Ethics and Legal Issues in Health Care - Case Study Example

Ethics and Legal Issues in Health Care Table of Contents Introduction 3 Ethical Situation of the Case Scenario 4 Discussion 5 Principles and Theory 5Ethical, Legal and Professional Aspects 6 Bioethical Principles of Nursing in the Case Scenario 8 Illustration of Ethical Issues in Practice 11 Key Ethical Points Identified in the Case Scenario 12 Evidence-Based Explanation 14 Conclusion 16 17 References 18 Introduction Code of ethics in relation to nursing comprises certain guidelines on the basis of which the nurses are required to conduct their responsibilities in a consistent way. These generally provide values along with principles with the assistance of which the nurses are able to develop ethical relationship, behaviours, decision-making and responsibilities (Slate, 2013). The code linked with nursing is often developed based upon the laws as well as the regulations and the professional standards that results in offering better care to the patients (Zahedi & et. al., 2013). In this regard, the nurses should provide quality care as well as treatment to the patients in accordance with moral responsibilities on the ground of professional relationship to families, populations, individuals, colleagues and communities (Butts, 2007). The ethical codes are implemented in the context of nursing practice with the intention of ensuring that nurses are capable to provide quality care along with treatment, resulting in mitigating ethical dilemmas (Slate, 2013). Ethical dilemmas arising in the situation of either alleviating suffering or preserving life of the patients are often recognised as critical issues in nursing practices (Casterle & et. al., 2008). According to Heiskell (2010), there exist four ethical principles that are essential to consider in nursing ethics, which include autonomy, beneficence or non-maleficence, justice and veracity along with fidelity. Theoretically, autonomy refers to the right, which is offered to an individual assisting in making decisions in a self-determined manner. Additionally, the individuals are required to be independent as well as competent in their action courses. The principle of beneficence or non-maleficence ensures that individuals are protected from any sort of harm and accordingly, proper care along with treatment is offered in a beneficiary way (Heiskell, 2010). The principle of justice signifies that patients are provided with quality treatment and care services in an equal manner. Finally, veracity and fidelity principle aids in developing a strong trustworthy relationship amid patients and nurses (Heiskell, 2010). With this concern, the essay intends to discuss about the ethical, legal along with the professional aspects considered in nursing practice and ethics. Moreover, the essay focuses on analysing the ethical dilemma, which can be identified in the specified case scenario and appropriate measures undertaken in order to ensure ethical decision making in relation to the identified dilemma. Ethical Situation of the Case Scenario Being a part of the nursing profession, it has been a daily task for the nurses or the care givers to address and overcome with numerous ethical issues relating to healthcare. In such situation, it often becomes quite difficult in making any sort of decision quickly. Similarly, in accordance with the provided case scenario, it can be affirmed that the major ethical dilemma was to inform a patient about his illness. The provided case scenario includes an 8 year old boy named Johnson, who had been admitted in the hospital by his grandfather for certain kind of illness. He did not actually know about the disease that he was suffering from. Later, it was known that Johnson was suffering from HIV/AIDS. In this regard, his grandfather requested the hospital authorities not to inform his grandson about the illness he was suffering from. Based upon the provided case scenario, it can be stated that Johnson was aware about his suffering from certain kind of severe disease, but he was completely unaware of the occurrence of such chronic disease such as HIV/AIDS. While admitting Johnson, his grandfather had requested the hospital authorities not to make him aware of the aforesaid illness that he was suffering from. This was a complete situation of confusion from the hospital’s authority end. The hospital authorities could not take any kind of decision regarding the request of his grandfather. It is worth mentioning that in the nursing profession, it often becomes quite hard in making decisions from emotional perspective. One of the aspects, which require to be taken into concern for addressing the dilemma is the decision made on the scale of ethical consideration. The subject matter of ethical consideration in healthcare context has been chosen, as it is a very recent and common situation observed in the nursing profession. Nowadays, it can be viewed that the ethical and the legal issues are of major concern in medical practices as well as studies owing to the reason that the nurses are often faced with similar dilemmas in healthcare practice. Discussion Principles and Theory While discussing the principles and the theories of children’s right relating to the case scenario provided, it can be affirmed that there lay certain fundamental rights provided to the children based upon which they are required to be treated with equal opportunity. The children must be facilitated with the opportunity of enjoying social, political and civil rights. However, minors are not provided with full autonomy, as they are incapable of making effective decisions (Sloth-Nielsen, 2013: 3-10). In this regard, the parents are responsible for making decisions on behalf of their children. Contextually, the decisions made by the parents are for serving the best interests of the minors. Legally, the minors are not offered with adequate rights of autonomy as they might make inappropriate decisions, which in turn, might