Case Study 1
Beneficence is defined as the balance created between the positive effects of medical treatment its complications, and cost. However, the process of avoiding the harms caused by treatments is termed as non-maleficence. The aim of beneficence is to promote the well-being of a person while non-maleficence aims at reducing the causation of harms and injuries (Stone, 2018)
Egg freezing is a type of artificial reproductive technology in which the eggs of the females are cryopreserved to protect them for fertilization in the future (Mayo Clinic, 2019). However, there are certain ethical considerations that are associated with this method. One of the ethical considerations is that women, nowadays, are using this method as an alternative to abortions. For example, the patient is first aborting the child, which is ethically wrong and then to fulfil her desire of motherhood she is planning to use egg freezing method for future pregnancy. Thus, egg freezing and other artificial reproductive methods have become an alternative to abortions for many career aspiring women which is ethically and morally incorrect.
As per Mandal, Ponnambath and Parija (2017), the discipline that encloses ethical, social, cultural and legal problems of healthcare and life science researches is termed as bioethics. For example, the processes of human cloning, and genetic engineering are guarded by bioethics. Bioethics plays an essential role in an ethical dilemma to make right and moral decisions.
Ethical dilemma is a condition in which the person faces difficulty in making decisions due to ethics. Every type of dilemma has certain ethics associated with it such as whether the decision is ethically right or wrong and whether the outcomes of the decision will be favourable or unfavourable for others (Frieger and Dordevic, 2016).
The ethical dilemma in the give case study is whether termination of pregnancy is right or wrong and whether the abortion of a child is moral or immoral. Killing any living organisms and especially an unborn child is considered against ethics, and this is the reason that abortion is regarded as impermissible in many areas of the world (Blackshaw, 2019).
The registered nurses should make sure that proper care is provided to the patients undergoing abortions. It is their responsibility to provide all the information about the complications that arise post-abortion. The nurse must give moral support, along with proper care to the patient. All medical treatments that a pregnant woman is entitled to must be provided to the patient and the nurse should build a safe and happy environment around the patient. The nurse should try to avoid all the circumstances that can have a negative impact on the health of the patient.
The registered nurses should follow the ethical framework provided by the law to make correct decisions about the patients undergoing an abortion. This framework gives cultural guidance to the nurses and helps them in the decision-making process (Fleming, Frith, Luyben & Ramsayer, 2018).
The guidelines or frameworks that can help a nurse in making ethically correct decisions for a patient undergoing abortions can be found in the Code of Ethics For Nurses (Reproductive Health In Nursing, 2017).
The nurse can use Kerridge’s ethical decision-making model to make an ethically correct decision. The nurse that has the ethical dilemma of informing the patient's former partner about her abortion can use seven steps of Kerridge’s ethical decision-making model. As per this model, the nurse must, first of all, analyze the ethical problem, followed by the collection of facts and then thinking about ethical problems. The nurse should then try to think with different theories or approaches that can be used to solve the ethical dilemma; then she must think about the ethical conflicts and relate them with the legal concepts (Scher & Kozlowska, 2018). As per Patient's Right to Privacy, registered nurses or any other health professionals do not have the right to interfere in their patient's life and decisions (Demirsoy & Kirimlioglu, 2016). Moreover, they cannot discuss their patient's medical conditions to other people without their consent, as this is morally and legally incorrect. The nurse should finally make an ethically correct decision thinking on the basis of all the mentioned steps. Thus, the nurse should not inform the patient's former partner about her abortion, especially without her consent as this is against laws, and the nurse could get into legal troubles due to this.
Case Study Two
The Health Insurance Portability and Accountability Act, 1996 states that all the patients have the Right of Confidentially to protect their medical conditions. All the nurses and other health professionals cannot disclose any information about their patients without their consent (Every Nurse, 2018). In the given case study, the nurse Tilly has breached the Right of Patient's confidentially by uploading the patient's photographs on social media without consent. Moreover, Tilly's act is not fine as she had taken pictures when the patient was in a state of unconsciousness. Thus, the patient has the right to file legal actions on Tilly's act of uploading the picture without his consent.
Tilly has breached professional practice guidelines in two ways, first by taking patient's watch without his permission and second, by uploading the patient's pictures on social media without consent. Tilly has robbed the patient's watch, which is illegal as no health professional is allowed to take any belongings of the patient. Secondly, Tilly has uploaded patient's picture in an unconscious state and has uploaded it on social media, which violates the Right of Patient's Confidentially.
The Crimes Act 1958, Section 75 states that any person taking other's property or belongings without their consent is entitled to an imprisonment of four to fifteen years (Victorian Current Act, n.d.). Tilly had violated this Act by stealing a patient's belongings when he was not in a state of consciousness.
