Discuss about the Bachelor of Nursing for Multidisciplinary Healthcare.
Multidisciplinary Healthcare Perspectives
Multidisciplinary patient care is the integrated team-based approach to the healthcare system and includes treatment planning and options by collaborative processes with the allied healthcare and medical professionals. In such cases, the delivery of care and the patient-specific treatment plans become a shared responsibility and along with that comes the ethical dilemmas and legal conflicts between the involved stakeholders. Most of the ethical and clinical decisions are made between the physician and his patient, however, for chronic or complex medical problems, multidisciplinary team of healthcare professionals comes together to perform an interdisciplinary patient care that often results in interprofessional arguments (McKinney et al., 2013). This assignment will discuss the various aspects of a case where there has been an ethical and legal conflict between the healthcare professionals.
Stakeholders in the Ethical Dilemma
In the case study, baby Thomas has been in the NICU (Neonatal Intensive Care Unit) since his birth where his physical condition is in a poor state and is creating a financial burden on his parents without any significant results. With respect to the poor response to his treatment, the head of the department of anesthesia and ICU has decided to remove the baby from the life support measures as it has proved to be medically futile. This has resulted in a situation of professional and ethical dilemma among the nurses and the physiotherapists who are concerned about the future disabilities of Thomas if he happens to survive. It is evident that babies born within such a short period of gestation have almost 5% chances of survival (Dupont-Thibodeau et al., 2014). Since the 24th week, the critical stages in development initiates and the lungs are not developed enough to handle the breathing process outside the womb. Due to this, Thomas was put into the cardio-respiratory support and cerebral perfusion and chances of other severe health degradation exists.
Although the two stakeholders, namely, the nurse and the physiotherapist are aware of his medical condition, yet they are in a condition of ethical dilemma and they are concerned for the baby. Ethical dilemmas occur whenever there is any discrepancy in the agreement between the medical professionals and the parents of the infant regarding the best course of action for the interest of the infant. It is known that the outcomes of premature delivery can result in lifelong disabilities and can suffer the conditions that are either unacceptable or acceptable by all (Alden et al., 2013). Some of these conditions are cerebral palsy, mental retardation, hearing or vision loss, later psychiatric disorder and learning disabilities. The two stakeholders were well aware of these facts and therefore when Thomas was under the high degree of medical support, there was an ethical dilemma in their conscience as for whether to continue with the aggressive and expensive treatment or withdraw the life supports. Withholding of the care escalation can result in prevention of the physician and parental anxiety and lessen the suffering and pain of the infant (Doherty & Purtilo, 2015). However, it can also create a guilt feeling in the minds of the medical professionals as letting the infant die even when there is a possibility of survival. Therefore, the recommendations for the withholding or withdrawal of treatment by the physicians are often disagreed upon by the parents as they do not want their loved ones to die. Here, an interprofessional argument is clearly visible between the nurse, social worker and the physiotherapist and the other stakeholders namely the head of the ICU and head of the finance department. The former group is concerned about considering the wish of the parents to be taken into account while the later is more concerned about the medical and financial aspects of the organization. This led to the growth of an ethical dilemma. It is the duty of the nurses and the physiotherapist to move the health condition of the patients from worse to better rather than letting them die (Larcher et al., 2015). The parents of baby Thomas were also not well prepared for the high possibility that their baby might not survive and are very distressed on the decision of withdrawing treatment. In addition, there might have been a possibility of a dilemma in the minds of the parents that according to the medical science, they are going to lose their child. Therefore, it will be a waste of money to continue the expensive treatment. However, the parents love for their child have caused them to contact the media for drawing attention towards the plight of their baby for his survival in spite of the low chances of such a happening. This factor has also contributed to the rise of the ethical dilemma among the nurse and the physiotherapist regarding the withdrawal of treatment for baby Thomas.
Ethical and Legal Conflicts
Dignity and Rights of the Stakeholders
In the neonatal and fatal medicine, several stages are found that involves decision making by the stakeholders based on the ethical theories for determining whether the baby should live or should be left to die. The ethical theories and principles should not be isolated if they happen to leave a difference in the practice by the stakeholders of healthcare. Therefore, it becomes essential that the legal, social and medical frameworks for the critical care decisions have to be well understood that are related with before and after birth situations (McSherry, 2016). The dignity and rights of the stakeholders play a crucial role in the decision making process and the NICU and it also leads to interprofessional conflicts. They, being the healthcare professionals help the parents of such babies to act and feel normal in the difficult environment of the NICU while few other stakeholders try to be hardcore professionals to achieve organizational goals. Achieving the decision making through a collaborative approach should be based on the ethical theories and the relationship between the parties (Kavanaugh et al., 2015). The dignity and rights of the shareholders help in the process of shared decision making with respect to the medical context. It is a common occurrence that the perspectives of the parents of the infant contrast with that of the healthcare stakeholders as they ignore the ethical theories and focus on the illness of the patient based on their expectations, experience and knowledge (Faden et al., 2013). It is evident that the parents are more positive in such difficult situations compared to the stakeholders who are more concerned about the future of the premature baby who is more prone to develop disabilities. Therefore, the right and dignity of the stakeholders have a crucial role to play in decision making considering the interest of the parents along with the patient.
