Child Abuse And Malpractice In Healthcare: An Ethical Essay.

TASK:

1. Identify the ethical issues that are raised by the events described in the case study
2. Analyse the ethical issues in relation to the notions of human dignity, human rights, your professional codes of ethics/conduct, relevant professional policies/legislation, and the principles of health care ethics studied in this unit; and
3. Make recommendations for professional practice

CASE STUDY

Jack and Sophie are paramedics. They are called out to a home at 2200 hours. On arrival, they hear shouting from inside the house. A woman (Sandra) opens the door to them and states that her 2 year- old child, Milly, has had a fall. Jack and Sophie examine Milly who is crying and clutching her arm. They suspect a likely fracture of the humerus, and inform Sandra that they will need to transport Milly to a nearby hospital for treatment. Sandra’s partner emerges from the kitchen, visibly intoxicated. He verbally abuses Sandra and the paramedics, and attempts to prevent them from removing Milly from the house. Jack and Sophie warn Sandra’s partner that they will need to call the police if they are unable to proceed with the transfer. On the way to hospital, Sophie notices small, round-shaped burns on Milly’s legs and abdomen. On arrival at the hospital, they are greeted by Beth, the triage nurse. They report their concerns to her regarding possible physical abuse. Beth states that she will report the matter to the doctors.

After receiving a handover from the paramedics, Beth is called to check a dose of Morphine with an agency nurse on duty. Beth checks the order and removes a 10mg ampoule from the locked cupboard. The agency nurse draws up the prescribed dose of 2.5mgs. She then draws up the remainder of the ampoule in a separate syringe and states: “do you want to go halves on this”?

Identification of Ethical Issues in the Case Study

Ethics generally refer to the moral obligations that the society expects an individual or group to exhibit. These moral obligations are generally viewed as the right way of doing things. For this reason, when a person acts or behaves in a manner contrary to the confines of ethics, they earn dissatisfaction and often attract punitive measures (Post and Blustein, 2015). Since man is the only social animal endowed with reason, these codes of conducts are set to ensure harmonious coexistence between human beings. In the 21^st century, ethics are as important as they were ages ago. The dynamics of ethics have also changed due to the extensive changes in lifestyle and technology seen through the years. Ethics have become a core requirement by employers and even legislators (Freeman, 2017).  Ethics call for respect for human dignity, abstinence from forms of abuse, professional conduct (for professional in a certain field), among others. Child abuse is a breach of code of conduct and may attract punitive legal measures. The same applies to any form of malpractice among the healthcare workers. This essay is going to discuss health care ethics. Using case study three, an identification of the ethical issues raised will be identified. This will be followed by an analysis of the ethical issues. Finally, recommendations for professional practice will be outlined.

Several ethical issues are raised in this case study. One is child abuse. Child abuse is a high form of unethical behaviour (Lasswell, 2017). The suspected abuse of the child (Milly) involves physical abuse. The paramedics suspect that there is possible fracture of the humerus. Some round shaped burns are also noticed on the child’s legs and abdomen. These signs point out to possible physical abuse. The law requires that such a matter be mandatory reported to the government offices that deal with child rights. Another ethical issue raised in the case is use of abusive language by Sandra’s partner. The abusive words are directed towards both the paramedics and Sandra. This is disrespect for human dignity and highly uncalled for. Despite the abusive language from Sandra’s partner, the paramedics do not reiterate with abuse but informs that they will need to call the police in case he prevents a smooth transfer of the child to the hospital.  This is right and ethical of the paramedics and amounts to ethical conduct. The paramedics further offer the care that they are mandated to and transfer the child to a medical centre. This too amounts to ethical practice. There is also another unethical practice perpetrated by the agency nurse. She attempts to intoxicate herself using morphine. This amounts to malpractice. It is highly likely that she was already intoxicated at the time of the attempt. In addition, there is a high likelihood that she is already addicted.

Analysis of Ethical Issues

Human dignity implies the worth and respect that is accorded to a human being by the virtue of being human (Barak, 2015). Human right agencies, the international community and legislation in many countries around the globe advocate for observing human dignity. As seen in the previous section, using abusive words towards a person amounts to disrespect and does not accord the appropriate human dignity. Inflicting physical pain on a child is also reflects a disrespect of the child’s dignity (Runciman, Merry and Walton, 2017). In this case, the abuse was significant enough to prompt immediate medical attention. Physical abuse or any abuse on that matter that is perpetrated against a child amounts to child abuse and should be reported. It is mandatory that it be reported and the nurse/doctors handling the child should report the issue. The triage nurse (Beth) promises to report the matter to the doctors. This is a good move and health professionals should work together to make sure that it is reported as soon as possible to initiate appropriate investigations.

