Legal and Ethical Decision Making in Person Centred Care

Introduction to Legal and Ethical Decision Making

Providing adequate nursing care is possible with effective regulations, principles, and codes that help in guiding the healthcare professionals to take suitable decisions for the beneficence and wellbeing of the patient (Grace et al., 2017). Breach of the bioethical principles can cause major harm to the patient and result in repercussions for the healthcare professional (Suhonen et al., 2018). This essay aims to identify the major health and legislation that controls the Australian healthcare system in association with the case study provided.

This essay will also explore the concept of valid consent and its exceptions in special cases. The significant consequences of medical negligence arising due to breach of duty of care and damage will also be discussed about the established guidelines. The bioethical principles of patient autonomy, beneficence, non-malevolence, and justice will also be elaborated in conjunction with the provided case study of the surgical failure of Mrs. Doris who has undergone major surgery.

Healthcare and Legislature

The Australian charter of healthcare rights describes that fundamental rights of the patients and identifies the seven essential rights, that are associated with access, safety, communication, respect, privacy, participation, and comment (Trevena et al., 2017). The patient rights regarding the access of healthcare assert that the patients must access the healthcare services to address the healthcare needs (Government of Australia, 2019). It is also ensured that the patient receives safe and high-quality healthcare services with professional care, competence, and skills. The Australian charter also ensures that the patients are treated with dignity and respect and they receive treatment with the socio-cultural considerations.

The charter also ensures that the privacy of the patient is protected at all times (Duckett &Willcoz, 2015). Communication about healthcare procedures in an understandable form has also been identified as a crucial aspect of essential healthcare practice. The patient must receive open, timely, and appropriate communication and deliver comment on same. The patients possess a univocal right to comment on the care services to get the concerns addressed. This also ensures the participation of the patient in the process of decision making and the delegation (Government of Australia, 2019).

In the given case study of Doris, the charter principles of patient safety, communication, participation, and comment have been neglected. This can be seen as a violation of patient rights to adequate healthcare. It has been recorded that the concerned nurse for Doris thinks that Peter might not be able to provide suitable consent regarding the healthcare decision for his wife and therefore, a blank consent form is collected. This is a breach of communication, participation, and comment as the patient was not informed of the due procedures, the participation and comment of the patient were neglected in the decision making. Even when Bert, a close ally of the couple arrived, the consent was not taken and the surgical procedure was initiated.

To assist the healthcare professionals to comply with the charter, the Nursing and the Midwifery Board of Australia has developed a national framework that guides the healthcare professionals for the development of the decision-making tools and their application in practice (Duckett &Willcoz, 2015). The primary principles associated with this framework aim to identify the core principles for the decision making for the overall wellbeing of the patient and to assert the accountability of the nurses for making professional judgment concerning the health and wellbeing of the patient (Nursing and the Midwifery Board of Australia, 2010).

It also asserts that decision making must be done with a collaborative and participatory approach to ensure the beneficence of the patient and the promotion of health (Nursing and the Midwifery Board of Australia, 2010). The given case can be associated with a breach of the delegation and decision-making principles established by the Nursing and the Midwifery Board of Australia. Since the wellbeing of the patient was not given essential priority. The well being of the patient was compromised when a junior orthopedic surgeon performed surgery on Doris resulting in increased pain and problems in mobility.

It was an essential duty of the care nurse to report the absence of the primary doctor. Further, since the consent of the patient was taken, this surgical procedure was unethical and breached the principles of patient wellbeing and collaborative decision making (Brooks et al., 2017). The nurses are required to function as the advocates of the patient and to provide them adequate knowledge about the clinical procedures for their consent and involvement in the process of decision making which was not done in the case of Doris (Nursing and Midwifery Board of Australia, 2018).

Valid Consent

Valid consent can be defined as the approval for the healthcare procedure given by the patient after complete knowledge of the risk and benefits that are associated with the procedure (Grace et al., 2017). This is also termed as “informed consent”. The patient or their carer available for the decision making must have understood the healthcare procedure or the treatment in association with the risks involved for critical analysis and decision making. Informed consent is an essential part of ethical nursing practice that has been included in the code of conduct by the Nursing and the midwifery Board of Australia.

