2805NRS Legal And Ethical Principles In Healthcare

2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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Course Code: 2805NRS
University: Griffith University

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Country: Australia

Question:
You are required to answer the following questions as a structured essay.
Ethical Issues
To begin, select a stakeholder— Eric, Debbie, Dean, Denise or Emily. When answering the following questions, you need to take their perspective. For example, if you select Emily, then when answering question 1, you need to identify two values that Emily may have that are relevant to the scenario. 1. Identify two values that you think your stakeholder may hold that are relevant to the scenario, and, referring to appropriate academic literature, describe these values. 2. Describe how these values may influence their decision-making in relation to Ewing’s treatment. To answer the next question, you must now put yourself in the position of a healthcare professional involved in Ewing’s care.
Answer:

Introduction
A terminal illness has major impacts to the patient and their carers. Once diagnosed, the patient experiences distressing and painful periods with adverse limitations in the lifestyle brought about by the illness (Bosslet, et al, 2015). Coping strategies at times can also cause friction between primary carer and other family members (Haughey& Watson, 2015). Ewing’s case is already taking that direction. Health professionals can help in ethical issues when they arise (Wallace, 2015).The person can continue to receive treatment to help manage the symptoms but not cure their illness (Haughey& Watson, 2015). End of life care helps everyone affected by the diagnosis have the best quality of life (Goodwin, et al, 2014). It also includes additional support and help with legal matters.
Values relevant to the case
Eric being Ewing’s carer for the longest time now has a role in supporting Ewing as his health and ability to care ofhimself diminishes. Being the principal carer he has to help Ewing in all his activities of daily living which is a more intensive care. As a carer he has a duty to help the patient to be healthy and well the best way possible (Goodwin, et al, 2014). Ewing’s health has shifted from curative treatment to palliative care which shows an increase in need for more support and physical care.  This requires an informal carer who will provide physical and emotional support to a patient with a life limiting illness (Horrell, Stephens &Breheny, 2015).  As a carer, Eric has values of commitment and care. Caring for a sick person is demanding and exhausting and difficult and requires more patience(Horrell, Stephens &Breheny, 2015). As a result, commitment needs to be built to improve patient’s care and experience while taking the necessary actions to handle the challenges ahead. Eric is committed to care for Ewing with the assistance from Debbie, Ewing’s daughter.Care as a value is at the center when delivering help to any sick person. It is a feeling of concern or interest towards them.  It helps improve their health and wellbeing. The type of care depends with the individual needs, choices and wishes in every stage of their life (Goodwin, et al, 2014). Eric is committed in giving Ewing the best care even as he nears his death. For this reason, together with Debbie they opt to buy a wheelchair and a mechanical lifter to help the patient in easy movements around home. He wants the best care for him and prefers him to be at home for the best palliative care rather than hospital where the patient may feel lonely, not loved and less catered for. Being a carer to Ewing for nine years, Eric has altered his own lifestyle to meet Ewing’s needs. It also means accepting the situations and making adjustments in one’s own life(Horrell, Stephens &Breheny, 2015). Commitment to care is about giving priority to other things other than oneself(Goodwin, et al, 2014).
Values and their influence in decision-making
Decision-making is about choosing a good choice from the options available through weighing the positives and negatives of each option available and the outcome of each when applied to the situation at hand(Holroyd-Leduc, et al, 2016). Based on this the best option is determined. In relation to the case study, Eric’s decision-making is about what was beneficial to Ewing at the moment. Ewing’s condition had no known treatment or any form of medication that would alter the trajectory of the disease. All he needed was palliative care until his time came (Bükki, et al, 2014). Eric and Debbie had already made a decision to care for him at home. There was no need for him to be kept under hospital care when there was no proper attention required at the healthcare. Eric had made a commitment about Ewing’s care and together with Debbie’s assistance they went ahead and bought the necessary equipment they thought were the best for the patient. Out of commitment and care that Eric had created a long-lasting relationship with the patient. Commitment is not a value for the weak(Holroyd-Leduc, et al, 2016). It requires persistence, self-discipline and resilience. Eric having made a decision of taking care of Ewing until his death, he had to stay committed to it. Commitment is about sacrifice. It binds one to a promise, course of action, a firm agreement and a pledge (Holroyd-Leduc, et al, 2016). He had made a sincere and a serious decision about the care and was determined to see to its completion. He is happy when Ewing is discharged for home. He is concerned and more attached to the patient and looking after him and providing for his needs is his priority (Sizoo, Grisold&Taphoorn, 2014).
Healthcare professionals and ethical problem solving
The disagreement between the family members on Ewing’s treatment needs to be looked into on both sides to enable proper understanding that can bring a consensus. The degenerative neurological condition has already caused severe damages on him and no medication to cure or improve the problem. Owing to this he can only continue to receive palliative care. The disease is progressive and death can be reasonably expected.Treatment to Ewing through parenteral hydration and artificial nutrition was a non-beneficial treatment (Houben, et al, 2014). This is because the intensity of treatment and the expected degree of improvement in quality of life was minimal (Haughey& Watson, 2015). The patient was also aware of his condition and felt no need of going to the hospital though proper monitoring was essential. End of life treatment to him was ineffective, costly and not in line with his wishes (Bosslet, et al, 2015). This limits medical care. Veracity in healthcare is important to enable patients and families make informed consent(Houben, et al, 2014). Patients and families rely on health professionals for information about their care. They need to be told the truth (Wallace, 2015). End of life and palliative care helps patients with life-limiting or life-threatening illness(Haughey& Watson, 2015). It helps in managing symptoms and providing assistance and comfort. The care offers emotional, mental, social and spiritual needs. It also provides practical help with daily activities. End of life and palliative care aims at improving the quality of life for the patient, family, friends and carers (Wallace, 2015). The care is not only for people nearing the end of life but also for people with chronic ongoing illness. The care is best begun early in the disease to help the patient have the best quality of life, with his wishes, for the longest time possible(Houben, et al, 2014). Palliative care can be received home, palliative care unit, or at a local hospital.
Common law on patient’s autonomy
To begin with, the degenerative neurological condition had impaired Ewing’s decision-making capacity. The patient was not in a condition to make an informed consent but his son requested the paramedics to further assess him at the hospital. If the patient lacks decision-making capacity or lacks competence regarding their treatment, another person must make decisions on treatment for them (Brazier & Cave, 2016). To have a capacity of decision-making a patient must have understanding, appreciation, reasoning and the ability to express a choice (Cartwright, et al, 2016). In cases where the patient lacks the capacity a surrogate decision-maker can intervene (Callaghan & Ryan, 2014). They can be legally appointed or next of kin(Moye, et al, 2013). Next of kin includes spouse, adult child, parent, adult sibling, close friend, or ethical committee. Dean being the adult child gave the paramedics the directive to further monitor his father.
Queensland legislation on potential decision-makers
In reference to Queensland legislation, a substitute decision-maker is a person allowed by the law to make decisions on behalf of a person who lacks the capacity to make informed consent by him or herself (Chesterman, 2013). When it comes to substitute decision-making, a person can have more than one. Decisions to be made can be on personal or financial matters (Carter, et al, 2016). Health is a personal matter. When one has not appointed a substitute decision-maker and their capacity is impaired, a statutory health attorney is appointed by law to make health decisions for the person (Chesterman, 2013). Other culturally appropriate people for the role are; a spouse or de facto partner with whom one has a close or continuing relationship, a primary carer who is not paid and is above 18 years of age, a close friend or relative above 18 years and not being paid for the role(Carter, et al, 2016). Failure to meet the criteria, the law appoints a public guardian as a statutory health attorney. An eligible substitute decision-maker must be 18 years and above, have decision-making competence, follow the patient’s values and instructions, readily available to for the role, willing to accept the decision-making responsibility, and have the ability to make decisions even in stressful situations (Tilse, et al, 2014).
Requirements for a substitute decision-maker
Eric being a primary carer for Ewing, he has lived long enough caring for him and is aware of all his needs. Eric and Debbie were well aware of Ewing’s condition. Before considering palliative care for him, the healthcare had informed them that there was no option treatment available for his condition. Knowing this, Eric was committed to caring for Ewing at home until his time came. He is also able to observe the necessary requirements by the patient at that particular moment to give him comfort(Then, 2013). The responsibility of a substitute decision-maker is that they must act in the best interest of the person, make decisions with the capacity they would have made for themselves, have knowledge and understanding of their medical condition and the expected complications in the future, have an understanding of future medical care options which entails current and future treatments benefits and risks, carefully considering the patient’s wishes and choices regarding their end of life care, talk about the choices of the patient with his or her family(Then, 2013). Eric being a carer is always available to take the role, he has a commitment to fulfill which means he would be willing to accept the responsibility. He knows what the best for Ewing is and is happy when he is discharged even when Dean does not want it. He also makes decisions in stressful in stressful situations.
Principles ofthe Act on a person with impaired decision-making
Ewing is impaired mentally and lacks the capacity to make decision regarding his health. The Principles Act seeks to oversee the rights of a person with disability in decision-making is independent and receives the needed support(Then, 2013). Ewing needs someone committed towards his care to live the best life he wishes for in his health condition. The presumption capacity highlights that adults are believed to have their own capacity of making decisions except where it is found out that they cannot(Then, 2013). The degenerative neurological condition has already impaired Ewing’s decision-making. Eric is already in a position to offer the best palliative care to the patient. He is aware of his best needs. Irrespective of capacity in decision-making, the basic rights are equal to all people(Carney, 2014). It is the duty of substitute decision-makers to see to it that the person exercises their rights (Then, 2013). Their human worth and dignity should also be respected despite their situation(Then, 2013).  They must also be encouraged and supported in to perform their social roles. Despite Ewing’s condition affecting him greatly, he still has the role to play as a home owner(Carney, 2014). A decision-maker must also encourage the person to be self-reliant and autonomous physically, emotionally, socially and intellectually the best way possible (Then, 2013). Eric spending most of the time with Ewing, as a man he knows what he needs best to be self-reliant. He is also less restrictive and offering proper care and protection that is consistent. He has been with him for a long time and his plan is to take care of him at home until his final rest. A person’s environment and values should also be maintained. The assistance given to the person should also be appropriate and meets the current needs and suits their individual characteristics (Carney, 2014). Eric wants the best for Ewing and needs him to be independent the best he can. To do this he goes with Debbie to source for a wheelchair and lifter for Ewing. He knew he needed it for the moment.
Conclusion
When it comes to caring for a patient, care should be at the heart of everything taking place in improving health and wellbeing. Individual needs, wishes and choices should be considered at every stage. To fulfill all these requires commitment. The core values should also guide in deciding the best for the patient. Ethical dilemmas are frequent in patient care. Health professionals can help resolve by maximizing benefits, respecting the preferences and reducing pain and suffering to the patient and facilitating communication. Futile treatment is not ethical in healthcare.If a patient lacks decision-making capacity another person can make decisions for them.
References
Bosslet, G. T., Pope, T. M., Rubenfeld, G. D., Lo, B., Truog, R. D., Rushton, C. H., …& Au, D. H. (2015). An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. American Journal of Respiratory and Critical Care Medicine, 191(11), 1318-1330.
Brazier, M., & Cave, E. (2016). Medicine, patients and the law.Oxford University Press.
Bükki, J., Unterpaul, T., Nübling, G., Jox, R. J., &Lorenzl, S. (2014). Decision making at the end of life—cancer patients’ and their caregivers’ views on artificial nutrition and hydration. Supportive Care in Cancer, 22(12), 3287-3299.
Callaghan, S. M., & Ryan, C. (2014). Is there a future for involuntary treatment in rights-based mental health law?. Psychiatry, Psychology and Law, 21(5), 747-76.
Carney, T. (2014). Clarifying, operationalising, and evaluating supported decision making models. Research and Practice in Intellectual and Developmental Disabilities, 1(1), 46-50.
Carter, R. Z., Detering, K. M., Silvester, W., & Sutton, E. (2016). Advance care planning in Australia: what does the law say?. Australian Health Review, 40(4), 405-414.
Cartwright, C. M., White, B. P., Willmott, L., Williams, G., & Parker, M. H. (2016). Palliative care and other physicians’ knowledge, attitudes and practice relating to the law on withholding/withdrawing life-sustaining treatment: survey results. Palliative medicine, 30(2), 171-179.
Chesterman, J. (2013). The future of adult guardianship in federal Australia. Australian Social Work, 66(1), 26-38.
Goodwin, N., Dixon, A., Anderson, G., &Wodchis, W. (2014). Providing integrated care for older people with complex needs: lessons from seven international case studies. London: King’s Fund.
Haughey, C., & Watson, M. (2015).Ethics in palliative care. InnovAiT, 8(6), 336-339.
Holroyd-Leduc, J., Resin, J., Ashley, L., Barwich, D., Elliott, J., Huras, P., …& Pullman, D. (2016). Giving voice to older adults living with frailty and their family caregivers: engagement of older adults living with frailty in research, health care decision making, and in health policy. Research involvement and engagement, 2(1), 23.
Horrell, B., Stephens, C., &Breheny, M. (2015). Capability to care: Supporting the health of informal caregivers for older people. Health Psychology, 34(4), 339.
Houben, C. H., Spruit, M. A., Groenen, M. T., Wouters, E. F., & Janssen, D. J. (2014). Efficacy of advance care planning: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 15(7), 477-489.
Moye, J., Sabatino, C. P., &Brendel, R. W. (2013).Evaluation of the capacity to appoint a healthcare proxy. The American Journal of Geriatric Psychiatry, 21(4), 326-336
Then, S. N. (2013). Evolution and innovation in guardianship laws: Assisted decision-making. Sydney L. Rev., 35, 133.
Tilse, C., Wilson, J., White, B., Willmott, L., &McCawley, A. L. (2014). E nduring P owers of Attorney: Promoting attorneys’ accountability as substitute decision makers. Australasian journal on ageing, 33(3), 193-197.
Wallace, C. L. (2015). Family communication and decision making at the end of life: a literature review. Palliative & supportive care, 13(3), 815-825.
Sizoo, E. M., Grisold, W., &Taphoorn, M. J. (2014). Neurologic aspects of palliative care: the end of life setting. In Handbook of clinical neurology (Vol. 121, pp. 1219-1225).Elsevier.

