Nursing Law and Ethics

Law and Ethics Case Study

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Law and Ethics Case Study

Physicians, nurses, midwives and other healthcare professionals operate within the confines of the legal and ethical standards. Codes of conduct and ethics provide guidance to all health professionals within the Australian healthcare system. The understanding of ethical codes and legal requirements promotes the best healthcare practices. The paper provides an in-depth analysis of an ethics case study, therefore, enhancing the understanding of how ethical and legal concerns are presented in this case study.

Legal and ethical concerns

The case study focuses on Elenor, who is 16 years old seeking treatment at a rural accident and emergency department to address the lower abdominal pain she experienced. All her vital signs were within normal parameters in addition to having a low pain score of 3 out of 10. Triage was used to asses her healthcare needs. According to Elliott, Aitken and Chaboyer (2011) triage is essential to assessing emergency patients to determine the level of priority that they should be assigned based on their current health status. The patient, in this case, Elenor experienced low pain threshold which is below 5 out of 10, and all vital signs were within the normal range identifying that she was not a high priority patient. The healthcare team was within its legal rights to have her wait while the patients who were critically injured received healthcare services. Elliott et al., (2011) noted that rating within the emergency department helps to prioritize patients based on their needs with those experiencing life-threatening situations accessing emergency services before those with less urgency healthcare needs such as Eleanor. It is a legal and ethical responsibility on the part of the healthcare team to serve the motorcyclist who had major leg, chest and head injuries before attending to Elenor.

The prioritization of cases with higher healthcare needs and greater severity of symptoms helps to promote quality care while saving patients life. Shortage of healthcare professionals such as doctor and nurses has a direct influence on the quality of care provided to the patients (Elliott et al., 2011). As the Emergency department was understaffed the physician prioritized the patients involved in the motor vehicle accident over Elenor even when her vital signs indicated her discomfort. The doctrine of informed consent was addressed in this case. A briefing on the nature of the treatment and the plan of care to Elenor and her mother achieved the concept of consent in the treatment process. In Australia consent for treatment must be provided by adults responsible for the health of the minor (Sahealth.sa.gov.au, 2019).  Informed consent in the treatment process is a legal requirement on the part of the healthcare professionals addressed in this case study. Australian law as argued by Hall, Prochazka and Fink (2012) provides for parents or guardians to provide consent to treatment for minors.  The nurse-patient relationship requires the nurse to respect the authority of the patients in making decisions concerning their health highlighting the importance of seeking informed consent in the treatment process (Hall et al., 2012). Patient confidentiality is another ethical practice that falls within the role of the healthcare professional (Hall et al., 2012). Elenor declined paid relief advising that she may be pregnant. The nurse acted ethically by refraining from informing her mother about the possible pregnancy which shows a respect to confidentiality in patient care. The nurses did not provide Elenor with pain relief medication as per request and this exemplifies the value of respect in the delivery of healthcare services. Respect for the patient informs the need to adhere to the wishes and desires of the client which is an important ethical concept.  Respect for others is termed as the highest principle and was well evidenced by the actions of the nurses in this case (Atkins, De Lacey, Britton & Ripperger, 2017). The nurse acted ethically by justifying the doctor to carry out an ultrasound to confirm the pregnancy.

Throughout the case study the nurse and the healthcare team acted ethically. Informed consent for surgery was gained identifying another example of how nurses applied ethical decision making (Hall et al., 2012).  Section 12(b) of the Consent to Medical Treatment and Palliative Act of 1995  provides that an individual cover 16 year of age may provide consent to medical treatment as effectively as an adult  (Sahealth.sa.gov.au, 2019). Based on this law, the nurse and doctors who administered blood transfusion to Elenor despite her mother’s objections provides insights into the legality of the decision taken by the healthcare team.  The legality of the action taken by the healthcare team to provide blood transfusion according to the wishes of Elenor is guaranteed in NSW section 49 of the Minors Act 1970 that recognizes consent by any child older than 14 years of age (Sahealth.sa.gov.au, 2019). The actions taken by the nurses and doctors can therefore be termed as both legal and ethical.

