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Ethical and Legal Conflicts

Discuss about the An Ethical Dilemma for Residential Aged Care.

An ethical dilemma is a situation in which one finds difficult to handle and often calls for an apparent mental conflict between moral laws, whereby choosing to abide by one would lead to transgressing the other. An ethical dilemma, in this case, is a situation, in which a registered nurse (RN) on duty insists on taking Elsie to the hospital because of her deteriorated health condition, and further, the paramedics attempted resuscitation despite the fact that Elsie did not want it done on her. Unfortunately, Elsie died upon arrival to the emergency department. As a result, Elsie’s family sues the RN, the paramedics and the Residential Aged Care (RAC) facility for taking Elsie to the hospital against her will, making her stressed leading to her death. The scenario presents different stakeholders: Two healthcare professionals – the RN and the paramedics, the RAC facility, the family members and the student studying the course. What follows in this discussion, therefore, is the ethical and legal conflicts of the scenario, and how they would be resolved in a legal and ethical manner.

In this setting, there are several potential sources of conflicts. The American Nurses Association Code of Ethics (2001) guides nursing practice in the U.S. It guides the duties and the ethical obligations of persons within the nursing profession. According to the Code, there is a conviction that “nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups and communities” (p.5). In this regard, nurses are obliged to adhere to the beliefs and values presented in code. However, nurses in a rehabilitation setting work together with diverse individuals each from different disciplines, with its unique set of values and beliefs to guide the professionals (Jiménez-Herrera & Axelsson, 2015). Despite the fact that these disciplines could have common beliefs and values like to respect the humanness, and the individual being attended to, there are differences in how to deliver the services. According to Savage, Parson, Zollman & Kirschner (2009), this can lead to a source of conflict. For example, the fact that the RN thought it was right to take Elsie to the hospital does not mean that she could find treatment there because she had not filled the advanced care directive. In this situation, a physical therapist at the hospital could refuse to attend to Elsie because according to the profession’s code of ethics it would be unethical to do what the patient does not want. Thus, it becomes an ethical conflict between the RN and the physical therapist at the hospital.

Impact of the Conflict on Stakeholders

Another possible source of an ethical conflict is the expectations and beliefs of the consumer according to the regulatory requirements. A governing body for rehabilitation known as the Commission on Accreditation on Rehabilitation Facilities calls for its team to involve and respect the decisions of the individuals they are serving throughout the recovery process (Holm & Severinsson, 2014). If at all the patients and the family members refuse recommendations or treatments from the healthcare provider, then there is a possibility for a moral dilemma to the healthcare personnel. A moral dilemma only transpires when there are two or more moral principles that apply but support mutually contradictory actions (Hopia, Lottes & Kanne, 2016). For example, the RN and the paramedics in the case believed it was right for Elsie to be treated. However, Elsie asked them to leave her the way she was. It becomes a difficult situation to the RN and the paramedics, and they decide to carry on with resuscitation which did not work.

Healthcare realm has become more and more litigious with patients expecting perfect results each time they attend care. However, requirements extend even beyond care and treatment to insurance authorization, licensure, regulations for healthcare organization accreditation, and privacy of healthcare information. Besides, they permeate daily practice and form a framework for providing care (Holm & Severinsson, 2014). Additionally, the Joint Commission for Accreditation of Healthcare Organizations surveys institutions whether ambulatory, hospitals, rehabilitation, hospice, among others, offering health care and awards accreditation upon meeting its standards, which get divided into three broad categories. One is the patient-focused functions such as patients’ rights. Two is the organization focused functions such as prevention and control of infection and management of the environment of care. Three is structures having features like management, medical staff, and nursing. Other than that, the controlled health care environment often has some hidden sources of legal conflicts; that is, the restrictions and the requirements of what should be done, when and by whom (Kangasniemi, Pakkanen & Korhonen, 2015). In the case of Elsie, a legal conflict arises because Elsie had already discussed with her family that she did not want any aggressive treatment or resuscitation done on her. However, the registered nurse insisted on doing what she thought was right. As a result, a legal conflict arises between the healthcare professionals and the family members, who claim that the RN and the paramedics are the causes of Elsie’s death. Their reason for this is that their actions made the patient stressed up because it was against her will.