adversely affect their life. Moreover, in the case of treatment services, the minors are not offered with full autonomy, as it might affect their health and lead life towards threatening situations (Fortin, 2009: 32-50; Bueren, 1998: 1-3). Presently, the nurses are required to operate in accordance with the ethical principles that are widely accepted in nursing ethics. Legal as well as ethical principles are required to be taken into concern for ensuring that the nurses provide quality and better treatment along with care services to the patients in an appropriate manner. In this respect, as per the case scenario provided, the nurses should act on the principles of autonomy and non-maleficence. Specially mentioning, the principle of non-maleficence would assist nurses in providing quality care and treatment services without causing any harm to the interests of the patients similar to Johnson as specified in the provided case scenario. Moreover, the principle of autonomy will ensure that care and treatment services are offered in accordance with the needs of the patients (Butts & Rich, 2012: 34-50). Ethical, Legal and Professional Aspects In relation to the specified case scenario, the parties i.e. grandfather and the hospital authorities were under the ethical dilemma of deciding whether to reveal the truth of the medical report to the patient or not. It would be vital to mention that the grandfather and the hospital authorities are required to make effective decisions in order to safeguard the interests of the child suffering from HIV/AIDS. In this regard, hiding the truth of the diagnosed report from the patient can be duly considered as an ethical issue. Subsequently, an appropriate analysis would be required to be undertaken in order to comprehend the power of the parties associated with the ethical dilemma, so that decisions are suitably made. Prior to coming into a particular conclusion, an analysis is required to be conducted for determining the power of the parties engaged in the ethical dilemma and also for the moral principles that should be duly taken into concern (Royal Veterinary College, 2011). The analysis has been discussed in the following. Patient In this case, the patient is an 8-year-old boy suffering from HIV/AIDS illness and was admitted to hospital. At the time of diagnosis, the grandfather requested the hospital authority not to reveal Johnson about the diagnosis in relation to HIV/ AIDS. Hospital Authorities The hospital authorities are required to perform their respective activities in accordance with the principles based upon nursing ethics. Additionally, full disclosure of medical information to the patients would require to be made so that appropriate decisions for treatment services can be undertaken (Slate, 2013). In this case, the patient was a minor and accordingly, decisions in relation to disclosure of the medical report were unclear. Grandfather The grandfather admitted Johnson to the hospital at the time of his illness. It can be stated that his grandfather cannot be considered as a legal guardian of Johnson and thus, he is not liable to take decisions on behalf of the patient, rather his father and mother are legally authorised for making decisions in serving the interests of Johnson. However, in the absence of parents during diagnosis, the grandfather can be duly regarded as legal guardian of Johnson and is liable to take decisions in protecting the interests of Johnson. In nursing practice, there are certain professional boundaries within which nurses are required to deliver quality care along with treatment services. Relating to this particular concern, the ethical, legal and the professional aspects include respect, moral courage, confidentiality, power, cultural sensitivity and ‘being a good citizen of the world’ (Butts, 2007). Conceptually, the legal as well as the professional aspects are the essential elements comprising important concepts in relation to nursing practice along with professionalism. Contextually, the nurses are required to possess responsibility along with autonomy based facets so that they are able to provide care and treatment services in a moral along with ethical way. Respectively, an alignment of nursing ethics with legal and professional grounds is required to be maintained for the purpose of delivering significant health benefits to the patients (Butts, 2007). Thus, according to the case scenario provided, the patient was a minor and thus, the medical authorities are needed to safeguard the interests of Johnson. Bioethical Principles of Nursing in the Case Scenario The bioethical principles often provide the nurses or the other medical professionals to take right decisions at any kind of situation. Fundamentally, there lay four major factors namely beneficence, non-maleficence, justice and autonomy that assist the nurses to take effective decisions regarding their patients and also addressing any sort of issue persisting within the healthcare settings (Masters, 2014: 112-114). Hence, this section will contain the study of all the four factors of bioethical principles in order to make proper and right decisions regarding the request of Johnson’s grandfather. Principle of Beneficence This principle explains that the prime responsibility of the nurses is to safeguard the patients from any kind of harm and also provide them with all sorts of necessary benefits (McCormick, 2013). This principle is duly considered as one of the basic characteristics, which must be inherent within the nurses and can also, be denoted as the prime aspect in nursing profession. If this principle is merged with the ethical considerations of nursing, the desired result would be that the nurses are required to serve or treat the patients according to their interests. In simple words, it can be stated that the principle of beneficence concentrates on serving the patients with the goal of saving their lives and placing them in a safe position. Similarly, in the case of Johnson, the