Ethics and Laws Nursing.
Ethics are explained merely as a system of moral laws or principles, and these are used by individuals to determine how they live and also make decisions in their everyday lives. Therefore ethics is a branch of philosophy which involves creating systems, having a way to defend and making recommendations on ideas on how to act and whether its right or wrong (Hall, Orentlicher, Bobinski, Bagley & Cohen, 2018). Hence medical ethics are a set of moral principles that individuals in the medical profession follow to govern the practice of medicine (Runciman, Merry, & Walton, 2017). Medical ethics are used by healthcare professionals to examine a particular medical issue or case and then utilize facts, values, and logic to come up with a solution. Laws are a set of rules and regulations that are set for a group of individuals to follow, and they are used to regulate their actions and also give a set of penalties if the rules are not followed (Veitch, 2017). Medical law, therefore, is a branch in the law which involves a set of rules and regulations that medical professionals are supposed to follow and also the rights of patients that are supposed to be followed (McLean, 2016). This essay will examine the case study on Jo and will describe some of the various laws and ethics that are applicable in the case study. It will also look at ethical principles theories should be applied in the case, the professional practices standards that were met or overlooked and torts applicable in this case.
In this current world, each patient holds the hope that the medical professionals that are taking care of them are up to date with the current laws and ethics about healthcare. These guidelines are essential especially in the healthcare profession to reduce the occurrence of medical malpractices and when they do occur to ensure the perpetrators are punished and that also patient rights are protected (Percival, 2014). There are various reasons why medical ethics and laws are essential. First, sometimes conflicts occur when practicing the healthcare profession and thus these medical ethics and laws aid in resolving these disputes that could happen that could occur between the families, the patients, and the physicians (Carrese, et.al, 2015). Next, it helps medical professionals have a clear conscience while treating their patients. When physicians follow these medical ethics and laws when treating their patients, they are sure they are doing the right thing every step of the way (Stahl & Coeckelbergh, 2016).
The case of Jo’s treatment has a variety of ethical issues and dilemmas. First, the registered nurse who examined Jo found her case necessitated the need for a doctor to examine her immediately, however, since there was a motorcycle traffic accident that had happened Jo was kept waiting and the doctor treated the accident patient. The dilemma comes in that the doctor had to decide whose life was more in danger at the moment the one whom they knew the extent of his injuries or Jo who they did not know what was wrong with her. The next one is that the rural accident and emergency department where Jo went to receive treatment was short staffed. This is ethically wrong since it shows that they are not well equipped to treat their patients when emergency incidents occur, and thus it means some of the patients might not receive proper care when they go to the hospital, and it is wrong as it is their duty. Another one is that one of the main side effects of Mylanta the drug that Jo informed the RN that she had been taking is nausea and vomiting (Rothman, 2017). The nurse should have known that this was a possibility and told the doctor of the urgency of the condition so that she could get assessed faster. Another ethical dilemma was the fact that even though Jo knew that she felt sick and not well she was so nice since she saw that the accident patient required more attention than her. She took it upon herself to decide not seek for help since she felt her case was not important enough and this might have affected her health outcome. Finally, since the patient aspirated in the ward before the emergency, there are ethical issues which will arise from this fact. The medical professionals who were monitoring her from the RN to the doctor should have noticed this before she went for the procedure as this could have led to worsening of her condition. However, aspirations are pretty hard to diagnose hence it is hard to say if they should have stopped to diagnose it or hurry her into the emergency endoscopy (Walker, 2016).
Healthcare professionals should always know the legal and ethical parts involving the rights of their patients which will ensure that they have a good relationship with them while caring for them. In the case of Jo and her course of treatment, various principles of medical ethics are applicable. The first principle is non-maleficence which means do no harm. Medical practitioners are bound by law to treat and act around patients in a manner which does not cause them harm (Sher, 2011). In this case, the RN and doctor did not practice this as they brought harm to Jo by putting off her care for a while since there was an emergency case and also the fact that they were short staffed this could not properly care for her. However, they also tried their best to do no harm to her since the RN ensured that she monitored Jo’s condition and decided to relive her pain and when she got worse the senior doctor was called in to examine her. Another one is that the medication prescribed to reduce her pain caused her other symptoms to worsen thus the doctor caused her harm. Another example is when the anaesthetist found it difficult to maintain Jo’s oxygen saturation levels during surgery. It is the medical team’s duty to ensure that the O2 saturation levels are maintained and no complications arise, and they should know that factors such as age, history of smoking, heart and breathing issues and sedation increase the likelihood that there will be oxygen desaturation in a patient. Therefore in a bid to cause no harm to the patient, the RN should have taken thorough patient history therefore the medical team would have known that there is increased likelihood that of complications like oxygen desaturation would have occurred during the endoscopy there taken steps to prevent this therefore making Jo’s condition better not worse (She,2011).Also, studies show that when high risk patients are monitored by use of pulse oximetry which will help RN’s to use some nursing intervention techniques to prevent the occurrence of oxygen desaturation and the risks associated with them. Therefore in this case such monitoring should have occurred for Jo since she was in a bad condition therefore such interventions would have prevented her from getting complications during her endoscopy (Sher, 2011).
