HLT51612: Ethical & Legal Principles in Nursing Assessment Answer

BethScenario Beth is 86 years old and resides in a nursing home. She is alert and has no signs of dementia. Unfortunately she is very unsteady on her feet and has a history of falls. The nurses are becoming increasingly concerned that she may injure herself seriously one day and it is highly likely that if she falls she may break her hip and may never walk again. They have spent a lot of time explaining this to Beth and she says she is aware of the dangers. The nurses have been asking Beth to call for help when she wants to walk, but she has not been doing this as she likes to be independent. They have also organised a walking frame for her which she is refusing to use, even though she is capable of using it properly and the nurses have explained the benefits. They have also included her family in the discussions to try and persuade her to use the walking frame and call for assistance but Beth is adamant that she wants her freedom. They have now suggested to Beth that when she sits down she wears a belt which is tied to her chair. The nurses hope this will remind her not to get up without asking some-one to walk with her and will also prevent her from getting up unaided. Beth objects. She is unwilling to give up her ability to move about the nursing home as she chooses. In desperation a nurse tells Beth that she must use the belt as it is a new rule of the nursing home (this is not the case). Beth reluctantly agrees to wear the belt because she is scared of the consequences of breaking the rules at the nursing home. The nurses are all very relieved that Beth is now using the belt.

1. Discuss what ethical principles are involved in this case study. Provide appropriate definitions with direct reference back to the case study.
2. Discuss the ethical principles that are in conflict.
3. Discuss what legal concepts are involved in this case study. Provide appropriate definitions with direct reference to the case study.
4. Discuss the actions of the nurses and discuss whether they are legally and ethically justified

Ethical and Legal frameworks for all nursing professionals and midwives in Australia were established back in 2008. Main objective of these frameworks was to ensure all nursing professionals cared for their patients in line with defined ethical principles and provided best possible patient-centred care (Cole et al, 2014). However, while abiding by these frameworks, healthcare professionals might often face an ethical dilemma. Ethical dilemma is defined as a complex situation which might involve a clear conflict between two or more moral and ethical principles. In such situations, complying with one ethical principle might result in transgressing another principle (Joseph et al, 2015).Part (b)The current case study presents a classic example of an ethical dilemma and requires the application of ethical and legal principles. In the provided case study, an 86 year old lady is adamant to not compromise her freedom. She has a history of falls and is aware of the fact that if she falls and breaks her hip, she might not be able to walk again. Owing to their extreme concern about the lady, one of the nursing professionals has lied and has suggested that it would be necessary for her to wear a belt that is attached to her chair so as to remind her to not attempt walking unassisted. Although the act has greatly relieved all nursing professionals, it has put various ethical and legal principles to conflict. In this context, the paper aims to discuss ethical and legal principles that are involved in the case study and at conflict with each other.

Involved Ethical Principles

The very first ethical principle involved in the case study is ‘autonomy’. The ethical principle of autonomy advocates for the patient’s right to preside over the course of his/her medical treatment. According to this principle, a patient who is mentally stable and capable of completely understanding his/her diagnosis has complete right to decide the course of medical action (Cole et al, 2014). The patient might or might not comply with wishes of healthcare professionals. Also according to the principle, it is the duty of healthcare providers and nursing professionals to respect and comply with the patient’s wishes (Joseph et al, 2015).

Applying this principle to the case study, it becomes evident that Beth is completely aware of her fall history and consequences of her future falls. Despite this, she wishes to exercise her freedom and is not willing to compromise the same. She is clearly unwilling to make use of a walking frame, use a belt that is tied to her chair or call for assistance whenever she wants to walk. Since she has shown no signs of dementia, it might also be suggested that she is mentally stable and is fully capable of making her care related decisions.

Another important principle is that of beneficence. This principle suggests that healthcare professionals are professionally and ethically responsible to care for their patients and only undertake care actions that would be beneficial for their patients (Joseph et al, 2015). Referring back to the case study, it is evident that nursing professionals have taken several steps to ensure Beth’s safety and wellbeing. They have discussed the consequences of future falls several times with Beth and have suggested various different measures in hopes that she would comply with one which suits her best. Even the aspect of lying to Beth about new nursing home rules has been initiated so as to ensure her safety and avoid the possibility of future complications (Schwartz, 2015).

Third important principle that comes to play in this case study is that of non-maleficence (Parahoo, 2014). In accordance with this principle, it is the professional and ethical duty of healthcare professionals to not undertake any medical action that might harm the patient in any manner (Gastmas, 2013). Referring back to the case study, it might be suggested that the action of lying to Beth about new nursing home rules has been initiated with the intension of preventing harm. However, the aspect of lying has the possibility of hurting her trust and her relationship with nursing professionals. This in turn might make defer Beth from complying with future medication and care regimes designed to help her thereby harming her (Joseph et al, 2015).

The ethical principle of veracity refers to truth telling and is directly grounded in respecting an individual’s autonomy. According to this principle, it is the ethical responsibility of healthcare professionals to truthfully disclose diagnostic and treatment related information (Parahoo, 2014). Looking at the case study, it is evident that this principle was clearly violated. Beth was lied to about using a belt that would prevent her from getting up unassisted.