Human Dignity and Human Rights

Of course, patient care is an essential aspect of a human right to health. It values both attention and scrutiny. Instead of appropriate care, healthcare providers and patients may face a variety of abuses that insult human dignity and jeopardize health outcomes (Rosoff & Leong, 2015). They range from violations of patient’s rights to confidentiality, privacy, informed consent, and non-discrimination to other abuses which are inhuman, cruel and degrade treatment. Likewise, the health care providers may face violations like sanctions for offering evidence-based healthcare, unsafe working conditions, denial of due process in case a client complains about them, and limits on the freedom of association. Based on the conflicts mentioned in the above scenario, there are vast violations of human rights. For example, the conflicts violate the nurses right to practice in a way that satisfies their duties to the community and the patient. Other than that, they violate the patient’s right to refuse treatment which affects her care.

In the society today, there are different values outlined in the Constitution providing the foundation for the society. Besides, there are four guiding principles of healthcare ethics: autonomy, beneficence and nonmaleficence, veracity and justice (Tomi?-Petrovi?, 2015). Autonomy is the obligation to allow a person the right to make a decision (Rosoff & Leong, 2015). Conflicts occurred when the individuals served to make decisions that collide with that of the healthcare professionals. An example is that of Elsie whereby she refuses treatment which the RN believes in not safe for her. The autonomy principle, however, indicates that the health care personnel must respect what the patient wants (Tomi?-Petrovi?, 2015). Beneficence, on the other hand, is the obligation to do good, while nonmaleficence is the requirement to do no harm. In this case, the nurse is expected to choose what is right when in a state of treatment options. Veracity offers the duty to truthful and provides the necessary information to the patient. In a situation where providing medication would be beneficial but has some significant risk, then it would be important, to tell the truth to the patient in a manner that the patient would understand (Sabatino, Kangasniemi, Rocco, Alvaro & Stievano, 2016). Lastly, justice is the responsibility of being fair. Health care services rely on the decisions about type, payer, duration of treatment and frequency. However, insurance carriers come in with more expensive packages which favor other individuals, though not all. Thus, the question is, is justice served or not?

Principles of Healthcare Ethics

The professional virtues that do not relate more to the medical science but relate more to the patient’s experience of illness are imagination, hope, and continuity of care, witnessing, listening, presence and respect (Snelling, 2016). Therefore, to deal with a complex problem, a doctor has to come up with a coherent story, which helps more to cope than to cure. Clinical care relies on how a teller and a listener relate, and how the audience respectfully and attentively listens to the story (Berghout, Exel, Leensvaart & Cramm, 2015). Therefore, a medical professional in Elsie’s case would try to explain to the family that it is not right for a normal human being to sit and watch a patient die, while there is something that can be done to save the patient’s life. Aside from that, the family should understand that there are laws that govern the nursing profession, and they had to abide by them, failure to which they would be answerable to the law.  

The Code of ethics and professional conduct in healthcare identifies core values for the profession and creates the standards of conduct as expected by nurses in practice (Bostock-Cox, 2015). It serves as a guide to help the ethical decisions that the health care professionals face, providing them with a framework to regulate their practice (Sutcliffe, 2011). According to the case study, the relevant codes of ethics are:

  • Nurses should respect the client’s informed decision to refuse care.
  • Nurses should find consent for the nursing interventions when required and collaborate with the other health care personnel to get consent for treatment. In case clients are not able to make decisions on their own, they should seek permission from the family members.
  • Nurses should provide the necessary care unless states otherwise.

The success of the decision making in the conflict resolution policy depends heavily on how well the process got done about providing healthcare to the patient (Dubler & Liebman, 2004). It is evident that the medics were the de facto champions that must commit to embracing conflict resolution, therefore, must be supported by all the parties involved. For effective adoption and implementation of the conflict resolution policy, a thorough process of educating the medics needs to get developed. On the other hand, if RN refuses to provide health care violates the patient’s right to healthcare. Therefore, providing treatment must be considered as the correct thing to do.

