linn to her family members and husbands but it is their ethical responsibility to act in a manner that will ensure no party is at a disadvantage and as such, may be required to disclose the HIV status of Madam Linn to her husband. Even though it is Madam Linn’s wish that the hospital staff keeps her HIV status unknown to her husband, the hospital staff at this instance may breach confidentiality and inform the husband as failing to disclose such information may put the husband’s life in danger. Justice as a bioethical principle refers to the moral obligation of nurses and health practitioners to distribute risk, cost and benefits, risk in a fair manner. Respect for autonomy is the agreement by a doctor to respect the decisions of competent and informed patients (Rwemisisi et al, 2009). It has a prima facie implication as it calls for healthcare professionals to first obtain informed consent of patients before undertaking any form of treatment to the individual. Beneficence, on the other hand, refers to the desire to good, take positive action and help others (patients). Lastly, non-maleficence is a bioethical principle which bars health practitioners from undertaking any action that may harm their patients. Avoidance of hurt/harm is the core of nursing ethics and medical oath. In accordance to the principle of respect for autonomy, individuals are supposed to have control over their lives (Lachman, 2006). This control includes the control over personal information that protects every individual from unjustified interference with personal business and information as regards the health of an individual. In relation to the case scenario, under the 25th Section of the Infectious Disease Act, the act of concealing one’s HIV-positive status while maintaining a sexual relationship with a spouse or sexual partner is treated as deliberate action of the infected individual to pit their spouse of sexual partner at the risk of an early death (Wilson-Barnett, 1986). It is true that an individual has the right to deny or consent any form of medical action without affecting the rights of other individuals. Medical practitioners are laden with the obligation and responsibility of protecting the well-being of the entire community. In respect to a patient’s autonomy rights, a nurse is supposed to weigh the impact of the injury of the patient on others in the community (Wolf & Lo, 2014). For the case of Linn, for example, it is evident that the grave injury of infection to her husband is outweighed by the harm caused to the patient in the event that the nurses and hospital authority breach the wishes of Madam Linn to remain autonomous and keep her HIV-positive status only known to herself. In order to prevent harm to her husband and others who might be unware of the HIV-positive status of Madam Linn but are at imminent danger, the obligation of confidentiality and respect for Linn’s autonomy has to give way. The nurses and entire hospital authorities, therefore, have the right to inform Madam Linn’s husband of Madam Linn’s HIV-positive status as the practitioners believe that Madam Linn may transmit the disease to her husband in the event that they continue having sexual relations without the husband’s knowledge of the status of her wife. In the case scenario, therefore, it is pertinent that the nurses, doctors and hospital authorities override the patient’s respect for autonomy and inform the husband of Madam Linn’s status. By informing the husband of Linn’s status, the hospital authorities may also breach the various principles of non-maleficence by resulting to hostility, embarrassment, discrimination and stigmatization. This may jeopardize the emotional feelings of Madam Linn by causing her emotional harm. It is therefore important that the hospital authorities weigh the implications of informing Madam Linn’s family members of her HIV-positive status and determine whether it will be necessary to inform them of keep the matter between the couple to avoid harm to the patient. To maintain the ethical principle of non-maleficence, the hospital authorities should also conduct HIV tests on Madam Linn’s husband to establish if he is infected with the virus. In the event that Linn’s husband has contracted the disease, the hospital authorities should counsel the couple and put them on suitable treatment to prevent the rapid spread of the disease. In the likelihood that the husband is still negative, the hospital authorities with the help of the nurses should also counsel the couple and advise them accordingly o measures of prevention and safe sexual intercourse in the event that the couple agrees to be discordant. The principles of beneficence and justice are also applicable to be used by the nurses and hospital authorities. In the event that they inform Madam Linn’s husband of the HIV-positive status of her wife, they will reduce the risk of him being infected by HIV. A person infected with HIV/AIDS has his own individuality and rights. Madam Linn has the right keep her HIV-positive status secret. However, concealing such a fact potentially puts this right in conflict with the rights of other individuals with particular focus on her husband’s right to health which may be compromised by this confidentiality (Butts & Rich, 2013). The husband has the right to be informed of the risk so that he can take appropriate measures to protect himself. Informing Linn’s husband of the status of her wife’s health is a form of compassion and positive action by the hospital authorities to help him regardless of the ethical dilemma and wishes of Madam Linn. Examples from Practice that Illustrate Ethical Issues A study conducted by Mykhalovskiy et al., (2010) found out that more than 1 in 10 individuals do not inform their spouses/sexual partners of their HIV status. In another exploratory research conducted by NAT (2012), reasons for non-disclosure and disclosure of HIV-positive status are considered. The semi-structured study interviews show that only 54 percent of the informants disclose their HIV status to their sexual partners and spouses. 