Ethics in Health Care - Elsie Lee's Ethical Dilemma - Assessment Answer

Ethics in Health Care Assignment

Assignment Task

Select a case study from the list below and address the following points.

1. Determine the stakeholders including two health care professionals in the case scenario; 2. Differentiate the ethical and legal conflicts and explain them from the following perspectives:

• The dignity and rights of all stakeholders in this case
• The principles and virtues of health care ethics that inform professional practice
• The relevant codes of ethics and/or codes of professional conduct 3. Propose a legally and ethically defensible resolution to these conflicts

CASE STUDY ONE Kamil Samra is a sports physiotherapist and specialist in treating musculoskeletal injuries who is employed by an AFL club on the basis of his notable success. Kamil enjoys friendly relations with the players and the club managers and has become a close friend of two of the players. One evening, at a bar, Kamil is made aware that the coach and sports scientists are supplying performance-enhancing drugs to the players. He later verifies this information for himself when he discovers a package containing the banned peptide Thymosin beta-4 at the club headquarters. Kamil discusses this issue with both the coach and the club management who, in turn, offer him an even higher salary in exchange for his silence on this matter. In accepting the offer Kamil can ensure care for his poor, aging parents in Lebanon. However, he is aware that Thymosin beta-4 not only enhances athletic performance (and is in breach of the anti-doping rules in sport), but it may also cause long-term health issues, but the players, in being contractually bound to follow instructions by the coaching team, are not really free to refuse to use this banned peptide.

CASE STUDY TWO Alex Ng, a senior paramedic in a regional centre, is called out to attend a motor vehicle accident on the main highway, involving two cars and a large transport truck. On arrival at the scene, Alex finds passengers trapped in both cars; two children in a small car are not moving and show no other signs of consciousness while the female driver is slumped over the steering wheel, bleeding from a head wound. The male driver of the other car is conscious but trapped in the wreckage; he tells Alex’s partner that he cannot feel or move his lower limbs. The male truck driver is walking around the wreckage and appears confused and disorientated; at a glance, he does not appear to be physically injured. A woman who was driving past stops her car and comes forward; she tells Alex that she is an emergency physician and can help. Alex is grateful for the offer of help and asks her to attend to the children, however, he notices the smell of alcohol on her breath when she walks past him. After opening the door of the other car, Alex notices that the trapped driver is wearing earphones attached to his mobile phone and the phone screen indicates that he was on a call when the accident occurred. The driver is alone and Alex recognizes him as the local magistrate, and a good family friend. Just then, he hears the screech of brakes and turns to see that the truck driver has walked up the highway and into oncoming traffic. He is lying on the road and does not appear to be breathing.

CASE STUDY THREE Baby Thomas was born at 24 weeks’ gestation and was at his parents’ request, immediately transferred to the neonatal intensive care unit (NICU) where he is administered an array of invasive measures for ensuring adequate cardio-respiratory function and cerebral perfusion, as well as preventing hypoglycaemia, hypothermia, malnutrition, thromboses and sepsis. Over the subsequent days and weeks, baby Thomas experiences recurrent episodes of apnoea requiring resuscitation. He has also required other medical measures for treating bronchopulmonary dysplasia, repeated episodes of diminished cardiac output, sepsis and pneumonia. Efforts to extubate the baby continue to be unsuccessful. Thomas has been in NICU for 52 days; notwithstanding his poor response to treatment, his parents wish to continue with NICU management. At the same time, the Head of the ICU and Anaesthesia Department is ordering the medical staff to remove Thomas’ advanced life support measures, given the evident medical futility of continuing treatment. The nurses and physiotherapists are very concerned that, in the most unlikely event that baby Thomas survives, he would be living with profound neurological damage, and other serious disabilities. The social worker is concerned that the parents were not properly prepared for the high probability that their baby may not survive at all. The Head of the Finance Department is also requesting that, in light of strict budgetary limits, NICU treatment be withdrawn for this baby, given its cost of $3,000 per day (approximately $156,000 to date). The parents are distressed by the suggestion to withdraw treatment and contact the media in order to draw attention to their baby’s plight.

CASE STUDY FOUR Elsie Lee, 88 years old had recently moved to a Residential Aged Care Facility (RAC). She had difficulty mobilising due to severe rheumatoid arthritis as well as short-term memory and vision impairment. Elsie also had a history of AMI, removal of bilateral cataracts, and a (L) hip replacement four years ago. On admission to the RAC facility, on Tuesday afternoon, the Nurse Manager suggested that Elsie consider making out an advanced care directive (ACD), indicating what she would want done in the event that her health should deteriorate. Elsie agreed and awaited the help of her family when they visited on Sunday. She was pleased to have this opportunity as, although she had discussed her wishes with her family, she wanted to make it clear to staff caring for her that she did not want aggressive treatment of any kind and did not want to be resuscitated. On Friday night, Elsie developed severe chest pain which radiated down her (L) shoulder, an irregular pulse and a BP of 73/48 and the RN on duty called the ambulance. Elsie pleaded with the paramedics to leave her ‘as she was’; the R.N. insisted that they transport Elsie to hospital as she had not filled out an ACD indicating otherwise. In transit to the hospital, Elsie suffered a cardiac arrest. The paramedics attempted resuscitation but were unsuccessful. On arrival to the ED, Elsie was pronounced dead. Her family determined that Elsie’s death was brought on by the stress of being moved to hospital. They decided to sue the R.N., the paramedics and the RAC facility for assault and battery.

