Legal Ethics Assignment: Case Narratives Of A Patient With Neurone Disease

Question

Task: The goal of this legal ethics assignmentis to recognise and become attuned to the legal requirements and moral/ethical aspects of everyday care and to consider your role as a healthcare student and future healthcare professional. The focus is on the application of legal principles, moral/ethical theory and ethical healthcare practice. Moral justification is important in moral decision making. Apply legal principles, ethical principles, moral theory, virtue ethics, and an ethic of care to frame your answers. Use high quality references (preferably peer reviewed journal articles, ethics and law textbooks, grey literature such as Health Practitioner Regulation in the last 5-10 years, or legal precedents) to support your points.

Choose three (3) of the case narratives from the five (5) below and answer the corresponding questions for the narratives you have chosen. Your task is to carefully consider the narrative from multiple perspectives and answer the question in relation to the specifics within the narrative and the relevant legal and ethical concepts using a reasoned approach. Each answer should be 500-700 words (includes intext references) in length and the usual guidelines for academic writing and apply APA referencing (see Canvas for links to Referencing guide).

The choice of which three (3) narratives to answer is up to you. These narratives may apply to a multitude of professional health disciplines including physiotherapy, nursing, medicine, pharmacy, psychology and counselling, to accommodate your ability to consider the legal and ethical principles related to your own discipline. Ensure that you have reviewed the marking rubric and have met the requirements of the assessment.

You are required to submit this assessment via the assignment box on this units Canvas page. It is encouraged that you submit to the draft submission section first to receive a URKUND report for text matching. This may take 24-48 hours for a report, so it is best to be submitted in advance of the due date to enable review and refinement as needed. In your submission please do not include the details of the case narrative, rather, just include the case narrative number as a heading to indicate which narratives will be addressed. Please include one reference list as per APA 7th Edition formatting at the end of your paper.

Narrative One
You are at work in an ACT public hospital when a colleague joins you for lunch and takes a bottle of antibiotic eye drops out of his pocket and begins to administer the drops into his (L) eye which is appears red and puffy causing him to squint. Your colleague explains that his eye has been getting worse over the shift, his vision is affected and that he knows it is just conjunctivitis, but he has not got time to go to the doctors. Your colleague states to you, “I have had this problem before, there are plenty of these antibiotic eye drops on the shelf in the medication room, no one will miss it and if I start it now, I will be OK for tomorrow and will not have to call in sick!”

Narrative One (1) Question: From the perspective of your discipline, consider the actions of your colleague in the above case scenario and identify at least three key areas of concern and discuss potential outcomes using ethical and regulatory frameworks.

Narrative Two
Your manager calls for an urgent staff meeting and reports that a complaint has been made by the family of an organ donor patient. The donor family had requested not to be identified, but at the funeral of the donor, the family of the organ receiver approached them and wanted to thank them in person for their lifesaving decision. The donor’s family are threatening civil action against the health service for the emotional distress this has caused them.

Further investigation has determined that a family member of the organ receiver entered a lift where they overheard a group of health professionals discussing the sad case of a 16 year old girl who had died recently as a result of an accident on Northbourne Avenue close to Civic, and who’s organs were able to be donated. The family of the organ receiver searched the internet and found the media report which gave the names of the people involved, where they lived and the details of the funeral.

Narrative Two (2) Question: Reflect upon the case study above and apply a reasoned approach in your response to the scenario highlighting at least three key relevant legal frameworks and ethical concerns.

Narrative Three
Mohammed is a 57-year-old man who has been diagnosed 18 months ago with Motor Neuron Disease. After discussions with his family, neurologist and GP, Mohammed completed a Health Direction / Advanced Care Plan 6 months ago which clearly states that if his health deteriorates that he does not want specific treatments to prolong his life such as antibiotic therapy and admission to intensive care. Mohammed has developed a chest infection in the last couple of days. This morning Mohammed’s wife finds him confused and disorientated with a high fever and rapid breathing. She calls an ambulance and he is transferred to the emergency department; a copy of his Health Directive is given to the Ambulance Officers. In the emergency department, Mohammed is unable to effectively communicate because of his current acute illness. Mohammed’s wife explains to the health professionals that Mohammed had in recent times come to terms with his diagnosis, and that he was looking forward to the upcoming birth of their first grandchild in approximately 5 months and an interstate family holiday after that. Mohammed’s wife expressed that she thought he would want to be treated for his severe chest infection, as the antibiotic therapy was likely to be effective.

