Case Study: Doris

Australian government strives to provide equal, accessible and safe healthcare to the people while recognizing the human rights of all the patients (Meyer et al., 2017). A goal of highest standard of physical and mental health is maintained in Australian healthcare system irrespective of the culture, race, sex or age. Although, Australia is taking a number of actions and steps to reach its goal of safe and accessible healthcare to the patients irrespective of differences. But, it still facing a number of legal and ethical issues including negligence issues, issues related to patient confidentiality and communication.

The aim of the assignment is to investigate the case study of Doris and apply a number of healthcare rights to the ethical, legal and moral issues faced by Doris and her husband Peter. The main issues that were identified in the case study were failure to perform ethical process of informed consent, breaching duty of care and medical negligence. This assignment will primarily discuss the relevant legal and ethical considerations in relation to the Australian Charter of Health Care Rights followed by the aspects of patient consent and safety. Further, the assignment will discuss the aspects of duty of care and breach of duty of care. It will then discuss the elements that are required for an action of medical negligence followed by the application of four main bioethical principles to the case study.

The Australian Charter of Health Care Rights provides the patients in the healthcare system with a number of legal rights (ACSQHC, n.d.). These rights are timely access to healthcare, safety and quality in care, respect and dignity, proper communication, participation in treatment, privacy and confidentiality for personal information and right to comment on any healthcare process. Doris was a 79 years old female who used to live with her 88 years old husband named Peter. She experienced a severe fall and needed hip surgery for the same. The doctors and nurses were inconsiderate toward the authentic process of informed consent. Moreover, they completely avoided the mental health of Peter while taking consent from him. The physician did not explain surgery procedure to Peter and influenced him to sign a blank document.

According to Katz, Webb and Committee on Bioethics (2016), informed consent is an ethical and legal principle in the healthcare which promotes legal processing of the healthcare functions in addition to complete awareness about the patient’s condition to the patient and the family members. The principle grants complete knowledge to the patients about the consequences of the medical procedure along with the risks and benefits (Nash & Wells, 2020).

The ethical issues in aspects of informed consent are very common and prevalent in the healthcare. The healthcare professionals either avoid the ethical principles of autonomy, justice and beneficence to the patients or neglect the physical and mental health of the patients or carers. It is important for the physicians to respect the rights and choices of the patients when it comes to their healthcare and treatment. Educating the patients or their family members about the medical procedure prior to the actual procedure can impart safety, respect, justice and beneficence to the patients (Davoudi et al., 2017).

Informed consent is a diverse subject and it brings up a number of legal and ethical concerns (Raposo, 2019). It can include areas of lack of awareness to the patients about their healthcare to faulty procedures that were not included in the consent form, to unethical ways of obtaining consent, to obtaining consent from physically and mentally unstable patient or to neglecting the need of a proper consent from a healthy individual (Raposo, 2019). The physician in the case study firstly used an inappropriate way of obtaining consent from Peter by not informing him about the process. This can charge the physician with civil offense such as gross medical negligence, and criminal offense such as betray and unauthorized touching of the patient.

Even though informed consent is followed in the healthcare premises but the physicians must also consider the issue of competent informed consent. It is an exception to the basic principle of informed consent in which some people of the society are considered as incapable of providing consent for their health condition. Competence is the physical and mental ability of a person to understand, process and deliver a certain type of information (Pouncey&Merz, 2019). The patients or the family members of the patients must be competent enough to provide consent to the physician or else it can be considered as an unethical procedure (Pouncey&Merz, 2019). Minors and mentally ill patients are considered as incompetent of providing informed consent for the treatment of self and other patients.

It is important for the healthcare professionals to obtain consent from other family members in such cases. Peter reported that he was having difficulties in remembering things. He was making mistakes such as leaving the gas stove on and forgetting way to his home which were complete signs of dementia. According to Beattie et al. (2020), dementia is an age based mental illness that makes a person incapable for making an informed consent. Peter reported his condition to the nurse and the nurse further reported it to the physician but he did not give any consideration to the matter. This was a serious violation to the Australian Charter of Health Care Rights for the patients.