Implications of different actions or inactions

The different actions and inactions taken by the nurses has varied outcomes. First the nurse carried out triage with Elenor to record her vital signs that aided in ranking her in terms of priority of care.  The nurses identified that Eleanor experienced low levels of pain rated at 3 out of 10 and with all vital signs within the average parameters she was not in urgent need of medical care. The action to have her wait while the victims of the motor vehicle accident who had life threatening injuries were addressed helped to save the lives of these patients. However, the failure to provide immediate care to Elenor execrated her symptoms with the pain score rising to 5 out of 19 and her vital signs were beyond the normal parameters. The inaction in this case enhanced the abdominal pain experienced by Elenor.  The action by the doctor to leave Elenor to care for the motor vehicle accident victims meant that extensive care was not provided to the patient.  The action to provide blood transfusion to the hemorrhaging patient helped to save her life. The inaction to inform the mother of Elenor’s pregnancy and to provide blood transfusion against her wishes was responsible for angering her thus developing aggression between her and the nurses.

Ethical theories

The ethical theories evidenced in this case include utilitarianism and deontology. Utilitarianism is based on the assumption that the action that promotes the greatest value or good for most people is the most ethical decision (Atkins et al., 2017).  According to Baker and Foxall (2019a) utilitarianism argues that consequences justify the actions taken. Based on the utilitarian theory the action by the nurses and the doctors to provide immediate care to the victims of the motor vehicle accident while Elenor waited was ethical. The action was ethical as it helped to save the victims experiencing life threating injuries while serving Elenor whose health problems were not serious later on. Additionally, the action to give Elenor a blood transfusion as she had requested helped to save her life since she was hemorrhaged heavily and needed the transfusion. The consequences of the action is what the utilitarianism theory respects and the actions by the nurses helped to save the life of the patient rendering this action as ethical (Atkins et al., 2017).

The deontology theory of ethical thinking is evidenced in this case. The theory of deontology is based on the specific duties of the actor in question (Baker & Foxall, 2019a). The nurses, doctors and the rest of the healthcare team acted within their duties in providing care to Elenor. It is the duty of the nurses to save the lives of patients and therefore prioritizing those with severe injuries after being involved in a motor vehicle accident was an exercise in their duty (Atkins et al., 2017). Triage was carried out on Elenor when she checked into the emergency department and this is yet another duty that the nurses honored. The healthcare professionals have the duty to provide the best care to their patients (Hall et al., 2012). The act of seeking informed consent before treatment while seeking to protect clients from harm shows an exercise in the duty of these professionals.  The nurses understood their duty and worked hard to adhere to best ethical and legal practices.

Ethical principles, concepts and doctrines

Various ethical principles, concepts and doctrines are evidenced in this case.  The actions of the nurses and the rest of the healthcare team were based on the principle of beneficence that establishes the obligation to serve the best interests of the patients (Baker & Foxall, 2019). Beneficence in the Australian healthcare environment calls for actions that promote good. The act of providing triage and seeking consent for treatment is an example of beneficence in action. The nurses acted in the best interest of the client, for instance no pain relief medication was provided after the objection of the client. The life of the patient has the greatest value with and by providing blood transfusion to a heavily hemorrhaged patient such as Elenor was critical to saving her life (Atkins et al., 2017). The actions aimed at saving the life of the patient and addressing her healthcare problems were based on the principle of beneficence.

Non-maleficence is yet another principle of using evidenced in this case study. The principle of non-maleficence is based on the premise of minimizing, avoiding and mitigating harm (Baker & Foxall, 2019). Preventing harm is a paramount principle to all nurses and the actions of the healthcare professionals in this case were aimed at preventing harm. The action to care for the victims of the motor vehicle accident who had severe injuries as compared to Elenor whose pain threshold was low was aimed at preventing further harm. Immediate health attention provided to patients experiencing life threatening injuries within the emergency department was essential to prevent the ultimate harm that is death or disability. Providing triage to assess the priority level of care to Elenor by assessing her vital signs and pain score was critical to avoid harm to the patient by ensuring that her health problems would not worsen (Atkins et al., 2017). An additional action that shows the principle of non-maleficence is the act of providing blood transfusion to the client to ensure that she did not die while in surgery. The nurses and doctors understood that inaction during surgery especially after heavy hemorrhaging had been observed would have led to the death of the patient and thus took action to prevent harm to the life of the patient. Non-maleficence therefore informs the nurses on the actions and inactions to take when seeking to prevent harm to the patients.

