Legal And Ethical Implications In Palliative Cancer Care - A Case Study Essay.

The Importance of Legal and Ethical Considerations in Healthcare

Question:

Discuss about the Ethical and Legal Implications of Mabel.

All kinds of services have to be conducted in complete accordance with the main ethical and legal considerations, in order to ensure that the provided services are just and fair. All sectors and industries have to work in accordance with the aforementioned, with the healthcare sector being no exception to this rule. The work of this sector is among the most crucial services to be provided within society since the very well-being and health of the people under care are in the hands of the service providers. The following study details the case of Mabel, a ninety-one-year old patient who has been diagnosed with the palliative stage of cancer.  Her family, out of concern for her mental and physical state, has requested that she remain in the dark regarding her condition. They are of the opinion that she can live the rest of her days in comfort, without the fear of knowing about the condition which she is suffering from. She has demonstrated awareness in knowing what her medications are for. Herein, this study is regarding the case study of Mabel and the main legal and ethical implications of the same. 

The details of this case make it clear that the relevant people have made it a point to take the mental and psychological well-being of the patient in question while taking the decisions that they did. They have instructed all the caretakers and service providers close to the patient to not tell her anything regarding the condition that she is currently suffering from. While the main intent behind the decision is noble in their part, the fact of the matter is that this decision can violate some ethical and legal considerations. Indeed, among the first and foremost ethical implications that can be observed from this case is that a patient has every right to know about the condition that she is suffering from, so as to be able to come to terms with the potential consequences in the first place. Indeed, Mabel must preferably be aware of the condition she is in, as she has the ethical right to know and reflect on the existing state that she is in.

Furthermore, her family is of the opinion that they are the ones who should be making the main decisions for her sake. This is in direct contrast to the legal rules and relevant legislations which have clearly stated that the main person responsible for making decisions regarding their own conditions is the patient under consideration themselves (Grace, 2017). The Australian Charter of Health Care Rights has clearly stated that the patient is the one who has the highest right to make decisions regarding their states and that their families and close relatives can only be considered to be the main decision makers in case they themselves are unable to (Cherry & Jacob, 2016). While Mabel is certainly old and frail, the fact that she has displayed a keen sense of awareness is a quite detailed and crucial indicator of her ability to make rational decisions. Thus, the main ethical and legal implications of this case scenario are both in favour of telling the patient under review about her condition, and enabling her to be involved in the decision making processes along with her family.   

Case Study: Mabel and Her Family’s Decision to Withhold Information

Several Acts and Regulations comprise of details which can prove to be immensely beneficial in this case scenario. The Consent to Medical Treatment and Palliative Care Act of the year 1995 clearly state that the people to be included in the main details of a condition suffered by someone are the attending doctors, caretakers, relevant family members and the patient themselves (Burkhardt & Nathaniel, 2013). The patient in this case, while old and feeble has still demonstrated enough awareness of her surroundings. She still possesses the rational thinking ability and keen awareness which makes her eligible to be declared able enough in making her decisions. While leaving her on her own can be problematic (considering her age), leaving her completely out of the entire decision-making process is unjust and legally wrong (as is evident from the details of the aforementioned Act). The Australian Charter of Health Care Rights has also made it a point to include the rights of the patient to know about their state as for matters of considerable importance (Australasian Legal Information Institute (AustLII), 2017).

The caretakers and service providers also have to work in accordance with certain rights and regulations. The Right of Informed Consent 2002 (as well as its revised version of 2009) is one such act which they have to abide by while completing their relevant tasks. This Act details the importance and necessity of obtaining the informed consent of the patient themselves before providing them with any kind of health care services. A revised version of this Act has also been included within the main Commonwealth Legislation, under the Legislations Act 2003. The only way a party is allowed to violate this Act in any shape of form is when the patient in question has been declared to be medically unable to consent to their own treatment in any shape, form or condition (Gaudine & Beaton, 2016). The details of the case scenario have clearly stated that the patient is not someone who is completely unable to make her own decisions in these conditions.

The Nurse Practice Act 2010 and the Nursing and Midwife Code 2016 are some of the Codes and Acts which are in complete accordance with, and highlight the importance of the ten codes of nursing. These Acts highlight the importance of practicing in a safe and secure manner, working in accordance with proper guidelines and standards, following all the necessary laws, respecting the culture and dignity along with the ethnic values of different people and maintain the confidentiality of their patient’s personal data. Furthermore, the nurses have to provide accurate and impartial information whenever necessary, support the decision-making rights and well-being of their patients, maintain the trust of people under their care, preserve the knowledge entrusted to them, build the trust placed on them by the community and the society as a whole and practice all of their tasks in an ethical, legal and reflective manner (Arnold & Boggs, 2015).  

