An ethical dilemma Case Study
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An ethical dilemma
Introduction
Ethical conflicts have been a subject of concern and in discussions in many science disciplines. Due to the advancement in medical practice and technologies, the healthcare providers often face challenges to make appropriate decisions especially in situations where complex situations may arise in practice (Fisher, 2011). This essay discusses ethical conflicts where the healthcare providers are torn between respecting patient’s rights and doing no harm ethical principle. The discussion helps one to understand healthcare ethics and law and their relevance in decision-making processes that ultimately uphold patient’s rights and protects them from danger (Beauchamp & Childress, 2013).
This paper explores Case Study 1 to identify the ethical conflict present in the case study. The essay will also explore the ethical and legal aspects of the identified ethical conflict in relation to ethical theories, principles of health care, professional code of ethics, professional standards of conduct as well as the national and international charters. The context analysis will be done so as to provide an appropriate solution to the identified ethical conflict.
Case study 1:
This case study is about an adult patient who has ended –stage cancer. Mr. Harry Nelson has exhausted all the treatment options and is currently receiving palliative care at his home, where he lives with his daughter. He has no advanced care directives. When his health deteriorates, he refuses to go to the clinic which forces his daughter and the paramedic’s team to transport Mr. Harry to the clinic forcefully (Paramedics Australia, 2011).
Through this case study, the impact of ethical principles autonomy, beneficence, nonmaleficence, and justice during decision-making processes is evaluated. In addition, the concepts of utilitarian and consequentialism ethical theory will be used to explore the impacts of Paramedics Australia professional code of conduct, Australian Nursing and Midwifery Council professional standards, national and international charters (Statute law and Common law, Australian Charter of Health Care, Universal Declaration of Human Rights (UDHR) in ethical decision making processes.
Ethical conflict
The ethical conflict central to this case study is autonomy vs. beneficence and nonmaleficence (save a life vs. respecting patient’s rights). In this case, the healthcare professionals intentionally used the paternalistic approach during the decision-making the process as they believed that this was the most beneficial approach to Harry and his family. Although the intervention seemed to be useful for the patient, it breached the ethical principle of autonomy by disrespecting the patient’s wish. Such situations require that the health care to critically analyze the benefits and risks associated with their decisions, along with the consequences associated with the decision making process. The decision made should be the one that promotes maximum beneficence and with the most minimal harm (Jones & Creedy, 2012).
Legally and ethically defensible approach that address the ethical conflict
Nursing profession in Australia is influenced by the four bioethical principles developed by Beauchamp and Childress including; a) autonomy- need to respect patients rights, b) beneficence – do good to prevent harm, c) non-maleficence – avoid causing harms and d) justice- fair distribution of resources to ensure equal and fair treatment to all clients (Banks & Gallagher, 2009). In this case, the principle of autonomy applies in terms of patient’s rights and obligations. Based on this principle, Harry has the right to make decisions about their medical treatment. According to Beauchamp and Childress, autonomy refers to as being “free from controlling influences or personal limitations such as inadequate understanding” (Beuchamp & Childress, 2013, p.56). Therefore, the healthcare provider is obliged to remain truthful (veracity) to their clients and to respect their choices. Relating to the case scenario, the healthcare team that transports Harry to the hospital against his will violates this ethical principle by not respecting the patient last wishes and therefore Harry has no choice to decide for himself which inhibits his autonomy (Kerridge, Lowe & Stewart, 2013).
Further analysis of the scenario, Harry’s daughter, and the medical team decision to forcefully transport his father to the hospital raises the questions about the family’s intention. Evidently, her intentions are good and this brings up the ethical principle of beneficence and no-maleficence. The ethical principle of beneficence mandates the healthcare professionals to treat their patients in a manner that is of maximum benefit to the patient (Australian Medical Association, 2004). On the other hand, the ethical principle of nonmaleficence assures that the actions of the healthcare providers do not cause harm. This basically implies that the main responsibility of the healthcare providers is to avoid doing any harm to their patients. This ethical principle correlates with the ethical theory of utilitarianism which argues that the healthcare professional’s actions should provide “highest good for a maximum number of people” (Berglund, 2012).
Utilitarianism theory supports the idea of taking actions that offer maximum benefits at minimized risks and costs (Tonti-Filipini, 2011). In this situation, the health care provider’s decision to transport Harry to the hospital for more treatment favors the intention of the family members but it does not favor Harry’s decision but it may positively impact the psychological well-being of the patient. This act outweighs the ethical principle of autonomy in regards to the nurse obligations to non-maleficence. However, this act may negatively affect the patient-physician relationship and may lose the trustworthy relationship with the patient. In addition, forcing the patient into treatment may make him depressed and could lead to serious mental complications such as suicidal attempts. In this case, the principle of beneficence may prove to be of benefits but the probability of causing harm is high (Doran et al., 2015).
The ethical principle of justice focuses mainly on equality and fairness in the distribution of the healthcare resources. There are different forms of justice including rights based justice and distributive justice. In rights-based practice, the principle states that every person has the right to access care plan (Catholic Health Australia, 2001). In this situation, the healthcare team violates Harry rights because he was forced to participate in care plan without his consensus. This is an ethical conflict because the patient had no limitations that he would not be able to make an informed decision. Based on the consequentialism theory, the healthcare provider’s action was appropriated as the consequences of taking Harry to the hospital was the choice that was likely to yield more net benefit as compared to loss (Tonti-Filipini, 2011). Therefore, this theory justifies the acts of overriding patient’s decision to refuse further treatment as Harry’s decision could have resulted into serious harm (Townsend & Luck, 2013).
