Case Study Four Ethical Dilemma Essay

Question:

Discuss about the Case Study Four Ethical Dilemma.

Answer:

Introduction

The different stakeholders involved in Elsie’s case included the Residential Aged Care Facility (RAC), nurse manager, the paramedics, the R.N. and Elsie’s family. Both the RAC and nurse manager had details of Elsie’s medical history and should have ensured that an advanced care directive (ACD) was signed on the same day that Elsie was moved into the facility. The paramedics were stakeholders in the case because they attempted to resuscitate Elsie against her wishes. The Registered Nurse (RN) on duty was the one who insisted Elsie to be taken to hospital when she developed the complications. Elsie’s family was also a stakeholder in the case as they knew Elsie’s wishes, they took her to the RAC and failed to ensure that she signed an ACD before they left the facility. The stakeholders might have caused Elsie’s death in one way or the other.

Ethical and Legal Conflicts

Elsie’s case presents a legal and ethical conflict. Whereas the guiding principles of the Australian charter of healthcare rights ensure that every Australian citizen gets high quality care that is safe from any health care facility, they also advocate for the patient’s rights to be involved in decisions involving their lives. In this case, the RAC, nurse manager, the paramedics and the R.N. were ethically obliged to provide quality care Elsie. According to Freegard and Istead (2012), the approach of health care in Australia is that health care professionals are supposed to return the human mind or body to a healthy state after episodes of ill health. This supposes that every person who experiences ill health shows up for health care services/to practitioner expecting and hoping that health care professionals would intervene and restore them to good health.

The ethical and legal conflict in this case arises from the fact that the decision of the patient required consideration while health care professionals worked to restore her health. The paramedics and the R.N. are legally bound to ensure that the patient got the best quality care. However, these professionals are also bound to ensure that whichever decision they make, the patient is involved. Elsie’s decision was that she did not want to be taken anywhere and she wanted to be left as she was, in the suffering state she was in. It was not right for the healthcare professionals to leave her alone, knowing that if they did nothing, she would have died. She finally died and Elsie’s family are of the opinion that Elsie’s decision to be left ‘as she was’ was not considered.

Consideration of How the Conflicts Affect Stakeholders

The RAC and nurse manager have the responsibility of ensuring that every person admitted in the facility receive the appropriate guidance. These stakeholders had details of Elsie’s medical history which informed them that Elsie’s health condition might worsen any moment, like it happened later. Although the Nurse Manager understood this and he/she even suggested for an advanced care directive (ACD), he/she did not insist to see that it was signed as soon as possible. After making the suggestion on Tuesday, the Nurse Manager should have called the family to ensure that the document was signed by the following day. The ACD could have guided the R.N. and the paramedics and the patient might have lived for more days.

When Elsie developed complications on Friday night, it was the responsibility of the Registered Nurse on duty to ensure that her health was restored. The RN called the ambulance and insisted that she be taken to hospital for treatment. The R.N. was ethically and legally right on the action he/she took. Elsie did not have an ACD that would have prevented the R.N. from taking her to hospital. The only thing threatening his/her actions is the fact that Elsie wanted to be left alone but the R.N. denied her that wish. Elsie’s condition was an emergency and the R.N. would not have waste much time consulting the patient’s family.

The paramedics on the other hand did their job as legally and ethically required. Paramedics respond to emergencies. In this case, when the R.N. called the ambulance, the paramedics arrived at the facility quickly. While in the vehicle to the hospital, Elsie suffered a cardiac arrest and the paramedics did their work of providing first aid through attempts to resuscitate her. According to Waldrop et al. (2014), paramedics spend more than additional 1200 hours training for advanced treatments and at least 110 hours for basic life-saving training. Their responsibility is threatened by the fact that Elsie had told them to leave her as she was and by the fact that she died. If Elsie did not die, the stakeholders might not have been sued by Elsie’s family.

Dignity and Rights of Stakeholders

Every person has the right to humanity, dignity and equality. Human rights Act provides a comprehensive legislative framework that protects people from any form of discrimination in order to promote fairness and equality (Book). The RAC facility is legally expected to ensure that every resident enjoys the right to quality care; full information about their health state; live in secure, homelike and safe environments; and maintains control over decisions in their daily lives (Leditshke, Crispin and Bestic, 2015; Jackson and Irwin, 2011; Parandeh et al., 2016). In this case, the nurses, the facility and the paramedics get attributed dignity as a result of how they treated Elsie. These health care professionals seemed to understand Elsie’s individual needs, they showed her sensitivity and compassion and they treated her in a way that people would equally be treated.