The subclass three of principle 2 of the code ethics, “Person-centered care” dictates that informed consent is an individual’s voluntary agreement to healthcare and must be collected before any treatment or intervention application (Nursing and Midwifery Board of Australia, 2018). The Australian Nursing and Midwifery Federation (2012) identifies that the consent can be classified into implied, verbal, or written forms. Implied consent is considered when the patient’s lack of action or action indicates their wishes. Verbal consent is obtained when the patients state their approval through clear communication. Written consent is often taken in healthcare where the patient signs a declaration associated with the healthcare procedure. The consent must be informed to be valid (Cook et al., 2016).

This implies, that the patient must be well aware of the benefits and risks before the admission to a procedure or treatment (Wen et al., 2017). The Medical Treatment Act of the government of Australia asserts the essential need for informed consent before initiation of any medical procedure. The Australian Nursing and Midwifery Federation (2012) also document the cases of exceptions where the decision and the consent of the healthcare practitioner can be taken into consideration. The decision of the healthcare practitioner is considered to be valid in situations where the patient is identified as incapable of providing consent. In cases where the patient is under the age of 18 years or with a significant mental health problem, the opinion of the medical practitioner is considered to be valid.

However, in the case of Doris, the consent obtained is illegal and invalid. The consent form was signed by Peter in a blank document where he was not informed about the potential benefits and the risks of the surgical procedure. Since the patient was not informed about the potential risks involved in the healthcare procedure, this consent is not valid. The nurse assumed that Peter was unwell to provide valid consent. This assumption was not validated by any significant evidence. Peter sure reported forgetfulness however, his cognition and rationality were not impaired making him a valid candidate to sign the consent of his wife, Doris. Moreover, on the arrival of Bert, even on asking about any due signatures, Bert was not informed and the due consent was not obtained for the surgical procedure.

Medical Negligence

The provided case scenario also serves as an example of medical negligence. The term medical negligence has been defined as the misconduct of a medical professional by lack of provision of adequate care resulting in a breach of the duties and harming the wellbeing of the patient (Cockburn & Butler, 2018). The four components that are associated with medical negligence in a healthcare setting include duty, dereliction, direct cause, and damage (Brous, 2020). Doris was attended by a junior orthopedic surgeon instead of the primary doctor scheduled for the surgery. The doctor did not miss the surgical procedure because of any significant reasons to justify his absence but had taken an off to play golf.

The duty of care in healthcare corresponds to a moral and legal obligation of the healthcare professional to ensure the safety and the wellbeing of the patient. The negligence of the doctor is a breach of duty of care in the case of Doris. Since the surgeon was new, lack of exposure and experience resulted in harm to the patient where her mobility was compromised post the surgical procedure and pain was aggravated. This imparts the unreasonable behavior of the doctors in the care setting (Hester et al., 2019). A reasonable person would have approached the situation with high caution and would have requested the assistance of other senior doctors available.

This medical negligence is a classical case of causation where the loss of the patient and healthcare deterioration is directly linked with the negligent behavior of the healthcare professionals in the hospital. This medical negligence further aggravated the healthcare problems of Doris as her mobility was reported to have impaired post-surgery and the pain had aggravated. It can be asserted that the overall wellbeing of the patient was compromised with a breach in the duty of care resulting in harm or damage to the patient’s health. This medical negligence is also associated with the breach of bioethical principles of care impacting the overall structure of the healthcare service provided to Doris.

Bioethical Principles

The four essential bioethical principles that govern medical practice include beneficence, autonomy, justice, and non-malevolence (Suhonen et al., 2018). Beneficence as an ethical principle in healthcare ensures that the healthcare interventions and treatments that are applied to the patient aim to result in the overall improvement of their health condition (Raus et al., 2018). The bioethical principle of justice guides that the healthcare professionals must treat all patients with justice providing them adequate access to the care services. The decisions taken by the medical team should ensure that no intervention or treatment harms the wellbeing of the patient under the provision of non-malevolence (Gray et al., 2018).