Legal and Ethical Implications of Withholding Information

Several ethical principles are to be taken seriously while discussing this case. Assessing the decision-making ability of the reviewed patient, Mabel, is of fundamental importance and cannot be underestimated or ignored in any manner. The aspect of autonomy has to be respected and dealt with accordingly, in a manner which fulfils the main rights that a patient such as the aforementioned has (Bramley & Matiti, 2014). The principle of autonomy has been recognized for its importance in several fields including healthcare. Indeed, this principle has been accorded immense importance in other fields such as law and ethics as well. Respecting the principle of autonomy in medical cases such as this one directly translates to providing appropriate respect to the capacity and right of a person in being capable enough in making decisions regarding the procedures of treatment to be provided to them (Greenfield & Jensen, 2016). Mabel is being deprived of this very right in this case scenario, as she is being left in the dark regarding the disease which is plaguing her. The ethical thing to do in this regard is to ensure that she is made aware of the fact that she is suffering from a palliative stage of cancer.

Completion of the aforementioned can help her in at least being able to make a relevant decision regarding her future and her bodily conditions, with proper help from her family members and relevant caretakers. In addition, an achievement of the same can also take care of the ethical requirement of taking informed consent from the patient under consideration in this case. The people with the highest amount of entitlement on what is to be done with their body are the patient themselves, as mentioned in the previous sections (Connelly, 2014). Not letting Mabel know about the condition and keeping her in the dark while administering her with the necessary medications is a violation of her basic right. Thus, the ethical principle of informed consent is extremely relevant in this case scenario, as the very validity of the legal and ethical status of the treatment depends on it. Maintaining proper ethical principles can help in providing proper levels of treatment while ensuring that all legal matters are dealt with in an efficient and appropriate manner.

Since the person under review in this study has displayed the ability to make certain decisions (as she is mentally fit enough to be aware of being administered with specified medications), the best thing is to inform her about all details. However, the ethical rights of the patient have not been met, as the patient is kept in the dark. But the reason of the family members in going through with these actions is mainly the well-being of Mabel. Thus, their ethical principles are in direct contrast with the legal requirements, which clearly state that they have to inform Mabel of her condition immediately. The view point of the family has to be changed in order to initiate a desirable situation for all.   

Acts and Regulations Relevant to Palliative Cancer Care

After going through all intricate details of the case scenario and conducting an analysis regarding the legal and ethical rights of the patient in question, the main course of action is undoubtedly ensuring that Mabel knows all the main details regarding her condition. Making sure that this process is completed in an efficient and effective manner is desirable, so the process in question has to be planned accordingly (Johnstone, 2015). The first thing to do is to inform the family members of the importance of letting Mabel know about all the relevant details of her case. Letting them know about the potential legal complications of a failure of the same as well as the importance of the consent of the patient in conducting a legal treatment can help with the same. Once their consent is obtained, the news has to be broken to Mabel in a slow and detailed manner so as to not startle her, with the addition of providing her with an assurance of comfort and proper treatment. Once the patient has been safely informed, all relevant decision and plans for the future must include her honest opinion as well.

The next stages of treatment (as well as all of the decisions to be made thereafter) have to be completed in accordance with the consent and honest desires of the patient. The patient has to be helped in this regard by the family members and caretaking service providers in order to ensure proper treatment and correct decision making. The main rationale for this course of action is to ensure that all the ethical and legal considerations are met while providing Mabel with treatment, which can prevent any potential legislative violations. In addition, an achievement of the same is ethically beneficial for all involved parties.

Conclusion

The importance of following ethical and legal considerations while completing a health care service can never be underestimated or ignored. All relevant rights and ethical requirements of a patient have to be respected, regardless of the age or gender of the patient in question. The patient under review in this study, Mabel has demonstrated a decent level of awareness and the ability to make proper decisions. In accordance with the legal and ethical considerations of several legislations, she has to be informed about her condition, with her consent being important for further treatment. The best way of going forward is by ensuring that the patient and her family members cooperate with her service providers in making proper decisions regarding her treatment in the future. Thus, it is concluded that a patient has the right to make decisions about their own state.

References

Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.

Australasian Legal Information Institute (AustLII). (2017). Austlii.edu.au. https://www.austlii.edu.au/

Bramley, L., & Matiti, M. (2014). How does it really feel to be in my shoes? Patients' experiences of compassion within nursing care and their perceptions of developing compassionate nurses. Journal of clinical nursing, 23(19-20), 2790-2799.

Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Cengage Learning.

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Connelly, L. M. (2014). Ethical considerations in research studies. Medsurg Nursing, 23(1), 54.

Gaudine, A. P., & Beaton, M. R. (2016). Employed to go against one's values: nurse managers' accounts of ethical conflict with their organizations. Canadian Journal of Nursing Research Archive, 34(2).

Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.

Greenfield, B. H., & Jensen, G. M. (2016). Understanding the lived experiences of patients: Application of a phenomenological approach to ethics. Physical Therapy, 90(8), 1185-1197.

Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.