Virtues and Principles of Health Care Ethics that Inform Professional Practice

Nurses and paramedics involved in Elsie’s case seemed to hold virtues of a health care profession. According to Newham (2015), health care professionals who seek excellence in their work seek the virtues of benevolence, respect, compassion, justice, integrity, self-effacement, care, prudence, friendliness and sincerity. The compassion of the R.N. on duty made her feel sympathetic of how Elsie was feeling and was concerned for her suffering. Although Elsie requested to be left as she was, the nurse and paramedics worked hard enough to try and make her feel better. These professionals acted in the patient’s interest, acted in good faith and did not intend to harm Elsie.

Relevant Codes of Ethics and Codes of Professional Conduct

Several codes of ethics are relevant in Elsie’s case. Value statement 1 states that nurses value excellent nursing (Scully, 2015). The Nurse manager and R.N. on duty had to do what was right, on reasonable grounds, in order to keep the standard of nursing care they provide high. Just like all nurses, nurses in this case recognized that Elsie was entitled to quality nursing care and had to strive and secure it for her. According to value statement 1, nurses have the obligation to question nursing care that seems illegal or unethical (Hodkinson, 2011). The R.N. on duty participated to minimize risks for Elsie by insisting that she be transported to hospital. Although it was against Elsie’s wish, health care professionals wanted to ensure that she received quality care.

Codes of ethics value statement 4 state that nurses value the access to quality nursing. This ethical statement requires the nurses to ensure that they uphold standards and principles of the right health and nursing care in terms of quality and safety, acceptability, availability and accessibility (Silvester et al., 2015; Tuckett, 2015). For Elsie’s case, despite her being 88 years and in a RAC, the R.N. wanted to ensure that she had access to quality care by calling an ambulance to take her to hospital. Value statement 5 states that nurses always value decision-making that is informed (White et al., 2014). On Tuesday, the Nurse Manager suggested that Elsie filled an advanced care directive (ACD). He/she wanted Elsie to make an informed and free decision, which she agreed to when her family members visited on Sunday. Although this did not happen, an advanced care directive (ACD) would have made the case to be different, in that Elsie’s decision was in writing, and therefore more binding.

Value statement 7 in the code of ethics states that nurses value ethical information management. This code requires nurses to manage information professionally and with integrity (Johnstone, 2016). When Elsie was admitted in the RAC, her information concerning medical history was accurately recorded. It was on the basis of such records that the Nurse Manager suggested that she filled an ACD.

Two codes of professional conduct apply to this case. Conduct statement 4 requires nurses to respect patients’ culture, beliefs and values. Nurses are supposed to protect and promote interests of the people they care for (Schadewaldt et al, 2016). The registered nurse on duty and the paramedics failed in this conduct as they did not consider Elsie’s interests. When she asked to be left ‘as she was’, the R.N. and paramedics ignored her interest and went on to provide care the way they knew best. The Nurse Manager had been informed that her family was aware of her wishes. Since the nurses did not want to consider her request of being left alone, they could have consulted her family, before it was too late, for the knowledge of Elsie’s interests and wishes.

Conduct statement 7 requires nurses to provide support on the wellbeing, decision making and health of the patient. In accordance to this conduct, nurses are expected to inform people requiring care on the way forward when a partner, family member health interpreter or a friend is nominated to be their decision maker (Gonz?lez-De Paz et al, 2012). In Elsie’s case, her family was aware of her wishes. However, the nurses should have provided Elsie with more information on how family was supposed to help her on decision making.

Legally and Ethically Defensible Resolution to the Conflicts

Elsie’s family argued that Elsie’s death was as a result of the stress she endured because of being moved from RAC facility to the hospital. It was wrong of them to sue the paramedics, the RAC facility and the R.N. for battery and assault. The R.N. and the RAC facility ethically and legally did what they were obliged to do. When Elsie’s condition worsened, they did what every other nurse, in good faith, would have done. Like any other health care professionals, the nurse acted in an attempt to return her ailing body to the state of health (Jones, 2016). RAC’s and Nurse’s hopes were that the interventions that they engaged in would have restored her health. Basically, the nurse and the facility acted within their ethical and legal boundaries.