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2805NRS Legal And Ethical Principles In Healthcare

2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

1 Download11 Pages / 2,553 Words

Course Code: 2805NRS
University: Griffith University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:

Ewing, 51, was a physicist when he was diagnosed with posterior cortical atrophy, a degenerative neurological condition that impairs his decision-making capacity. Since being diagnosed 6 years ago, Ewing has lost most of his vision, speech and the ability to move independently. More recently, Ewing has developed problems with swallowing, and has a very weak cough. He is reliant on his family and caregivers for all aspects of his daily living.
 
Ewing’s principal carer is his partner of 9 years, Eric. Prior to his relationship with Eric, Ewing lived with his wife Emily, who is the mother of their three children – Dean, Denise and Debbie. Ewing and Emily are not divorced, but Emily rarely sees Ewing. Debbie is very involved in Ewing’s day-to-day care, however her two siblings have only limited contact with her and their father.
Because they had been caring for Ewing for such a long time, Eric and Debbie are well aware there is no known treatment that would cure or alter the downward trajectory of his disease; Ewing’s condition will continue to deteriorate until he eventually dies. They planned to care for Ewing at home until this time came.
 
To assist with Ewing’s care, Eric and Debbie needed to source a wheelchair and mechanical lifter. They asked Dean to stay with Ewing one afternoon while they went shopping for these items. Dean had not seen his father for several weeks and reluctantly agreed to help Ewing with his dinner. However, Dean was not aware of the extent to which his father’s swallowing had deteriorated and while feeding him some pasta salad Ewing began to cough. Dean panicked, thinking that his dad was choking and quickly called 000. The ambulance arrived, and the paramedics assessed that Ewing’s airway was clear, but thought it best to transport him to hospital for further monitoring. As the paramedics moved Ewing onto the ambulance stretcher, he began shaking his head and making sounds that indicated he was not willing to go. On Dean’s request the paramedics transported Ewing to hospital for further assessment and treatment.
 
When Eric and Debbie arrived home they were very distressed to hear what had happened. They had seen Ewing experience these episodes before, and knew that they generally settled down without any treatment. They were not at all happy that Ewing was admitted to hospital.
 
At the hospital, to ensure that Ewing could continue to receive the nutritional support he required while minimising the risk of aspiration or choking, a naso-gastric feeding tube (NGT) was inserted, and artificial nutrition and hydration (ANH) commenced. Within a few days, Ewing’s condition had stabilised, and the healthcare team suggested that he was ready to be discharged home. They were of the view that the ANH could be stopped, and the tube removed. Eric and Debbie were happy with this, and prepared to take Ewing home.
 
Dean, on the other hand, had been very upset seeing his father struggle to eat, and believed that it would be best for Ewing if he continued with the ANH. Without it, Dean thought, Ewing would either be at risk of aspiration or choking, or, become very dehydrated. This, he surmised, would hasten his father’s death. Despite reassurance by the healthcare team that ANH would be of little benefit to Ewing, Dean could not be swayed. He called Denise and told her that Eric and Debbie were trying to starve Ewing to death.
 
Dean and Denise decided that the best thing to do was to approach the Queensland Civil and Administrative Tribunal and have themselves appointed as substitute-decision makers for Ewing. They told their mother, Emily, that this was what they were planning so that they could instruct the healthcare team to leave the NGT and maintain the ANH.
 

1. Identify two values that you think your stakeholder may hold that are relevant to the scenario, and, referring to appropriate academic literature, describe these values.
 
2.Describe how these values may influence their decision-making in relation to Ewing’s treatment.
 
3.Describe how the healthcare professionals caring for Ewing may have helped address the disagreement between family members by applying the Kerridge et al. (2013) model for ethical problem solving.
 
4.Identify whether the paramedics had the authority to transport Ewing to hospital in view of his possible refusal. Refer to common law or legislation to justify your response.
 
5.Refer to the relevant Queensland legislation, and list all potential substitute decision-makers.
 
6.Identify whether the stakeholder you have selected could be the substitute decision- maker for Ewing. Refer to the legislation to justify your answer.
 
7.Discuss how the outcome you are seeking is consistent with the health care principle set out in the Guardianship and Administration Act 2000.

Answer:

Introduction
The doctrine of patient autonomy is very imperative when it comes to the making of decisions regarding the treatment and diagnosis that the patient should have administered to him or her subject to the advice of the doctors. The doctor is only allowed at law to advise the patient and makes him understand the nature of his or her health condition and the available treatment and diagnosis alternatives and not to decide for the patient. This brief responds to a case study involving Ewing who is suffering from a degenerative condition that has made him mentally impaired.
Ethical issues
Based on the facts of the case study, it is evident that Emily holds the two important ethical values of honesty and open-mindedness. With regard to honesty, it is evident that Emily does is not feel comfortable with the struggles that the husband is going through by all standards. This is anchored on the fact that she cannot stand to see the husband suffering and at constant pains in the comfort of the home and that is why as a person, he was really not happy with the fact that the husband was struggling at home. To her, it was proper for the husband to be taken to the hospital where he could receive the best attention and care from the professional healthcare officials instead of languishing at home and in the hands of his children who are not professional enough to handle him in the best way. Being honest is an important value that someone should endeavor to have since it helps in always going for real solutions and stating things as they are without concealing any facts. An honest person is always straightforward and as such, he or she cannot be accused of misleading others by lying to them for self-gain. Dean in this scenario is very honest and ready to take the bull by its horns without any compromise whatsoever. Emily demonstrates her honesty by keeping off her husband since she could not pretend to be taking care of her when by all standards there was no hope for survival. In fact, given time and chance, Emily could have proposed assisted suicide for her husband to relieve him from the constant pain and anguish.
The next ethical value that is evident in Emily is that of being open-minded. This is anchored on the fact that Emily does not pretend to support the idea that the husband is doing well at home since after losing hope, she opted to keep off and cater for the children without bothering the suffering man. This is an important development that is important to the scenario given the fact that in as much as she rarely made efforts to visit her husband, she did not at the same time struggle to file for divorce though she had this particular option at her disposal. She is convinced that the death of her husband was imminent and as such, he was better off in the hands of healthcare professionals and not in her hands since she was lacking in the necessary experience to tackle or handle such a person.
The two values of Honesty and open-mindedness have the capacity to influence the decision that Emily may hold concerning the treatment of her husband Ewing to the extent that she may propose measures such as assisted suicide to be performed upon her husband. This is anchored on the fact that she had lost all hope of ever having the health of her husband restored subject to the confirmation of the doctors who had declared the health condition of Ewing to be untreatable by all standards. she could thus decide for her husband to undergo assisted suicide to relieve him from the unnecessary pain and anguish that he was going through since it was more than obvious that he was going to die sooner than later. Such a decision could also have been informed by the fact that there was the need to save the resources that were being used to maintain the husband who instead of getting better, his condition was deteriorating by the day.
As a medical professional with full understanding and commitment to the Kerridge model of ethical decision making, I could have addressed the disagreements among the family members by considering what is in the best interest of the patient. This is based on the fact that given the mental instability of Ewing and his inability to make decisions, I would have convinced the family members to agree on the best way of taking care of the sick person instead of focusing on their personal interests and what they feel (Kogetsu, Ogishima, & Kato, 2018). This could have been the best approach since all that Ewing needed was constant care to the extent that the family members could only be made to agree to hire a professional that could attend to his father while at home instead of leaving him at the health facility where he could continue to accommodate the health bills when it was obvious that there was no much of specialized treatment that Ewing could get from the hospital. As a health professional I could thus solve the disagreements among the family members by inviting their attention to the health condition of the old man Ewing and look into the best possible ways that can be used to give him the best care instead of grumbling and pointing fingers at each other something that could only end up into some form of conflict or violence.
Legal issues
Part one
It is on record that at common law, adult persons are often presumed to be competent unless it can be proven that they do not have the necessary competence to make sound decisions regarding treatment and diagnosis. Basically, the law demands that the patient should not only be able to comprehend but also to retain the information regarding treatment, believe and weigh the information before finally making a sound decision and communicate it (Tierney & Perlas, 2018). This is also in line with the doctrine of patient autonomy which puts them at the center of all the decisions touching on their treatment and diagnosis. In Victoria which also practices common law, the functional test for competence is provided for in section 36(2) of the Guardianship and Administrative Act 1986. Before the implementation of the Mental Capacity Act 2005, common law had put in place the best interest principle which is only applied in circumstances where the patient refuses to consent or agree to the treatment and in such circumstances, the doctor who goes on to continue the medical treatment without the consent of the patient can thus be held liable for criminal offense and also a civil suit can be filed against such a medical practitioner in this respect. The consent of the patient should not derive from undue influence. The best interest principle was established in the reported case of Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital where the doctors were only allowed to advise the patient and not to make a decision on his behalf (Bryden, McKnight, & Houston, 2018). The primary function of the doctors is only to tell of the seriousness of the treatment and at the same time give advice to the patient regarding any alternative treatment that can be applied to address the health condition at hand something that was held in the reported case of Malette v Shulman at the Ontario Court where the defendant was held liable in trespass and the right of individual autonomy and the principles of self-determination were further stressed by the courts in this landmark case that involved a Jehovah witness patient who was transfused with blood against his will.
Based on the facts of the case study and the above-discussion, it is proper to state the fact that the paramedics had the authority to transport Ewing to the hospital by all standards. this is based on the fact that in as much as the courts may be very much reluctant to interfere in the decision of the patient who is mentally sound, the situation is however different in circumstances in which the patient does not have the mental capacity to agree to the treatment. Under such circumstances then the courts often provide assistance on the basis of the principle of best interest. Ewing at the point of being taken to the hospital was in the most dangerous situation to the extent that he was at the brink of death and at the same time he did not have such a stable mind to make any sound decision as he did not understand the severity of the condition that he was going through. The Mental Health Act 2005 thus supports the action of the paramedics to forcefully carrying or rather transporting Ewing to the hospital after having been chocked with food since there was the need for urgent medical attention that could not by any standard be performed in the house. At the same time, the patient needed specialized examination so as to have his condition fully addressed and restore his poor health to the condition that it was for him to be able to swallow food without much struggle. Despite the various ethical reasons that supports and vindicates the paramedics from the action of transporting Ewing to the hospital, their greatest defense at law remains to be the deteriorated state of mind of the patient to the extent that he did not have the capacity to fully understand what was going on and as such, patient autonomy principle cannot be called into action under these circumstances. It is thus prudent to underscore that in the principle of best interest as well-laid down under the common law and the Mental Health Act 2005, the paramedics were in order to transport Ewing to the hospital for further treatment despite his resistance and refusal or denial of consent (Blease, Bishop & Kaptchuk, 2017).
Part two
As Emily who is the wife of Ewing who is ailing, the common law gives him priority as the first decision maker with the alternative ones being the three children who are all of the sound mind and able to make decisions on behalf of their father though this can only come into play when Emily is not present or in the circumstances in which she may have been incapacitated. Based on the facts of the case study under consideration alongside the consideration of the law, Emily remains to be the lead decision-maker in her capacity as the wife of the ailing husband who lacks the mental capacity to decide for himself in this case (Ashall, Millar, & Hobson-West, 2018). The doctors only come in to make treatment and diagnosis decisions in the event that the other four lack the necessary capacity to carry out such an important function in the healthcare circles. The selected decision maker that could be the alternative for Ewing is Emily who is the spouse and as such allowed to do so under the common law provisions. The principle established in the Guardianship and Administration Act 2000 under section 36 is that of the functional test for competence and it designs the criteria that can be used to establish whether the patient has the right capacity to make a competent decision (Beeker, Schlaepfer, & Coenen, 2017). The outcome that I am seeking for which is to establish that the paramedics were legally right and allowed to transport Ewing to the hospital falls right within the province of this particular principle by all standards.
Conclusion
To sum up, this is a classic case that primarily revolves around the consent of the patient when it comes to treatment and diagnosis especially in circumstances where it has been duly established that the patients have impaired mental capacity to understand the seriousness of their health condition and the various diagnosis and treatment methods available. The case also involves the issue of making decisions on behalf of the patient since family members were in disagreement with each other regarding some of the treatment alternatives. In the final analysis, it is clear in the various pieces of legislation and common law that the impaired mental capacity of the patient ushers in the principle of the best interest which is to be used in guiding the final decision.
References
Ashall, V., Millar, K. M., & Hobson-West, P. (2018). Informed consent in veterinary medicine: ethical implications for the profession and the animal ‘patient’. Food ethics, 1(3), 247-258.
Beeker, T., Schlaepfer, T. E., & Coenen, V. A. (2017). Autonomy in Depressive Patients Undergoing DBS-Treatment: Informed Consent, Freedom of Will and DBS’Potential to Restore It. Frontiers in integrative neuroscience, 11, 11.
Blease, C., Bishop, F., & Kaptchuk, T. J. (2017). Informed consent and clinical trials: where is the placebo effect?. Bmj, 356.
Burton, E., Clayville, K., Goldsmith, J., & Mattei, N. (2018, April). The Heart of the Matter: Patient Autonomy as a Model for the Wellbeing of Technology Users. In AAAI Spring Symposium 2018.
Bryden, P., McKnight, D., & Houston, P. (2018). To Ask or Not to Ask: The Ethics of Informed Consent for Transesophageal Echocardiography Education.
Chan, S. W., Tulloch, E., Cooper, E. S., Smith, A., Wojcik, W., & Norman, J. E. (2017). Montgomery and informed consent: where are we now?. Bmj, 357, j2224.
Grady, C. (2015). Enduring and emerging challenges of informed consent. New England Journal of Medicine, 372(9), 855-862.
Huttner, A., Leibovici, L., Theuretzbacher, U., Huttner, B., & Paul, M. (2017). Closing the evidence gap in infectious disease: point-of-care randomization and informed consent. Clinical Microbiology and Infection, 23(2), 73-77.
Jalal, S., Imran, M., Mashood, A., & Younis, M. (2018). Awareness about Knowledge, Attitude, and Practice of Medical Ethics pertaining to Patient Care, among Male and Female Physicians Working in a Public Sector Hospital of Karachi, Pakistan-A Cross-Sectional Survey. European Journal of Environment and Public Health, 2(1), 04.
Kotaska, A. (2017). Informed consent and refusal in obstetrics: A practical ethical guide. Birth, 44(3), 195-199.
Kogetsu, A., Ogishima, S., & Kato, K. (2018). Authentication of Patients and Participants in Health Information Exchange and Consent for Medical Research: A Key Step for Privacy Protection, Respect for Autonomy, and Trustworthiness. Frontiers in genetics, 9.
Main, B. G., McNair, A. G., Huxtable, R., Donovan, J. L., Thomas, S. J., Kinnersley, P., & Blazeby, J. M. (2017). Core information sets for informed consent to surgical interventions: baseline information of importance to patients and clinicians. BMC medical ethics, 18(1), 29.
Palmer, B. W. (2018). Executive Dysfunction as a Barrier to Authenticity in Decision Making. Philosophy, Psychiatry, & Psychology, 25(1), 21-24.
Pallett, A. C., Nguyen, B. T., Klein, N. M., Phippen, N., Miller, C. R., & Barnett, J. C. (2018). A randomized controlled trial to determine whether a video presentation improves informed consent for hysterectomy. American journal of obstetrics and gynecology, 219(3), 277-e1.
Smith, M. K., & Carver, T. (2018). Montgomery, informed consent and causation of harm: lessons from Australia or a uniquely English approach to patient autonomy?. Journal of medical ethics, medethics-2017.
Tierney, S., & Perlas, A. (2018). Informed consent for regional anesthesia. Current Opinion in Anesthesiology, 31(5), 614-621.
Vickers, A. J., Young-Afat, D. A., Ehdaie, B., & Kim, S. Y. (2018). Just-in-time consent: the ethical case for an alternative to traditional informed consent in randomized trials comparing an experimental intervention with usual care. Clinical Trials, 15(1), 3-8.