Negligence is defined as the practice of not providing enough attention to a condition or a person (Cambridge Dictionary, n.d.). Negligence in healthcare can be fatal for the patient, as it can lead to severe health complications.
A negligent behaviour has four criteria; breach of duty, any suffering due to breached duty, existing legal duty and a proof of breached duty (Legal Information Institute, 2017). Tilly's behaviour meets the criteria of negligent behaviour as she being a nurse (her legal duty) breached the Right of Patient's Confidentiality and Privacy. Tilly's negligent behaviour can be supported by the fact that she uploaded her patient's picture on social media without caring about its legal actions.
The permission that is given by a person voluntarily and without any type of pressure is termed as valid consent. This type of consent is given freely by people and is not influenced by any pressure (Pallipedia, n,d.).
Tilly's behaviour does not meet the criteria of valid consent because valid consent is given by the person voluntarily, freely and under no pressure. However, in the given case, Tilly took the patient's photograph and watch when the patient was unconscious and not in the state of providing valid consent. Moreover, Tilly did not take permission before taking the patient's watch, photograph or uploading the picture on social media. Tilly can face legal challenges due to the violation of valid consent.
According to Cambridge Dictionary (n.d.), the act of damaging someone' reputation by spreading wrong information is termed as defamation. The defamation laws are essential to protect a person, especially public figure from defamation and all people have the right to file a case against the ones who try to defame their reputations.
Tilly' behaviour is defamatory as she took unflattering photos of the patient, which can harm the patient's reputation. This can give a wrong impression of patient's life in the public and can also harm the patient's professional and personal life. Moreover, Tilly can get into legal troubles because of breaching the defamation laws.
As per Aphra & National Boards (2020), the four reporting areas for all health professionals are as follows:
Tilly's act that must be reported to the higher authorities includes robbery and breaching of patient's Right to Privacy and Confidentially. Both these acts are against the law, and Tilly can face legal problems due to these acts.
A registered nurse can make a complaint to the Australian Health Practitioner Regulation Agency about the misconducts of other health professionals (Aphra & National Boards, 2020). For doing so, the nurse must consider all the factors of the misconduct and analyze whether the misconduct is affecting the life of any person or not. The nurse should take help from the policies of the Australian Health Practitioner Regulation Agency for better decision-making.
Case Study Three
As per ESCR (n.d.), no one can withhold food and water of any person as it is a violation of the Right to Food and Water. It is the responsibility of the government to provide a sufficient amount of food and water to its citizens. Every individual must be provided with water and food, and in case anyone violates this law, then strict actions can be taken against that person.
The registered nurse can provide food and water to the patient knowing that it can be harmful to the health conditions of the patients. The ethical reason that supports this statement is that it is ethically incorrect not to provide water and food to anyone. This is morally as well as ethically incorrect because a person can die due to the unavailability of food and water. Moreover, the nurse can use the Right of Food and Water as a legal reason to provide food and water to the patient.
Cardiopulmonary resuscitation (CPR) is defined as the process of providing oxygen to the patients facing a sudden cardiac arrest by mouth-to-mouth breathing or by chest compressions (Centers for Disease Control and Prevention, 2018). It is very beneficial in the absence of medical professionals as a normal person can perform CPR and protect the life of the person. Thus, CPR should be performed in case the patient has a sudden cardiac arrest as it can protect patient's life.
As per the Legal Information Institute (n.d.), false imprisonment is defined as a type of imprisonment in which the movement of a person gets restricted within a particular area. This type of imprisonment does not need any type of legal orders. The violation of false imprisonment is punishable, and the violator can face legal problems due to this.
The restraint chairs are used by the family members of the patient to restrain their unwanted movements (Visaggio et al. 2018). There are certain diseases in which the patient is unable to stand or walk properly, and they are at high risks of falls. Moreover, the patients being restrained get impulsive in extreme conditions and thus, can harm themselves or the other people present near them. As a result, Branco's restraint is also legally justified.
Restraining Branco to prevent him from getting out of the chair is correct as it will prevent his chances of falling. In case, he gets off his chair, he will fall down, and this can cause severe head injuries or can lead to other health problems.
Yes, pushing Branco back into his chair is correct as it is important to reduce his risks of falling down, which can cause head and other body injuries. This is a way of keeping him safe and secure.
As per Ye et al. (2019), restrain is considered as an abuse in the absence of legislation and when there are other alternatives to treat the patient. However, in this case, the patient's daughter is aware of his father's restrain and its importance, then it would not be considered as an abuse.
No, calling a Buddhist Monk for the cleansing ceremony of a Catholic person is not right as it can lead to ethical conflicts.