Question FIVE: In light of Mohammed’s written direction that refused antibiotics and intensive care treatment (within the Health Direction), analyse and discuss at least three relevant ethical and legal considerations that the team of health professionals must assess to determine their next steps.

Narrative Four
Barry is 77years old, he has Type 2 diabetes which sometimes requires insulin, he has cardiac medical history and lower limb weakness following a stroke. Barry lives in Residential Aged Care. Barry has advised the RAC Facility and its staff verbally and in writing that he does not want staff waking him in the morning to test his blood glucose levels. Barry justifies his request by explaining that he has trouble getting to sleep at night and enjoys sleeping in, he always eats breakfast late and believes early testing is pointless. Barry has been awoken with a sharp sting on his toe at 0610 by a night shift nurse testing his blood glucose level. When questioned by Barry, the nurse advises him that she needed to test the blood glucose early as it was likely to be a busy morning and she was making sure it didn’t get missed because some staff would be off that morning attending mandatory training. Narrative Four (4) Question: Reflect upon the case study above and discuss at least three legal and ethical theories and obligations in relation to the clinician’s rationale.

Narrative Five
Ehani is a 15 year old girl who approaches a health professional and seeks assurance from the health professional that her conversation will be kept confidential. The health professional assures her that unless there are compelling reasons i.e. that the public will be at risk of harm, that the conversation would be confidential. Ehani proceeds with her request for the ‘morning after’ pill as she is concerned that after having unprotected sex with her boyfriend that she may be pregnant. Ehani is not taking regular oral contraceptives. Ehani shares that her parents (who access the same health service) are ‘very religious’ and ‘don’t believe in premarital sex’, hence her seeking reassurance about confidentiality. Ehani further states that her parents would be ‘disgusted’ if they found out she was seeking the morning after pill and would disown her. Ehani has researched social media and online materials and has determined that there are no negative short (apart from a potential headache) or long term health consequences for her if she takes the pill. She tells the health professional that ‘one of her friends has had the morning after pill and she was fine’, and she wants to have it too, just in case.

Question Five: What are three key legal and ethical principles raised in this case Are there multiple perspectives to consider Give reasons (drawn from the literature) for your answers.

Answer

Narrative Three
Introduction
In the present case scenario of legal ethics assignment, it is witnessed that motor neurone disease patient named Muhammad completed and advanced care plan which was six months long and which plan clearly stated that in the absence of antibiotic therapy as well as admission to intensive care his health might deteriorate. In such a situation, with regard to the current situation of Muhammad with chest infection it becomes a concern for the health professionals to raise ethical and legal concerns. In this case three ethical and legal concerns will be discussed in the following section to determine the steps to be taken by the team of healthcare professionals with the intention of determining the next steps.

Relevant ethical and legal considerations for the health professionals
James F. Childress Tom L. Beauchamp has developed a standard approach to the HealthCare ethics. According to their four basic principles related to the evaluation of merits and difficulties associated with medical procedure three of the following can be considered for the present case as a means of legal and ethical considerations to be taken into account by the healthcare professionals in this case.

Autonomy
It becomes crucial for the healthcare professionals to determine the wish of a patient in order to protect his autonomy (Vergano et al., 2020). In the present case, it has been observed that being a patient of motor neurone disease Mohammed was required to follow different diagnosis plans and after 18 months upon a discussion with neurologist as well as his family he decided to complete our healthcare direction plan 6 months ago.

However, during this health direction Mohammed expressly refused to take antibiotics as well as intensive care treatment. Now the ethical concerns arise that despite the refusal of the patient whether the healthcare professionals were exclusively required to follow his refusal to force him to take his medication so that he could get better. Now, it is also to be observed that the explanation of autonomy states that the healthcare professional will do as per the wish of the patient by considering the protection of the autonomy. Now, there was a concern raised as the protection of autonomy for Mohammed required him to take his antibiotics and intensive care that he refused to do. Hence, in this case the health care professional raised the issue that upon the refusal of the patient they did not continue with antibiotics and intensive care.

Beneficence
In the case of beneficence, the healthcare professionals seek best interest of the patient and assess the treatment which will count as good for the same.However, unlike the ethical and legal consideration of autonomy, in the case of beneficence, there is lack of room of justification for the healthcare professionals with regard to the given case. The healthcare professionals wherever of the fact that with the refusal of treatment by the patient in this case the patient might go through health deterioration(Dipla, 2021). Despite the awareness regarding this fact Muhammad was not denied from refusing his medication and as a result he has been suffering from chest infection which is another read aloud to his health condition. However,it is also to be mentioned that there are many other cases raising the issue of autonomy v. beneficence that create concern for the healthcare professionals regarding their decision-making process.