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2805NRS Legal And Ethical Principles In Healthcare

2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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Questions:

You do not need to include a detailed account of the facts in the scenario; the markers are aware of the facts and this is an unnecessary use of words.
Legal Issues
Using structured sentences and paragraphs, answer the following questions in relation to legal issues raised by the case.

As Edward had previously refused medical treatment for his viral infection, do the paramedics have any legal authority to institute treatment for his diabetic coma? What legal authority can you rely upon to support your answer?
What elements must be present for this consent to be valid? What legal authority can you rely upon to support your answer? What potential legal consequences may flow if healthcare practitioners provide treatment without first obtaining consent?
As Edward is unresponsive he will not have decision-making capacity. Provide a rationale that supports the legal obligation to obtain consent in these circumstances.
List the potential options available for the healthcare practitioners to obtain consent for Edward’s ongoing care in these circumstances. What legal authority can you rely upon to support your answer?
In circumstances where there are two or more substitute decisions-makers who could potentially provide consent, and they disagree, describe the legal options available to provide a definitive answer as to what course of action the healthcare practitioners should take.
What factors will be taken into account when making a decision as to whether Edward’s life-sustaining measures can be withdrawn?

Ethical Issues           

Identify two principles that are relevant in this scenario and describe how the selected principles apply to the facts in the scenario.

Describe where a conflict between these principles may arise by considering the differentvalues of each of the stakeholders in the scenario.

Apply the modified Kerridge et al. (2013) model for ethical problem solving to address the conflict.

Answers:

Introduction
Health care is a very challenging sector because it confronts the practitioners with a wide range of ethical and legal dilemmas. However, should this happen, the healthcare providers should use the principles of ethical codes of conduct as well as the legislations governing the profession to resolve them. After a long struggle with illness, it has reached a point when Edward is incapacitated. He is in a coma and cannot make any decision regarding his treatment. The decision should therefore be made by his family members who are authorized to be his surrogates.  In case of refusal, the decision should be respected because it was given by a qualified person.
Legal Issues
Q1
It is true that the law gives paramedics authority to institute or terminate a treatment for a patient who is in a coma. The paramedics are therefore free to choose whether to continue with or terminate the life support given to Edward who has been in a diabetic coma. However, based on the patient’s condition, it would be inappropriate to continue providing life support to the patient because his condition does not allow. A thorough analysis of the patient’s condition revealed that he is in a vegetative condition and cannot benefit from any intervention (Walsh, Mitchell, Francis, van Driel, 2015).
At the same time, the patient has expressed his views to Genevieve when he told her that he would like to refuse life support when he gets into a coma. Although he is unconscious and cannot give his decision regarding the matter, his earlier wishes should be respected (Hutchinson, et al., 2014). The National Policy Framework for Advanced Care Directives gives a provision for the patients to refuse treatment as long as they are convinced that it is the right thing to do.
The paramedics should withdraw life support because it has been supported by the patient’s family members. The views expressed by Genevieve are a clear proof that the patient should not be subjected to a further treatment because it will not benefit him in any way (Rehnsfeldt,et al., 2014). Genevieve can be used as a witness because he was available when the patient was declaring his refusal intentions.  She can be relied upon to provide substitute decision on behalf of the vegetative Edward. Meaning, she can formally consent on behalf of Edward.
Q2
As already hinted Edward is in a coma and cannot give consent for treatment. His unconscious condition cannot allow him to approve or refuse treatment. He is considered incompetent because he is unconscious and cannot understand what is going on or effectively communicate with the paramedics. Therefore, his family members should provide consent on his behalf (Peate, Wild & Nair, 2014). The law allows another party to provide a substitute decision and give consent on behalf of the patient. This is allowed by the Victorian Civil and Administrative Tribunal (VCAT) and the enduring powers of the attorney.
However, for the consent to be valid, it should meet the following conditions. First, the consent should substitute decision-maker should formally sign a Refusal of Treatment Certificate. Here, the guardian of incompetent person should clearly indicate the kind of treatment that he/she wishes to refuse and the reasons why it has been done. Besides, the guardian should be adequately informed on the conditions of the patients and reasons why the treatment is necessary or not necessary for the patient (Bodenheimer & Berry-Millett, 2012). Moreover, the guardian should express an understanding of the information provided by the medics. The law requires that only an informed guardian should be allowed to give consent on behalf of an incapacitated patient. Last, but not least, the guardian should voluntarily.
However, in case the law is violated, the medic will have to be made to be legally liable. The medic will have to be prosecuted and charged with criminal and civil violations. If the medic proceeds with the treatment after the refusal of the guardian, the medic must face the law. This will be done especially when the patient dies or faces further complications as a result of treatment. In case, the medic will be accused of negligence and infringement of the law even if the complications had nothing to do with negligence.
Q3
Since Edward is incapacitated, he cannot be allowed to make decisions regarding the treatment that should be given to him. However, this does not mean that the medics should decide o behalf of the patient. Instead, the decision making process should be left for the patient’s carers. The medics should give mandate to Una and Genevieve to make decisions on behalf of the patient. Substitute decision is required because the law guarantees that an incapacitated patient should be supported to make decisions before any treatment is initiated (Gjerberg, Lillemoen, Pedersen & Førde, 2016). The medics should therefore seek for the opinion of Una and Genevieve because it has reached a point when the patient should be served to help in saving his life, prevent unnecessary sufferings, and fatal damages to his health.
Q4
Ordinarily, consent to treatment should be provided by the patient. However, I case the patient is deemed incompetent to do so, the medics only have one option: rely on surrogates to give consent on behalf of the patient. However, in case this fails, the medics can go ahead and treat the matter as an emergency in which they assume the decision-making roles (Hsu, et al., 2012). However, in the case of Edward, the medics have an option of relying on the surrogates to consent on behalf of the patient because he is a coma and cannot do so on his own.
The law requires the medics should not assume the role of a sole decision maker, but has to collaborate with substitute decision makers to help in coming up with strategies that best serve the interests of the patient. Una and Genevieve are allowed to be decision makers because they are close family members (Oh & Gastmans, 2015). They therefore qualify to equip the medics with the decision to follow. Since Edward is their loved one, it is presumed that they will always serve his interest. When they make decisions, they should formally endorse it and enable the medics to do their work.
Q5
Once the medics give authority to the substitute decision makers to decide on behalf f the patient, they should take the challenge and discharge their mandate. The substitute decision makers should deliberate on the matter before coming with a consensus regarding the action to take to save the life of the patient (Kirkman, et al., 2012). However, in case the substitutes fail to come into a consensus, it might not be easy for their decisions to be accepted because it will be conflicting. In this case, the medics should apply the principles of law that govern the choice, powers and privileges of substitute decision makers.
Should this be the case, the medics should only accept the decision made by one of the substitute decision makers. However, the acceptance should be done based on the hierarchy of the decision makers. According to the National Policy Framework for Advance Care Directives, preference should be given to the person who is at the top of the hierarchy based on the scope of the powers held regarding the patient and his life saving decisions. Since Una has disagreed with Genevieve on the next course of action, the medics should accept Genevieve’s decision. She has more powers because she is acting on the wishes of the patient (Mastal, 2014). Besides, he decisions coincide with the medics’ who have grounded their decision on the law as well as ethical and professional convictions.  
Q6
The two main factors to be considered when withdrawing Edward’s life support machines are the law and ethics. Legally, the medics are allowed to withdraw or continue providing life support to a patient in a coma. However, this choice can be made based on the consent of the patient or surrogates. In case they decide that the life support measures should be withdrawn, the medics have no choice, but to comply (Heslop, 2015). However, since health care is a profession governed by ethics, the medics are allowed to apply the principles of ethics when making a decision regarding the withdrawal of life support measures.         
Legal and ethical factors should play a prominent role in the removal of Edward’s life support measures. It is justified to remove the life support measures because of the following reasons: 1) the patient had consented to it, 2) the surrogate or substitute decision makers have consented to it, and 3) it is legally and morally justified because it will not benefit the patient, but will cause him unnecessary sufferings and prolong his death (Cannaerts, Gastmans & Casterlé, 2014).
Ethical Issues
Q1
Universal Declaration on Bioethics and Human Rights is a set of guidelines that were put in place to address all the ethical issues pertaining to life sciences and medicine I regards to environmental, legal, and social dimensions. According to the declaration, human beings should be treated as equal people who should reap the benefits of similar ethical standards in life science and medicine.  Universal Declaration on Bioethics and Human Rights is one of the guidelines that should be applied in the treatment of Edward because of the relevance of the principles of consent, and benefit and harm.
The first principle that should be applied in the case is the principle of benefit and harm.  According to this principle, scientific knowledge in medicine and life science should be based on the concept of utilitarianism. Meaning, it should optimal benefits to the society. Whenever a patient goes to the healthcare facility, deliberate efforts should be made to improve his life and protect him from anything that can cause harm to his life (Ludman & Von Korff, 2012). This is what should be done to Edward. The other principle of consent which stipulates that any medical action done to an individual should be performed after seeking for the informed consent of the patient. Meaning, it should be done voluntarily after a formal consent by a patient or substitute decision makers in case of any incapacitation. Just like any other patient, Edward should be given a benevolent service that can improve his condition as well as eradicate any suffering, pain or harm (Laughlin & Beisel, 2013). This can be achieved by applying these principles.
Q2
It is true that a conflict between the principles of consent, harm and no harm can arise as a result of the disagreement between Genevieve and Una. According to the principles of consent, a patient should accept or refuse a treatment based on their moral conviction. This is what Edward had done when he told Genevieve that he would prefer his life support to be withdrawn in case he gets into a coma. So, by disagreeing with Genevieve, it implies that Una does not want the patient to exercise his consent rights. At the same time, by disagreeing on the withdrawal of life support, the two parties are not committed to providing the patient with a holistic, safe, and ham-free care. It is therefore true that the conflict has contravened the application of the principles of the pro-patient Universal Declaration on Bioethics and Human Rights.
Q3
The conflict in the application of the principles of the pro-patient Universal Declaration on Bioethics and Human Rights is unnecessary and should be resolved. To do so, the Modified Kerridge et al. (2013) Model for Ethical Problem Solving         should be applied. According to this model, the ethical and legal challenges faced by the healthcare providers can be resolved if appropriate measures are taken. So, when handling this matter, the disagreement between the surrogates can be addressed by applying the law. The healthcare provider should apply all the relevant legislations and use them in providing a solution to the stalemate. Besides, the healthcare provider should apply the ethical codes of conduct governing health care (Wagner & Dahnke, 2015). Here, a beneficial decision should be made to conform to the standard requirement of beneficence, non-maleficence, justice and autonomy. Ethical decision making is an important activity that should be taken so seriously when attending to patients (Walsh, 2016). It can help in addressing all the ethical and legal challenges that confront healthcare professionals especially when dealing with complex issues such as end-of-life decisions.
Conclusion
In conclusion, Edward is in a coma and is not conscious of what is going on in his immediate surroundings. When attending to him, the healthcare providers should liaise with his substitute decision makers to decide the next course of action. The substitute decisions provided to the medics should be enforced because Edward’s health is an issue of concern to his family as well. No one should dispute or reject their decision because they have powers to decide on behalf of the patient. However, any conflicts that might arise in the application of the principles of Universal Declaration on Bioethics and Human Rights should be ultimately resolved by applying the concepts of the Modified Kerridge et al. (2013) Model for Ethical Problem Solving.
References
Cannaerts, N., Gastmans, C., & Casterlé, B. D. D. (2014). Contribution of ethics education to the ethical competence of nursing students: Educators’ and students’ perceptions. Nursing  ethics, 21(8), 861-878. Gjerberg, E., Lillemoen, L., Pedersen, R., & Førde, R. (2016). Coercion in nursing homes:
Perspectives of patients and relatives. Nursing ethics, 23(3), 253-264.
Hutchinson, K. M., et al., (2014). Ethics?in?the?Round: A Guided Peer Approach for Addressing
Ethical Issues Confronting Nursing Students. Nursing education perspectives, 35(1), 58- 60.
Oh, Y., & Gastmans, C. (2015). Moral distress experienced by nurses: a quantitative literature review. Nursing ethics, 22(1), 15-31.
Peate, I., Wild, K., & Nair, M. (2014). Nursing practice: knowledge and care. New York: John Wiley & Sons.
Rehnsfeldt, A.,et al., (2014). The meaning of dignity in nursing home care as seen by relatives. Nursing ethics, 21(5), 507-517.
Wagner, J. M., & Dahnke, M. D. (2015). Nursing ethics and disaster triage: Applying utilitarian ethical theory. Journal of Emergency Nursing, 41(4), 300.
Bodenheimer, T., & Berry-Millett, R. (2012). Care management of patients with complex health care needs, the Synthesis Project. Princeton, NJ: Robert Wood Johnson Foundation.
Heslop, L. (2015). Outcome detection using hospital activity data: Implications for development of nursing-sensitive quality monitoring and reporting in Australia (Commentary on
Schreuders et al., Int. J. Nurs. Stud. 51 (3)(2014) 470–478). International journal of nursing studies. 2015 Jan 1;1(52):487-90.
Hsu, C., et al., (2012). Spreading a patient-centered medical home redesign: A case study. Journal of Ambulatory Care Management, 35(2), 99-108.
Kirkman M., et al. (2012). Diabetes in older adults. Diabetes Care. 35(12):2650–64.
Laughlin, C.B., & Beisel, M. (2013). Evolution of the chronic care role of the registered nurse in primary care. Nursing Economic$, 28(6), 409-414.
Ludman, E. & Von Korff, M. (2012). Cost-effectiveness of a multicondition collaborative care intervention: A randomized controlled trial. Archives of General Psychiatry, 69(5), 506- 514.
Mastal, M. F. (2014). Ambulatory care nursing: Growth as a professional specialty. Nursing  Economic$, 28(4), 267-269, 275.
Walsh, RI, Mitchell G, Francis, L, van Driel, ML. (2015). What Diagnostic Tools Exist For The
Early Identification of Palliative Care Patients in General Practice? A systematic review. Journal of Palliative care. 2015 Jun 15;31(2):118-23.
Walsh, K. (2016). Perspectives: Nursing, ethics, human rights and asylum seekers: an Antipodean perspective on 2015. Journal of Research in Nursing, 20(8), 741-745.