The duty to care concept is further evidenced in this paper.  Negligence for instance was observed when Elenor was forced to wait for about 4 hours before she could see a doctor. The negligence on the part of the doctors worsened her symptoms with the power adnominal pain experienced rising from 3 to 5 on a ten point scale. The right of the patient to make decisions about their health is well engrained within the principle of autonomy (Funnell, Koutoukidis & Lawrence, 2008). The nurses respected the decisions of the client by refraining from providing pain relief medication and giving her a blood transfusion despite objections from her mother. The nurses understood the competency of Eleanor as a 16 year old to make decisions regarding her health.

Application of professional codes of conduct and ethics

The nurses and doctors in this case applied effectively the professional code of conduct and ethics.  The nurses follow the law and refrain from unlawful behavior which is an important code of conduct as defined by the (Nursing and Midwifery Board of Australia, 2018). According to the Nursing and Midwifery Board of Australia (2018) nurses are obligated to practice legally and by taking into account the decision made by Elenor to provide a blood transfusion is legal as children above the age of 16 have the competency to make decisions regarding their health. Shared decision making between the Elenor, her mother and the nurses in designing the treatment plan was another evidence that the code of conduct was respected within this case. Informed consent is another important aspect of the code of conduct for nurses evidenced in the case (Nursing and Midwifery Board of Australia, 2018). The nurses sought informed consent in developing the treatment plan in addition to seeking consent for surgery.

Conflict between ethical principles

Conflict between the ethical principles of beneficence and autonomy are evidenced in this case. Beneficence calls for acting towards the greater good while autonomy focuses on respect to the decisions made by the patient. The nurses are conflicted on whether to respect the decision by the mother to refrain from blood transfusion in respect to her religious beliefs as a Jehovah witness or to act in the best interests of Elenor by providing her with a much needed blood transfusion. By respecting the decision of the mother the health of the patient would have been compromised. The ethical dilemma in this case is whether or not to provide a blood transfusion to the patient which promotes her wellbeing or to respect a decision that may harm the patient.

Conclusion

In summary, the case study on Elenor provides insights into the various legal and ethical issues faced by nurse and other healthcare practitioners. The actions and inactions by the nurses and doctors were based on two ethical theories that are deontological and the utilitarian theory of ethics. The principles of ethics evidenced in the case include beneficence, non-maleficence and patient autonomy. The nurses promoted the best interests of the patients, avoided harm in addition to respecting the decisions of the patient. The concept of duty of care was evidenced in the case study as the nurses’ implemented actions that aimed to promote the best care. The principles in conflict in this case include autonomy and beneficence. The nurses respected and adhered to the standards defined by the code of conduct.

 

References

Atkins, K., De Lacey, S., Britton, B., & Ripperger, R. (2017). Ethics and law for Australian nurses. London, UK: Cambridge University Press.

Baker, M. & Foxall, F. (2019). Ethical principles and Doctrines. Edith Cowan University

Baker, M. & Foxall, F. (2019a). Law and Ethics in Health. Edith Cowan University

Elliott, D., Aitken, L., & Chaboyer, W. (2011). ACCCN’s critical care nursing.  Victoria Avenue, Chatswood: Elsevier Australia.

Funnell, R., Koutoukidis, G., & Lawrence, K. (2008). Tabbner’s nursing care: Theory and practice. Sydney, Australia: Elsevier Australia.

Hall, D. E., Prochazka, A. V., & Fink, A. S. (2012). Informed consent for clinical treatment. Cmaj184(5), 533-540.

Nursing and Midwifery Board of Australia (NMBA). (2018). Code of conduct for nurses. Retrieved from http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD17%2F23850&dbid=AP&chksum=L8j874hp3DTlC1Sj4klHag%3D%3D

Sahealth.sa.gov.au. (2019). Consent to medical treatment and healthcare. Retrieved from https://www.sahealth.sa.gov.au

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