Non-maleficence
Lastly, non-maleficence is an ethical consideration that determines the situations that can be counted as home and to be avoided for the good of the patient (McDougall et al., 2019). In the present case considering the health situation of Mohammed it was observed that the motor neurone disease affects his health if the medications do not continue properly. However, despite having this information there were no measures taken when Mohammad refused to take his antibiotics and intensive care treatment.

Conclusion
From the observation of the three legal and ethical considerations discussed above, it has been summarised that the healthcare professionals will be required to justify their acceptance towards the refusal of Muhammad in relation to his antibiotics and intensive care treatment. It is to be mentioned that, as a means of justification the healthcare professionals can use the fact that they what according to the patients’ rights of refusing medication and treatment. In which case that could not do anything when Muhammad refused to continue his treatment.

Narrative Four
Introduction
In the present case the primary concern has been identified to be denial of the patient named Barry to wake up early in the morning for participating in his blood glucose test routine. Now it is mentionable that being a patient of type 2 diabetes at the age of 77 years it becomes important for the medical personnel to keep a daily routine of his blood glucose level in order to maintain his medication properly and avoid failure of health condition. However, as Barry has expressed that he does not want to wake up early in the morning as he gets trouble getting sleep at night and he wants to wake up late. However, despite this declaration, a nurse woke him up with the sharp sting at night in order to test his blood glucose. In this case the ethical and legal theories are to be analysed in order to examine the position of the clinician.

Legal and ethical theories and obligations
Depending upon the analysis of the given case the following theories of legal and ethical consideration for the clinician can be taken into consideration in order to justify and examine his or her act.

Beneficence
Beneficiaries can be described as a principle that focuses on the obligation of the medical practitioners to act in such a way that it aims at the ultimate benefit of the patient and his health and it also supports different morals and rules for the protection and defence of their rights to prevent harm and remove similar conditions. This particular principle not only focuses on avoiding harm but at the same time it aims at securing ultimate benefit for the patient in order to promote their welfare. The beneficence of a physician confirms the assurance of moral rules (Cordelli, 2018). In the present case the act done by the nurse by waking him up at night despite his express guidance to avoid doing so, was for the benefit of Barry. Hence, with the application of this particular legal and ethical theory the decision taken by the nurse can be justified.

Informed consent
Depending upon the analysis of the particular case, another principal under question can be identified to be the principle of informed consent. With regard to this particular principle, a medical procedure needs express consent from the patient with regard to the execution of such procedure. The requirements of informed consent include competency of the patient to understand and decide the medical procedure, receiving a full disclosure of the act being done, comprehension of the disclosure, voluntary act and consent of the patient with regard to the proposed action(Cody, 2020). It is identifiable that in this case Barry expressly denied giving consent for his blood glucose taste early in the morning. Hence, waking him up during the night despite his denial is a violation of this particular principle that might raise obligations against the clinician.

Justice
The last principle raising concern in this situation can be identified to the principle of justice. This particular principle is generally interpreted as equitable and fair as well as appropriate treatment for the patient. Among the different categories of justice, distributive justice is identified to be the most pertinent in relation to clinical ethics(Joy, 2019). It refers to an equal table and fair as well as appropriate distribution of resources related to health care for the patient that is determined followed by justified norms structured in the terms in relation to social corporation. This particular principle develops justification in the favour of the clinician as he or she was acting for the ultimate benefit of the patient as it is immensely important for a diabetes patient to participate in the blood glucose test in order to assure better treatment.

Conclusion
From the analysis of the identified theories and obligations in the present case, relevant justification as well as obligation for the clinician have been recognised. It has clearly been determined that the nurse was required to wake Barry up as it was crucially important for him to participate in the glucose test being the patient of type 2 diabetes. However, in the absence of consent regarding this act, there also remains an obligation against the clinician.

Narrative Five
Introduction
In the present case the matter unveils itself as Ehani wants to take a morning after pill course after she had unprotected sex with boyfriend and wants to keep it confidential from the end of the medical practitioner and doesn't want to involve her parents. Now the primary concern in relation to legal and ethical principles will be raised as confidentiality. However, it is also not to be avoided that the patient is a minor and as a result the medical practitioners must consider autonomy before proceeding with the health care plan as she is seeking for.