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2805NRS Legal And Ethical Principles In Healthcare

2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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Questions 
Case Study Scenario 
Richard is 41 year-old-man who works as a fly-in-fly-out worker for a mining company in Central Queensland. Richard has worked at the mines for twelve years, and is an experienced blast crew member. He has been in a relationship with Meryl for 22 years, and they have four children aged 9, 11, 13, and 15. Although his home is in Brisbane with Meryl and the children, he shares a two-bedroom unit with his best friend and crew manager Lucas every second week, while they are on-site at the mines.
Richard is muscular and physically fit, as he works out in the gym nearly every day on top of his physical work in the mines. His mining crew call him ‘The Mountain’ in honour of his size and strength. It was a surprise to them, then, when partway through a scorching hot workday he announced that he simply couldn’t continue work and needed to sit down in the shade tent because he felt like he was going to collapse. Lucas took Richard over to sit in the cabin of the crew vehicle with the air conditioner on, and gave him some chilled water to drink. A few minutes later Richardlet himself out of the vehicle and loudly announced, he did not feel well at all.
Lucas decided to take Richard to the mining camp clinic, which was staffed by companyemployed paramedics. The paramedics offered Richard a drink and sat him down to rest in the adjacent treatment room. They took his observations, which were mostly within normal limits, but noted that his respiratory rate was high. After about half-an-hour one of the paramedics went to retake Richard observations, only to find him collapsed on the floor. She immediately called an ambulance, but by the time it arrived, nearly an hour later, Richard had recovered and stated he was ready to go home. His respiratory rate had slowed, but he wouldn’t allow the paramedics to take his blood pressure, retracting his arm each time they tried. The paramedics advised Richard to drink plenty of water and stay out of the heat for the rest of the day, as he left the clinic.
Richard did not intend to return home though. He was a diligent worker so headed straight back to the mine site, ready to get back on the job. As he got back to site he realised he had left his safety equipment in the shade tent, and began walking over to pick it up. Unbeknownst to Richard, while he had been at the clinic the crew had set up for the next round of blasting. As he crossed the site the blast was set off. A large chunk of rock hurtled through the air and struck Richard in his unprotected head. Richard fell, landing heavily on the ground.
Lucas rushed over and saw that Richard had sustained significant head injuries and was lapsing in and out of consciousness. He radioed for urgent medical assistance. Luckily, the ambulance had not long left the clinic and was only a few minutes away. Upon arrival, the paramedics assessed Richard as having severe traumatic brain injury with bleeding and bruising, extensive facial and skull fractures, suspected fractured ribs and a pneumothorax. As Richard was minimally responsive and bleeding profusely, they immediately intubated him, attempted to address the bleeding, and called for helicopter evacuation, to transport him to Brisbane Hospital.
At the hospital CT scans confirmed multiple skull and facial fractures, a large subarachnoid haemorrhage and a left pneumothorax. While these injuries were potentially life threatening, given Richard’s excellent physical condition the healthcare team believed that with appropriate treatment he could recover and, therefore, was admitted to the intensive care unit. In the meantime, Lucas had begun the long drive back to Brisbane hospital. Meryl, too, had been contacted and immediately went to Richard’s bedside.
After ensuring that Richard’s haemodynamic condition was stabilised he was prepared for surgery to fix the facial fractures and evacuate the haematoma. Meryl was hopeful of positive outcomes; Lucas had seen the extent of Richard’s injuries before he received any health care, so was considerably less optimistic.
Unfortunately, after treatment in the intensive care unit for several weeks, Richard’s progress was poor, and as time went on the chances of a full recovery become increasingly slim. A tracheostomy tube was inserted, but despite several attempts, he could not be weaned from the ventilator. Richard also no longer moved spontaneously, although Meryl believed that he did tilt his wards her and squeeze her hand when she spoke to him.
Understandably, this was a devastating turn of events for Meryl and the children, as well as for Lucas. As weeks turned into months, Meryl began to accept that Richard might not return to his former state of health. The healthcare team caring for Richard formed the opinion that Richard was in a minimally conscious state. They believed that because of the extensive traumatic brain injury Richard had no awareness of his surroundings, and as long as he remained unable to breathe on his own there was no possibility of recovery.
Lucas agreed with the assessment made by the healthcare team, believing that Richard displayed no sign of recognising anyone, or even that people were there with him at all. He described Richard’s condition, saying that, ‘initially you could think that he might notice you were there, but it was really like he was asleep on the inside and just startling at noise or contact’. Lucas insisted that he and Richard had discussed how they would each want to be treated if they were ever to be involved in a significant workplace accident. Richard had been clear and adamant that he would not want to be left in a situation where he could not care for himself, would be a cause of distress to his family, and would be unable to provide for the people he loved the most. Lucas said Richard had said ‘if that ever happens, mate, please just turn the bloody machines off’.
Meryl’s perception of Richard’s situation was quite different. She had undertaken some research and found several cases in which people had ‘woken up’ after being in comas for prolonged periods, and several more in which people had substantially recovered from traumatic brain injury. Meryl did not agree that Richard had no awareness of his surroundings, and thought that from time to time he would try to turn his head when he heard the children’s voices – not always, but sometimes. She also knew that Richard would not want to remain reliant on others’ care in the long term but was hopeful that given adequate time and constant encouragement, Richard would once again be able to communicate with his family, if not return to his prior self entirely.
Lucas and the healthcare team caring for Richard believe that continuing treatment is not in his best interests. They have reached the conclusion that all treatment should stop. Meryl, however, is opposed to stopping treatment and wants Richard to be given every opportunity to recover; evenif this means that he needs to remain highly dependent in hospital for many more months or years.
Meryl wants to do whatever is necessary to ensure that the life-sustaining measures Richard is currently receiving continue indefinitely.
 
You are required to answer the following legal and ethical questions as a structured essay with the following headings.
Introduction
A short introductory paragraph that outlines what you will be presenting in your case report.
Legal Issues
Using structured sentences and paragraphs, answer the following questions in relation to legal issues raised by the case.
1. What elements must be present for Richard’s consent to treatment for heat shock to be valid? What legal authority can you rely upon to support your answer? What potential legal consequences may flow if healthcare practitioners provide treatment without first obtaining consent?
2. As Richard had previously refused medical treatment by the ambulance crew for his heat shock, do the paramedics have any legal authority to institute treatment for his head injury? What legal authority can you rely upon to support your answer?
3. After sustaining the head injury, Richard will not have decision-making capacity. Provide a rationale that supports the legal obligation to obtain consent for Richard’s cranio-facial surgery in these circumstances.
4. List the legal options available for the healthcare practitioners to obtain consent for Richard’s ongoing care in these circumstances. Support your answer with Queensland legal authority.
5. In circumstances where there are two or more substitute decisions-makers who could potentially provide consent, and they disagree, describe the legal options available to provide a definitive answer as to what course of action the healthcare practitioners should take.
 