Ethically, if the RN could have stopped the medics from responding to the distress call from Elsie, she or he could have faced patient’s coercion while providing treatment because of the fear of objectionable consequences from the family.  Although, it is nice to respect and acknowledge the positive decisions made by RN and the medics, the rights of the patient also need to be considered (Kangasniemi, Vaismoradi, Jasper & Turunen, 2013). With open, transparent communication, patient involvement, and cooperation healthcare conflict can get transformed into a safer one. Moreover, the health institution that is involved in the conflict must try in cooperating steps such as conducting an organization conflict assessment, providing training in conflict management and prevention among others. Additionally, the patient’s family must be involved in any action taken by the patient. Furthermore, if the situation is not easy as was in the case of Elsie, a more formal process such as mediation can help.

Solving such conditions calls for the involved parties to sit down together and talk about the issue. Legally all the parties need to follow healthcare policies. Otherwise, the professional voice of the RN attending to the patient, honest feelings of the paramedics, and the bilateral discussion of the clinical action proposals can also prevail. Moreover, the family needs to know that the paramedics have a privilege and professional obligation of assisting the patient. On the other hand, to solve such conflicts, there must be; structured communication and collaboration as well as formal mediation. It is evident that the best way to resolve problems is to bring together the affected parties so that they may talk through their dilemma. With effective communication and collaboration, there is a satisfactory resolution of the differences. Therefore, working collaboratively decreases the risk of patient outcomes.

To conclude with, an organization ought to have a well-developed system that can help in the management of the healthcare conflict (Morreim, 2015). Health institution must deviate from secretive, and blame focused formations on developing cultures of openness and learning that require all of the skills of collaboration and communication. A well-equipped health center has to incorporate effective conflict management principles and processes into their culture. Moreover, cultures that help in managing conflict positively and prioritize continuing education and training in conflict resolution equip themselves with essential means on how to solve patient safety dilemma. Further, it is vital to bring to the table the right parties, and if the problem persisted, then a mediator should come in.

References

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Washington, DC: Author.

Berghout, M., van Exel, J., Leensvaart, L., & Cramm, J. M. (2015). Healthcare professionals' views on patient-centered care in hospitals. BMC Health Services Research, 15(1), 1-13.

Bostock-Cox, B. (2015). The Nursing and Midwifery Code: Making it work for you and your patients. Practice Nurse, 45(4), 34-37.

Dubler, N. N., & Liebman, C. B. (2004). Bioethics: Mediating Conflict in the Hospital Environment. Dispute Resolution Journal, 59(2), 32-39.

Holm, A. L., & Severinsson, E. (2014). Reflections on the ethical dilemmas involved in promoting self-management. Nursing Ethics, 21(4), 402-413.

Hopia, H., Lottes, I., & Kanne, M. (2016). Ethical concerns and dilemmas of Finnish and Dutch health professionals. Nursing Ethics, 23(6), 659-673.

Jiménez-Herrera, M. F., & Axelsson, C. (2015). Some ethical conflicts in emergency care. Nursing Ethics, 22(5), 548-560.

Kangasniemi, M., Vaismoradi, M., Jasper, M., & Turunen, H. (2013). Ethical issues in patient safety: Implications for nursing management. Nursing Ethics, 20(8), 904-916.

Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an integrative review. Journal Of Advanced Nursing, 71(8), 1744-1757.

Morreim, H. (2015). Conflict Resolution in the Clinical Setting: A Story Beyond Bioethics Mediation. Journal Of Law, Medicine & Ethics, 43(4), 843-856.

Rosoff, P. M., & Leong, K. M. (2015). An Ethical and Legal Framework for Physicians as Surrogate Decision-Makers for Their Patients. Journal Of Law, Medicine & Ethics, 43(4), 857-877.

Sabatino, L., Kangasniemi, M. K., Rocco, G., Alvaro, R., & Stievano, A. (2016). Nurses’ perceptions of professional dignity in hospital settings. Nursing Ethics, 23(3), 277-293.

Savage, T. A., Parson, J., Zollman, F., & Kirschner, K. L. (2009). Rehabilitation team disagreement: Guidelines for resolution. Physical Medicine and Rehabilitation, 1, 1091–1097.

Snelling, P. C. (2016). The metaethics of nursing codes of ethics and conduct. Nursing Philosophy, 17(4), 229-249.

Sutcliffe, H. (2011). Understanding the NMC code of conduct: a student perspective. Nursing Standard, 25(52), 35-39.

Tomi?-Petrovi?, N. M. (2015). Moral responsibility of healthcare personnel. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal Of Serbia, 72(1), 77-81

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