Every nurse primary commitment is to the patient, and their main role is to advocate for the patient’s rights, with the aim of protecting patient’s health and safety. A nurse is expected to maintain professional’s integrity during care delivery. This is supported by Universal Declaration of Human Rights (UDHR) which mandates that healthcare providers should deliver care based on the patient’s needs and with unrestricted considerations of class, personal attributes, economic status, or the nature of the disease (AHPRA, 2012). Based on these nurse values, the healthcare provider decision to forcefully transport Harry to the hospital for further treatment was appropriate. However, on this value, the nurse owes the same duties to the patient including maintaining cultural competence and to preserve integrity when determining the appropriate action and consistent with their obligations to provide optimum care. This value was violated by the nurse actions as they are expected to practice with compassion and to respect patient’s dignity (Freegard, 2012).
Australian Charter of Healthcare states that healthcare providers are also expected to conduct themselves in accordance with the relevant laws relevant to the nursing practice. The professional standards nursing and Midwifery Board of Australia outlines the professional codes of conducts. Nurses are expected to deliver safe and with competence. In addition, the nurses are also expected to respect culture, dignity, values and beliefs of the person receiving care (Australian Nursing and Midwifery Council, 2008). They are expected to promote and to preserve the trust as well as the privilege the inherent in the relationship between the people receiving care and the nurses. In addition, healthcare providers are required to deliver care to any person who is need of the care and anyone who refuses to deliver it commits a crime and is liable to imprisonment. They are mandated to work in good faith and without any recklessness. This rule is established by the Medical Practitioners Act 1938 (NSW) and the current Health Practitioner Regulation National Law Act which states that it is illegal for any health care provider who fails to deliver satisfactory care without any reasonable cause, unless the healthcare provider proves that they have taken all reasonable steps to save the patient and within a reasonable time (Australian Health Practitioner Regulation Agency (AHPRA, 2012).
All treatment procedures normally require consent, but there are key legal factors that determine of a person can receive treatment without consent including; a) the patient’s mental health capacity, b) if there is advance care directives, c) the degree of urgency based on the patient’s health and situation and d) if there a substitute decision –maker (usually a relative) is present and is able or willing to make the decision (Forrester & Griffiths, 2015). Where the patient is unable to give consent or substitute decision is absent, this legal requirement is usually waived under the Statute law and Common law. In this situation, the principle of patient autonomy is outweighed by the Common Law (Atkins, de Lacey & Britton, 2014). This is because, Under the Common Law, a health care provider is expected to deliver urgent treatment to the patient, if the healthcare provider acts honestly and reasonably believes that the treatment provided is needed to prevent serious complications to the patient’s health. In addition, the healthcare provider’s decision is supported by the principle of necessity in Common Law. This principle justifies a healthcare provider actions of giving treatment even in the situation where the patient’s condition is not life threatening and also without the patient’s consent (Australian Commission on Safety and Quality in Health Care, 2012).
Analyzing context and proposing a solution
In my opinion, there is no perfect answer for the identified ethical conflict. It is not easy to reach a perfect situation, but the situation can be analyzed using ethical decision-making process and by applying the best possible principle. However, it is evident that two ethical principles conflict; beneficence or non-maleficence vs. autonomy (Fisher, 2011). Nurse’s action to respect patient’s autonomy implies that she or he is accepting the patient’s decision and in other words, increasing serious harm to occur. However, the healthcare in-charge carried out actions against Harry’s expressed wishes which would be expected to result in the ‘net benefit’ of improving his health condition and quality of life (Forrester & Griffiths, 2015).
Reinforcing this action is nurse professional standards that emphasize that the primary nurse duty is to help and save lives (Fisher, 2011). Although the professional conduct of ethics asserts that the appropriate course of action should be chosen on behalf of the patient (with or lacking capacity) should be in line with the patient’s beliefs and values so as to promote their autonomy and to act in their best interests, but in this situation, the resulting consequences would have been harmful to the patient (Ozolins, & Grainger, 2015). Therefore, it would have been morally right to override Harry’s decision. However, one fundamental aspect of a nurse role is advocating for patient’s rights, making sure that they are adequately informed, supporting and respecting their decision (accept or decline treatment) and to involve them when making decisions about their care. In cases where there are disputes, then it would be advisable to obtain legal guidance from the courts. In a case where a decline of care would lead to serious harm to the patient, the professional guidance is crystal clear that the patient’s wish must be respected (Morrison, & Furlong, 2014).
Conclusions
The complexities of healthcare practice are increasing as the health care sector continues to evolve. This case study provides useful insights into the nature of ethical dilemmas faced by the healthcare providers in their daily practice. Therefore, it is important to understand the ethical and legal frameworks governing decline of treatment and capacity. This case study has helped me understand the role of nurses when making ethical decisions and the importance of upholding patient’s rights while preventing doing harm.
References
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Australian Commission on Safety and Quality in Health Care (2012). Safety and quality improvement guide standard 6: Clinical handover ACSQHC, Sydney. Retrieved from <www.health.gov.au>
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