Successful healthcare relies on many negotiations and compromises and the privacy of the conversations between individuals is protected by law. The impression of ethical practice can be shaped by the ‘out of the ordinary', complex, and sometimes extreme cases, and these are often shared by the mainstream and social media. Nurses are patient supporters who must strike a balance when offering health care. Ethics has four core principles: autonomy, beneficence, justice, and non-maleficence (Ahmed et al., 2020). Based on their convictions and principles, each patient has the freedom to make their own choices. A patient visiting a specialist expects medical attention to provide help to his medical condition with all the experience and expertise that the specialist has. The communication takes the form of a contract that preserves the basic elements of misconduct. A doctor owes certain duties to his patient and a breach of any of these duties gives a cause of action for negligence against the doctor. Before carrying out medical testing and clinical management, the doctor should seek prior written consent from the patient (Raveesh et al., 2016).
In all aspects of patient care, physicians frequently experience ethical dilemmas. The resolution of these dilemmas should always be done to optimize advantages, honoring the wishes of the patient, and mitigating hurt and distress. Patients should be briefed before surgery on all of their medical methods, including possible complications and benefits. Competent patients, or, in some cases, their surrogates, are entitled, for whatever reason, to withhold permission for any action at any time. Ethically and lawfully, a practitioner is obligated to keep the personal records of a patient private, except in isolated situations where the patient is at risk of harm to himself or others (Lim et al., 2020). In this article, three case studies have been discussed which involves ethical and legal obligations the health professional goes through during their practice.
A 15-year-old girl meets a health professional in the provided case study, Tara, and receives confirmation from the health professional that her interaction will be kept private. Unless there are persuasive explanations, i.e., the health provider tells her. That perhaps the public is at risk of loss and that the discussion is private. Tara is continuing with her plea for the 'morning after' pill because she is worried that she might be pregnant after having unprotected sex with her partner. Australian common law clearly states that to agree to medical care, a person needs to be 16 years or older. The revised PSA protocol still provides an allowance for accessibility to an emergency contraception pill for women under the age of 16. The revised PSA protocol still provides an allowance for access to an emergency contraception pill for women under the age of 16 (Dineen-Griffin et al., 2020). To assist pharmacists in ensuring that the women they serve can obtain and use this pill efficiently, comfortably, and unobtrusively, the current guidance has been fully revised. However, whether you are 14 or 15 years of age, a practitioner will always need to seek your family's or guardian's permission until you object; whether you are 14 or younger, your parent's or guardian's approval to undergo medical care is usually necessary. In this very particular case, the legislation surrounding secrecy and agreement has to be checked (Li et al., 2020). A 'competent' 14-year-old has a right to obtain medical advice and to agree to care (and there are clear meanings of 'competent'). Medical secrecy ensures that the person in the meeting is kept private. In this case, most medical professionals will strive to include parents in the debate as they are the legal guardians of the girl.
In this situation, the ethical challenges may be that clinicians often encounter sexually active adolescents without the consent of their parents and are forced to give contraceptive details to them (Briggs, 2018). The girl should be counseled about sexual health as well as the adverse effects of the treatment at a young age. Also, the health care professional should inform her parents regarding the same, as the moral obligation is that she might harm her health in long run through these contraceptives (Katz et al., 2016). It is a fact that better communication between doctor and patient can be used constructively in the future, means is questions about genders, relationships and big decisions around them will be more open, but essentially this is based on confidence and honesty, not regulation. In their position, doctors should take advantage of opportunities to raise consciousness among young people about the dangers of underage sex, to educate them, and to protect them.
The contraceptive pill ('the pill') is the most widely recognized option for young adults and the first contraception alternative administered by most physicians. Long-acting reversible contraceptive procedures can potentially be more suited for adolescents, nevertheless. They might well rely on the contraceptive’s negative effects, such as the concern of weight gain, frequent bleeding, or issues with fertility, ensuring that they know somebody who took it and was unable to be pregnant later down the line, while at the same time boasting about a friend who got pregnant while taking the drug. The task of the practitioner is to illustrate the technique's mode of operation and to help weigh the advantages and adverse effects (Polis et al., 2018). Of course, reliability is the biggest advantage for a young woman, but non-contraceptive advantages, such as a decrease in menstrual failure, dysmenorrhoea, and the risk of ovarian cancer, can also be significant, although an adolescent may seem quite distant. In this first session, it is appropriate to discuss possible slight side effects, such as breast pain or moderate headaches, but also to explain that they are acute and may decline after the first pack or two. Young women tend to be generally unconcerned with the more extreme possible dangers, such as venous thromboembolism, and yet the overall risk should be proportionate to them (Menon, 2020).
In the given case study two critically ill patients present to the hospital, both suffering from COVID – 19. There is only one ventilator, and both patients are likely to die if they don't receive support from the ventilator. Justin is a 39-year-old and has a history of mild asthma and epilepsy for which he takes medication. Justin has a less than 50% chance of surviving and will need at least 3 weeks on the ventilator. Mara is 70 and has osteoarthritis and mild depression, she has been unwell for 4 days. Doctors predict that Mara has a more than 50% chance of survival and will require up to a week on the ventilator. Guidelines that may decide which patients with coronavirus are prioritized for lifesaving treatment differ by jurisdiction, including variables such as age, health conditions, maternity, and cognitive skills. Hospitals and public health authorities are collaborating around the country on proposals on what will happen if the number of patients with coronavirus exceeds the available space in intensive care units. The proposals fail to solve a multitude of legal questions, as well as social inclusion concerns.