In any healthcare center, ethical principles, ethical and legal codes apply to enable the health care professionals in that field make effective moral decisions. According to Wilcoxon, Remley, & Gladding (2013), there are several ethical dilemmas that arise in hospitals and residential aged care facilities that give these professionals a hard time to make effective decisions on their own. This paper is going to look at an ethical dilemma in a residential aged care facility involving Elsie Lee, an 88 year old patient. Elsie was sick and admitted in a residential aged care facility where she developed further problems that resulted to her death. She had warned the healthcare nurses not to resuscitate her but they had done that in a logical manner that brought her death. Therefore, this paper is going to discuss about the ethical and legal conflicts surrounding the situation, the legal rights of every stakeholder involved, the codes of ethics surrounding the situation and then provide an effective legal defensible solution towards the situation.

Stakeholders in the case scenario

Elsie Lee who is an 88 year old patient is the centre of this ethical dilemma and thus the main stakeholder. She denied being resuscitated in whatsoever. Other stakeholders that were involved in the case scenario include the healthcare professionals who played a crucial role in her decisions, transportation, and her health care attention until her death. The first was the Nurse Manager who was in charge of the advanced care directive (ACD) that could result in the attainment of Elsie’s consent. Hamric, Hanson, Tracy & O'Grady (2013) say that every patient whether in the hospital or in the residential aged care facility who is in a critical condition or could undergo operation is required to provide his/her consent through ACD. Therefore, the Nurse Manager played her role by requesting Elsie to provide the ACD and Elsie said that she did not want any resuscitation. The Nurse Manager also played her role by getting this information from Elsie though Elsie wanted help from her family that had not arrived.

The second health care professional stakeholder was the Paramedics team that were responsible for her well being at the residential aged care facility that she was admitted. The third stakeholder in the health care profession was the Register Nurse (R.N) who was behind the entire ethical dilemma. She insisted that Elsie be taken to hospital for serious medical attention as she has developed severe chest pain and irregular BP of 73/48. According to the healthcare principles and regulations, Kass (2011) observes that a healthcare profession is supposed to do all his/her best to ensure that the patient gets effective medical attention and saves the situation. Therefore, the R.N was doing her duty within her role requirements. Other stakeholder in the case scenario includes Elsie’s family members who were to help her in decision-making and to act as surrogates. In a health care institution and the field of nursing, Clayton (2013) commends that it is important for the professionals to respect the patients consent and autonomy to avoid serious conflicts that could result in a law case.

Ethical and legal conflicts

Ethical and legal conflicts in respect to dignity and rights of stakeholders

According to Burkhardt & Nathaniel (2013), both ethical and legal principles play a bigger role in healthcare sector in providing effective moral decisions and trying to effectively defend subsequent decisions. In this case, there are ethical and legal principles that bind and protect Elsie, Register Nurse, Nurse Manager, the Paramedics and Elsie’s family members who want to sue the paramedics and Register Nurse for assault and battery. Ethically, all the healthcare professionals in any healthcare sector are supposed to respect the dignity and the rights of the patient to avoid ethical dilemmas. Legally, Sahler et al. (2015) say that all the health care professionals are expected to abide by and respect the consent of the patient once made while he is normal and conscious. Therefore, there are possibilities of emerging a conflict between the ethical and legal principles. In Elsie’s case scenario, the ethical and legal conflicts comes about when legally Elsie wants no resuscitation and it needs to be followed as it is her right but ethically needs medical attention for her emergence case. It is the responsibility of the paramedics and register nurse to save Elsie from dying even if she does not wants resuscitation and this brings about ethical and legal conflicts.

Ethical and legal conflicts in respect to principles and virtues of healthcare

There are several ethical and legal principles that have been put in place to solve ethical dilemmas in a healthcare institution. They include autonomy, beneficence, non-maleficence, consent, surrogacy, fidelity, relationships and malpractice (Furrow, Greaney, Johnson, Jost, & Schwartz, 2014). This principles are both ethical and legal even though they posses some conflicts at one point or the other especially during ethical dilemma cases. According to Yoder-Wise (2014), consent principle is both an ethical and a legal principle that has brought conflicts in many ethical dilemmas. In this case, Elsie provided her advance care directive by making it clear that they should not do any aggressive treatment. Even after developing her chest pain and having irregular BP of 73/48, she did not want any resuscitation but wanted to be left as she was and this makes her consent and autonomy clear. Legally, the register nurse and the paramedics are supposed to respect this and do there procedures in line with it. Ethically, the autonomy and consent principles have to be accepted to and thus the register nurse might have done a mistake by organizing Elsie’s transportation to hospital.