The Australian Charter of Health Care Rights influence a healthcare professional to provide complete safety and quality in the healthcare irrespective of the religion, age or culture (ACSQHC, n.d.). It require the healthcare professional to maintain dignity and individuality of all the patients while considering their physical and mental state with critical decision making. The patients can file legal complaints against the physician in such case as it brings up serious issues of decreased patient safety and medical negligence (Guzik-Mukaruk et al., 2018). The issues of medical negligence and consent of the patient can lead to legal actions that can not only impact the patients but also the professional practice of the physicians, In this case the patient can file a case of medical negligence against the physician as he ignored the need of obtaining informed consent from a healthy individual and proceeded with an incomplete and unauthentic informed consent (Guzik-Mukaruk et al., 2018).

It is important for the physicians in the healthcare department to maintain the patient’s confidentiality, consent and privacy while providing safe and effective care to them. Both consent and privacy comes under the duty of care of the physician. Any negligence to the confidentiality, consent and privacy of the patients can result in a violation to the dignity, autonomy and individuality of the patients. The patient in the case study was a victim of improper consent and breached duty of care by the physician. “According to standard 3 of registered nurse standards for practice NMBA (2017), a nurse must provide relevant and authentic information to the patients in order to bring up a patient-centered and effective healthcare approach”. A patient –centered caring approach can minimize the risk of medical negligence and enhance the duty of care of the nurses as well as the physicians. It can favor a legal and ethical work environment for the patients and hence it can reduce the incidents of conflicts related to patient confidentiality, consent and privacy.

According to standard 2 of the NMBA standards for registered nurse standards for practice NMBA (2017), a registered nurse must always report notifiable conduct of the healthcare professionals and workers in order to ensure patient safety and wellbeing. The nurse in the case study was well aware of the Peter’s condition and the negligence shown by the physician in obtaining appropriate informed consent. It was her duty of care to get involved in the matter and respond with acute decision making skills. The nurse definitely tried to perform her duty of care by reporting the incident to the nursing unit manager. Documenting the incident was another important step that was followed by the nurse in response to her duty of care.

According to Cook, Schouten and Henrickson (2018), duty of care of a nurse suggest them to perform activities and interventions that justifies the 4 bioethical principles of care. These principles involve “principle of respect for autonomy, principle of non-maleficence, principle of beneficence and principle of justice” (Mendes, Wool & Wool, 2017).The physician was well aware of the mental health of Peter and his inability to provide legal consent for the patient which was a breach to his duty. Moreover, he did not considered involvement of Bert in the case which represented his rigidity toward inappropriate consent. Incidents like this indicated the breach of duty of care for the patient.

Medical negligence in the healthcare department is one of the most serious healthcare concern (Mendes et al., 2017). It not only impart harm to the patient’s health but also possess risk to the entire medical career of the physicians as well as the nurses. The orthopedic surgeon was inconsiderate toward the surgery of Doris and went to play golf while handling Doris to a junior doctor. The physician did not considered the importance of supervision for the operation and neglected the health and safety of the patient. His duty of care oblige him to take control over the surgery as he was the one the patients reached to or he should have acutely monitored the junior doctor performing his task. But, the physician chose to leave Doris alone with the junior doctor which resulted in a medical mistake and left acute pain for Doris after the surgery. Had the orthopedic surgeon involved in the surgery then the incident might have prevented and the safety of the patient might have maintained.

The Consumer Protection Act 1986 contain a number of provisions and legal decisions related to medical negligence. According to Bell et al., (2018), medical malpractice is an offence that decrease the patient safety and enhance a risk of physical and mental injury to the patients in addition to decreased professional practice of the nurse. The four Ds of medical malpractice include duty, dereliction which is complete deviation from the basic standard of care, damage and direct cause of the incident (Chan, Khong& Wang, 2017). It is important to prove all these four elements in order to prove incidents of medical malpractice in nursing care. Preponderance of evidences such as documented inappropriate informed consent in addition to discontinue of appropriate surgery measures.

