Ethics and Law for Australian Nurses - Case Study Example

Ethics and Law for Australian Nurses Client Inserts His/her Name Client Inserts Grade Course Client Inserts Tutor’s Name 28/05/2012 Case Study Health care has always been described as being personal. It is important that any healthcare delivery system is recognized to not only have scientific validity but also ethical and legal integrity. Ethics also referred to as “moral philosophy” has been defined by Kerridge, Lowe and Stewart (2009) as “the study of what we ought to do”. Hippocratic Oath has been known over the years to bound medical practitioners to perform their duties as per the human and social ethics. The reason as to why ethics and in particular bioethics is a major focus in health care delivery is the fact that making of sound judgments, good decisions, and right choices are of paramount importance given that human life is involved (Beauchamp 2007). In this case various ethical theories are put into practice to ensure that moral integrity is adhered to. Various legal structures have been put into place to govern practices in health care. This is recognized to be a sensitive matter with human life at stake. Therefore, a culture of “legal sensitivity” has been inculcated and emphasized in Health care industry (McLean & Mason 2003). Ethico-legal issues in healthcare industry have been known over the years to protect both the interests of clients (patients) as well as those of health care professionals (Pozgar 2012). These ethical-legal issues are known to guide healthcare professionals in their day to day service delivery as per the required set standards. It has to be bore into mind that while trying to adhere to these ethico-legal concepts, one has to consider cultural diversity among patients and other co-workers (McLean & Mason 2003).. However, putting these concepts into practice has been a great challenge in the health care industry as they tend to conflict each other. Consequently, many health care practitioners have been left wallowing in miasma of confusion and dilemma with regards to the right procedures to follow when faced with such cases (Pozgar 2012). The case at hand involving Patty is a classic example of the cases faced by health care professional while in their line of duty. In such a scenario, a case conference drawing from all the stakeholders in convened to seek a way forward to come up with sound decisions. As such this is exactly what happened. In this case, Patty; a 65 years old Australian born woman living in an age care service is suffering from stroke and also significant end-stage cardiac disease. This case raises a significant number of ethico-legal issues. The rest of the essay tries to identify, conceptualize and argue out some of these ethical-legal issues that emerge. The issues discussed include; Beneficence and Non-maleficence, Therapeutic Relationship, Paternalism and Informed consent, the Right to Autonomy and Power of Attorney, and lastly the Right to Good Life and Advanced Care Directive. Beneficence and non-maleficence is a major ethical issue arising from this case. Beneficence in general describes the principle ‘to do good’ (Beauchamp 2007). This is in an attempt to demonstrate kindness and show compassion while helping others. This is a core ethical obligation of health care practitioners. Non-maleficence on the other hand is based on the principle ‘do no harm’ (Gillon 1994). This is in line with the Hippocratic Oath that that bounds all the medical practitioners. Balancing between the two concepts has proved to be a great challenge for many health care providers. The balance is related to the benefits and risks of administering treatments (Atkins Britton & de Lacey 2011). In this case, Patty seems to have given up and demoralized after the death of her roommate. She refuses to undertake any medication and feeding. This in turn affects her health status. The staff understands that it is beneficial for Patty to take her medication and feeding. That’s why they try to persuade her and even go to an extent of using invasive procedures i.e. feeding tubes and medication via alternative routes. Their objective in this is to try to improve Patty’s health. The concept of therapeutic relationship has also been significantly brought out in this case. Pullen and Mathias (2010) define therapeutic relationship as a helping relationship that is mutually based on trust, respect, faith, and hope. The caring relationship is developed so that a caregiver can effectively understand the patient thus providing quality service. In this case, the patient is viewed as an equal partner in this quest to wellness (White 2005). The case involving Patty has this issue clearly brought out form the statement “The nursing staff also had the advantage of establishing a therapeutic relationship with Patty over a long period of time”. This is further cemented by the observations on Patty’s character made since she entered the facility. Paternalism and Informed Consent are also another issue in this case study. Paternalism has been described by Pozgar (2012) as a form of beneficence. This normally occurs when an individual or institution have a belief that they know what is best for the patient thus making decisions on their behalf. Medical paternalism can involve making decisions on behalf of the patient and preventing the patient from making an informed decision (Kelly 2011). One of the ethical obligations of health care professions is obtaining informed consent for clients to make medical decisions. This is an attempt to respect the patient as a person. As can be noted, the two principles can be antagonistic in a situation of disagreement between the patent and the care giver (Pozgar 2012). The nurse and the facility management in this case can argue on the basis of medical paternalism as they believe feeding and medication is for the good of Patty as a patient. This can however be confusing when Informed