However, there is an ethical principle of beneficence, which requires register nurses and the paramedics to help Elsie in their best capacity to save the situation. According to Pozgar (2014) knowledge, the principle of beneficence states that it is the duty and responsibility of every health care physician to do good to the patient. The register nurse and paramedics could not watch Elsie die when they were supposed to help her heal, and thus doing good to her. Therefore, they were to some point right if the only way to save Elsie was taking her to hospital for aggressive treatment where resuscitation could be involved. Therefore, this situation brings about ethical and legal conflict. This is because the law does not allow a health care profession act against the patient’s autonomy and consent, but at the same time, the law does not allow the same health care professional watch the patient die (Thompson et al., 2011). This poses a serious ethical dilemma here as Elsie’s family members have sued the register nurse and paramedics for assault and battery and wants them charged.

The register nurse and the paramedics did right on their own both legally and ethically but they have also done wrong both legally and ethically. There are also conflicting ethical principle of non-maleficence with consent and autonomy of Elsie in line with legal principles. According to Corey & Callanan (2014), non-maleficence principles state that it is the duty and responsibility of the health care physician not to do any harm to the patient. Pauly, Varcoe, & Storch (2012) says that harm involves providing wrong medication, treatment or making medical decisions on their own without consent of the patient. The paramedics and the register nurse were both aware of Elsie’s ACD, but went ahead to take her to hospital where on the way her condition become worse and put her on resuscitation where she was later pronounced dead. However, they could have done harm along the transportation if they could have left her die in the ambulance without resuscitation, but the fact that they attempted and later causing death brings a conflict with Elsie’s consent and autonomy. Legally, they are supposed to be charged but ethically they are supposed to be left alone and understand the situation since they were saving the life of Elsie.

Ethical and legal conflict in respect to codes of professional conduct

Ethical codes are essential in a health care practice even if they do not provide the final solution to an ethical conflict or dilemma because they provide a basis for defensive decision. They provide moral direction to an ethical dilemma and the best subsequent decision to be made in that case. In this case, codes of professional conduct plays a bigger role in determining whether the register nurse and the paramedics should be charged and prosecuted or not. Pont, Stöver, & Wolff (2012) observe that an ethical code needs to be rational and provide effective basis for the health care professionals to follow and administer effective service to their patients. The paramedics and the register needed to understand clearly the ethical codes that govern professional practice and how they were supposed to go about it. However, the fact that there are ethical principles, which are stronger that ethical codes conflict in some situations, brought this entire dilemma.

Proposed legally and ethically defensible solution to this case scenario

According to Elwyn et al. (2012), ethical code of professional practice plays a bigger role as it can help to provide solution to the ethical dilemma at hand. However, any ethical code needs to ensure that the consensus of every stakeholder in that situation has been effectively gained. Therefore, the defensible decision that could be made in an ethical dilemma situation needs to fair and moral effectively to all the stakeholders involved. Doherty & Purtilo (2015) say that they have to look at the point at which the register nurse and the paramedics decided to transport Elsie to the hospital and the point at which they decided to perform the resuscitation. The fact that it is very difficult to predict future circumstances and consequences in a situation makes it had to make an ethical code that could solve this ethical dilemma. It still becomes hard to determine whether to charge the register nurse and the paramedics of assault and battery since they were acting in their position and understanding to save Elsie’s life.

The register nurse was transporting Elsie to hospital and even put her on resuscitation because she felt it was necessary at that point and if she had not done, she could have been charged of delay and negligence. The paramedics also saw this necessary and that is why they allowed the register nurse to organize Elsie’s transportation. The family members were not around to make a quicker decision in that situation, and thus the register nurse did what she thought was right. However, she did not follow ethical code of professional practice effectively as she could have found a quicker way to contact Elsie’s family members and request for their opinion. This makes her and the paramedics guilty to some extend of battery and assault since she assumed this option. She also assumed the option given by Elsie to the paramedics requesting to be left alone even in that critical condition. According to Doherty & Purtilo (2015), this poses a serious ethical dilemma that brings about ethical conflict that is not clear on whom to blame. Meanwhile, from the fact that they were ignorant of Elsie’s consent and autonomy and that fact that they did not conduct Elsie’s family members for further opinion, they have to be charged of negligence, assault and battery.

Conclusion

In summary, Pozgar (2014) says that ethical and legal principles play a bigger role in ensuring that ethical conflicts and dilemmas in a healthcare institution are effectively solved on fair grounds. Ethical codes of professional practice are there to provide further moral direction towards making effective defensible subsequent decisions. Elsie who initially made it clear through ACD not be put on resuscitation needs to be respected. This is her right and failure will be going against her right and her dignity. However, providing a believed best solution by the register nurse and paramedics makes them right as they were exercising their duty, but things went wrong afterwards. Therefore, they have to be charged of assault and battery since they were negligent of contacting Elsie’s family members for further opinion and did not initially consider the legal principle of consent.