Health Care Ethics: 724829

Questions:

Students are required to:

1. select ONE case study in the Assessments tile on LEO;
2. identify the ethical issues that are raised by the events described in the chosen case study
3. analyse the ethical issues in relation to the notions of human dignity, human rights, your professional codes of ethics/conduct, relevant professional policies/legislation, and the principles of health care ethics studied in this unit; and
4. make recommendations for professional practice

Weighting:                                         50%

Length and/or format:                      1000 words

Purpose:                                              To identify, understand, analyse and resolve the ethical issues

and conflicts likely to arise in the course of professional work.

Learning outcomes assessed:        3 & 4

How to submit:                                Submit the essay on to the essay turnitin link in the Assessments tile on LEO. You are advised to submit your essay in time to check the similarity rate and make amendments as required

Return of assignment:                             Feedback available on turnitin (attached marking criteria sheet).

Marks recorded in gradebook

Assessment criteria: 

 Answers:

Introduction

 Law and ethics are essential in healthcare practice. Law dictates what one is expected to do and the penalties that would be imposed when one does not comply (Herring, 2015). Ethics is more of a professional philosophy that dictates the conducts of its members in the course of their duty (Fremgen, 2015).  The values are set by a regulating professional body. The United nations has also set principles of bioethics that regulate research and also some aspects of clinical practice. The essay deals with the case study of Amos, who lost his life due to discriminatory behavior of the nurse. The aim of the essay is to recognize and analyze the ethical issues presented in the case study. The ethical issues are analyzed in relation to the principles of health care ethics, professional code of ethics/conduct, human dignity and human rights. The findings from the analysis will be used to make the recommendations for professional practice.

Ethical issues

Amos and some members of his school suffered from cholera. On arrival at the school’s clinic, he was denied treatment in an effort to treat those who were boarders. Amos later dies hours after arrival at home. In this case scenario, there is a violation of his human rights and his human dignity has been down trodden. The triage nurse has offered services on a discriminatory basis and violated the principle of beneficence. This amounts to an ethical misconduct. The principle of justice has been violated (Percival, 2014). The nurse could also be charged for negligence. On discovery of the outbreak of a deadly disease, healthcare practitioners have the duty to alarm the public and seek intervention of other government and non-governmental agencies for more assistance. The way the whole issue was handled, does not portray a deliberate effort to preserve lives and stop the spread of cholera.

In conclusion the ethical issues can be summarized as breach of principle of beneficence, justice, violation of human rights and dignity, and breach of principle of negligence.

Analysis of ethical issues

The principle of justice in provision of healthcare services has been violated in case of Amos. According to Brown et al. (2013), the principle of justice is the moral obligation to act fairly between competing claims. It implies fair distribution of the scarce resources, respect for people’s rights and confirm to legal justice. The nurse has made a decision to send Amos away on the basis that he was not a boarder in the school. This step cannot be justified as he had already presented himself in the clinic. This was violation of equality and equity. According to nursing principle of beneficence, the nurses must act in a manner that promotes the greater good. It means acting in the best interest of the patients (Poikkeus et al., 2014).  In this case the nurse did not consider any alternate option to promote care for Amos. If there was scarcity of resources, he could have been refereed to another health care centre or provided any other aid. The nurse did not take any initiative, demonstrating the lack of willingness to promote patient good.

The conduct of the nurse also surmounts to professional negligence. According to principle of negligence, it is the behavior, where a fully competent nurse does not care in the   preudent manner that causes the patient to suffer unnecessarily (Blais, 2015;  Cerit & Dinç, 2013). When a patient approaches a healthcare provided, they assume the responsibility of care. They are supposed to act under the available conditions in the best interest of the patient. In this case scarcity of resources is an issue. Sending away the patient was not in their best interest. It was a preventable death and could be prevented if the nurse was a little prudent in decision making (Oviedo, 2016). First aid on rehydration should be performed to sustain the patient until further help can be sought. He would be in a better position to survive in the hospital as rehydration could be done. This would sustain his life for some time. This act of negligence can be compared to the standards of care. The standards of “Nurses and Midwives Council of Malawi” mandate that the nurse demonstrates the empathetic understanding. The nurse must be sensitive and have caring attitude (nmcm.org.mw, 2018).