consent is introduced (Kelly 2011). Legally Patty has the right to accept or refuse any form of treatment. In this case, Patty is right to refuse feeding and medication being administered to her. Her sister seems to understand this. Related to Paternalism and Informed Consent are the Right to Autonomy and Power of Attorney. The right to autonomy is based on the principle of respecting individual’s right to self- determination and respect of individual liberty. According to White (2005), “right to autonomy rests on the client’s competency to decide”. It can however be noted that this is linked to informed consent as respecting autonomy implies that the health care practitioner respects the client’s choice even if they happen to conflict with the nurse’s values. As demonstrated in this case, Patty has a right to autonomy to refuse any medication given her self- determination and competence. As per the case, Patty’s moral personhood emerged as the determinant of how she led her life and that her decisions and actions were intentional and conscious choice. Based on this principle, it is therefore wrong for the facility management including the staff to force medication and feeding on Patty as her actions seem to be suicidal ideation (Atkins Britton & de Lacey 2011). Power of attorney is evident in this case. Power of attorney sometimes referred to as “Authority of the agent” is a principle in health care whereby an agent is allowed to make decisions regarding medical treatment within the terms of legislation (Collier & Lindsay 1992). This However does not include palliative care. As such, “Palliative care” is inclusive of the provision of reasonable medical procedures with regards to pain relief, discomfort and suffering, or reasonable provision of food and water (Kelly 2011). From Patty’s case in discussion, Patty had granted her Sisters her enduring Power of Attorney. In this case they are the ones bound to make medical decisions on her behalf. Patty’s refusal to medication and feeding (right to autonomy) is justifiable and complemented legally by the fact that her Sisters (Power of Attorney) were of the view that Patty had made her decision and did not want her wishes overruled. However, If the sisters had a different view, they would not by any means go against her wish as Power of attorney does not include palliative care which food and water falls into. The Right to Good Life and Advanced Care Directive are other ethico-legal issues present in this case. Advanced Care Directive through Enduring Guardianship has been provided for the Guardianship and Administration Act 1995 of the Tasmanian Laws for the best interest of the patient (The Clinical, Technical and Ethical Principal Committee of the Australian Health Ministers’ Advisory Council [CTEPCAHMAC] 2011). This principle has been used by those individuals who fear for loss of autonomy after losing their decision-making capacity. Advance Care Directives therefore provide a means for people to plan ahead of such situations. These in particular are written documents regarding a person’s medical-life management that is aimed at ensuring that even in the event of their death; they die with dignity as per their personal values (Dossey & Keegan 2008). It is clearly stated that Patty had not completed an Advanced Care Directive. This suggests that she entirely placed her decision making powers to her sisters who in this case had the “Power of Attorney”. ACD is usually linked to Right to quality life as the issue mostly revolves around End of Life Care. The objectives of any interventions by health care practitioners are usually to improve quality of life (Nursing and Midwifery Board of Australia 2010). Most patients will complete an ACD in case a health crisis occurs with potential reduction in quality of life (Dossey & Keegan 2008). In this case, the nurses are trying their best to ensure that Patty’s health improves thus provision of medication and feeding. Her refusal to cooperate results to her health deterioration and this is against the nurses wishes. Here the nurses are acting based on the principle of Paternalism as they know what is best for Patty. However, Patty based on the principles of Right to autonomy has a right to refuse. This is further backed by her sisters “Power of Attorney” views of supporting her decision. List of References Atkins, K., Britton, B., & de Lacey, S., 2011, Ethics and Law for Australian Nurses. Port Melbourne: Cambridge University Press, Beauchamp, T.L., 2007. Principles of Health Care Ethics. 2nd ed. Sussex: John Wiley & Sons, Ltd. Collier, B., & Lindsay, S., 1992. Powers of Attorney in Australia and New Zealand. Sydney: Federation Press. Dossey, B.M., & Keegan, L., 2008. Holistic Nursing: A Handbook for Practice. 5th ed. Massachusetts: Jones & Bartlett Learning. Gillon, R., 1994. Medical Ethics: Four Principles plus Attention to Scope. BMJ, 309, 184. Kelly, P., 2011. Nursing Leadership & Management. 3rd ed. Connecticut: Cengage Learning. Kerridge, I., Lowe, M., and Stewart, C., 2009. Ethics and Law for the Health Professions. 3rd ed. Sydney: The Federation Press. McLean, S., & Mason, J.K., 2003. Legal and Ethical Aspects of Healthcare. Cambridge University Press. Nursing and Midwifery Board of Australia, 2010. Information Sheet on Social Media. Melbourne: Nursing and Midwifery Board of Australia. Pozgar, G.D., 2012. Legal and Ethical Issues for Health Professionals. 3rd ed. Massachusetts: Jones & Bartlett Publishers. Pullen, R.L., & Mathias, T., 2010. Fostering Therapeutic Nurse-Patient Relationships: Nursing Made Incredibly Easy. American Journal of Nursing, 8(3), p. 4. The Clinical, Technical and Ethical Principal Committee of the Australian Health Ministers’ Advisory Council [CTEPCAHMAC], 2011. A national Framework for Advance Care Directives. Sydney: Australian Health Ministers’ Advisory Council. White, L., 2005. Foundations of Nursing. 2nd ed. Connecticut: Cengage Learning. Read More