Medical Law and Ethics
The role of medical ethics and law is important in guiding good medical practice. Ethics in medicine involves being able to examine a clinical case using facts, values, and logic to determine the best course of action when providing treatment (Bernstein & Jain, 2014). It provides guidance whereby some cases are simple to solve. In contrast, others can be hard, especially when the choices of action are conflicting or when deciding between different value systems, such as patient versus doctor decisions. In the event of such perplexing situations, healthcare professionals should utilize fundamental ethical principles, including autonomy, beneficence, justice, and non-maleficence (Ganz et al., 2015). Similarly, they should also use ethical and legal frameworks of decision-making, namely utilitarian and deontology approach. That said, this paper proceeds to analyze a clinical case involving Tim and his interaction with healthcare professionals at the hospital using the ethical and legal frameworks as aforementioned and how they also align with the Nursing and Midwifery Board of Australia (NMBA) professional code of conduct for registered nurses.
Healthcare professionals can utilize two ethical frameworks of decision-making in healthcare, namely deontology and utilitarianism. The utilitarian approach ascribes to making decisions that will benefit many people (Ganz et al., 2015; Mandal et al., 2016). The healthcare professionals at the hospitals seemingly based their decisions on utilitarianism whereby they were attending to the influx of patients they were receiving at the emergency department. The impetus of this nature, Tim was left unattended for a particular period. This is a consequence of utilitarian decision-making approach whereby it leads to harming others, as healthcare professionals try to achieve a maximum net benefit (Mandal et al., 2016). As the medical staff were busy receiving patients that were being brought in by the ambulance, Tim was left waiting to receive a further medical intervention, which was a change from when he arrived.
The medical staff at the hospital also blended their decision-making framework with the deontology realm. The deontological approach refers to the act of making decisions that will lead to morally right actions (Ganz et al., 2015; Mandal et al., 2016). It is noted that the interactions between patients and healthcare professionals are naturally deontological, which is explicit in the case study whereby despite the high influx of patients at the emergency wing, the medical staff worked in the interest of the patients. This overtly ascribes to Standard 6 of NMBA (2016) whereby nurses are required to provide safe and responsive nursing care that will meet the needs of patients. Further, he was immediately rushed to the theatre for operations, where he was returned to the ward stable.
The principle of non-maleficence states that healthcare professionals should provide care to ensure that a patient achieves positive health outcomes (Doody & Noonan, 2016). In other words, this principle states that healthcare staff should not harm patients (Tingle & Cribb, 2017). This is further envisioned in NMBA Standard 3 that states nurses should maintain the capability of practice (2016). The medical staff at the hospital were providing care to all patients to minimize or avoid further risks. Notably, the medical staff ensured that before taking Tim for operations, he was in a fasted state. Evidence-based practice requires that regardless of the type of surgery, patients’ stomach should be empty before having anesthesia (Chen et al., 2019). This is because anesthesia can inhibit the body’s ability to prevent and protect foods, liquids, and acids from reaching and entering the lungs, a process known as aspiration. Therefore, it can be deduced that while the healthcare professionals at the hospital took longer to provide attention to Tim, it was because they were waiting for his stomach to empty all that he had eaten. This is an important consideration as it can be deduced that their operations ascribed to Standard 6, Clause 6.1, whereby they intended to provide safe and quality healthcare (NMBA, 2016). Thus, the medical staff at the hospital followed through the principle of non-maleficence to provide care to Tim.
The principle of beneficence is evident in the clinical case. This principle states that healthcare professionals must do all they can to benefit patients in every situation (Jansen, 2016; Tingle & Cribb, 2017). First, the principle of beneficence was seemingly in conflict with that of non-maleficence, whereby the latter cause created an ethical dilemma. In this scenario, the medical staff were working in the best interests of all patients who being presented at the emergency ward and admitting them accordingly. As such, these actions conflicted with beneficence, whereby Tim had to wait for a longer period prior to receiving medical attention. Regardless, the medical staff embarked on providing quality care to Tim by taking him for operation. In this event, they followed all procedures and treatments that would benefit the patient. This entailed taking him for operation in a fasted state to ensure safety. Further, they also discredited his right to autonomy, whereby the doctor ordered that he should be injected with more morphine to prevent him from leaving the hospital, especially considering that he was from having an operation. Importantly, research highlight that morphine hinders the ability of a person to make good decisions (Brown, 2020). It is for this reason that Tim’s judgment was impaired and could not think critically that he is not fit to play but insisted that his team needs him. Therefore, the medical professionals’ capacity to not respecting the patient’s autonomy was warranted. Thus, all these actions were working in the best interest of Tim to bring out positive health outcomes.
Finally, the medical staff were negligent in various accounts. Markedly, negligence refers to the situation where nurses would engage in omissions when attending to a patient (Sohn, 2017). This is a retrogressive undertaking as it is not at par with NMBA (2016) code of standards and also professional obligations of nursing. First, there is no evidence that Tim was subjected to triaging, whereby his vitals were taken to determine the severity of his condition (Wolf et al., 2018). Instead, they only screened him for drugs and alcohol content in his blood. This also contrary to the demands of NMBA (2016) Standard 5 whereby conducting a triage would have provided data that would be used in assessment and developing an evidence-based plan of care. Moreover, the healthcare staff did not follow the principle of veracity, which is a bioethical requirement to know the truth in everything (Ganz et al., 2015). This would have been done when he was in the emergency department. Nurses would have engaged him to inform him that he should be patient and that they are trying their best to attend to all of them despite the high stream of patients. This would have been prospective to calm him down, knowing that he will be taken care of. Thus, there are subtle events of negligence in the clinical case.
Summing up, the events at the hospital provide an ideal clinical case to lens on healthcare ethics guidelines and also using the NMBA’s code of practice. The medical staff used utilitarianism and deontology to make medical judgements. They also followed the principles of beneficence and maleficence to advance quality care to Tim that would ensure that he achieves positive health outcomes. There were also two accounts where the medical staff were negligent by not triaging Tim and also not being honest about the situation at the hospital. That said, the use of ethical frameworks at the hospital should be an imperative and on-going discourse by all medical staff during ethical situations and dilemmas.
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