46 percent of the participants informed the researcher that they disclosed their HIV status to friends, colleagues and family members. From the research, it was concluded that the major reason for disclosure was to obtain physical and psychosocial support and ultimately to fulfill the responsibility of the sick person to an individual they love. The major reason for non-disclosure of the HIV-positive status was cited as being the fear of stigmatization, abandonment and concern on how their spouses/sexual partners will cope with them after the disclosure of the status (NAT, 2012). Key Ethical Points Based on Case Scenario The ethical challenge in the case scenario emerges between maintaining medical confidentiality and the duty to protect the imperiled third party. Before making any decisions as concerning the disclosure of Madam Linn’s health to her husband and family members, it is important that the nurses consider the reasons that make Madam Linn what to keep her HIV-positive status confidential. The husband needs to be informed since Linn plans to continue with the sexual relationship that they have and this act put the husband susceptible to potential harm and the risk of contracting the disease. As for Madam Linn’s family, it is also important that necessary consideration should be made by the nurses before disclosing the health status of Madam Linn to them. In the event that the family members are not under any imminent danger of infection by Madam Linn, then the right/wish of Madam Linn may be considered as they will prevent emotional harm and other discriminative and stigmatization practices that are associated with HIV/AIDS. Confidentiality is concerned with keeping of promises. Confidentiality is important in establishing trust between a patient and the healthcare provider (Benjamin & Curtis, 2010). The common law of confidentiality states that any relevant information that pertains to a patient’s health should not be divulged to a third party without the consent of the patient unless there exists legitimate reasons supporting the sharing of the information to a third party (Benjamin & Curtis, 2010). According to the code of ethics and professional conduct for nurses, the disclosure of confidential information is only allowed in cases where there is consent from the patient unless the practitioner perceives that there is the risk of harm to other individuals, in cases of emergency or in cases where there is legal obligations to share the information (Benjamin & Curtis, 2010). In the case of Madam Linn, the information needs to be shared to the husband as his health is at risk in the event that the hospital authorities fail to inform him of the health condition of his wife. It is also important to note that confidentiality does not necessarily imply the hiding of relevant information from the individuals who are likely to be harmed by the said information. With regard to the principal of beneficence, health practitioners, nurses included, are obligated in protecting, preventing harm and maintaining the best interest of patients. Challenges of bioethics occur when rules and ethical principles conflict which put nurses and other medical practitioners in ethical dilemma not knowing who to protect (Kälvemark, et al., 2004) The dilemma in this case is by the doctor not knowing who to protect, whether it is Madam Linn or her husband in regard to the wishes of Madam Linn. The hospital staff and various authorities by the code of conduct should thus inform Linn’s husband of his wife’s health condition. By doing so, they do not breach the confidentiality of the patient in any way. Madam Linn has informed the relevant hospital staff of her HIV-positive status because she trusts them. Disclosing of this information to her husband is not a breach of the duty of care, trust and confidentiality established by Madam Linn with the relevant hospital staff. The duty of care in this case was established the moment the patient (Madam Linn) was brought to hospital for treatment. However, health practitioners are tasked with other ethical and legal obligations such as protecting the greater harm to the society and ensuring that the well-being of every member in the community is achieved. In the case scenario, sharing of the health status of Madam Linn with the husband is thus not a breach of trust or confidentiality but rather a moral obligation of the doctor in preventing the greater harm to the society in line with the health of Linn’s husband which is under imminent danger if the information is disclosed form him. Professionalism is an important factor in the nursing profession as it safeguards the interests of the entire public and serves as a beacon of moral conduct and ethics for the nurses (Sim, 1997). In order to maintain very high standards of quality care, the nurses are tasked with the responsibility of using their knowledge in determining the best cause of action when confronted with ethical dilemmas. Moreover, the nurses are also accountable and responsible for the personal judgment and action taken in the course of their nursing practice irrespective of the emotional implications and organizational policies. Conclusion In conclusion, ethical dilemmas are existent to health practitioners, nurses included on a daily basis. Nurses are legally and ethically bound to act and make decisions in line with stringent ethical and legal considerations that make up the professional code of conduct in the health sector. The key ethical issues in the case scenario are the need to maintain confidentiality of Madam Linn’s HIV-positive status by the hospital staff. With the request and right of confidentiality, Madam Linn hopes that the hospital authority will honor her wishes and keep her HIV-positive status unknown to her husband so that she may continue having a sexual relationship with her husband. The hospital authorities are in a dilemma as withholding such information from the husband and family of Madam Linn may have serious health implications for them especially for Madam Linn’s husband. The hospital authorities and personnel are tasked by ethical principles and obligations to protect the entire community from harm. At the same time, they have an obligation to keep patient information confidential and private and not to share the same with any third parties unless with consent from the patient. In such a case, the health authorities should act in manner that has the best interests of all parties accommodated and catered for. By informing Madam Linn’s husband of her wife’s health condition, the hospital authorities would have acted in beneficence and prevented harm to an innocent party. References Benjamin, M., & Curtis, J. (2010). Ethics in Nursing: Cases, Principles, and Reasoning. Oxford, Oxford University Press. Butts, J. B., & Rich, K. L. (2013). 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