Finally, the ethical principle of fidelity advocates for various values such as fairness to patients, loyalty and dedication (Cole et al, 2014). Looking at the case study, it might be argued that nursing professionals were dedicated towards caring for Beth. They however were not truthful and fair to her and did not respect her autonomy.

Ethical Principles in Conflict

Looking closely at the case study, two major conflict scenarios might be derived. First, the ethical principle of autonomy is in conflict with the principle of beneficence. Falling in line with the principle of autonomy, it would have been essential that nursing professionals complied with Beth’s wishes to retain her freedom and not use a belt that is tied to her chair (Gastmas, 2013). On the other hand, ethical principle of beneficence (and her long history of falls) motivated nursing professionals to ensure Beth’s safety and lie to her about using a belt. This ended up violating her right to preside over the course of her own medical action (Parahoo, 2014).

In the second scenario, the ethical principle of beneficence is in conflict with the principle of non-maleficence. In line with the principle of beneficence, the act of lying and its immediate benefits for Beth might be justified (Schwartz, 2015). On the other hand however, this might harm Beth in the long run. The act might hurt Beth’s ability to trust her care professionals and comply with her care regime in the future thereby suggesting that the nursing professional should not have lied to Beth in line with the ethical principle of non-maleficence (Cole et al, 2014).

Finally, conflict between ethical principles of beneficence and veracity might be witnessed in the case study. The ethical principle of veracity stands for truth telling and respecting the patient’s autonomy (Joseph et al, 2015). This however conflicts with the principle of beneficence which suggests that only those actions which might benefit the patient need to be taken. Truth telling in this case might not benefit Beth as she might fall and break her hip (Parahoo, 2014).

Involved Legal Concepts

Informed consent is one of the most important legal concepts in nursing practice today. In accordance with this principle, it is the legal responsibility of healthcare professionals to obtain an informed consent from their patients before initiating a medical intervention (Judkins-Cohn et al, 2013). Also, the definition of informed consent clearly states that healthcare professionals must fully explain all details to the patient. This includes (but is not limited to) benefits, risks, other possible alternatives etc (Weber & Polkey, 2015). It is also the duty of healthcare professionals to ensure that patients completely understand the information that is being given to them and are mentally stable to comprehend and act on the same. Finally, healthcare professionals must not force the patient to provide his/ her consent. Consent should be completely voluntary (White, 2013). Referring back to the case study, it might be suggested that an informed consent for making Beth use the belt was not obtained. Nursing professionals tried their best to explain the concept, need and benefits of using a belt. Various other options were also suggested. However, Beth clearly refused suggesting that she would not want to compromise her freedom and completely understands the consequences. She showed no signs of dementia and was completely capable of understanding information and making decisions (Porter, 2012).

Medical negligence is another important legal aspect that governs nursing practice. In simple terms, medical negligence refers to breach of duty of care by a healthcare professional. However, there are three main conditions to prove breach of duty of care in a court of law. First, the healthcare professional must be responsible for caring for the patient. Second, the healthcare professional must have failed to fulfil this duty (Weber & Polkey, 2015). Finally, the patient must have suffered an injury as a result of breach of duty of care. Relating this principle to the provided case study, it becomes evident that nursing professionals were trying to fulfil their duty of care towards Beth and not breach the same. Looking at Beth’s history, they feared that Beth might fall again and break her hip. This might seriously harm Beth and they might get charged of negligence (White, 2013).

The principle of false restraint or false imprisonment is defined as illegal confinement of an individual against his/ her will. In order for the act to qualify as restraint, it is essential that the act violates an individual’s fundamental right to be free (Judkins-Cohn et al, 2013). A physical force for restraining is not required. This case presents a classic example of false imprisonment as Beth was restrained against her wishes. She was threatened that not using the belt would involve breaking new nursing home rules which made the belt compulsory (Porter, 2012).

Legal Principles in Conflict

Looking at the case study, it might be suggested that both informed concept and negligence are at conflict with each other. The intention of fulfilling their duty of care towards Beth motivated a nursing professional to lie to Beth about using belts. This however went against the principle of informed consent where truthful disclosure of information is a key component (Judkins-Cohn et al, 2013). It can be clearly seen that Beth would not have consented to using the belt if she was told the truth and this might have harmed her in the long run. This might have also resulted in nursing professionals responsible for caring for Beth with medical negligence (Porter, 2012).

Conclusion

In light of the above discussion, several key ethical and legal concepts at play in the case study might be recognised. From an ethical viewpoint, principles of autonomy, beneficence and non- maleficence might be considered as important. These principles can also be seen as conflicting with each other as respecting the patient’s autonomy has the potential to harm her. From a legal perspective on the other hand, the principles of informed consent and medical negligence might be considered important. Both these principles can be clearly seen at conflict with each other as obtaining an informed consent from the patient puts the patient at a serious risk for injury.