Another principle is beneficence which is related to the Hippocratic oath whereby physicians are expected to heal and help those in their care. Healthcare givers are required to ensure that their patients receive the best care possible when they seek their help. Therefore, in this case, this did not happen for Jo since she was put in waiting even though she was sick and it was until her condition worsened that a doctor saw her. However, they did everything for the patient who was involved in the motorcycle traffic accident (Schwab, 2017). Next, is the principle of justice where every patient has the right to be treated fairly. Specifically, in this case, is distributive justice which means that any individual who seeks healthcare in any medical institution should be treated equally regardless of their ethnicity, age, gender, social standing, medical diagnosis and any other individual characteristics they may have (Steele, Iribarne & Carr, 2016). Thus in this case since Jo’s diagnosis was not as urgent as the accident patient, she was made to wait, and this was not fair since she came to the hospital to get treated and she had to wait.
The next is the principle of autonomy. This principle means that an individual has the right to make decisions concerning their health without any influence and there should be no coercion, threat or manipulation when they are making this decision. The patient's autonomy should always be respected. Therefore, in this case, it was no respected even though it was indirectly done Jo made her decision not to disturb the healthcare givers and this decision was influenced by what she saw (Holmes, 2016). When she saw that the hospital was short-staffed and that there was an accident she decided not to seek further help since she felt she would be overwhelming the hospital and this affected the care she received as she was made to wait.
Two ethical theories can be applied in this case; the utilitarianism and deontology ethical theories. The utilitarianism theory is whereby the greatest good is done where it will benefit the most significant number of people and how it will be done will be determined by what the results. Primarily this theory considers the needs of the many over the needs of an individual and thus good will be done where it will influence the most significant number of people (Wagner & Dahnke, 2015). In this case study, this theory can be applied in resolving the issues that are found in it. The medical center is understaffed since they could not take care Jo and the other accident patient at the same time therefore for the greater good of the community, the center needs to employ more staff to help this situation. When there is enough medical staff at hand, it ensures that patients have quality healthcare when they seek help at the medical center. The next one is deontology theory which advocates for a healthcare professional to treat the patients in the right way and that they respect a patient’s rights. This theory puts into consideration if an action is right or wrong and thus it is primarily black and white in the sense that what is right is right and what is wrong is wrong (Filip, Saheba, Wick, & Amir Radfar, 2016). In this case, it was wrong for Jo to be kept waiting since her medical diagnosis was not that urgent and thus her conditioned worsened until she was taken to the high dependency unit. Both theories, when used on their own, are not very effective, but when they are combined, they work well. Therefore by using both of them, it ensures that patients get the best and quality healthcare.
Medical laws and doctrines are a set of rules and regulations about the rights and responsibilities that a healthcare professional and patient have. These laws guide them on how to behave and how they are supposed to be treated in the healthcare setting. The first one is consenting which is a fundamental medical law. Patients or their families are required to give their permission for a procedure to be performed, and they should understand what they are consenting to and the risks that come with them. Therefore it is vital for consent to be always given so that both parties can avoid conflict after the treatment is already done (Martí, Monguet Fierro, Trejo Omeñaca, & Ecarrabill, 2015). In this case, consent was given for the emergency endoscopy to be done on Jo when her condition worsened.
Next, the doctrine of double effect which means that a medical procedure can permissibly do harm while in the pursuit of doing good. It is perfectly legal for patients to suffer from their side effects from taking to medication to treat medical conditions. This is because these medications were prescribed to treat the conditions and if they suffer from the side effects the doctor is not the label (Gross & Carrick, 2016). In Jo’s case, the RN prescribed Pethidine 100mg and Maxolon 10mg by the doctor which was supposed to treat her pain and also nausea. However, the medication caused her other symptoms to worsen and caused her to be drowsy and vomit the coffee ground fluid once more. The doctor is not liable since they intended to relieve the symptoms and not cause any harm to Jo. Another example is that every doctor advices their patients to not eat a few hours prior to an operation to prevent complications such as aspiration during the procedure. In this effect this could not happen since Jo required emergency endoscopy and as a result she could not have fasted as advised and thus to save her life the doctor had to overlook such complications therefore exposing her to risks to save her life.