It was also wrong to sue the paramedics for attempting to resuscitate Elsie. Paramedics operate within the communities where they are exposed to professional liabilities. It is very important that they solidly understand ethics and law in order to avoid liability. Like in Elsie’s case, the failure of paramedics to perform their job as required by the legal community, jurisdiction regulations and the medical fraternity exposes them to criminal and/or civil liability. They paramedics who attempted to resuscitate Elsie seemed to understand all these as they did their job after determining that there were no ACDs such as the Do-Not-resuscitate order (Roth, 2014). The paramedics acted according to their three primary ethical principles which includes acting in good faith; not harming the patient; and acting in the best interest of the patient.

In conclusion, the basic standards and freedoms considered by societies to belong to people are human rights. They enable all human beings to live with dignity. The right personal freedom, right to liberty and right to life are the fundamental principles in the discourse of human rights. Once health care professionals interfere with any one of them, the patient is considered less human and dignity is lost. Elsie was treated with dignity by the Nurse Manager, the R.N. on duty and the paramedics. Her death was not because of anyone’s negligence or unethical behavior. Although the RAC facility was supposed to ensure that Elsie filled an advanced care directive as soon as possible, it was nobody’s fault that she died. The court case against paramedics, RAC facility and the R.N. should be terminated unconditionally.

References

Freegard, H. & Isted, L. (2012). Ethical Practice for Health Professionals. (2nd ed.). Melbourne: Cengage

Gonz?lez-De Paz, L., Kostov, B., Sis?-Almirall, A., & Zabalegui-Y?rnoz, A. (2012). A Rasch Analysis of Nurses' Ethical Sensitivity to the Norms of the Code of Conduct. Journal of Clinical Nursing, 21(19/20), 2747-2760. doi:10.1111/j.1365-2702.2012.04137.x

Hodkinson, K. (2011). How Should A Nurse Approach Truth-Telling? A Virtue Ethics Perspective. Nursing Philosophy, 9(4), 248-256. doi:10.1111/j.1466-769X.2008.00370.x

Jackson, A. & Irwin, W. (2011). Dignity, Humanity and Equality: Principle of Nursing Practice A. Nursing Standard, 25(28), 35-37.

Johnstone, M. (2016). Key Milestones in the Operationalization of Professional Nursing Ethics in Australia: A Brief Historical Overview. Australian Journal of Advanced Nursing, 33(4), 35-45.

Jones, S. (2016). Ethically Questionable Situations. Australian Nursing & Midwifery Journal, 24(2), 48

Leditshke, A., Crispin, T., & Bestic, J. (2015). Advance Care Directives in Residential Aged Care. Nursing Home Patients, 44(4), 186-190.

Newham, R. A. (2015). Virtue Ethics and Nursing: On What Grounds? Nursing Philosophy, 16(1), 40-50. doi:10.1111/nup.12063

Parandeh, A., Khaghanizade, M., Mohammadi, E., & Mokhtari-Nouri, J. (2016). Nurses’ Human Dignity in Education and Practice: An Integrated Literature Review. Journal of Nursing and Midwifery Research, 21(8).

Schadewaldt, V., McInnes, E., Hiller, J. E., & Gardner, A. (2016). Experiences of Nurse Practitioners and Medical Practitioners Working In Collaborative Practice Models in Primary Healthcare in Australia. A Multiple Case Study Using Mixed Methods. BMC Family Practice, 171-16. doi: 10.1186/s12875-016-0503-2

Scully, A. (2015). Who owns your Code of Ethics? Australian Nursing Journal, 2(11), 30.

Silvester, W., Fullam, R., Parslow, R., Lewis, V., Sjanta, R., & Jackson, L. et al. (2012). Quality of Advance Care Planning Policy and Practice in Residential Aged Care Facilities in Australia. BMJ Supportive & Palliative Care, 3(3), 349-357.

Roth, L. (2014). Advance Care Directives. NSW Parliamentary Research Service.

Tuckett, A. G. (2015). Residents’ Rights and Nurses’ Ethics in the Australian Nursing Home. International Nursing Review, 52(3), 219-224. doi:10.1111/j.1466-7657.2005.00429.x

Waldrop, D. P., Clemency, B., Maguin, E., & Lindstrom, H. (2014). Preparation for Frontline End-of-Life Care: Exploring the Perspectives of Paramedics and Emergency Medical Technicians. Journal of Palliative Medicine, 17(3), 338-341. doi:10.1089/jpm.2013.0442

White, B., Tilse, C., Wilson, J., Rosenman, L., Strub, T., Feeney, R., & Silvester, W. (2014). Prevalence and Predictors of Advance Directives in Australia. Internal Medicine Journal, 44(10), 975-980.

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