Ethical And Legal Nursing in Ravi - Case Study Example

ETHICAL AND LEGAL NURSING IN RAVI CASE STUDY Ethical issues The oncologist made a phone call to the nursing staff in the ICU and ordered that Ravi was Not For resuscitation (NRF). The nurses followed this order although it is not ethical for patients in ICU not to receive resuscitation since most of them are in critical conditions and are hooked onto life machines. When the oncologist calls on Ravi in the afternoon, he indicates to him that the treatment has been sorted out but does not elaborate what sort of treatment it is or ask for his opinion. (Staunton 2003). Ravi had communicated with his doctor that he would have loved to have the cardiac valve surgery but he had been denied due to the fact that success was not guaranteed. NFR order from the doctor had not been duly communicated to Ravi by the doctor, which is wrong since he deserved to know. Neither Ravi nor his relatives had been involved by the doctor when making the decision to issue a NFR order pertaining to his case. It is always advisable for a doctor who is making such a serious decision to consult the patient or the family (Peterson 1992) Legal issues The PICC line site which was inflamed and red did not arouse the interest of the nurses. The communication with the Ravi’s doctor was done after 48 hours after a note was made on redness, pain and a rise in temperature which is negligence by the nurses. When the oncologist was writing his clinical assessment report, he did document the directive on NRF that he had given earlier through the phone. This is illegal since such a serious decision should be clearly documented with the reasons why it was issued. By not documenting it, the oncologist was withholding vital information involving the patient. The nursing staffs who later on wrote the NFR initials using a pencil, is breaking the law since they are interfering with patient information from the doctor (Irwin law 2006). Making a decision to issue the directive of NFR on Ravi by the doctor without his consent or that from his family is not legal since such major decisions require consent from patients or family to avoid law suits (Longstaff 1994). Refusing to administer intravenous atropine to Ravi to correct arrhythmia can pass for withholding of treatment in a court of law (Kenneth 1989). Cultural issue-Ravi only wants to get well to take care of his sick wife since she depends solely on him and she is also terminally ill, as she has cancer. (Staunton 2003). Further information needed is on whether Ravi had any close relatives apart from his sick wife who would have been consulted by the doctor before making the NRF decision. When Ravi says how wonderful that the doctors were taking good care of him, this is a value laden statement since previously he had been lamenting about the denial of his heart surgery (Staunton 2003). this means that he knows the doctor is not willing to give him a chance for survival. Fundamental ethical principle and their application in the case study Principle Explanation Autonomy definition This is described as a self determination right which gives a person the controlling ability of what happens to them. This applies in health since an individual has a right to consent a certain form of treatment (Staunton 2003). Ravis autonomy is constantly breached by the doctor who issues the directive of NFR on Ravi without his consent. He also withholds the injection of atropine intravenously from Ravi, although it would have made the arrhythmia to be more responsive and made Ravi more comfortable. He does this without informing him. Beneficence Definition This is normally described as the principle that enables a person to do good above all. This is applicable in health where treatment cannot be ceased because a patient is terminally ill (Pellegrino and Thomasma 1993) Beneficence is breached in Ravi’s case since NFR order is given by the oncologist as Ravi is terminally ill. Ravi is also denied the cardiac valve replacement surgery since he has fifty chances of survival although he wants the surgery done. Ravi is denied atropine injected intravenously which would treat the arrhythmia and stabilize his heart rate. Non maleficence Definition This is the principle that upholds that a person should not do any harm above all. This is a strong health care principle that is mostly used by nurses when taking care of the patients by ensuring there is no negligence (BMJ medical 1998) The non maleficence principle is breached in Ravi’s case since when his PICC line became inflamed and red, the nurses only called the doctor after 48 hours since they noted pain, redness and a rise in temperature. They should have informed him immediately they noticed the redness and inflammation, since this would have prevented an infection. Confidentiality or privacy Definition This refers to protection of information which is regarded as confidential. The information about a patient’s illness should be kept private by the doctor and should not be given to every one. However, the information on treatment should be communicated to the patient thus limiting confidentiality (Kuhse and Singer 2001). This is breached by the nursing staff, who writes NFR with a pencil when the doctor fails to document this deliberately. The limitation of confidentiality is also breached since the doctor keeps vital information on the treatment from Ravi who has a right to know, such as the NFR directive. Veracity Definition This is considered to be the quality of being true by telling the truth. In health it refers to informing the patient or the family the truth about the illness and treatment. (Kirby 1989). In Ravi’s case veracity is breached