The fourth principle of patient autonomy dictates that the patient must possess the complete right to decide for the application of the treatment through informed consent (Gray et al., 2018). In the given case study, the bioethical principles have been breached. Conduct of surgical procedure by an unexperienced orthopedic surgeon breaches the ethical principle of beneficence where the wellbeing of the patient is compromised. Further, Peter was not given adequate knowledge about the surgical procedure before getting the consent signed, this is a breach of justice as the patient’s ability to make an informed decision was presumed to be compromised.

This case also breaches the principle of non-malevolence as the surgical procedure done by a junior surgeon in absence of senior guidance had high risks of potentially harming the health of the patient. Since the consent taken was invalid and taken without any proper education of the patient about the risks and benefits of the surgical procedure, the bioethical principle of autonomy was also breached in the provided case study.

Conclusion on Legal and Ethical Decision Making

The given essay summarizes the ethical and legal considerations associated with the case of Doris. This essay discusses the legal issues associated with the healthcare provided to the patient for her treatment. This has been done by a critical discussion of the concepts of legal guidelines associated with patient care and decision making in a clinical setting along with valid consent and the concept of duty of care. This essay also relates the core bioethical principles of nursing, justice, autonomy, beneficence, and non-malevolence in association with the case study provided.

References for Legal and Ethical Decision Making

Australian Nursing and Midwifery Federation (2012). Informed consent for nursing. 

Brooks, L. A., Manias, E., & Nicholson, P. (2017). Communication and decision-making about end-of-life care in the intensive care unit. American Journal of Critical Care, 26(4), 336-341.

Brous, E. (2020). The Elements of a Nursing Malpractice Case, Part 3B: Causation. AJN The American Journal of Nursing, 120(1), 63-66.

Cockburn, T., & Butler, D. A. (2018). Medical negligence. In Health Law in Australia [3rd Ed.]. Thomson Reuters Australia.

Cook, W. E. (2016). “Sign here”: Nursing value and the process of informed consent. Plastic Surgical Nursing, 36(4), 182-186.

Duckett, S., & Willcox, S. (2015). The Australian health care system (No. Ed. 5). Oxford University Press.

Government of Australia (2019). Australian Charter of Healthcare Rights – ACSQHC. 

Grace, S., Innes, E., Patton, N., & Stockhausen, L. (2017). Ethical experiential learning in medical, nursing and allied health education: A narrative review. Nurse Education Today, 51, 23-33.

Gray, C., Fox, M., & Hobson-West, P. (2018). Reconciling autonomy and beneficence in treatment decision-making for companion animal patients. Liverpool Law Review, 39(1-2), 47-69.

Hester, N., Pang, C. L., Cho, A., Kasivisvanathan, R., & Gooneratne, M. (2019). Shared perioperative decision making: a shift in the doctor–patient paradigm. British Journal of Hospital Medicine, 80(4), 216-219.

Nursing and Midwifery Board of Australia (2010). A national framework for the development of decision-making tools for nursing and midwifery practice. 

Nursing and Midwifery Board of Australia (2018). Code of conduct.https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx

Raus, K., Mortier, E., &Eeckloo, K. (2018). The patient perspective in health care networks. BMC Medical Ethics, 19(1), 52.

Suhonen, R., Stolt, M., Habermann, M., Hjaltadottir, I., Vryonides, S., Tonnessen, S., ... & Scott, P. A. (2018). Ethical elements in priority setting in nursing care: A scoping review. International Journal of Nursing Studies, 88, 25-42.

Trevena, L., Shepherd, H. L., Bonner, C., Jansen, J., Cust, A. E., Leask, J., ... & Hoffmann, T. (2017). Shared decision making in Australia in 2017. ZeitschriftfürEvidenz, Fortbildung und QualitätimGesundheitswesen, 123, 17-20.

Water, T., Rasmussen, S., Neufeld, M., Gerrard, D., & Ford, K. (2017). Nursing's duty of care: From legal obligation to moral commitment. Nursing Praxis in New Zealand, 33(3).

Wen, X., Feng, X., Ziyi, H. U., Jin, L. I., & Mei, F. R. (2017). Application of Subject-Centered Informed Consent in Nursing Research. Chinese Medical Ethics, 30(9), 1130-1132.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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