Legal and ethical principles raised in the case
It has been studied that among all the principles of clinical ethics and legality, the principle of confidentiality remains one of the most important ones. However, in the present case, since the patient is a minor there remains multiple perspectives to be considered.

Confidentiality
This particular principle states that physicians will be obliged to maintain the confidentiality of the patient if the patient requires so (Affairs, 2021). An obvious exception to this principle will be sharing necessary information for the patient's care and well-being from the primary physician to the other consultants and team. In the present case, it has been disclosed that the patient does not want the information to be shared as the healthcare will be related to pregnancy and contraception and she believes her parents will disown her if they get notified regarding the same. The patient has made the decision of keeping it confidential after doing research on social media. The exception made by the medical practitioner in this case states that unless there arise compelling reasons, the conversation and details of the treatment will be kept confidential. Hence the primary legal and ethical principle in this case will arise for the principle of confidentiality to be followed and maintained by the medical practitioner for the will of the patient.

Minor patient
Despite the fact that confidentiality is one of the primary principles to be taken into consideration by a medical practitioner and it is not to be avoided that there are certain exceptions related to the same principle and when it comes to the treatment of minor patients the medical practitioner must reconsider(Rimmer, 2017). In any situation when an immature and minor patient is requesting for contraceptive services or any other services related to pregnancy care or medical services related to treatment of sexually transmissive disease, the physician can encourage the patient for parents’ involvement as it may be proved to be counterproductive to the betterment of the patient's health(Du et al., 2016). However, it is also mentioned that if the minor is continuously objecting to the involvement of parents the patient's wish should be respected by the physician. However, depending upon the age of the patient and uncertain medical consequences that can arise from such treatment, the medical practitioner in this case must consider communicating with the parents and encourage the patient to give consent for the same.

Different perspectives to consider
It has been witnessed in this particular case that there are two different perspectives to consider. The first perspective is to maintain the principle of confidentiality as requested by the patient. On the other hand, the other perspective is to consider the age of the patient and seek medical advice for a very serious matter involving potential pregnancy. In such cases involvement of parents will be required as the situation is uncertain and the consequences are unforeseen. However, as per the dominant feature of the principle of confidentiality in the medical industry, it is the duty of the medical practitioner to consider appropriately for the best benefit of the patient.

Conclusion
The situation in this present case demanded a multi-perspective examination. On one hand, the principle of confidentiality specifically required the medical practitioner to keep the conversation confidential so that the parents of the patients do not get involved. On the other hand, the patient being minor, the medical practitioner may be required to communicate with the parents of the patient in order to avoid undesirable conditions in future as the age of the patient is delicate for such treatment.

References
Affairs, A. (2021). AMA Code of Medical Ethics’ Opinion on Adolescent Care. Journal of Ethics | American Medical Association. Retrieved 23 October 2021, from https://journalofethics.ama-assn.org/article/ama-code-medical-ethics-opinion-adolescent-care/2014-11.
Cody, A. (2020). Reflection and clinical legal education: how do students learn about their ethical duty to contribute towards justice. Legal Ethics, 23(1-2), 13-30. https://doi.org/10.1080/1460728x.2020.1799303 Cordelli, C. (2018). Prospective Duties and the Demands of Beneficence. Ethics, 128(2), 373-401. https://doi.org/10.1086/694274
Dipla, V. (2021). AI and the Healthcare sector: Industry, legal and ethical issues. Bioethica, 7(1), 34. https://doi.org/10.12681/bioeth.26540
Du, L., Murdoch, B., Chiu, C., & Caulfield, T. (2016). Compelled Disclosure of Confidential Information in Patient Safety Research. Legal ethics assignmentJournal Of Patient Safety, 17(3), 200-206. https://doi.org/10.1097/pts.0000000000000293 Joy, P. (2019). Reflections on Adrian Evans' Contributions Internationally to Clinical Legal Education and Legal Ethics.
International Journal Of Clinical Legal Education, 26(2), 105-111. https://doi.org/10.19164/ijcle.v26i2.852 McDougall, R., Shadbolt, C., & Gillam, L. (2019). The practice of balancing in clinical ethics case consultation. Clinical Ethics, 15(1), 49-55. https://doi.org/10.1177/1477750919897377
Rimmer, A. (2017). Five facts about patient confidentiality. BMJ, j636. https://doi.org/10.1136/bmj.j636