6. What factors will be taken into account when making a decision as to whether Richard’s life-sustaining measures can be withdrawn?
Ethical Issues
Referring to the Universal Declaration on Bioethics and Human Rights, and using structured sentences and paragraphs:
1. Identify two principles that are relevant in this scenario and describe how the selected principles apply to the facts in the scenario.
2. Consider the values of two stakeholders in the scenario. Describe how those values might create a conflict with the principles you selected in question seven.
3. Apply the modified Kerridge et al. (2013) model for ethical problem solving to address the conflict.
Conclusion
A short concluding paragraph that brings it all together.
You are not required to decide the outcome of this case – in relation to the legal issues this would be a role for the courts. In relation to the ethical issues, there will not be one “right” answer; it is the process that you are being asked to apply.
Answers
Introduction
The role of a healthcare professional is challenging from different angles. There are many ethical and legal hurdles, which a healthcare professional has to face while treating a patient. It is important for the healthcare professional to know about the legal and ethical consequences so that the professional can practice within the legal boundaries (Gillers, 2014). The prime purpose of this assignment is to identify the legal and ethical issues present in the case study analyze the possible outcomes and understand the reason of those ethical conflicts.
1. Consent is an important part of healthcare legal formality, as everyone has the right to know about his or her health and body. The valid consent should include competence or the capacity of the patient, the consent should be given voluntarily, the consent should cover the entire procedure and finally the patient should be informed about the processes. During the heat shock treatment, Richard refuses to be admitted to hospital as he refused to admit to the hospital. Hence, in such scenario, the consent should be inclusive of factors that makes the patient avail the healthcare for the betterment of his health. The consent should include statements of patient’s family and close friends so that patient cannot refuse to take healthcare assistance (Sherlock & Brownie, 2014). For this modified consent, legal department of the organization should be approached. However, if the healthcare facility does not obtain prior consent from the patient, the person who is striking, touching and moving is known to assault the person. However, the healthcare facilities have several protections for any criminal act.
2. As Richard denied the medical treatment from ambulance crew after his heat shock, ethically he should not be provided with any healthcare facility, as he is not ready. However, both the situations of accidents are different. In first case, after heat shock, Richard came to normal state for a while and refused to acquire further treatment from any medical staff. However, in the second accident, he was highly injured and was in coma during entire healthcare process. hence, in that situation, his family and friends has the right to take decision. Furthermore, according to the Australian health care law and statute, during emergency of saving a person’s life, it is not important to take consent from Richard in this case (Holloway & Galvin, 2016).
3. After the head injury, Richard 3was not been able to move, as he had multiple skull injuries. Due to excess bleeding, he became senseless and therefore, no consent is needed for a patient, who has impaired decision-making ability or who is struggling between life, death, and need medical assistance as soon as possible. Hence, if the family member is present, they will be given the consent to fill up. As Richard has multiple skull and face injury, the consent in this condition should be inclusive of points which defines that hospital authority does not bear any responsibility if the patient becomes unstable while surgery. This consent helps the hospital authority to save themselves from any legal consequences that can arise while treating a serious patient (Juurlink & Dhalla, 2016).
4. According to the Queensland Legal Authority, if a patient is non-responsive of is critically ill, then the consent will not be collected on the priority basis. The doctors are supposed to carry out the treatment of the patient on priority and then the family member or friends will be asked for the consent. If no one of the family is present in the healthcare system, then no consent will be collected as the patient was admitted in the hospital in emergency health condition. In the case of Richard as well, he was admitted to hospital after having severe head and facial fracture. He was not in conscious state and no one accompanied him with the medical team. Therefore, no consent will be taken from Richard. However, a consent is necessary before removing the life supporting system. The first priority will be given to his family, as they are responsible to take action about the patient (Jackson et al., 2014). To resolve the problem, IRAC framework will be used. According to this framework, I stands for issue, R stands for rule, A stands for application and C stands for conclusion (Burton, 2016). This problem solving technique can be used in case of Richard, as both Meryl and Lucas were opposing each other for consent. This is an organizational technique as well, that can be used to resolve problems analytically.
5. In case of Richard, there were two decision makers present in the healthcare facility, while taking decision about the patient’s health condition. The first one is the life partner Meryl and his friend and crew manager Lucas. While taking decision for removing the life supporting system, the doctors were to take consent and this was the moment, when these two disagree to come to a point. In such situation, the doctor should take the consent from Meryl, as she was with the patient from 22 years. However, ethically it is not correct, as it is not possible for the hospital authority for keeping the patient on life supporting system for such longer time. Hence, the doctor should take consent from the Meryl, as she is responsible to make decisions about Richard (Halley, 2016).
6. Richard, as per his friend Lucas did not wanted to become dependable on her family members or friends because he had spent his entire life freely without any hurdle and with complete compassion. He was famous as ‘The Mountain’ in his workplace, and the strength and dedication he used to put in his work was commendable. Therefore, as per Lucas, Richard did not want to force himself on his closed people. From the doctor’s perspective, Richard was not responding to the life-supporting system and was not responding to the medication or to his family members. Therefore, these steps should be taken into consideration before making a decision about terminating the life supporting system for Richard. Furthermore, the doctors treating him understood the fact that he is not been able to revert from the health condition he is in, and the life supporting system is not going to improve his condition. This is because his health condition was deteriorating every day. Hence, this factor as well is important, as the doctors did not observed any changes in the patient. On the other hand, if the issue cannot be resolved, the IRAC framework can be used to resolve the dispute for the betterment of Richard.
Ethical issues
1. Considering the case study and referring to the Universal Declaration on Bioethics and Human Rights two principles are found to be similar to this scenario (Andorno, 2014). The two identified principles are the incidents that occurred and are describes below.
Firstly, on one sunny hot day, Richard started complaining that he could not continue work and was not feeling well and wanted to sit and take rest because he was feeling that if he still continues to work he could collapse. Thus, Lucas took him to an air conditioned cabin of the crew vehicle and also gave him chilled water to drink. But this did not alleviate the health condition of Richard as he went out of the vehicle and loudly announced that he is not feeling well at all. This time Lucas took Richard to a nearby mining clinic which had the paramedics that look after the mining worker health condition. The paramedics were employed by the mining company and thus the paramedics gave Richard something to drink and told Richard to sit in a treatment room. the paramedics checked Richard and found that he had only elevated levels of respiratory rate but other than that everything was normal. However, after half an hour when the paramedic again came to check Richard, he was found collapsed on the floor. Although, ambulance was called but by the time it reached the place, Richard recovered and was advised to stay out of the sun for the rest of the day. Thus, from the above case it can be inferred that a paramedic should have not let Richard alone in the treatment room, considering the high respiratory levels of Richard. At the same time although Richard was warned that he should not go out in the sun for the rest of the day, but still he did not listen to the paramedics. Considering the health condition of Richard and as the mining works requires a person to work under the sun all day long. Lucas being the crew manager and also a friend of Richard should have stopped Richard from going out to work regarding the health condition of Richard. According to article 18 which promotes professional and transparent decision making. Lucas should have adhered to this principle and as Richard was frequently complaining about his health (Plomer, 2013).
Secondly, another principle according to the Universal Declaration on Bioethics and Human Rights Meryl was adamant and unwilling to remove the life supporting services away from Richard. However, according to the doctors Richard can never recover from the accident and continuing the life sustaining services can cost huge sums of burden on the Brisbane Hospital. While according to the article 5 of the Universal Declaration on Bioethics and Human Rights, which promotes autonomy of the individual. Thus, Lucas mentioned that although the health condition of Richard is poor, Richard once revealed that he will never be a burden to his family if any critical situation arrives in future and would rather choose to die (Andorno, 2014).
2. To emphasize the values of the two stakeholders in the scenario, firstly Lucas who is the crew manager as well as a best friend of Richard, and the second stakeholder is Meryl, the partner of Richard.
Thus, it can be inferred that both the values of Lucas and Meryl cannot be neglected considering the scenario, and their respective values will raise conflicts among the two people. Firstly, Richard was complaining frequently about his uneasy feeling and was at first unwilling to work because he felt that he might collapse. Although at that moment Lucas acted proactively and took Richard to the crew cabin and even later took him to mining camp clinic. However, Lucas did not prevented Richard from going back to work considering that the fact that paramedics warned Richard not to stay under the sun for the whole day. This is an area of conflict between Meryl and Lucas. Because Meryl could have expected from Lucas, that Lucas being the best friend of Richard as well as the crew manager could have asked the mining company higher officials to provide Richard a work leave based on medical grounds (Banks, 2012).
Secondly, on the other hand Meryl was adamant and unwilling to remove the life sustaining measures from Richard. It was already mentioned by Lucas that Richard once mentioned that he does not want to be left in a situation where he will be unable to take care of himself. This fact was unknown to Meryl and this could arise a conflict because Meryl can state that why Lucas went on to revealing such facts to the hospital authorities before having a talk with Meryl. On the other hand, Lucas though was willing to remove the life sustaining measures from Richard but Meryl was not (Shockley-Zalabak, 2014).
3. Ethical problem:
The major ethical problem is the removal of life supporting measures from Richard which led to a conflict between Meryl and the Brisbane Hospital. Although it was previously mentioned by Lucas that one day Richard during a discussion revealed that if in future any accident occurs to him, and he moves into a condition where he can no longer take his own care. If such a condition arises, then Richard said that he does not want to live and would rather prefer to die. Meryl also knew the fact that Richard would never want be in a condition where he could no longer take his own care. The doctors already told that Richard is neither responding nor recovering from the medical condition. However, Meryl thinks Richard is moving is head and trying to follow the sounds of the children. Thus, this is one ethical conflict between Meryl’s assumptions and the doctor’s decision (Ford & Richardson, 2013).
Core ethical principles (Kerridge, Lowe & Stewart, 2013):
Autonomy- Considering Richard health condition, he is not in a state to give the consent of moving the life supporting measures away from him. However, the closest person to Richard is his life partner, Meryl. Thus, Meryl’s consent is necessary but she is not ready to believe that Richard is not responding.
Beneficence- Although, Richard is not in a state to give his own consent. However, he once shared to Lucas that if in if in future any accident occurs to him, and he moves into a condition where he can no longer take his own care. If such a condition arises, then Richard said that he does not want to live and would rather prefer to die. Thus, the benefit that can be quantified is that Richard’s wish will be fulfilled.
Risk- However, the probable risk is that Richard is not in a condition to give the consent and Meryl not ready to conform to the doctor’s decision of removing the life supporting measure form Richard.
Justice- It is obvious for Meryl to behave in an adamant way. Because it is her life partner who is in deteriorating health condition, and it is not easy for any person to let their beloved person to die without making an effort for their recovery. Thus, the Brisbane Hospital can arrange the necessary life supporting measures for around a month or two, and even after that if Richard shows no sign of recovery. Then, the life supporting measures can be removed.
Confidentiality/privacy- regarding the case, no such information is private where confidentiality needs to be maintained.
Veracity- yes, the patient’s family members are duly informed about the removal of life sustaining measures from Richard.
Way forward (Kerridge, Lowe & Stewart, 2013):
Regarding the case, the best and viable option is to continue providing the life supporting services for two to three months. This can enable Meryl to practically understand that Richard cannot recover from the fatal injuries he had received. The Brisbane Hospital can clearly inform Meryl that, they are willing to continue the life support measures only if she can provide the necessary funds.
Conclusion
Therefore, from the above disclosure it can be concluded that, this case study revolves around three main characters Richard, Meryl and Lucas. The Role of the Brisbane hospital although comes at the final part but its role has majorly affected the outcome of the study. The legal and the ethical issues generally revolve with the health conditions of Richard.
Reference
Andorno, R. (2014). Human Dignity and Human Rights. In Handbook of Global Bioethics (pp. 45-57). Springer Netherlands. https://doi.org/10.1007/978-94-007-2512-6_66
Banks, S. (2012). Ethics and values in social work. Palgrave Macmillan.
Burton, K. (2016). Teaching and assessing problem solving: An example of an incremental approach to using IRAC in legal education. Journal of University Teaching & Learning Practice, 13(5), 6.
Ford, R. C., & Richardson, W. D. (2013). Ethical decision making: A review of the empirical literature. In Citation classics from the Journal of Business Ethics (pp. 19-44). Springer Netherlands. https://doi.org/10.1007/978-94-007-4126-3_2
Gillers, S. (2014). Regulation of Lawyers: Problems of Law and Ethics. Wolters Kluwer Law & Business. https://books.google.co.in/books?hl=en&lr=&id=78vfDgAAQBAJ&oi=fnd&pg=PT40&dq=healthcare+professional+ethical+and+legal+issues&ots=V11AhulCq5&sig=vxrDbVP_UPOwWw6Bm30qHm_iXGo#v=onepage&q=healthcare%20professional%20ethical%20and%20legal%20issues&f=false
Halley, J. (2016). The Move to Affirmative Consent. Signs: Journal of Women in Culture and Society, 42(1), 257-279. doi/abs/10.1086/686904
Holloway, I., & Galvin, K. (2016). Qualitative research in nursing and healthcare. John Wiley & Sons. https://books.google.co.in/books?hl=en&lr=&id=EKu-DAAAQBAJ&oi=fnd&pg=PR11&dq=taking+consent+in+healthcare&ots=1a8F6PSYdm&sig=wyJJ75nBQgL40UaNyBWcm4QhI1c#v=onepage&q=taking%20consent%20in%20healthcare&f=false
Jackson, J., Tyler, T., Hough, M., Bradford, B., & Mentovich, A. (2014). Compliance and legal authority. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2403795
Juurlink, D. N., & Dhalla, I. A. (2012). Dependence and addiction during chronic opioid therapy. Journal of Medical Toxicology, 8(4), 393-399. https://doi.org/10.1007/s13181-012-0269-4
Kerridge, I., Lowe, M., & Stewart, C. (2013) C. Ethics and law for the health professions (4th ed., pp. 136-137). The Federation Press.
Plomer, A. (2013). The law and ethics of medical research: international bioethics and human rights. Routledge.
Sherlock, A., & Brownie, S. (2014). Patients’ recollection and understanding of informed consent: a literature review. ANZ journal of surgery, 84(4), 207-210. DOI: 10.1111/ans.12555
Shockley-Zalabak, P. (2014). Fundamentals of organizational communication. Pearson.

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2805NRS Legal And Ethical Principles In Healthcare

2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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Discuss about the Legal and Ethical Issues In Healthcare.
 
 
Answer:

Introduction
Undoubtedly, the law and ethics of practice play a crucial part in the decision-making ability of a person, be it a patient or a healthcare practitioner. Consequently, individuals possess rights to make decisions that affect their health. However, competencies or lack of the capacity to make decisions may serve as a barring factor, and someone can be considered unfit to make his or her decisions. This paper encompasses the identification and the discussion of the legal as well as the ethical issues presented in the case study. It discusses options that are available to ensure that treatment is provided when a patient is not in a better position to make decisions.
Legal Issues
It is evident that the management of healthcare always presents complex situations especially when the capability of a person to be treated to engage in decision making is called into question (Pozgar, 2016). Edward’s case is different because he had refused to be treated for a viral infection before becoming unconscious. As such, the paramedics were legally forced to institute treatment since it was an emergency situation and the requests to initiate psychiatric consultation for purposes of assessing Edward’s capacity could not be performed when he was in a diabetic coma. The actions of the paramedics were guided by the legal authority that states that the healthcare professionals ought to come up with a feeling that a patient or client who rejects a particular type of recommended treatments is in a way incompetent until the doctors or a court proves otherwise (Forester-Miller & Davis, 1995). Consequently, it is not the refusal to treatment that has the ability to determine a patient’s capacity to decide, but the right to self-determination that matters in treatment (Ulrich, 2001). However, the paramedics had to do what was legally acceptable to save Edward’s life, and as a result invoked the principle of implied consent in emergent situations such as his by surrogating (Ashcroft, 2007).
The elements of this consent exist such as the nature of a medical procedure or decision. It is s primary goal of any healthcare center to ensure that patients are given an opportunity during the consultation periods to make informed choices before the start of treatment. This element requires that analysis is done on the nature of the decision involved in a surgical operation. It is a requirement to check if patient’s decision to decline treatment before the occurrence of an emergent situation is valid or not. The other element of this consent revolves around the search for a reasonable alternative that may lead to the invocation of applied consent to be the only proposed intervention. As such, an aspect that entails the comprehension of relevant risks, and uncertainties as well as benefits that may lead to the betterment of patient in critical condition. Although the case study of Edward’s condition brings about mixed reactions, it is evident that the element understanding together with acceptance of an intervention of treatment could not be relied on after discovering that he showed no signs of recovering from fatal brain injury. For the case of implied consent, the paramedics who were responsible for Edward’s care are obligated to make a decision on how best the commencement of the treatment could be done using the legal authority that employs the principle of “best interests.” The National Health Act permits medical treatment for an emergency situation to foster the prevention of death or causing permanent damage to the health of the client (Gillon, 2003).
 
Health care practitioners are not allowed to provide treatment to a patient before the informed consent is first obtained because the act has legal consequences that may impact the careers of physicians (Satyanarayana, 2008).  The legal consequences that flow when a practitioner breaches the policy of informed consent involve being sued upon the realization that no informed consent was obtained before the start of treatment. A health care practitioner is usually sued for medical battery, which is considered as a purely legal issue that is associated closely with the application of effective treatment for someone who is unwilling. A medical battery is usual referred to offensive touching when no consent or permission has been sought. The other legal consequences that come with the application when no consent was obtained before the start of medical treatment is the suing of a physician for medical malpractice, and this may lead the provider’s license to be suspended. 
Since Edward is unresponsive, the rationale that can be used is that which values the life of a patient. It is usually the work of the medical practitioners to maintain confidentiality to ensure that no information about the patient leaks to other people (Beauchamp & Childress, 2001). Since situations may turn out to be critical at times and the situation on the ground is life-threatening, treatment has to be done with immediate effect to ensure the patient is treated to stabilize his or her conditions (Limerick, 2007). As such, quick actions must be done to make sure that the relevant people are contacted in case the situation presents nothing useful to indicate that a patient can recover from a diabetic coma, and in the next minute provide full informed consent. The rationale is to be thoughtful of what should be done as options for the dilemma (Kälvemark et al., 2004). In essence, an evaluation of the available alternatives to standing in the place of the first one is the rationale that works in this scenario.
 
Medical practitioners have access to a number of options that can be practically utilized to obtain consent to facilitate Edward’s ongoing treatment. Evidently, some circumstances require the listing of the next of keen based on what the state law would recommend. Therefore, health care professionals have an obligation to get to know the people who are intimately related to him and can be relied upon in the decision-making process. As such, there is a specific hierarchy that must be followed to enhance the appropriate decision-making process to obtain consent before the beginning of a medical treatment procedure. For this case, Una can be called upon to assist in giving out informed consent. The effectiveness of the process would be apparent by her willingness or ability to understand the procedures to be undertaken. When she fails to understand the actual processes, Genevieve can come in to help with the matter at hand without interfering with the operation of giving consent for his unresponsive husband. If no surrogate is settled on, health care practitioners might be forced to act using the principle of “best interests until the court intervenes to appoint a guardian who will help with informed consent. The legal authority that can be relied upon is that of Potential Surrogates and Priority. This is based on the reason that statutory provisions provide a toolkit that addresses the person with a potential of acting as a proxy for an unresponsive patient such as Edward.
It is the ultimate cause of action for the healthcare practitioners to provide a definitive answer in cases where there exist two substitute surrogates or even more who have the potential of providing a consent regarding what should be done to a patient who is unresponsive or lacks the capacity of making decisions (Leo, 2017). The availability of legal issues that can be undertaken in realizing a definitive solution makes the entire process to be successful. As such, the legal options will begin by first designating a hierarchy since it is the only primary strategy that can be incorporated to find consent that wasn’t clear due to disagreements between two or more surrogates. This approach will rely on the policy that those who are lower in the hierarchy do not stand a chance in situations like this to overrule a surrogate who is authorized by skipping judicial proceedings. One of the option that can be implemented in circumstances where there are multiple surrogates involves allowing the healthcare providers to depend more on what the majority of the potentially relevant surrogates settled on during the process of obtaining consent before the disputes erupted (Morrison & Monagle, 2009). In essence, a definitive answer has to be deprived in a situation like this because judicial interventions assist in resolving the disagreements even in the absence of provided provisions.
 