since the doctor made the decision on NFR solely without consulting Ravi or his relatives. Veracity is upheld when the doctor informs Ravi that he has a 50 percent of survival if he has the surgery to replace his hearts valve. Advocacy Definition This implies that people should be treated equally with neutrality and impartiality (Staunton 2003). Advocacy is breached in Ravi’s case since he is not treated fairly due to his terminal condition. Treatment is withheld when a NFR directive is made by the doctor. The law that states that the practice by a nurse should be competent and safe is breached since we see the nurses letting Ravi to get an infection on his PICC line site which is inflamed and red (Kerridge 2005). They do not report this soon to the doctor but waited until Ravi was in pain and his temperature high. Even then, they call the doctor after 48 hours. The conduct of the nurse must be within the agreed standard of this profession, is a law that is upheld by Georgia since she questions the decisions that are made by the doctor concerning Ravi (Government of Australia 2006). During her conversation with him, she inquires about the kind of treatment he wants and if he had told his doctor so. She is the only nurse who is concerned that the NFR directive was given without the consent of the patient or his relatives. Sue on the other hand breaches this law since she doesn’t question or concern herself with the directives given by the doctor (The Nurses board of Western Australia 2000). She even goes further to defend the doctor’s actions by saying she cannot challenge or oppose his decisions since her duty is to oblige by his rules. The clinical and resident nurse refuse to inject Ravi with atropine even if they knew it would treat the arrhythmia which is quite irresponsible. We also see the nursing staff writing NFR with a pencil when the doctor deliberately forgets to document this in his report. This is wrong since such directives should have been written by the doctor who gave them. Although there is professional etiquette the nurses should have informed the one in charge, on the decisions the doctor was making if they found them inappropriate (Chiarella 2002). The relevant stakeholders in this case is the metropolitan hospital. the interest of the hospital is to protect its reputation. if the negligence and withholding of treatment was to get out the hospital would lose credibility and clients. their interests are significant since health care is an income generating sector maintained by patients. they are powerful since they would do anything to safeguard business. This is not legitimate since several codes of ethics that guard hospitals have been broken e.g negligence. these problems are extremely urgent since there is a lot to lose for the hospital. from the hospital point of view the doctor is doing what is right since he is saving the hospital unnecessary cost. Ethical conflict There is an ethical conflict since Georgia doe not approve the NFR decision made by the doctor without the consent of the patient or the relatives. She also has a problem with the fact that this decision was not communicated to Ravi who believes he is getting good treatment and will be well soon to continue taking care of his wife. The conflict occurred because the doctor chose to make such a vital decision without engaging the patient. The conflict can be solved by the doctor communicating his decision to the patient and assisting him in understanding why he thinks its right. (Forrester 2005). The concept of ethics concerns itself with the well being of humans and maintenance of tranquility in the society and thus any decision made should not contravene the two (Kerridge 2005). The management should make a decision that does not put the doctors and nurses in a collision course. The importance of ethics overrides all importance e.g. self interest and this should guide the management to make a decision that is based on resources allocation. The legal concept that can be used is that it is a legal right for a patient to be informed about the risks that are associated to the options of treatment that are available to him and let him make a decision (Wallace 2001). The management should inform Ravi on the condition of his illness and let him make his own decision on the NFR process. The ethico- legal decision to be made in Ravi’s case is to tell him the truth about the NFR decision and let him decide if it should hold or be done away with. This will be ethical since he will know how far his leukemia has extended and prepare himself for eventuality, since the doctor will explain why he recommended this form of treatment (Kerridge 2005). Conflict between the doctor and nurses will be reduced since the nurses will know the decision came from Ravi. This will help in maintaining the professional etiquette that exists between nurses and doctors. This decision is legal since the hospital will be avoiding any future law suit due to breaking the law regarding letting a patient to make a decision on his method of treatment. This decision can be communicated to the doctor by the doctor who is in charge, who will in turn communicate it to the matron. The matron can communicate it to the nurses working in the ICU. The doctor can tell Ravi about the intended treatment as long as it won’t put him at a risk of further deterioration in health. If it is deemed that telling him about the treatment will adversely affect his life further, the doctor can tell a close relative who will make the decision for him. This way the ethico-legal decision can be duly communicated to all the stake holders eliminating the conflict. 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