A nurse should accord their loyalty to the patient (Gillon, 2015). In this case the nurse is according her loyalty to a particular section of the students and sending away others. Cholera has hit both those in the school and those living in premises outside the school. The source of cholera has not been identified. It might be affecting everyone in the locality. It’s possible that they may have acquired it within the school’s premises. Treating some of those who have it and leaving out others who share common facilities with them is not a rational decision. Even from a public health perspective, the intervention was irrational. Cholera spread may continue anyway. Mass chemotherapy for those in the area would be the viable option. Amos death was consequence of discrimination by the nurse. He would have had a chance to survive if at least the nurse intervened on time

The UN insists on the provision of universal healthcare to all human beings (Young & Kroth, 2017). They have a right to be accorded dignity in their respective countries.  It sets certain principle for health care professionals. These principles are binding to all healthcare practitioners in countries which are signatories of the UN. Ethical misconduct may not be subject to penalties as per the existing laws but can be dealt with by the regulating professional body. Malawi is a signatory of the United Nations charter and is thus bound by its regulations. The nurse should be aware of the laws governing their clinical practice. Healthcare is a universal basic right which the healthcare providers are bound by duty to provide. The state has a responsibility to provide healthcare to all its citizens. The nurse and other healthcare providers are supposed to seek the intervention of the relevant authorities in the case. They are bound by duty to recommend for immediate referral to a bigger facility with more capacity to deal with the other patients. Considering the gravity of the epidemic in the given case, sending him Amos away was the least one could expect. The mortality cases from cholera are very high and a treatment could not be delayed. Thus, it can be considered the violation of the international code of ethics for nurses in the sense the protecting the patient’s rights was inherent in nursing. It includes right to live, right to dignity and be treated with respect (Griffith & Tengnah, 2017).

Recommendation for professional practice

A patient should not be refused treatment under any condition. Just by the virtual of being human, they are entitled to being treated with dignity and their rights safeguarded. The nurse should be charged with professional negligence that resulted in the death of a patient. This is punishable by the laws. They should take responsibility for what befell the Amos. There must be training for nurses in regards to responsibility and accountability for actions (Cerit & Dinç, 2013).  It is because the main barriers in dealing with the ethical issue are the lack of awareness among nurses (Poikkeus et al., 2014).

 Under the circumstances, they would have made a different decision in handling the case. According to standing (2017), they should have attended to the patient on priority basis. Determining the most severe cases and according them help as they were all students in the school. This would help them stabilize the severe cases as they await more help or referral.  Thus, nurses must be given formal education and training to meet the challenges related to prioritization of care. It is because simply the existence of the ethical, legal professional guidelines in the organization does not mandate ethical conduct. Training will ensure accountability of the clinical decisions. An occurrence of an epidemic attracts a multisectoral approach to manage. The concerned government department dealing with health should be involved. Investigations into food handling and sanitation would be necessary. These may fall in different sectors but an action from them would be required. The governmental and non-governmental organizations are key players whose input would be very significant to salvage the situation. There is a need for the health care organizations to develop environment where nurses fee free to approach with ethical dilemma (Griffith & Tengnah, 2017).

Conclusion

Sometimes healthcare providers are torn between two opposing forces. In nursing, the ethical dilemma is inevitable. In the given case study there was negligence, violation of the principle of beneficence, justice, and human right and dignity. They are made to work in unfavorable conditions but expected to deliver the best. Such is a case of the nurse in this context. The scarcity of supplies is one such scenario. Sometimes they feel that their hands are tied and opt to watch and wait for help. Such circumstances demand for critical decision making in view of the laws and ethical standards (Johansen & O’Brien, 2016). The nurse made a decision without considering other students who were in more critical conditions. The decision was not sound as Amos became a casualty. The resources supply was out of her control but she had control over her conduct, prioritization and decision making. This problem can be mitigated by increasing nurse’s awareness and ensuring training to allow meeting of standards by nurses.