Medically, the decision to enhance the withdrawal of life-sustaining measures is quite difficult to reach because it may be considered to be culturally repulsive. One of the factors that need to be taken into account is the level of acceptance that has been collectively reached (Elwyn et al., 2012). This depends on the seen benefits of the life-sustaining measures, and the decision must be arrived at by the family and the clinicians (Tilden et al., 2001).  This factor is used after noticing the fact that the Edward is undeniably and unquestionably gaining no benefits from the measures of life-sustenance proposedly to be withdrawn. The other factor that can be used to foster the withdrawal of Edward’s life-sustaining measures is that which involves a realized stabilized medical condition. This is because if a state of a patient is stable to a level that no further signs of improvements is expected; the decision can be reached at by both the healthcare professionals and the family to withdraw the measures (Danis et al., 1991).
Ethical Issues
Ethical issues in healthcare play a pivotal role in enhancing medical treatment in hospitals. As such, one of the ethical principles that are relevant in this scenario is the principle of autonomy. In particular, this moral principle stands for the proposal or proposition that adults with the ability to make informed decisions possess complete as well as the perfect rights to influence what treatment can be done with their bodies. This is in reference to the declaration on bioethics as well as human rights, and it is a principle that has universal recognition in ethical practice in healthcare. As such, Edward’s case relies on this principle since it is his unresponsiveness or the lack of the capacity to make decisions due to the diabetic coma that calls for the invitation of his family to provide informed consent on his behalf legally. It is evident from the case study that Edward had in the previous days refused the treatment of the viral infection, which the ethical principle of autonomy accepts but now his emergent condition made it hard for him to give his informed consent before treatment. Similarly, the other principle that applies to the facts in this scenario is that of beneficence. This applies in the scenario by promoting healthcare benefits to a patient who is unresponsive or in a diabetic coma. This ethical code disregards all the others and makes the healthcare practitioners act using what they view to be of “best interest.”
 
However, a conflict between the above principles can arise when the clinicians decide to perform first aid on a patient in an emergent situation. The principle of beneficence could have been applied to resuscitate a diabetic coma, but because the principle of autonomy makes it difficult for the healthcare professionals to make decisions since Edward had previously refused to seek medical treatment yet treatment was provided without his own consent. This is because the patient may have had own ideas that he views beneficial his health. As such, scenarios that differ in intensity with this one requires that clinicians involve patients in dialogue to enhance the realization of the most appropriate treatment after obtaining informed consent without coercion. As such, the other stakeholders in the scenario such as Edward’s wife can try to use what her husband had said in the earlier conservation about treatment.
Conflicts of ethical practices are best solved using the modified version of Kerridge, Stewart, and Lowe’s (2013) model in problem-solving to address the disputes accordingly. Evidently, the model involves the application of critical thinking in addressing the steps that finally determines the cause of action (Kerridge et al., 2013). For this case, the first thing to be done to solve the ethical conflict starts with the identification of a problem. It involves precisely stating what the ethical issue is, after which the code of ethics that governs healthcare practitioners is applied (Pera & Van, 2005). Subsequently, the nature, as well as the dimension of the conflicts, is determined to demonstrate the most preferred side that works to benefit the patient. After analyzing the situation of a patient involved in scenarios where the principle of autonomy is bridged, the healthcare providers will do the generation of all the potential courses of action. However, before the full incorporation, an evaluation of the chosen cause of action is done, upon which its implementation is later performed. As such, the conflict can be solved by taking into consideration the idea that medical treatment is done according to the best interests of a person. As such, the practitioners are legally allowed to justify their actions by evaluating whether it is the best judgment to forego the principle of autonomy and do what is critical to the current condition of a patient.
Conclusion
This paper has discussed and identified the legal as well as the ethical issues that are evident in the case study. Ethics and laws are crucial in guiding the healthcare practitioners to provide medical treatment to patients in a way that cannot result in the infringement of patients’ rights. Various legal and ethical issues arise in Edward’s case since he had in the preceding days refused to seek medical attention. But when found unconscious and unresponsive, an analysis of his condition is analyzed, and treatment is provided by the paramedics without his own consent. This is because the practitioners have several options to treat a patient such as that of finding surrogates or substitutes who can provide consent on Edward’s behalf. However, there are occasions where disagreement occurs between two or more of such surrogates and the jurisdiction to be implemented involves considering the hierarchy of the substitutes when a patient is not in a capacity to make critical decisions of a given health procedure.
 
References
Ashcroft, R. E. (2007). Principles of health care ethics. Chichester, West Sussex, England: John Wiley & Sons.
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. Oxford [u.a.: Oxford Univ. Press.
Danis, M., Southerland, L. I., Garrett, J. M., Smith, J. L., Hielema, F., Pickard, C. G., … & Patrick, D. L. (1991). A prospective study of advance directives for life-sustaining care. New England Journal of Medicine, 324(13), 882-888.
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., … & Edwards, A. (2012). Shared decision making: a model for clinical practice. Journal of general internal medicine, 27(10), 1361-1367.
Forester-Miller, H., & Davis, T. E. (1995). A practitioner’s guide to ethical decision making. Alexandria, VA: American Counseling Association.
Gillon, R. (2003). Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”. Journal of medical ethics, 29(5), 307-312.
Kälvemark, S., Höglund, A. T., Hansson, M. G., Westerholm, P., & Arnetz, B. (2004). Living with conflicts-ethical dilemmas and moral distress in the health care system. Social science & medicine, 58(6), 1075-1084.
Kerridge, I., Lowe, M., & Stewart, C. (2013). Ethics and law for the health professions.
Leo, R. (2017). Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians. PubMed Central (PMC). Retrieved 11 April 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181079/
Limerick, M. H. (2007). The process used by surrogate decision makers to withhold and withdraw life-sustaining measures in an intensive care environment. In Oncology nursing forum (Vol. 34, No. 2).
Morrison, E. E., & Monagle, J. F. (2009). Health care ethics: Critical issues for the 21st century. Sudbury, Mass: Jones and Bartlett Publishers.
Pera, S. A., & Van, T. S. (2005). Ethics in health care. Lansdowne, South Africa: Juta.
Pozgar, G. D. (2016). Legal and ethical issues for health professionals.
Satyanarayana Rao, K. (2008). Informed consent: An ethical obligation or legal compulsion?. Journal Of Cutaneous And Aesthetic Surgery, 1(1), 33. https://dx.doi.org/10.4103/0974-2077.41159
Tilden, V. P., Tolle, S. W., Nelson, C. A., & Fields, J. (2001). Family decision-making to withdraw life-sustaining treatments from hospitalized patients. Nursing research, 50(2), 105-115.
Ulrich, L. P. (2001). The patient self-determination act: Meeting the challenges in patient care. Georgetown University Press.

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2805NRS Legal And Ethical Principles In Healthcare

2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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Discuss about the Legal and Ethical Issues In Healthcare.
 
 
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Introduction
Undoubtedly, the law and ethics of practice play a crucial part in the decision-making ability of a person, be it a patient or a healthcare practitioner. Consequently, individuals possess rights to make decisions that affect their health. However, competencies or lack of the capacity to make decisions may serve as a barring factor, and someone can be considered unfit to make his or her decisions. This paper encompasses the identification and the discussion of the legal as well as the ethical issues presented in the case study. It discusses options that are available to ensure that treatment is provided when a patient is not in a better position to make decisions.
Legal Issues
It is evident that the management of healthcare always presents complex situations especially when the capability of a person to be treated to engage in decision making is called into question (Pozgar, 2016). Edward’s case is different because he had refused to be treated for a viral infection before becoming unconscious. As such, the paramedics were legally forced to institute treatment since it was an emergency situation and the requests to initiate psychiatric consultation for purposes of assessing Edward’s capacity could not be performed when he was in a diabetic coma. The actions of the paramedics were guided by the legal authority that states that the healthcare professionals ought to come up with a feeling that a patient or client who rejects a particular type of recommended treatments is in a way incompetent until the doctors or a court proves otherwise (Forester-Miller & Davis, 1995). Consequently, it is not the refusal to treatment that has the ability to determine a patient’s capacity to decide, but the right to self-determination that matters in treatment (Ulrich, 2001). However, the paramedics had to do what was legally acceptable to save Edward’s life, and as a result invoked the principle of implied consent in emergent situations such as his by surrogating (Ashcroft, 2007).
The elements of this consent exist such as the nature of a medical procedure or decision. It is s primary goal of any healthcare center to ensure that patients are given an opportunity during the consultation periods to make informed choices before the start of treatment. This element requires that analysis is done on the nature of the decision involved in a surgical operation. It is a requirement to check if patient’s decision to decline treatment before the occurrence of an emergent situation is valid or not. The other element of this consent revolves around the search for a reasonable alternative that may lead to the invocation of applied consent to be the only proposed intervention. As such, an aspect that entails the comprehension of relevant risks, and uncertainties as well as benefits that may lead to the betterment of patient in critical condition. Although the case study of Edward’s condition brings about mixed reactions, it is evident that the element understanding together with acceptance of an intervention of treatment could not be relied on after discovering that he showed no signs of recovering from fatal brain injury. For the case of implied consent, the paramedics who were responsible for Edward’s care are obligated to make a decision on how best the commencement of the treatment could be done using the legal authority that employs the principle of “best interests.” The National Health Act permits medical treatment for an emergency situation to foster the prevention of death or causing permanent damage to the health of the client (Gillon, 2003).
 
Health care practitioners are not allowed to provide treatment to a patient before the informed consent is first obtained because the act has legal consequences that may impact the careers of physicians (Satyanarayana, 2008).  The legal consequences that flow when a practitioner breaches the policy of informed consent involve being sued upon the realization that no informed consent was obtained before the start of treatment. A health care practitioner is usually sued for medical battery, which is considered as a purely legal issue that is associated closely with the application of effective treatment for someone who is unwilling. A medical battery is usual referred to offensive touching when no consent or permission has been sought. The other legal consequences that come with the application when no consent was obtained before the start of medical treatment is the suing of a physician for medical malpractice, and this may lead the provider’s license to be suspended. 
Since Edward is unresponsive, the rationale that can be used is that which values the life of a patient. It is usually the work of the medical practitioners to maintain confidentiality to ensure that no information about the patient leaks to other people (Beauchamp & Childress, 2001). Since situations may turn out to be critical at times and the situation on the ground is life-threatening, treatment has to be done with immediate effect to ensure the patient is treated to stabilize his or her conditions (Limerick, 2007). As such, quick actions must be done to make sure that the relevant people are contacted in case the situation presents nothing useful to indicate that a patient can recover from a diabetic coma, and in the next minute provide full informed consent. The rationale is to be thoughtful of what should be done as options for the dilemma (Kälvemark et al., 2004). In essence, an evaluation of the available alternatives to standing in the place of the first one is the rationale that works in this scenario.
 
Medical practitioners have access to a number of options that can be practically utilized to obtain consent to facilitate Edward’s ongoing treatment. Evidently, some circumstances require the listing of the next of keen based on what the state law would recommend. Therefore, health care professionals have an obligation to get to know the people who are intimately related to him and can be relied upon in the decision-making process. As such, there is a specific hierarchy that must be followed to enhance the appropriate decision-making process to obtain consent before the beginning of a medical treatment procedure. For this case, Una can be called upon to assist in giving out informed consent. The effectiveness of the process would be apparent by her willingness or ability to understand the procedures to be undertaken. When she fails to understand the actual processes, Genevieve can come in to help with the matter at hand without interfering with the operation of giving consent for his unresponsive husband. If no surrogate is settled on, health care practitioners might be forced to act using the principle of “best interests until the court intervenes to appoint a guardian who will help with informed consent. The legal authority that can be relied upon is that of Potential Surrogates and Priority. This is based on the reason that statutory provisions provide a toolkit that addresses the person with a potential of acting as a proxy for an unresponsive patient such as Edward.
It is the ultimate cause of action for the healthcare practitioners to provide a definitive answer in cases where there exist two substitute surrogates or even more who have the potential of providing a consent regarding what should be done to a patient who is unresponsive or lacks the capacity of making decisions (Leo, 2017). The availability of legal issues that can be undertaken in realizing a definitive solution makes the entire process to be successful. As such, the legal options will begin by first designating a hierarchy since it is the only primary strategy that can be incorporated to find consent that wasn’t clear due to disagreements between two or more surrogates. This approach will rely on the policy that those who are lower in the hierarchy do not stand a chance in situations like this to overrule a surrogate who is authorized by skipping judicial proceedings. One of the option that can be implemented in circumstances where there are multiple surrogates involves allowing the healthcare providers to depend more on what the majority of the potentially relevant surrogates settled on during the process of obtaining consent before the disputes erupted (Morrison & Monagle, 2009). In essence, a definitive answer has to be deprived in a situation like this because judicial interventions assist in resolving the disagreements even in the absence of provided provisions.
 
Medically, the decision to enhance the withdrawal of life-sustaining measures is quite difficult to reach because it may be considered to be culturally repulsive. One of the factors that need to be taken into account is the level of acceptance that has been collectively reached (Elwyn et al., 2012). This depends on the seen benefits of the life-sustaining measures, and the decision must be arrived at by the family and the clinicians (Tilden et al., 2001).  This factor is used after noticing the fact that the Edward is undeniably and unquestionably gaining no benefits from the measures of life-sustenance proposedly to be withdrawn. The other factor that can be used to foster the withdrawal of Edward’s life-sustaining measures is that which involves a realized stabilized medical condition. This is because if a state of a patient is stable to a level that no further signs of improvements is expected; the decision can be reached at by both the healthcare professionals and the family to withdraw the measures (Danis et al., 1991).
Ethical Issues
Ethical issues in healthcare play a pivotal role in enhancing medical treatment in hospitals. As such, one of the ethical principles that are relevant in this scenario is the principle of autonomy. In particular, this moral principle stands for the proposal or proposition that adults with the ability to make informed decisions possess complete as well as the perfect rights to influence what treatment can be done with their bodies. This is in reference to the declaration on bioethics as well as human rights, and it is a principle that has universal recognition in ethical practice in healthcare. As such, Edward’s case relies on this principle since it is his unresponsiveness or the lack of the capacity to make decisions due to the diabetic coma that calls for the invitation of his family to provide informed consent on his behalf legally. It is evident from the case study that Edward had in the previous days refused the treatment of the viral infection, which the ethical principle of autonomy accepts but now his emergent condition made it hard for him to give his informed consent before treatment. Similarly, the other principle that applies to the facts in this scenario is that of beneficence. This applies in the scenario by promoting healthcare benefits to a patient who is unresponsive or in a diabetic coma. This ethical code disregards all the others and makes the healthcare practitioners act using what they view to be of “best interest.”
 
