Identification of the Ethical Issues
Discuss about the Ethical Issues Prevailing In The Case Study Of Archie Simpson.
Health care delivery and access can be considered as a multifactorial phenomenon, there are various internal and external factors associated with the delivery of care and the quality of the care provided to the patients. Along with that, there are myriad of different factors associated with the care delivery scenario, one of the most impactful aspects can be the ethical right and wrong in the care provided (Runciman, Merry & Walton, 2017). This essay will aim to explore the ethical issues prevailing in the case study of Archie Simpson and will analyze the case study with respect to notions of human dignity, human rights, professional codes of ethics or conduct, relevant professional policies or legislation, and the principles of health care ethics.
This case study deals with the case of Archie Simpson, who was born with a progressive disorder known as the encephalomyopathic mitochondrial DNA depletion syndrome or MDDS. According to the El-Hattab and Scaglia (2013), this particular disease represents a group of autosomal recessive disorders that directly result in a significant drop in the mitochondrial DNA in the affected tissues and lead to any combination of myopathic, hepatopathic or encephalomyopathic symptoms. This particular disease is fatal in infancy or in the early years of childhood and in case of Archie as well, the doctors have told Archie’s parents that he will not survive more than a few months, and the patient was soon referred to the palliative care team for controlling the symptoms. However, the midwife instructed them not to give up as there is early stage research going on the MDDS syndrome and it may benefit their son in the future. In this case, it has to be mentioned that health care given by any care provider needs to be based on evidences. A care provider is not allowed to provide intervention or recommendations to the patients or their family members based on opinion or incomplete information or irrelevant data. In this case, the midwife named Mandy gave the parents of the patient with false hope and recommended them to pursue treatment with the hopes of recovery in distant future. In this case, the midwife did not have any core evidence, based on which she made that recommendation to the parents, and hence it can be considered a significant ethical violation of the code of conduct with respects to the registered practice of midwives in the Australian context (Nursing and Midwifery Board of Australia, 2018).
Analysis of the Ethical Issues
The second and most important ethical issue in this case study had been the hospital administration and the doctors’ decision to cease the medical treatment that was being provided to the patient. On a more elaborative note, it has to be mentioned that with respect to the information available in the case study, Archie’s parents took him back to the hospital due to the symptoms of breathing troubles, and in the health care facility, it was discovered that Archie also had severe muscle weakness and was non-responsive to any stimuli. He was admitted to neonatal intensive care unit and was incubated and ventilated. The doctors soon after informed the parents that Archie had not been responding any external stimuli and any further treatment will be futile hence withdrawing the curative measures will be of best interest to the patient. However, when, as recommended by the midwife the parents declined to opt for this alternative, the doctors under the pressure of hospital administration staff wanted to withdraw the treatment, as there is urgent need for beds in the NICU. This is the most important ethical issue presented in the health care scenario, according to the basic human dignity and fundamental right to health, each and every patient is entitled to life-sustaining treatment without any discrimination (Chadwick & Gallagher, 2016). Along with that, withdrawing medical treatment is a decision that can only be taken by the patient or the next of kin of the patient in case the patient is not able to make conscious decision regarding the same. In this case, the doctors or the health care facilities cannot decide to stop the treatment of the patient under any circumstances. Hence, it also violates the professional code of conduct and the human dignity along with human rights as well (Hmanrights.gov.au, 2018).
The first and foremost ethical issue represented by the case study is the lack of evidence based practice by the midwife named Mandy. According to the professional standards for practice for the midwives in the Australian demographics, the first standard states that the practice of the midwives must “Promote health and wellbeing through evidence-based midwifery practice” (Nursing and Midwifery Board of Australia, 2018). Evidence based practice can be defined by the model of health care that integrates current best research evidence that has been published in relevant and authentic articles that can be accessed from relevant and authentic databases. In this case, the midwife had very vague information regarding the research being conducted on the MDDS and Mandy had no definite evidence on how the research can benefit Archie either. Hence, while advising the parents with the fact that the research can help Archie with the treatment, the midwife gave the parents of the patient a false hope which is not only violation of professional practice standards and the code of conduct, it also violated the basic human dignity and justice (Hmanrights.gov.au, 2018).