References.

Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson. 7^th ed.

Brown, J. M., Kitson, A. L., & McKnight, T. J. (2013). Challenges in caring: explorations in nursing and ethics. Springer. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=tM69BwAAQBAJ&oi=fnd&pg=PP6&dq=respect+to+autonomy,+beneficence+nursing+&ots=Q5FeThJ92E&sig=iUIRH1jIybq6LosaFQAyzzJbp84&redir_esc=y#v=onepage&q=respect%20to%20autonomy%2C%20beneficence%20nursing&f=false

 Cerit, B., & Dinç, L. (2013). Ethical decision-making and professional behaviour among nurses: a correlational study. Nursing ethics, 20(2), 200-212. Doi: https://doi.org/10.1177/0969733012455562

Fremgen, B. F. (2015). Medical law and ethics. Prentice Hall.  Retrieved from: https://testbanktop.com/wp-content/uploads/2016/12/Downloadable-Test-Bank-for-Medical-Law-and-Ethics-3rd-Edition-Fremgen_irm_fm-1.pdf

Gillon, R. (2015). Defending the four principles approach as a good basis for good medical practice and therefore for good medical ethics. Journal of medical ethics, 41(1), 111-116.

Griffith, R., & Tengnah, C. (2017). Law and professional issues in nursing. Learning Matters. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=z_X-DQAAQBAJ&oi=fnd&pg=PP1&dq=Lack+of+awareness+of+the+ethical+and+legal+issues+nurse+&ots=UF54FVOo9L&sig=fSjqrDXn8eZCCxwIr7xhJ3-POlQ&redir_esc=y#v=onepage&q&f=false

Herring, J. (2015). Q&A Medical Law. Routledge. ISBN: 978-1-138-83101-8 (pbk)

Johansen, M. L., & O’brien, J. L. (2016, January). Decision making in nursing practice: a concept analysis. In Nursing forum (Vol. 51, No. 1, pp. 40-48).

nmcm.org.mw. (2018). Nurses and Midwives Council of Malawi. Retrieved from http://www.nmcm.org.mw/standards/NMCM%20Professional%20Practice%20Standards%20for%20Registered%20Nurses%20(Nov%202012).pdf

Oviedo, A. D. (2016). Use of jurisprudence to teach professional negligence. Journal of Nursing Education, 55(12), 720-720. Doi: https://doi.org/10.3928/01484834-20161114-11

Percival, T. (2014). Medical ethics. Cambridge University Press. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=iPLCAwAAQBAJ&oi=fnd&pg=PR3&dq=Medical+ethics+percival&ots=Mjy0ChY_yE&sig=q9g6hyNnXU9DvPWgblVM4rSlg_w#v=onepage&q=Medical%20ethics%20percival&f=false

Poikkeus, T., Numminen, O., Suhonen, R., & Leino‐Kilpi, H. (2014). A mixed‐method systematic review: support for ethical competence of nurses. Journal of advanced nursing, 70(2), 256-271. DOI: https://doi.org/10.1111/jan.12213

Standing, M. (2017). Clinical Judgement and Decision Making in Nursing. Learning Matters. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=sylyDgAAQBAJ&oi=fnd&pg=PP1&dq=Clinical+Judgement+and+Decision+Making+in+Nursing&ots=b-BO2PBXqa&sig=vHg5Yf7tUslLHv3P_m6P8SxnfFQ#v=onepage&q=Clinical%20Judgement%20and%20Decision%20Making%20in%20Nursing&f=false

Young, K. M., & Kroth, P. J. (2017). Sultz & Young’s Health Care USA. Jones & Bartlett Learning. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=wx8CDgAAQBAJ&oi=fnd&pg=PP1&dq=Sultz+%26+Young%27s+Health+Care+USA.+Jones+%26+Bartlett+Learning.&ots=3Cvyb0mFat&sig=SmSe-3raZ9sWyAbAHZ8iCvp4VoM#v=onepage&q=Sultz%20%26%20Young’s%20Health%20Care%20USA.%20Jones%20%26%20Bartlett%20Learning.&f=false