nurses must focus upon offering best care to the patient and develop his diagnosis procedure (McCormick, 2013). Principle of Non-maleficence This principle states that the nurses must prioritise upon assuring the patients are not hurt or injured in any way either through their act or the method of treatment. It can be stated that this principle requires providing the patients with such standard of care so that they are protected from all kind of physical or mental injuries (Masters, 2014: 112-114). In case of Johnson, the hospital authority was in dilemma of how to keep the request of his grandfather. Thus, it can be suggested that the nurse or the other medical professionals must comply with the request of Johnsons’ grandfather as this principle concentrates on the protection of the patients from physical as well as psychological harm (Masters, 2014: 112-114). In this scenario, the medical authorities must think about the safety of the patient and should not let him know about the disease (Canadian Nurses Association, 2008). In this regard, it can be stated that Johnson’s state of mind might be highly affected after hearing the news, causing severe physical harm as well. Thus, taking this consequence into concern, it is suggestible that Johnson must not be known about his illness. Principle of Justice In medical terms, principle of justice is explained as fair and equal treatment to the patients with varied age group. This principle implies for mostly the patients falling under the category of 65 years and above (Masters, 2014: 112-114). In precise, the principle states that there must lay an equal treatment between a young and an elderly patient. The medical authorities diagnosing Johnson must focus on this principle as it represents that it is important to prevent the patients from any kind of harm rather than thinking about the rights of healthcare processes. In this situation, the hospital authorities must not inform Johnson about his illness as it might lead to certain other chronic illnesses and also having psychological effects (American Nurses Association, 2011). Principle of Autonomy This can be regarded as one of the decisive principles to consider amid all the bioethical principles of nursing. This principle entails the respect to be given to the patients and also determines the ability of taking decisions independently (Paul & Williams, 2009: 27-28). In relation to healthcare sector, the principle of autonomy includes facilitating the patients with their own decisions on treatment process, informing them with all medical information and above all maintaining the confidentiality of the patients. Moreover, the principle also implies that if any patient is suffering from communicable diseases, he/she can lose their right of independence (American Nurses Association, 2011). Similar is the case of Johnson, where he was suffering from the illness of HIV/AIDS. In this situation, it is highly required that Johnson must not be informed about his illness. This can lose his independence along with confidence to lead a healthy life. In order to prevent such situation, it is recommended that the request of Johnson’s grandfather must be kept. He must not be informed about his illness so that any kind of physical or psychological harm can be prevented. After analysing the bioethical principles, it can be affirmed that the medical professionals must apply or take the assistance of these principles in order to ensure that right decision is being taken, concerning patients’ health security and safety (Held, 2006: 262-272). Illustration of Ethical Issues in Practice The ethical issue pertaining within the specified case scenario can be illustrated in a clear manner with the help of an example relating to a 36 year old lady Maria. She had given birth to an HIV infected daughter named Amelia as she was infected with the disease. But Maria did not want Amelia to know about her disease. Due to this reason, Amelia was given certain medication stating that she has got problem in her blood. However, it was observed that Amelia stared to dislike the medicines as she was growing up. In this similar context, the hospital staff opined that she must be told about her disease as she might become more conscious towards the intake of required medicines. In response, Maria requested the hospital staff not to let her know as she is not matured enough to know about her disease and also it is her responsibility to protect her from all sorts of discrimination. This is one of the examples of ethical dilemma that the medical authorities often come through in their daily activities. The hospital staff members assumed that Maria might be feeling guilty of passing on the virus to her daughter and due to this reason, she might be willing to hide it from her daughter Amelia (Klitzman & et. al., 2008). Legally, if this case is to be taken into concern, the federal and state law represents that the parents have the full right to think about their child’s well-being (Klitzman & et. al., 2008). Thus, it can be affirmed that the nurses or the other staff members must take decisions on ethical grounds in order to deal with this kind of dilemma, which emerges in their daily activities (Klitzman & et. al., 2008). Key Ethical Points Identified in the Case Scenario In relation to the provided case scenario, the grandfather of Johnson decided not to reveal Johnson about the HIV/AIDS diagnosis with the intention of protecting cognitive and emotional aspect, violating the autonomy principle. On the other hand, nurses are required to ensure that treatment as well as care services to patients are offered with better protection, respect and integrity. In this respect, there are certain ethical issues that have been identified in relation to the principles of nursing practice (Masters, 2014: 112-114). The key ethical issue raised from the case scenario can be related to autonomy principle, as the patient is not provided with the opportunity of making independent