However, a conflict between the above principles can arise when the clinicians decide to perform first aid on a patient in an emergent situation. The principle of beneficence could have been applied to resuscitate a diabetic coma, but because the principle of autonomy makes it difficult for the healthcare professionals to make decisions since Edward had previously refused to seek medical treatment yet treatment was provided without his own consent. This is because the patient may have had own ideas that he views beneficial his health. As such, scenarios that differ in intensity with this one requires that clinicians involve patients in dialogue to enhance the realization of the most appropriate treatment after obtaining informed consent without coercion. As such, the other stakeholders in the scenario such as Edward’s wife can try to use what her husband had said in the earlier conservation about treatment.
Conflicts of ethical practices are best solved using the modified version of Kerridge, Stewart, and Lowe’s (2013) model in problem-solving to address the disputes accordingly. Evidently, the model involves the application of critical thinking in addressing the steps that finally determines the cause of action (Kerridge et al., 2013). For this case, the first thing to be done to solve the ethical conflict starts with the identification of a problem. It involves precisely stating what the ethical issue is, after which the code of ethics that governs healthcare practitioners is applied (Pera & Van, 2005). Subsequently, the nature, as well as the dimension of the conflicts, is determined to demonstrate the most preferred side that works to benefit the patient. After analyzing the situation of a patient involved in scenarios where the principle of autonomy is bridged, the healthcare providers will do the generation of all the potential courses of action. However, before the full incorporation, an evaluation of the chosen cause of action is done, upon which its implementation is later performed. As such, the conflict can be solved by taking into consideration the idea that medical treatment is done according to the best interests of a person. As such, the practitioners are legally allowed to justify their actions by evaluating whether it is the best judgment to forego the principle of autonomy and do what is critical to the current condition of a patient.
Conclusion
This paper has discussed and identified the legal as well as the ethical issues that are evident in the case study. Ethics and laws are crucial in guiding the healthcare practitioners to provide medical treatment to patients in a way that cannot result in the infringement of patients’ rights. Various legal and ethical issues arise in Edward’s case since he had in the preceding days refused to seek medical attention. But when found unconscious and unresponsive, an analysis of his condition is analyzed, and treatment is provided by the paramedics without his own consent. This is because the practitioners have several options to treat a patient such as that of finding surrogates or substitutes who can provide consent on Edward’s behalf. However, there are occasions where disagreement occurs between two or more of such surrogates and the jurisdiction to be implemented involves considering the hierarchy of the substitutes when a patient is not in a capacity to make critical decisions of a given health procedure.
 
References
Ashcroft, R. E. (2007). Principles of health care ethics. Chichester, West Sussex, England: John Wiley & Sons.
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. Oxford [u.a.: Oxford Univ. Press.
Danis, M., Southerland, L. I., Garrett, J. M., Smith, J. L., Hielema, F., Pickard, C. G., … & Patrick, D. L. (1991). A prospective study of advance directives for life-sustaining care. New England Journal of Medicine, 324(13), 882-888.
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., … & Edwards, A. (2012). Shared decision making: a model for clinical practice. Journal of general internal medicine, 27(10), 1361-1367.
Forester-Miller, H., & Davis, T. E. (1995). A practitioner’s guide to ethical decision making. Alexandria, VA: American Counseling Association.
Gillon, R. (2003). Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals”. Journal of medical ethics, 29(5), 307-312.
Kälvemark, S., Höglund, A. T., Hansson, M. G., Westerholm, P., & Arnetz, B. (2004). Living with conflicts-ethical dilemmas and moral distress in the health care system. Social science & medicine, 58(6), 1075-1084.
Kerridge, I., Lowe, M., & Stewart, C. (2013). Ethics and law for the health professions.
Leo, R. (2017). Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians. PubMed Central (PMC). Retrieved 11 April 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181079/
Limerick, M. H. (2007). The process used by surrogate decision makers to withhold and withdraw life-sustaining measures in an intensive care environment. In Oncology nursing forum (Vol. 34, No. 2).
Morrison, E. E., & Monagle, J. F. (2009). Health care ethics: Critical issues for the 21st century. Sudbury, Mass: Jones and Bartlett Publishers.
Pera, S. A., & Van, T. S. (2005). Ethics in health care. Lansdowne, South Africa: Juta.
Pozgar, G. D. (2016). Legal and ethical issues for health professionals.
Satyanarayana Rao, K. (2008). Informed consent: An ethical obligation or legal compulsion?. Journal Of Cutaneous And Aesthetic Surgery, 1(1), 33. https://dx.doi.org/10.4103/0974-2077.41159
Tilden, V. P., Tolle, S. W., Nelson, C. A., & Fields, J. (2001). Family decision-making to withdraw life-sustaining treatments from hospitalized patients. Nursing research, 50(2), 105-115.
Ulrich, L. P. (2001). The patient self-determination act: Meeting the challenges in patient care. Georgetown University Press.

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5N1794 Safety And Health At Work
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Course Code: 5N1794
University: University College Cork

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Answer:
Assignment 1
Answer to question 1
I have conducted a survey at my workplace maned Lady’s Hospice and Care Services to observe the working environment. The aim of the survey is to find if it is a safe, healthy, secured and fulfilling place to work. A visual survey was conducted to locate and record the safety signs in the workplace. The objective of the survey is to observe and list different types of signs, location, their prom…
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Tags:
Australia Maple Ridge Management Introduction to film studies University of New South Wales Masters in Business Administration 

400837 Health And Socio Political Issues In Aged Care
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14

Course Code: 400837
University: Western Sydney University

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Country: Australia

Answers:
Introduction
Palliative care services are designed to improve the life of patient with progressive disease. People receiving palliative care have illness that has no prospect of cure.  As per the World Health Organisation, palliative care is a care given to patient suffering from life threatening illness to improve their quality of life by preventing and providing relief from sufferings by early recognition , assessment and trea…
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Australia Minchinbury Management University of New South Wales 

PUBH6304 Global Health
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Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) is the spectrum of medical conditions caused due to human immunodeficiency virus (HIV) following which the patient suffers from a series medical complications due to suppression of the immune system of the body. With the progression of the disease, the patient is likely to suffer from a wide range of infections like tuberculosis and other opportu…
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CON 321 Health Related Research
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Introduction
Leadership in the hospital is the ability to influence the staff toward providing quality health care. Leadership involves influencing human behavior to create a positive working environment (Langlois, 2012). Good leadership enables healthy relationships among staffs in the hospital enhancing quality delivery of health care services. Leadership is responsible to building teams that have trust, respect, support and effecti…
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BL9412 Public Health
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Introduction
According to the researchers, it can be said that the management of the health care organizations has become a difficult task nowadays and the reason behind this is the occurrence of various issues in this sector (Hall et al., 2014). Therefore, the administrative employees of the organization should incorporate various revolutionized strategies for enriching the worth of care provided by the hospital to its clients and re…
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Australia Ryde Management Information system strategy University of New South Wales (UNSW) Masters in Business Administration 

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2805NRS Legal And Ethical Principles In Healthcare

2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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Course Code: 2805NRS
University: Griffith University

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Country: Australia

Question:
Discuss about the Legal and Ethical Principles in Healthcare.
 
 
Answer:

Introduction
Healthcare is one of the most important pillars of the government commissioned to enhance the welfare of the community. There are various activities experienced on a daily basis concerning the health and welfare of individuals. The constitution of every state takes into account the laws and policies that should be followed for maximum service provision for the society. The welfare of every individual in the community is equally important and the health institution should maximise their services to reduce the level of illness in the community. Some medical conditions are thought to be resistive to drugs among others being yet to be conquered; moreover, research institution is stretching their potentials to be able to invent the best appropriate drugs (Pozgar, 2014).
Despite having health conditions that do not have confirmed medicines, others such as diabetes have drugs that are used in controlling the condition. However, these drugs need to be used consistently and failure to that, complications might be experienced. Every person is entitled to quality health care despite their medical condition. Before any medical intervention, the patient should read, understand and confirm its applications to ensure that all the implications are accounted. In cases where the patient is not able to perform all the requirements of the consent, a family member or guardian can make the informed decisions concerning the treatment. In this paper, legal and ethical issues will be explored concerning the case of Edward, who was in a comma for failing to manage Type 1 Diabetes (Lin, et al., 2013).
 
Legal Issues
Mr Edward has been living and fairly managing Type 1 Diabetes very well by the use of insulin and avoiding the meals that the doctor had warned. However, the body is prone to many health conditions that should be medicated if the signs and symptoms are experienced. It is also important to seek guidance from the medical practitioners if unusual changes in the body are pursued. Edward developed sore muscle pains but he did not think it could be much of a problem because there were no severe symptoms. His wife Genevieve advised him to visit the doctor to get a report on the same and if it is a worse condition, he would receive relevant medical support immediately. He did not embrace the advice from his wife, but he used paracetamol, lemon juice and warm honey. This was not according to the doctor’s recommendations and this would conflict the management of diabetes conditions (Lin, et al., 2013).
According to the Australian Health Act 2008, it states that the community should be kept healthy by providing the best medication available (Stirton, 2016). This act governs both the public and private health institutions in the country. It also states the nest of kin and guardians are responsible for providing decisional support for their patients. However, an individual has the right to make personal health decisions. Edward decided not to visit the doctor for the sore muscles and used the stated control measures. His wife Genevieve did not have the right to force him to seek the required medication because he is a grown up. The medical assumptions made by Edward led to worsening of the Type 1 Diabetes when he went to work out of town.
 Edward was taken to the hospital while in a comma and he could not make any decision concerning his medical support. Later, his family realised that he was in the hospital because his condition has worsened. The best of the health support that Edward could receive was appropriate diabetes type 1 and comma related first aid services and before the family member could show up to make the informed consent medical decisions. According to his case, either Genevieve or his mother Una could provide the required informed support because they are all legally attached to him (Faden, Beauchamp, & Kass, 2014). Una is Edward’s biological mother and she has the right to make informed decisions under the law. Genevieve has been provided with the right to make a decision about Edward’s health because she is legally married to him. The importance of consulting and following the consent process is to avoid holding the doctors responsible for any misfortunes that might happen in the treatment process. For instance, if a treatment intervention is implemented without signing the consent form by either the patient or the family and death occurs, the doctors could be answerable and they can be sued (Kerridge, Lowe, & Stewart, 2013).
 
Informed decisional support conflicts are one of the most dangerous occasions in cases where the patient is unable to contribute in the process of treatment. This situation is experienced when there are two or more potential individuals to provide the support (Lin, et al., 2013). The issue occurs when one or two of the individuals have differing opinions in how the medical intervention should be conducted. For instance, one might state that the intervention should be stopped and the other wishing to a continuity. In Edward’s case, Una thought that more effort and time could be allowed to give him another chance of recovery. The medical support should not be withdrawn when there is a conflict because it might lead to blames, hence leading to a court case. For example, Una can sue the medical team if the support is withdrawn when she is able and willing to pay the bill in time. Also, she can sue Genevieve in occasions when her decision is followed and Edward dies because she is also a significant decision make in Edward’s treatment (Pozgar, 2014).
Some of the factors that should be considered in solving the conflicts between the two would include the availability of resources to support the treatment and their willingness to take the medical risks. Una stated that she would do what it takes to pay for the extra medical care required to keep his son the life support machine. On the other side, Edward has told his wife Genevieve that he would not like to be in a helpless state in his life. Therefore, Genevieve was honouring the wishes of her husband, although it is against the law to let a person die when there is a way of controlling the case. Therefore, the best option would be adhering to Una’s decision and maintain the medical support until he either recovers or otherwise (Kerridge, Lowe, & Stewart, 2013).
Ethical Issues
There are ethical issues that are attached to any medical treatment interventions that need to be considered to avoid conflicts and legal cases that might arise. There are Universal Declaration and Bioethics that have been developed to govern the health sector and ensure that all the requirements connected to medical services are accounted. Benefit & Harm and Persons without the Capacity to Consent are the two principles of the Universal Declaration and Bioethics principles that are most relevant in Edward’s case (Petrini, 2014). Benefit and harm principle states that before implementing any scientific treatment method, all the process should be justified to be no harm to the patient. Therefore, the medical interventions should be focused on providing the best health support to the patients. In cases, where the treatment are perceived be of general benefit to the patient, it should be used reduce the discomforts experienced (Faunce, 2012).
 
Edward was not in the capacity to adhere to the informed consent, hence involving the family in the decision-making process for the treatment. This principle states that before any form of medical practice is undertaken, an informed consent should be signed by one of the most appropriate family member or guardian. Consultations should be done consistently in the process to ensure that the patient receives the best services out of the medical care. In cases where there are trial drugs that can be tested, the research practice should be of the best support for the patient’s medical needs. Medical interventions and research proceedings that do not have direct medical importance and benefit to the patient should not be used in the treatment process. Therefore, the medical process should be imposed with minimal burden and risk to the patient (Mayes, Lipworth, & Kerridge, 2016). Edward’s treatment should be implemented after it is justified that the intervention bears the minimum risk in his health. Moreover, a treatment process that has the highest chance of making him recover should opt. Genevieve’s option of withdrawing the life support treatment should not opt because it causes harm to Edward and his mother Una (Kaufmann & Rühli, 2010).
The two principles; patients without the capacity to sign the informed consent and benefit & harm can possibly conflict in the case of Edward. The opinion of the patient is best followed to ensure that the treatment in peace with their wishes. Edward told his wife Genevieve that it would be his last wish to be in a helpless condition hence preferring to die. Therefore, the medical team have shown insufficient hope in his recovery and it can only take the life support machines to keep alive. Therefore, it would be his wish is the medical plan is stopped, which harms him and the family, hence conflicting both of the principles. It is the right of Genevieve to sign the informed consent and she wishes the withdrawal of the medical treatment plan. However, this is the human rights act 2004, that advocates for healthy community and respect for human dignity (Stirton, 2016).
 