Child abuse is a gross violation of human rights. Every human being is entitled to the highest attainable physical and mental wellbeing (Forsythe, 2017). Inflicting physical pain and grievous harm to the child (Milly) amounts to a violation of human rights. Within the jurisdiction of Australia and as outlined in the convention of rights of a child, every child is entitled to special protection due to their vulnerability (Mathews, Bromfield, Walsh and Vimpani, 2015). This was not upheld in the case of Milly. Consequently, the case should be reported (mandatory) as required by the law to initiate investigations. If found culpable, the perpetrator of the act will be arraigned in court and justice will be administered.

Health professionals are required by their professional code of conducts to only practice that which they are trained and licenced for (Hall, Orentlicher, Bobinski, Bagley and Cohen, 2018). They are also required to avoid any form of intoxication during their work as it may lead to impaired reasoning and low productivity (Kangasniemi, Pakkanen and Korhonen, 2015). In addition, it is ethical of them to treat their patients with dignity and respect. The paramedics uphold a high level of ethical conduct in the following ways. They attend to the child as per their training, they abstain from using abusive language despite being verbally abused and indicate that they will need to call the police instead of using force. The agency nurse fails to uphold the professional code of ethics by attempting to intoxicate herself with morphine. Morphine is a drug intended for pain relief. Using it for other purposes amounts to drug abuse. Use of opium for purposes of intoxicating oneself is illegal and could lead to jailing. It follows that the act of the agency nurse was a great malpractice and breach of the professional code of ethics.

Recommendations for Professional Practice

As seen above child abuse and abusing certain drugs such as opium are illegal and are punishable by law. There is also legislation that requires mandatory reporting of cases of child abuse. There are four principles of healthcare ethics. These are justice, autonomy, beneficence and non-maleficence. For any medical procedure to be considered ethical, it must uphold the four principles outlined above (Nurses and Council, 2017). In the case study, the paramedics did not breach any of the principles. They maintained a high standard of ethical conduct.

The following recommendations might be necessary to address the issues in the chosen case study. The police should have been called to arrest Sandra’s husband. This would be on several grounds. One is verbally abusing Sandra and the paramedics. Secondly, he is preventing the paramedics from taking the child to a health facility for treatment. Thirdly, he is a suspect for perpetrating the act of physical abuse on the child. Calling the police would help get to the bottom of the matter. Another recommendation is immediate withdrawal of the services of the agency nurse. She has engaged herself in a great malpractice. Intoxication of a health professional would potentially put patients at risk since it might lead to impaired reasoning. The agency should investigate the situation and arrive at the bottom of the matter. If found guilty of having attended to patients while intoxicated, the necessary legal measures should be taken. In case she is addicted, it might be necessary for her to undergo appropriate counselling o avoid a repeat of the same in future. It would also be recommended that healthcare professionals be trained on the necessary legal aspects that pertain to their practice. An example of such is the mandatory notification/reporting of child abuse. In a nutshell, ethics must be upheld in the environment of health care and a breach of it should be appropriately dealt with.

Conclusion

In conclusion, ethics are the fundamental moral requirements that the society has generally bestowed upon individuals or groups. Upholding of ethics has become very crucial in the contemporary society. One requirement that is generally expeted of every person is to respect and treat other people with dignity by the virtue of them being human. Child abuse and other forms of abuse such as verbal amount to disrespect and does not uphold human dignity. In case study 3, Sandra’s partner behaves unethically by abusing Sandra and the paramedics. In so doing he does not uphold human dignity. Some other ethical issues raised in the case study include an attempt of intoxication by the agency nurse. It is a great malpractice and breach of professional code of ethics as it is likely to lead to impaired reasoning thereby putting the health of patients/clients at risk. Inflicting physical pain and grievous harm to a child is a gross violation of human rights and law requires mandatory notification/reporting. Some recommendations to the ethical issues raised in the case study include calling the police to deal with Sandra’s partner and immediate withdrawal of the services of the agency nurse to create room for appropriate investigations.

References

Barak, A. (2015). Human dignity: the constitutional value and the constitutional right. Cambridge University Press.

Forsythe, D. P. (2017). Human rights in international relations. Cambridge University Press.

Freeman, M. (2017). Human rights. John Wiley & Sons.

Hall, M. A., Orentlicher, D., Bobinski, M. A., Bagley, N., & Cohen, I. G. (2018). Health care law and ethics. Wolters Kluwer Law & Business.

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

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

Lasswell, H. D. (2017). Power and personality. Routledge.

Mathews, B. P., Bromfield, L., Walsh, K. M., & Vimpani, G. (2015). Child Abuse and Neglect: A Socio-legal Study of Mandatory Reporting in Australia-Report for the ACT Government. Commonwealth of Australia.

Mathews, B. P., Bromfield, L., Walsh, K. M., & Vimpani, G. (2015). Child Abuse and Neglect: A Socio-legal Study of Mandatory Reporting in Australia-Report for the South Australian Government.

Nurses, U., & Council, M. (2017). The Professional Code of Conduct and Ethics for Nurses. 2009.

Post, L. F., & Blustein, J. (2015). Handbook for health care ethics committees. JHU Press.

Runciman, B., Merry, A., & Walton, M. (2017). Safety and ethics in healthcare: a guide to getting it right. CRC Press.