As per Nguyen (2017), there are various religious conflicts and discriminations between the Buddhists and Catholics, which reflect that Catholics would not prefer Buddhist Monks to conduct their cleansing ceremony. Moreover, Branco's psychological conditions can also get affected in case he knows that a Buddhist Monk has performed his cleansing ceremony and not a Catholic Monk.
In case of an unexpected death of the patient, the nurse should complete three documentation, which are DNACPR form, verification of the death form signed by medical professionals and the form of Verification of Expected Adult Death by Registered Nurses (The Newcastle upon Tyne Hospitals NHS Foundation Trust, 2019).
Aphra & National Boards. (2020). Making a mandatory notification. Retrieved from https://www.ahpra.gov.au/Notifications/Raise-a-concern/Mandatory-notifications.aspx
Blackshaw, P. B. (2019). The ethics of killing: strengthening the substance view with time-relative interests. The New Bioethics, 25(4), 332-348. https://doi.org/10.1080/20502877.2019.1674492
Cambridge Dictionary. (n.d.). Defamation. Retrieved from https://dictionary.cambridge.org/dictionary/english/defamation
Cambridge Dictionary. (n.d.). Negligence. Retrieved from https://dictionary.cambridge.org/dictionary/english/negligence
Centers for Disease Control and Prevention. (2018). Three things you may not know about CPR. Retrieved from https://www.cdc.gov/features/learn-cpr/index.html
Demirsoy, N. & Kirimlioglu, N. (2016). Protection of privacy and confidentiality as a patient right: physicians' and nurses' viewpoints. Biomedical Research, 27(4). Retrieved from https://www.alliedacademies.org/articles/protection-of-privacy-and-confidentiality-as-a-patient-right-physicians-and-nurses-viewpoints.html
ESCR-Net. (n.d.) The rights to food. Retrieved from https://www.escr-net.org/rights/food
Every Nurse. (2018). How nurses should be using social media. Retrieved from https://everynurse.org/blog/how-nurses-should-be-using-social-media/
Figar, N. & Dordevic, B. (2016). Managing an ethical dilemma. DE GRUYTER, 54(3), 345-362. doi: 10.1515/ethemes-2016-0017
Fleming, V., Frith, L., Luyben, A. & Ramsayer, B. (2018). Conscientious objection to participation in abortion by midwives and nurses: a systematic review of reasons. BMC Medical Ethics, 19(1), n.d. doi: 10.1186/s12910-018-0268-3
Legal Information Institute. (2017). Negligence. Retrieved from https://www.law.cornell.edu/wex/negligence
Legal Information Institute. (n.d.). False Imprisonment. Retrieved from https://www.law.cornell.edu/wex/false_imprisonment
Mandal, J. Ponnambath, D. K. & Parija, C. S. (2017). Bioethics: A brief review. Tropical Parasitology, 7(1), 5-7. doi: 10.4103/tp.TP_4_17
Nguyen, T. H. (2017). Buddhist-Catholic relations in Ho Chi Minh City. International Journal of Dharma Studies volume, 5(13). doi: https://doi.org/10.1186/s40613-017-0060-1
Pallepedia. (n.d.). Valid consent. Retrieved from https://pallipedia.org/valid-consent/
Reproductive Health in Nursing. (2017). Professional Ethics in Unintended Pregnancy and Prevention Care. Retrieved from https://rhnursing.org/wp-content/uploads/2017/01/Patient-Situation-1-Professional-Ethics-Module.pdf
Scher, S. & Kozlowska, K. (2018). Rethinking Health Care Ethics. New York City: Springer
Stone, E. G. (2018). Evidence-based medicine and bioethics: implications for health care organizations, clinicians, and patients. The Permanent Journal, 22(n.d), 18-30. doi: 10.7812/TPP/18-030
The Newcastle upon Tyne Hospitals NHS Foundation Trust. (2019). Nurse Verification of Expected Death Policy. Retrieved from http://www.newcastle-hospitals.org.uk/downloads/policies/Nursing/NurseVerificationofDeath201908.pdf
Victorian Current Acts. (n.d.). Crimes Act 1958 - SECT 75. Retrieved from http://classic.austlii.edu.au/au/legis/vic/consol_act/ca195882/s75.html
Vissagio, N. et al. (2018). Is it safe? The restraint chair compared to traditional methods of restraint: A three hospital study. Archives of Psychiatric Nursing, 32(5), 723-728 doi: 10.1016/j.apnu.2018.04.003
Ye, J., Wang, C., Xiao, A., Xiao, A., Zia, X., Yu, L., Lin, J., Liao, Y., Xu, Y. & Zhang, X. (2019). Physical restraint in mental health nursing: A concept analysis. International Journal of Nursing Science, 6(3), 343-348. doi: https://doi.org/10.1016/j.ijnss.2019.04.002
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