It has to be mentioned that the most impactful and grave ethical issue represented in the case study had been the issue of withdrawing curative measures for Archie. However, access to medical care cannot be denied to any patient without the consent of the patient, and their family members (The National Code of Conduct for Health Care Workers, 2018). Considering the standard 2.3 of Good medical practice issued by Medical Board of Australia, the health care providers need to practice shared decision making while making any clinical decisions that may directly or indirectly harm the patient. According to the code 1.6, the in case the patient is not able to make conscious decisions; the parents can act as the substitute decision maker (Medical Board of Australia, 2018). Hence, any clinical decision needs to be made with complete consent and equal participation of the patient or the substitute decision maker. In this case, the hospital administrators have violated this professional code of shared decision making while pressurizing the doctors to withdraw treatment. Along with that, the hospital administrators have been forcing the doctors to end all curative measures for Archie due to scarcity of beds in the NICU unit, which is a direct discrimination towards the patient and a violation of human rights and dignity (van Manen, 2014). According to the code 2.4 (Decisions about access to medical care), each and every patient needs to be treated with equality and there should not be any discrimination while providing care to the patients based on any related confounding factors. According to the basics of human dignity and basic right to health, adhering to the dignity and fundamental rights of a patients is associated intricately with the code of ethics of health care legislation in Australia. Denying any life sustaining treatment to the patient which can lead to the death of the patient has to be considered as violation of basic human dignity as well (Humanrights.gov.au, 2018).
Lastly, considering the ethical principles, there are 4 key ethical principles violated in this scenario. Firstly, according to the principle of non-maleficence and beneficence, the care providers not to participate or design a procedure that has the probability of harming the patients and participate in activities that has the singular intent of benefiting the patient. In this case, even though the treatment measures were futile, ending all curative measures will lead to the death of the patient (Hmanrights.gov.au, 2018). Hence withdrawing the curative measures will not be beneficial for the patient instead it will cause harm to the patient directly. Hence, even though Archie was not responding to the treatments, the care providers intending to withdraw it violated both principles of non-maleficence and beneficence. Along with that, the third ethical principle violated in this case had been justice, which directs the health care providers to treat all patients with equality and fairness. In here as well, the health care providers decided to discontinue treatment for Archie to accommodate more patients in the NICU due to limited numbers of beds which is undoubtedly a violation of the ethical principle of justice (White, Willmott, Cartwright, Parker & Williams, 2014).
It has to be highlighted that actions present in the study cannot and should not be repeated in the future care scenarios that can harm the patient or can lead to the death of a patient. Firstly, the midwives need to adhere to evidence based practice even when giving suggestions to the patient families (NMBA Code of ethics, 2018). In order to ensure compliance from the midwives, there should be advanced training and skill enhancement programs that will help the midwives and the other care professionals can understand their scope of practice with clarity and be aware of the code of conduct and practice protocol (Feltman, Du & Leuthner, 2012). The training should also focus on enhancing the ability of the care providers to use evidence based practice and implement it strictly into their everyday practice. Along with that, there should a patient welfare protection committee overlooking the actions of the medical and administrative staff of the facility to ensure that no malpractice are being encouraged in the facility and that all the patients are treated with justice and equality (Brecht & Wilkinson, 2015).
On a concluding note, ethical dilemma is a common construct in the context of care designing and delivery and as a result, there are various ethical standards and practice principles that help in guiding the health care providers to adhere to the most ethical manner of care delivery. This essay outlined a very similar ethical dilemma that gave rise to two key ethical issues that violated key ethical principles, code of conduct and professional legislations. This essay had been a wonderful opportunity to analyze the ethical issues with respect to professional codes of conducts, ethical principles and professional standards and to understand how to avoid such ethical and professional mishaps from happening in the future.
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