In the given case study the ventilator should be given to Mara as she has got more survival chances than Justin. Both of the patients are suffering from other ailments but the ventilator requirement duration is different. Mara needs it for a week and if it is provided to her after one week it can be used for other patients who are in serious requirement for the same. But Justin's health conditions demand the ventilator for three weeks and there is less than 50 percent chance for survival. Many states have established triage systems for what occurs after a natural catastrophe or a major pandemic, where hospitals are overrun. If the coronavirus pandemic spreads, they have also been re-examining those proposals, hoping they will be beneficial if hospitals get more critically ill patients than ventilators (Holmes et al., 2020). As even more details on Covid-19 becomes accessible, any of the proposals could be revised; these are the iterations that have been made available to the public. Nearly all the plans offer preference to otherwise stable individuals who are more likely to survive entirely. Individuals with existing medical issues can be ranked lower, but people of low wages and people of color also face more health issues since they may not access top-notch treatment. If a hospital has a staff deficit, the first question it may decide is whether to refuse access to an intensive care unit for individuals of illnesses that would possibly result in near-immediate death, even if the hospital has a lack of services (Maciosek et al., 2017).
One typical technique is to remove patients who are unable to respond to traditional treatments, such as defibrillation, or may have a heart attack. Plans may also exempt those who, where the chance of survival is poor, may have suffered a serious brain injury or extreme burns. A triage strategy states that "people with serious mental retardation" are among those who "could be weak candidates for ventilator help." Some recommendations require for each patient the evaluation of a "baseline functional state," taking into account considerations such as drops in energy level, physical capacity, and cognition (Weise et al., 2017). Patients with a variety of variables that largely aim to measure both short-term and long-term survivability will be assessed under other criteria. The rating protocols give younger people a greater chance of accessing treatment if two patients have the same predicted survivability, with the 'lowest preference' given to patients 85 and older.
Some states depend at least in part on the Sequential Organ Failure Evaluation (SOFE) ranking, which tests the functioning of major systems of the body, including the heart, lungs, kidneys, liver, blood, and neurological processes. It will be less likely for patients with higher SOFE scores to apply. For this use, the scoring system was never intended, and some experts doubt how effective it would be in forecasting survival. Some proposals use multiple scoring mechanisms or use a sliding scale so that if it turns out there are enough ventilators, anyone whose score is significantly higher than a predetermined cutoff would not be immediately disqualified (Maitra et al., 2018).
In this case, a 57-year-old man named Harry has been diagnosed with Motor Neurone Disease. Harry completed a Health Direction which clearly states that if his health deteriorates that he does not want specific treatments that prolong his life. Over the last couple of days, Harry has developed a chesty cough, rattily breathing indicating a chest infection. He is transferred via ambulance to the emergency department along with a copy of his Health Directive. His wife is requesting doctors to give him a treatment. Advance care planning can help a person to state what should be done when the person falls ill and also who should be consulted in those conditions for decision making. Since the patient has already made his health directive in presence of family members and health professionals that he should not be treated if his condition deteriorates. The doctor is hence under legal obligations of following the will of the patient. The principle of ethics gives the patient autonomy to choose the treatments as well as deny the treatment. Of course, many of the issues that involve thinking about the end of life care will be similar regardless of what sort of family connection one has (Pattison et al., 2018).
This case highlights the challenges encountered by healthcare professionals when regard for autonomy contrasts with the related ethical concept of beneficence and where it is important to identify the absolute authority of an advance directive, particularly in emergency circumstances and end-of-life decisions with an appropriate sense of professional risk, whichever direction is chosen (Ries et al., 2020). Advance directives are an essential and legitimate statement of patient rights, Advance directives are an incentive to prepare for end-of-life treatment, so if they are aware, are frequently updated, if their limits are known, and if they are written up to represent motives rather than identify specific circumstances or treatments, they are more likely to be implemented. Healthcare practitioners have a responsibility under the Mental Competency Act to recognize their obligations and derive the relevance and applicability of any advance direction they get, although it will be appropriate to explain the legal status of healthcare professionals who refuse to act in compliance with an advance directive to save a life (Ries et al., 2017). Based on their convictions and principles, each patient has the freedom to make their own choices. This is called autonomy. The need for autonomy for a patient may clash with treatment standards or recommendations that are better understood by nurses or other healthcare professionals. A person has the right to reject drugs, therapy, surgery, or other medical procedures, irrespective of the profit that might result from them. The nurse must honor the decision if a patient decides not to undergo a medication that might have a benefit (Callaghan & Ryan, 2016).
Healthcare staff is obligated to refrain from maltreatment, reduce damage, and allow patients to benefit. This obligation of unique care determines beneficence. Healthcare staff proves this by presenting the patient with a balance of benefits and costs (Russell, 2017). Many examples of beneficence are assisting patients with activities they cannot handle on their own, holding side rails up for fall precautions, or delivering drugs in a fast and timely manner. Advanced care preparation helps patients throughout their clinical cycle and their lifetime to assert their beliefs and expectations for care so that when unforeseen circumstances occur and patients are unable to make medical choices, doctors and family members will guide care in a way that is per patients' wishes. In doing so, ACP would only increase the quality of patient care, but may also lead to regions of greater need by explicitly restricting health care services, increasing the efficacy of the health care system. For certain resident doctors, engaging in ACP with patients may be difficult (Bramley et al., 2020).
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