decision for care as well as treatment services. Moreover, the patient is not provided with the right of autonomy due to fact that Johnson is a minor and will be unable to make competent decisions. Additionally, the grandfather of Johnson requested the hospital authorities to conceal that Johnson is diagnosed for HIV/AIDS as it might adversely affect his psychological along with social conditions in an immense manner. Subsequently, the hospital authorities are recognised to be under conflict situation in relation to the principles of nursing for making decision whether to reveal or conceal the medical information of Johnson. Evidence-Based Explanation In the UK, there exists an effective clinical practice, which is based upon Gillick competency. According to Gillick competency, the patients of above 16 years of age are required to be provided with autonomy principle so that they are able to make their decisions in a self-determined manner (Masters, 2014: 112-114). In this regard, patients under the age of 16 years are recognised as immature in making competent decisions and understanding medical conditions, social as well as moral issues appropriately (Cornock, 2007). Subsequently, the parents or the guardians are provided with the right of making decisions on behalf of the minors for serving their best interests and minimising risks associated with social, cultural and moral issues (Cornock, 2007; Hunter & Pierscionek, 2007). Respectively, in relation to the case scenario provided, Johnson was a minor and unable to make competent decisions. In this respect, the grandfather was legally authorised to make decisions on behalf of Johnson for serving his best interests. Moreover, the provided case scenario can also be related with the principle of non-maleficence as the decisions in relation to care along with treatment are required to be made for serving Johnsons’ interest. In this regard, the medical decisions towards providing quality care and treatment to Johnson would be made in accordance with his needs along with interests. Thus, it can be comprehended that nurses often face ample legal as well as ethical dilemma in their daily practices. In this regard, the four principles that include autonomy, non-maleficence, justice and veracity as well as fidelity are duly followed in making effective decisions morally (Vasey, 2009). It is worth mentioning that concealing and revealing medical information to Johnson might deliver both positive along with negative outcomes. In this regard, it can be affirmed that concealing medical information will assist Johnson to remain unaware of the fact that he is HIV infected. On the other hand, there are certain negative outcomes that can be observed such as anxiety or eager to know about the illness that he was suffering from, which in turn might affect his psychological conditions at large. Revealing medical information to Johnson about the diagnosis of HIV/AIDS will assist him in having a better control over his life. Moreover, he will be able to attain better and quality care as well as treatment services in accordance with his needs (Redman, 2013: 1-10; Butts & Rich, 2012: 34-45). Conclusion After the entire study of ethical and legal issues pertaining within healthcare segment, it can be apparently observed that the medical professionals were in serious dilemma of making Johnson informed about his disease. The legal issues state that the minor children must not be informed about their disease as they are not developed up to that stage of maturity. Similarly, in case of 8 year old Johnson, his grandfather had requested the hospital authorities not to inform about his disease. This became the major dilemma of the hospital authorities including the nurses along with the other related staff members. On the other hand, the legal issues entail that all ethical dilemmas in healthcare must be concerned with the help of Gillick competency, which states that the patients above the age of 16 years are required to be informed about their medication processes so that they can make effective decisions on their own. Thus, the children below the age of 16 years are not being informed about their illness as they are unable to make their decisions. Subsequently, Johnson is also going through the same situation and his grandfather had the complete authority to take decisions on his behalf. Specially mentioning, the medical authorities such as the nurses or the other medical staff members must take the ethical decision on the matter of Johnson’s grandfather’s request. Thus, in this regard, the bioethical principles of nursing can be taken into concern as these might help the nurses to take ethical decisions in their daily activities. All the four factors of bioethical principles i.e. non-maleficence, maleficence, justice and autonomy provides a common aspect that saving of the patient’s life must be the ultimate goal of the medical professionals. This aspect can be linked with the example of Maria and Amelia as mentioned in the aforesaid section. Maria wanted Amelia to know about her disease at a matured age but the hospital authorities had a different notion that she must be informed as it will help her to become much conscious about curing her illness quickly. Hence, from the grandfather’s end, it was justified that he wanted his grandson to have little knowledge about his disease. Thus, it can be concluded that the request of Johnson’s grandfather request must be kept rather revealing the illness to Johnson as the legal aspects also entail that the minor patients must not be informed about the disease till maturity. References American Nurses Association, 2011 Short Definitions of Ethical Principles and Theories Familiar words, What Do They Mean? Autonomy, pp. 1-4. Bueren, G. V., 1998. The International Law on the Rights of the Child. Martinus Nijhoff Publishers. Butts, J. B., 2007. Ethics in Professional Nursing Practice. Chapter 3. 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