Life of a person is a gift offered by the supreme leader and there are no individuals with the right to take it away. It is very important to provide Edward with the best time possible for his recovery and not just to pull off the treatment procedures. Letting him die will be a loss to the family by making his two children be single parented. The human rights principles do not support the withdrawal of the treatment plan; however, it advocates for the implementation of best health care services that can lead to his recovery by managing the conditions. External advisors should be involved to provide the required support to the parties so that they can agree on one option. The medical team should therefore not rush them in the decision support to avoid influencing any form of an inappropriate option. After deciding on one of the options, the informed consent should be signed by both parties to avoid future problems (Taylor, 2015). The non-regrettable decision should be opted to keep every individual party in peace in future even after the unexpected happen on Edward’s health.
Conclusion
In conclusion, constitutional health and welfare acts should be fairly considered in imposing any decision towards Edward’s treatment. Both Genevieve and Una’s opinion should be considered in signing the informed consent and deciding whether to withdraw the services or not. External and family consultations should be conducted for the case of making the best decision towards the health of Edward (Lo, 2012). Finally, the medical team should do the best practice possible to try stabilising Edward’s health condition to restore the family’s happiness.
 
References
Cohen, I. (2013). Globalization of Health Care. Cary: Oxford University Press, USA.
Faden, R., Beauchamp, L., & Kass, E. (2014). Informed consent, comparative effectiveness, and learning health care . N Engl J Med, 370(6), 766-768.
Faunce, T. (2012). Governing planetary nanomedicine: environmental sustainability and a UNESCO universal declaration on the bioethics and human rights of natural and artificial photosynthesis (global solar fuels and foods). Nanoethics, 6(1), 15-27.
Furrow, B. R., Greaney, T. L., Johnson, S. H., Jost, T. S., & Schwartz, R. L. (2013). Health Law: Materials and Problems. Minnesota: West Academic.
Kaufmann, I. M., & Rühli, F. J. (2010). Without ‘informed consent’? Ethics and ancient mummy Research. Journal of medical Ethics.
Kerridge, I., Lowe, M., & Stewart, C. (2013). Ethics and law for the health professions (4 ed.). Leichhardt: The Federation Press.
Lin, M. Y., Lyles-Banks, R. D., Lolans, K., Hines, D. W., Spear, J. B., & Petrak, R. (2013). The importance of long-term acute care hospitals in the regional epidemiology of diabetes type 1. Clinical infectious diseases, 500.
Lo, B. (2012). Resolving ethical dilemmas: a guide for clinicians. Philadelphia: Lippincott Williams & Wilkins.
Matsubara, J., Sugiyama, S., Akiyama, E., Iwashita, S., Kurokawa, H., Ohba, K., & Hokimoto. (n.d.). Dipeptidyl peptidase-4 inhibitor, sitagliptin, improves endothelial dysfunction in association with its anti-inflammatory effects in patients with coronary artery disease and uncontrolled diabetes. Circulation Journal, 77(5), 1337-1344.
Mayes, C., Lipworth, W., & Kerridge, I. (2016). Declarations, accusations and judgement: examining conflict of interest discourses as performative speech-acts. Medicine, Health Care and Philosophy, 19(3), 455-462.
Petrini, C. (2014). Organ Allocation Policies 10 Years after UNESCO’s Universal Declaration on Bioethics and Human Rights. Transplantation Proceedings, 48(2), 296-298. doi:https://dx.doi.org/10.1016/j.transproceed.2015.10.059
Pozgar, G. D. (2014). Legal and ethical issues for health professionals. Burlington: Jones & Bartlett Publishers.
Saul, P. (2013). Neat model for ethical problem solving. The Medical Journal of Australia, 199(7), 511. doi:https://dx.doi.org/10.5694/mja13.10868
Spofford, C., & Easker, D. (2015). Unresponsive Patient in the Post Anesthesia Care Unit. Mededportal Publications. doi:https://dx.doi.org/10.15766/mep_2374-8265.10005
Stirton, R. (2016). The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: A Litany of Fundamental Flaws? The Modern Law Review, 299-324. doi:https://dx.doi.org/10.1111/1468-2230.12255
Taylor, H. (2015). Legal and ethical issues in end of life care: implications for primary health care. Primary Health Care, 25(5), 34-41. doi:https://dx.doi.org/10.7748/phc.25.5.34.e1032
 
 
 

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2805NRS Legal And Ethical Principles In Healthcare

2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

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2805NRS Legal And Ethical Principles In Healthcare

0 Download8 Pages / 1,943 Words

Course Code: 2805NRS
University: Griffith University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:
You are provided with a case study. You are asked to select 3 articles that best provide evidence-based guidance for the patient in the case study. There are three parts to this task:
Part 1: Annotated Bibliography
Part 2: Justification for your choice of articles
Part 3: Recommendations for patient/clinical practice
Case Study
William, a 75-year old overweight man, has arrived at the general practice clinic where you are currently working as a Registered Nurse. William is breathless, has visible peripheral oedema and tachycardia. In 2017, William was diagnosed with chronic heart failure as a result of ischaemic cardiomyopathy and hypertension. He states that in the past few days he has experienced distressing shortness of breath and is becoming increasingly unwell. Select each article that you believe best provides evidence-based guidance on how William can better manage his condition.
 
Answer:

Part 1
The systematic review of the randomised control trial, conducted by Jiang, Shorey, Seah, Chan, Tam and Wang (2018) aimed towards examining the overall impact of the psychological interventions in increase the provision of self-care, psychological health and overall health outcomes of the patients who have encountered chronic heart failure (CHF). The authors reviewed 29 randomised control trial (RCT) articles that are published with the last 10 years. While the selection of the articles within the last 10 years helped the author to provide the current approach of the evidence based practice, but a total of 29 articles showed a reduced sample size that might lead to biased results (Parahoo, 2014). The analysis of the RCT studies showed that psychological interventions are effective in improving the overall skills of self-care among the CHF patients. However, the significance is only positively associated with the patients who are free from cognitive problems and clinical depression. The study also revealed that implementation of the psychological interventions help to improve the comprehensive health and well-being by improving health-related quality of life of the patients. However, authors failed to highlight any significant correlation with the psychological interventions and anxiety management. Moreover, the review of the articles also failed to provide the underlying approach of how psychological interventions are helping to improve the quality of life of post CHR patients.
 
The study conducted by Molloy et al. (2012) attempted to provide an evidence-based practice in improving the overall medication adherence of the people suffering from cardiovascular problems. The main study approaches selected by the authors include systematic review of the randomized control trials. This is can be regarded as one of the important strength of the study in the domain of the study design as systematic review of the RCT falls under the level 1 of the evidence. The RCT studies that conducted a comparative analysis with the intervention group and the placebo group were selected for the review. The main population of interests were adults (people who are 18 years old or above). The final analysis of the 16 articles revealed that non-pharmacological intervention, which is successful in increasing the patient’s adherence of the medication include increased provision for the patient education. The review of the RCT studies however failed to highlight any valid justification behind the simplification of the drug regime in improving therapy adherence of the patient. In order to increase the level of patient engagement by education, patient centered educational plan based on the behavioral needs of the patient is found to be effective. One of the limitations of the study is poor sample size (Parahoo, 2014). This might be a reason why the review failed to provide the detail perceptive of the therapy adherence in relation of simplification of the drug regime.
Sagar et al. (2015) conducted a systematic review and meta-analysis in order to update the Cochrane systematic review about the importance of the exercise-based cardiac rehabilitation (CR) program for heart failure. A total of 33 trials were included in the review consisting of 4740 participants. The papers were selected in such a way that it had a follow-up period of 1 year. The selection of the study of a standard sample size can be considered as one of its strength. However, having a long follow-up period is regarded as one of the limitations as candidate dropouts occurs during the follow-up leading to decrease in the overall sample size of the participants (Parahoo, 2014). The analysis of the results highlighted that regular practice of mild to moderate physical activity under in CR program helps to reduce the overall risk of the re-hospitalization of the heart failure patients. Meta-regression analysis showed that overall benefits were independent in relation to the dosage and type of exercise in the CR program along with the duration of the total follow-up of the trial. The results also showed decrease rate in the overall hospitalization of the post-stroke patients for further cardiac complications. However, the authors recommend an individual participant data meta-analysis in order to provide a confirmatory evidence for the importance of the subgroup of the patients and program level characteristics (duration and intensity of exercise) over the outcome.
 
Part 2
The review conducted by Jiang, Shorey, Seah, Chan, Tam and Wang (2018) was selected for this paper because it helps to get an idea regarding the importance of the psychological interventions for improving the overall quality of life. In relation to this, Steptoe, Deaton and Stone (2015) stated that mental health and well-being is a significant influence over the physical well-being of the individuals with complex cardiovascular problems. A person who is happy and free from unwanted tension or depression is more likely to follow health lifestyle regime and self-care in order to improve the physical well-being. William had a past history of hypertension, ischaemic cardiomyopathy and has been experiencing shortness of breath for the past few days. However, he went for medical help only when the conditions went more severe for example, visible signs of peripheral oedema. This highlights that William lack self-awareness and skills of self-care. Thus implementation of the psychological interventions will help to induce self-care and self-management skills in William. In relation of the psychological interventions, Ward, White and Druss (2015) are of the opinion that proper implementation of the psychological interventions helps to improve the mental well-being of the people and thereby helping them to take active initiatives in favour of their physiological health like abiding by healthy lifestyle regime and periodic mentoring of vital signs and visit to doctor when needed. This helps to avoid chances of encountering medical emergencies.
 
The systematic review of Molloy et al. (2012) was selected in order to highlight the importance of the patient education   in generation of the disease awareness and increase in the tendency of the therapy adherence. The study conducted by de Melo Ghisi, Grace, Thomas and Oh (2015) stated that proper education of the patients with chronic heart failure in the domain disease prognosis helps to promote the therapy adherence and at the same time helps to decrease the chance of the rehospitalisation resulting from further cardiac complications. Case study reveals that in spite of having the previous reported cases of the chronic heart failure, Mr. William is over-weight. Thus it shows that he is not abiding the therapy like for example promoting of physical activity to lose weight. The case study also reveals that William was experiencing distressing symptoms for the past few days but showed zero initiatives to contact doctors at that time and this lead to delayed reporting. Powers et al. (2018) stated that proper education of the patient about disease prognosis helps in identification of the early signs and symptoms of cardiovascular complications and thereby helping to prevent the negative prognosis of the disease. Stanhope and Lancaster (2015) argued that patient education given under the community health approach and in a culturally competent manner is found to fetch positive results in the domain of effective self-management of the disease.
The study of Sagar et al. (2015) was selected because it provides significant evidence in the domain of importance of the physical exercise under the cardiac rehabilitation program for improving the health-related quality of life of the cardiac patients. The analysis of the case study reveals that William is over-weight. Owen et al. (2015) stated that older adults who are over-weight patients are more vulnerable in developing cardio-vascular complications, as they are more prone to develop atherosclerosis. Owen et al. (2015) further reported that weight people who have previous history of cardio-vascular problems and are over-weight are prone to disease reoccurrence. William, a 75-year old man was over-weight and has past history of CHF. Thus promotion of physical activity practice through CR program will help to reduce body weight of William and thereby helping to reduce body mass index (BMI). Decrease in the BMI will help to reduce the breathing problems and hyper-tension and thereby helping to decrease the severity of the cardiovascular disease.
 
Part 3
The recommendation for the clinical practice includes recruitment of the home-based physical exercise trainer for Mr. William and an occupational therapist in order to aid William with person-centred physical exercise training regime. Practice of person-centred approach of for devising of the physical activity regime helps to fetch improved outcome (Sagar et al., 2015). The promotion of weight loss and maintenance of the healthy lifestyle habits can be further facilitated by designing of the person centred health education program. The education program will include dietary regime that will be helpful for William to overcome his body weight. Since William is 75 years old it is recommended to avail a home cooking help for William in order to abide by the diet regime. Commonwealth Home Support Programme of Australian Government might be proved to be helpful for William (Australian Government Department of Health, 2019). The psychological interventions of William must be framed under the active supervision of the mental health professionals. Moreover, informal caregivers must also be educated about the disease prognosis in order to take active action at the time of emergency through identification of the early signs and symptoms (Piette et al., 2015).
 
References
Australian Government Department of Health. (2019).  Aeging and Aged Care Service. Access date: 27th March 2019. Retrieved from: https://agedcare.health.gov.au/older-people-their-families-and-carers/staying-at-home/help-to-stay-at-home
de Melo Ghisi, G. L., Grace, S. L., Thomas, S., & Oh, P. (2015). Behavior determinants among cardiac rehabilitation patients receiving educational interventions: An application of the health action process approach. Patient education and counseling, 98(5), 612-621. https://doi.org/10.1016/j.pec.2015.01.006
Jiang, Y., Shorey, S., Seah, B., Chan, W. X., Tam, W. W. S., & Wang, W. (2018).The effectiveness of psychological interventions on self-care, psychological and health outcomes in patients with chronic heart failure—A systematic review and meta-analysis.International Journal of Nursing Studies, 78, 16-25. doi:10.1016/j.ijnurstu.2017.08.006
Molloy, G. J., O’Carroll, R. E., Witham, M. D.,&McMurdo, M.E. T. (2012). Interventions to enhance adherence to medications in patients with heart failure: A systematic review. Circulation Heart Failure, 5, 126-133.https://dx.doi.org/10.1161/CIRCHEARTFAILURE.111.964569
Owen, C. G., Kapetanakis, V. V., Rudnicka, A. R., Wathern, A. K., Lennon, L., Papacosta, O., … & Whincup, P. H. (2015). Body mass index in early and middle adult life: prospective associations with myocardial infarction, stroke and diabetes over a 30-year period: the British Regional Heart Study. BMJ open, 5(9), e008105. https://dx.doi.org/10.1136/bmjopen-2015-008105
Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan International Higher Education.
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