Principles and Virtues of Healthcare Ethics
The principles and virtues of healthcare ethics that informs the professional practice involve the principles of healthcare ethics in context to the Australian regulation. The legal principle of the country states that all the decisions taken by the healthcare professionals regarding the treatment of the premature newborn should be based on the best interest of the child. It is entirely a clinical judgment whether or not the resuscitation should be provided (James, Nelson & Ashwill, 2014). There are three ethical principles that related to the decision making and states that the decisions of the stakeholders should be depended on the best available evidence considering the prognosis of the newborns in the existing situation (Health.gov.au, 2016). The prognostic factors of Thomas were all degrading and none of them were in favor of the baby. Therefore, decision making considering the prognostic factors states that the survival chances are minimal and the life supports should be withdrawn. The second principle states that the wishes of the parents should be sought about resuscitation in case of survival or death with severe morbidity (Health.gov.au, 2016). Since the head of the anesthesia and ICU department along with the support of the head of the finance department did not consider the wish of the parents for continuing life supports, therefore the principle has been conflicted in this case along with interprofessional arguments. The third principle again states that if the parents feel that resuscitation is not going to help their child, they can opt for withdrawal of life-sustaining measures and go for comfort care (Health.gov.au, 2016). Again, this principle was conflicted since the opinion of the parents were not taken into account and the stakeholders decided to discontinue the life sustaining measures on the best interests of the child along with the NICU without consulting the parents.
Relevant Codes of Ethics and Professional Conduct
It is evident that about two-thirds of the babies who are born at the 24th week of gestation in Australia who are admitted to NICU do not suffer from health complications and survive to return home. On the contrary, about one third of the babies are prone to develop disabilities and therefore codes of ethics and professional conducts have been framed by the department of health for increasing the survival rates of the babies (Leuthner, 2014). According to the ‘Maternity and Neonatal Clinical Guideline’ laid down by the department of health of Queensland, Australia, honest and open communication between the healthcare team and the parents is the cornerstone of care provision and ethical decision making (Health.qld.gov.au, 2016). According to the Australian case law, the withdrawal of the interventions that are life sustaining should be carried out in consultation with the parents and other family members in accordance with the codes of professional conduct (Kemh.health.wa.gov.au, 2016). Respect and dignity should be provided to the parents and the baby for relieving the sufferings with support for the bereavement. These principles were not followed in case of baby Thomas that led to interprofessional conflicts and ethical dilemma among the healthcare stakeholder groups.
Legal and Ethical Resolution
Considering all the codes and principles of ethics and professional conduct discussed in the assignment, a legally and ethically defensible resolution can be proposed for resolving the interprofessional conflicts and the ethical dilemma. According to the clinical guidelines by the government of Australia, the decisions for critical care for the infant raise lots of critical issues (Forrester & Griffiths, 2014). Therefore, in accordance with the legal and ethical principle, the best interest of Thomas have to be taken into account as it has been observed in several cases that continuation of life-sustaining interventions has resulted in irremediable sufferings for the baby and ethical obligations cannot be imposed to continue life under such circumstances. Acknowledgment of death should also be considered as a part of life when the continuation of treatment becomes medically futile. For baby Thomas, a similar condition has arrived where the baby is no longer in a stage to return to normal condition and even if he survives, he will be living with lifelong disabilities. Since the ‘Australian and New Zealand Society of Palliative Medicine’ does not support the concept of euthanasia, therefore such an intervention has to be provided to Thomas that will relieve him of the pain even if it shortens his life as it is lawful and morally acceptable (Anzspm.org.au, 2016). This decision should be taken as a joint decision and would help to resolve the interprofessional conflicts and arguments between the different stakeholders of the NICU. A family-centered approach has to be undertaken that will consider the best interests of the family as well along with the baby and views of the different stakeholders have to be considered that will acknowledge the various responsibilities of the different stakeholders (Hagger, Ellis & Strumidlo, 2016). If the parents raise objections to this collaborative decision making, their views have to be considered prior to withdrawal of life-supporting interventions.
It can be concluded by stating that interprofessional collaboration is very much essential in cases of premature delivery and when the infant is in NICU. This is also a moment of crisis for the parents as well as they are exhausted, vulnerable and frightened and ethically, their decision should be respected since they have to live with their decision for the rest of their lives. Therefore, the stakeholders should not suffer from ethical dilemma due to the abrupt decision making by other stakeholders of the organization and everyone should abide by the code of ethics and professional conduct of Australia while making decisions for continuing or withdrawing the life-supporting interventions for baby Thomas.
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