NURBN 1001: Mrs. Doris Ethical Case Study Sample

• Subject Code : NURBN-1001
• University : Federation University My Assignment Services is not sponsored or endorsed by this college or university.
• Subject Name : Nursing

Legal & Ethical Decision Making in Person-Centred Care

Ethics is defined as the principles by which the behaviour of a person is governed and dictates the morale and duty by which a person acts (Peter, 2018). Depending on the field or area in which a person works the definition of ethics can change. In the field of medicine it is necessary that everyone who is related to the healthcare of a patient is required to act in such a way that the care provided to the patient is such that there is no ethical or legal implication of the same (Haddad & Geiger, 2019). Earlier the care for the patient followed a paternalistic approach and now it has changed towards person-centered care which has made the ethical duty even more important (Herlitz et al., 2016).

Ethics are the universal rule by which the practical basis of actions taken, intentions behind those actions and motives are judged. In case of healthcare it is influenced by the dilemmas, ability to make good judgments and value based decisions. There are various guidelines which help the healthcare professional and they are required to comply with the same as the failure to do so can result in legal repercussion not only for the healthcare professional but also for the healthcare facility they are working for. The aim of the present essay is identify and discuss the ethical and legal considerations in the case study given.

The present case given is of Mrs. Doris who is a 79 year-old female with her spouse Peter. She reported to the emergency department and radiograph confirmed that she had fractured her right hip which required surgery for rectification. The patient was admitted and transferred to orthopedic department. It was seen that due to accident she was confused and disoriented prior to which she did not have any cognitive dysfunction. There was a gap of communication that was seen while providing the healthcare to the patient in the emergency department as first the patient should have been asked if she is aware where she is and her situations should be explained to her.

It is right to knowledge and communication and her right to healthcare under charter of healthcare as given by the government of Australia (Australian Commission on Safety and Quality in Health Care, 2009). There are three principles which help in the description of the charter system and its application to Australian healthcare system. The first principle towards the right to healthcare service as when it is required, that is, accessibility to healthcare service. The next principle is the same as the universal right of the human beings to be able to enjoy the highest possible level of physical and mental health. The third principle is towards the level of care which is appropriate to the cultural background of the patient and is safe in all the sense (Couzos& Thiele, 2016).

According to the Australian healthcare system the rights of a patient is towards the accessibility to the care facility, the care should be safe, it should be provided such that the patient’s dignity and respect is maintained (Trevena et al., 2017). The patient has right to communication with the healthcare team in regards to their healthcare plan and the patient has right to be included in the care plan of under the provision of patient-centered care. The patient should be given the chance and should be encouraged to take part in any decision pertaining to their healthcare and medical care. The patient has a right to their privacy when healthcare is being provided to the patient and they should be able to and encouraged to comment about the healthcare plan that is being provided to them.

In case of Mrs. Doris it was seen that she has access to healthcare but the communication was inadequate. When she was brought to the emergency department he level of alertness should have been checked and she should have been informed about the fact that she had been in accident and she had been brought to the hospital. The violation of ethics was seen when the patient was shifted to the orthopedic ward and the surgeon did not explain the procedure that the patient will be undergoing. This violates the right to communication, participation and comment.

The doctor should have explained the procedure that will be conducted on the patient in detail and the importance of the procedure including the duration of the procedure. Informed consent is an important part of healthcare and it should be taken from the patient or the caregiver (Van Damme et al., 2020). In the present case, the surgeon did not explain the form or the purpose of the procedure to the husband. When the nurse spoke to Peter while caring for Doris it was seen that there were issues with the memory that he was facing and it was not documented with the general practitioner. His condition does not make him an ideal candidate for the obtaining consent. The doctor should have asked the patient about the next of kin other than her husband like their children or any living relative who can be contacted. Due to the constraints of time, the doctor should have delegated the work to the nurse who is in charge for the care of the patient.

The nurse based on her experience, understanding and judgment was able to escalate the condition of the patient first to the doctor who was in charge of the case but when the response that she had obtained was not satisfactory she escalate the case to the manager of the nursing unit. According to the rights and responsibilities of the registered nurse it was appropriate measure. The registered nurse before she signed off for the duty she did not action regarding the issue of consent. The neighbor of the couple had come to visit and requested that he can be give consent if required for the surgery. The action taken by the nurse should have in accordance to the right of the patient and policy that have given by the hospital.

In this case, the nurse should have spoken to the patient directly regarding the medical decision and asked her if she would like to like to make Bert the neighbor as her medical proxy. Health proxy or medical proxy is the term which is used in healthcare where a person can be designated to make medical decision for the patient when the patient is deemed unfit (Bravo et al., 2018). In the present case, the patient does not have any cognitive defect and she can be given in charge of her own health and consent should be obtained from her instead of her husband.

There are four main principles that are the cornerstone in the ethics of healthcare and they are autonomy, beneficence, non-maleficence and justice (Teays, 2019). In the present case it was seen that the all the four principles were violated. Autonomy is the respect for others and that the person if capable of making decisions should be allowed to make decision about their life or in this case health. It also comes under the dignity of the patients that the person as the decisions made by a person is made in his/her best interest and it should not be interfered with. In the present case, Mrs. Doris should have been given complete information about her condition and that she would require surgery for the correction. Consent is the when the patient agrees to get a procedure done by and informed consent is when the procedure is explained by the doctor in respect to the effects it might have also any adverse outcome that the patient might face as a consequence of the procedure (Cocanour, 2017).

The next principle is that of beneficence according to which a healthcare provider is obligated to do only such things which will bring about the good and positive changes in the health of the patient. The third principle is that of non-maleficence which is to do no harm to the patient. It has corollary principles like the harm should be mitigated if it cannot be avoided, the risk to others should not be there as a part of the community, waste of resources should not occur more importantly there should not be any intention of harm (Wolf et al., 2016).