Duty of the physician was to be present at the time of surgery which he violated. Moreover, he violated the basic standard of care which was either performing surgery himself or providing supervision to the junior.It further imparted direct harm to the patient in the form of persistent pain and reduced mortality in the patient. Moreover, the injury to the patient was a direct cause of medical malpractice Medical negligence itself is breach of the duty of care by the physician and it significantly impact the professional practice of the physician (Chan, Khong& Wang, 2017). Medical negligence is an act that completely violate the four bioethical principles of justice, autonomy, respect and non-maleficence hence it should be avoided in the healthcare setting.

In conclusion, informed consent is an important medical practice. It has been considered as an important step of maintaining patient’s consent, confidentiality and privacy in the healthcare setting. The physicians in the healthcare setting are required to seek consent from the patients I order to pursue any kind of medical intervention that impose a health risks to the patients. It is important to follow correct measures of consent seeking by educating the patients about all the possible kind of health risks that the intervention can poses.

However, it is common for the nurses to experience exceptions such as patient competence in seeking consent. Very young children in addition to patients with mental disabilities such as dementia are considered as incompetent of providing consent. Medical practices must be focused toward the duty of care and they should oblige to impart complete medical safety. However, acts of medical negligence can reduce the safety of the patients and this in turn can also impact the professional practice of the physicians.

Reference

ACSQHC. (n.d.). Australian Charter of Healthcare Rights. Retrieved from https://www.safetyandquality.gov.au/sites/default/files/migrated/Charter-PDf.pdf

Beattie, E., O’Reilly, M., Fetherstonhaugh, D., McMaster, M., Moyle, W., & Fielding, E. (2019). Supporting autonomy of nursing home residents with dementia in the informed consent process. Dementia, 18(7-8), 2821-2835

Bell, S. K., Etchegaray, J. M., Gaufberg, E., Lowe, E., Ottosen, M. J., Sands, K. E.,& Kenney, L. (2018). A multi-stakeholder consensus-driven research agenda for better understanding and supporting the emotional impact of harmful events on patients and families. The Joint Commission Journal on Quality and Patient Safety, 44(7), 424-435.

Chan, S. T., Khong, P. C. B., & Wang, W. (2017). Psychological responses, coping and supporting needs of healthcare professionals as second victims. International Nursing Review, 64(2), 242-262

Cook, C. M., Schouten, V., &Henrickson, M. (2018). Ethical underpinnings of sexuality policies in aged care: Centralising dignity. Ethics and Social Welfare, 12(3), 272-290.

Davoudi, N., Nayeri, N. D., Zokaei, M. S., &Fazeli, N. (2017). Challenges of obtaining informed consent in emergency ward: A qualitative study in one Iranian hospital. The Open Nursing Journal, 11, 263.

Guzik-Makaruk, E. M., Pływaczewski, E. W., Mroczko, P., Olesiuk-Okomska, M., &Kulczyńska-Przybik, A. (2018). Consent to medical procedures of patients with neurodegenerative diseases: a comparative study of legal regulations in selected European countries and in the United States. Journal of Alzheimer's Disease, 63(1), 53-67.

Katz, A. L., Webb, S. A., & Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), e20161485.

Mendes, J., Wool, J., & Wool, C. (2017). Ethical considerations in perinatal palliative care. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(3), 367-377.

Meyer, C., Ogrin, R., Al-Zubaidi, H., Appannah, A., McMillan, S., Barrett, E., & Browning, C. (2017). Diversity training for community aged care workers: An interdisciplinary meta-narrative review. Educational Gerontology, 43(7), 365-378.

Nash, R. R., & Wells, M. J. (2020). Ethical Principles in the Practice of Medicine. In Ethical Issues in Pediatric Hematology/Oncology (pp. 19-35). Springer, Cham.

NMBA. (2019). Registered nurse standards for practice. Retrieved from https://www.safetyandquality.gov.au/sites/default/files/migrated/Charter-PDf.pdf

Pouncey, C., &Merz, J. F. (2019). Informed Consent in Psychiatry: Philosophical and Legal Issues. The Bloomsbury Companion to Philosophy of Psychiatry, 257.

Raposo, V. L. (2019). Lost in ‘Culturation’: medical informed consent in China (from a Western perspective). Medicine, Health Care and Philosophy, 22(1), 17-30.

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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