Another one is negligence which is where a medical professional omits an act or fails to act in a manner that is not acceptable in the healthcare setting and does not meet the medical standards of care. When medical professionals operate negligently, they are liable to be charged with medical malpractice suits since negligence most of the time result in harm to the patient in question (Mortensen, 2018). In this case, Jo’s care was neglected when she was made to wait to be treated. This was some form of negligence since she required attention, but she had to wait for another patient to be served. Another form of negligence was the fact that the nurse should have taken the patient history to find out what she had eaten before and this would have helped them find out if the vomiting could cause aspirations. As a result of not finding out patient history, the doctors could not find a safer way to treat Jo thus her condition would not have worsened to the point that she had to be taken to the HDU. Another law is liability whereby an employer is found responsible for the actions of their employee such as when they are negligent. When the employer pays the damages for the suit filed due to negligence, the employee will pay for these damages. The negligent employee will be reported a medical body of conduct where they will punish for their actions in case the patient who has been harmed files a legal suit. Therefore in this example, if Jo’s family takes legal action, they can find out if there was negligence and the one found guilty will be reported and the necessary disciplinary action taken (Boumil & Hattis, 2017). Another example of liability in this case is the fact that it is the RN’s duty to ensure that they take a very thorough patient history to find out everything that will make th doctors job easier while designing a course of care for the patient. Since the aspiration event seems like it could have been prevented through taking patient history, the RN is liable for this since it led to Jo getting worse.
Next is documentation and that is where there are medical laws which require healthcare center should keep documents on anything that happens while caring for a patient. This documentation is showing precisely what is done to a patient while they are being taken care of in a hospital (Utter, Vermoch, & Rogers, 2015). These documents provide good defense in case of anything, and thus this can be used by doctors to defend themselves in case of a malpractice suit (Clarke, 2017). Therefore it is their responsibility to ensure that the correct records are kept, and everything is noted down always. In this case, since Jo’s condition worsened even after she went to the hospital. Therefore records of what was done to her should have been kept since there are legal actions taken by her or her family in the future.
Finally is the doctrine of necessity whereby medical professionals have the legal permission to treat their patients when they are not able to give consent in cases of emergency situations. When a patient is in an emergency situation, and they cannot provide permission for the treatment, and the procedure is required for life to be preserved, the procedure can be done without any consent or any delay (Chandler, White & Wilmott, 2016). In Jo’s case since her condition was worsening the medical team was within their rights to perform the emergency endoscopy so that they would find out what was wrong with her.
There medical standards that medical professionals are required to follow when treating and caring for their patients. These standards are regulated by different bodies of medical professionals depending on the country, and when a patient is unsure of their doctor’s conduct, they can check with them. In this case, the RN followed procedure, and when the condition worsened, she called in the doctor once they could not get her to better a senior doctor was brought in. This is the right thing to do according to the standards set. Therefore these standards ensure that there is accountability in the healthcare setting (Baker, 2015).
Medical torts are basically whereby an individual has civil wrongdoing done to them, and in this case, the wrong is in medical terms in regards to a healthcare setting. When the injustice is done the individual seeks to file a suit due to an injury suffered, and they require damages mostly money damages against the alleged person who did the wrong (Reagan, 2016). In this case, Jo or her family can argue that she was made to wait for medical attention and she received attention when her condition worsened. Also, since she aspirated in the ward and the RN or doctors did not catch this it likely affected the outcome of her emergency endoscopy. Finally, the medication that was supposed to relive her pain worsened her other conditions such as nausea and vomiting which ultimately required her to get an emergency endoscopy, and she ended up in the high dependency unit.
In conclusion ethics and laws in the healthcare setting are quite important especially should always be followed by medical practitioners while doing their work. It will ensure that they do their work safely, ethically and follow the rules and regulations. They also ensure that medical professionals are afraid of committing mistakes while caring for their patients and thus this ensures that their patients receive quality health care. The case study evaluates the different legal and ethical issues present in the case. It clearly shows that different situations in the healthcare setting can result in a moral dilemma which requires healthcare professionals to make decisions which are for the best of the patient in their care. These decisions, however, should follow the rules, ethics and should have the consent of the patient to ensure they know what is being done to them. At other times in cases of emergencies, decisions should be made that are in the best interest of the patient’s health. Therefore more studies should be cone on medical laws and ethics focusing on different case studies which will help healthcare professionals know what to do in different situations.
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