The last principle is of justice which means that the health care provider should work in such a way that everyone is treated in a similar way that is equally and fairly. The doctor violated the principle of autonomy, non-maleficence and justice while the care was being provided to the patient. He did not explain the procedure completely to the patient thus affecting the autonomy of the patient and the ability to make decision for herself. Next due to personal and leisure reason of playing golf the doctor delegated the work of performing the surgery to a junior doctor who performed the surgery without supervision.

This affected the intent of harm as the outcome of the surgery was adverse which led to further restriction of her movement post-operative which could be considered as violation to non-maleficence. If the surgery would have been conducted by the main surgeon himself the chance of untoward outcome would have been mitigated and as this was not a just behaviour towards the patient even that principle of ethics was violated. Lastly, the nurse did not follow-up to make sure appropriate consent was obtained before the surgery this is in violation regarding beneficence as it says all the work should be done towards the good of the patient and not otherwise.

Violations of ethics have legal repercussions not only for the healthcare professionals involved but also for the healthcare facility where the practice took place (Wheeler & Bertram, 2019).It is because in the former there is medical negligence while in the latter the hospital authorities let the negligence take place. Medical negligence or medical malpractice needs to be proven so that action can be taken against the healthcare professional and if there is any compensation which can be provided to the patient or the family members. The factors that need to be considered while making a case against medical malpractice and they are: there should be failure to provide the optimum standard of care; the injury should be from negligence and there should be consequences which are damaging (Stimson, 2016).

In the present case, all these factors were fulfilled when the doctor himself did not conduct the surgery or was present to manage the situation and it led to restriction of motion which would hinder the care she was taking of herself as well as her husband. The elements of the malpractice are: the doctor or the hospital was capable of providing the care; the care provided was not optimum; the breach resulted in injury and it created damage (Shandell et al., 2018). All these were fulfilled in the present case as the doctor was capable of conducting the surgery which was delegated to someone who was less than standard, which led to damage which created physical restriction for Mrs. Doris.

In conclusion, practicing healthcare means that the patient is always at the centre of the healthcare and the care provided is such that it customized for the patient and follows the ethical and moral duties of the healthcare provider. In the present case it was seen that the patient was confused and agitated when she was in emergency department and no attempt was made to address this. Later when the patient was transferred to the ward, the surgeon did not explain the procedure that would be conducted to the patient and consent was taken from the husband who showed signs of dementia. The nurse tried following it up but did not see it through. There was medical negligence that was seen as the doctor who was to perform the surgery did not and he delegated the work to junior doctor without supervision which caused injury resulting on physical restriction to her movement. In this case there was violation to ethical principles in healthcare and medical negligence.

References for Legal & Ethical Decision Making

Australian Commission on Safety and Quality in Health Care.(2009). Australian charter of healthcare rights.Australian Commission on Safety and Quality in Health Care.https://www.safetyandquality.gov.au/sites/default/files/migrated/Charter-PDf.pdf.

Bravo, G., Sene, M., &Arcand, M. (2018). Making medical decisions for an incompetent older adult when both a proxy and an advance directive are available: which is more likely to reflect the older adult’s preferences?. Journal of Medical Ethics, 44(7), 498-503. DOI: 10.1136/medethics-2017-104203.

Cocanour, C. S. (2017). Informed consent—It's more than a signature on a piece of paper. The American Journal of Surgery, 214(6), 993-997. DOI: 10.1016/j.amjsurg.2017.09.015.

Couzos, S., & Thiele, D. D. (2016). Aboriginal peoples participation in their health care: A patient right and an obligation for health care providers. Aboriginal and Islander Health Worker Journal, 40, 6.

Haddad, L. M., & Geiger, R. A. (2019).Nursing ethical considerations.StatPearls [Internet].

Herlitz, A., Munthe, C., Törner, M., &Forsander, G. (2016). The counseling, self-care, adherence approach to person-centered care and shared decision making: moral psychology, executive autonomy, and ethics in multi-dimensional care decisions. Health Communication, 31(8), 964-973. DOI: 10.1080/10410236.2015.1025332.

Peter, E. (2018). Overview and summary: Ethics in healthcare: Nurses respond. OJIN: The Online Journal of Issues in Nursing, 23(1). DOI: 10.3912/OJIN.Vol23No01ManOS.

Shandell, R. E., Schulman, F. A., & Smith, P. (2018). The preparation and trial of medical malpractice cases.Law Journal Press.

Stimson, C. J. (2016). Hospital risk management and the US legal system: An introduction to US medical malpractice tort law. In Risk Management in Medicine (pp. 69-76).Springer, Berlin, Heidelberg. DOI:10.1007/978-3-662-47407-5_7.

Teays, W. (2019).Applied Ethics: Principles and Perspectives. In Doctors and Torture (pp. 131-147). Springer, Cham.

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. DOI: 10.1016/j.zefq.2017.05.011.

Van Damme, J., Neiterman, E., Oremus, M., Lemmon, K., &Stolee, P. (2020). Perspectives of older adults, caregivers, and healthcare providers on frailty screening: a qualitative study. BMC Geriatrics, 20(1), 1-12. DOI: 10.1186/s12877-020-1459-6.

Wheeler, A. M., & Bertram, B. (2019). The counselor and the law: A guide to legal and ethical practice. John Wiley & Sons.

Wolf, L. A., Carman, M., & Clark, P. R. (2016).Protecting Behavioral Health Research Participants in the ED Setting: Issues of Consent. Journal of Emergency Nursing, 42(1), 85-86.

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