Ethical dilemma Law and Ethics Assessment Answer

Introduction ( Slide 1 )

• The aim of this presentation is to review the clinical scenario and identify the ethical dilemma faced by the nurses in the case scenario.
• The essay will analyze and compare all important concepts and ethical theories to engage in ethical decision making.
• The key concepts that will be evaluated to resolve the ethical dilemma are utilitarianism theory and the deontology theory, the ethical principles of practice, duty of care and the tort of negligence.
• The Model of Ethical Decision Making will be used to discuss the tehical dilemma and decide the best ethically appropriate action in the scenario.

Ethical issue in the Case Scenario ( Slide 2 )

Based on the review of the video, one major issue identified was that of neglect or missed opportunities of care evidenced by the following events:

vAfter admission to the hospital, no routine vital signs assessments and medical status assessment were carried out for the patient and only palliative care documentations were completed.

vThe nurses did not evaluate if she was eligible for hospice care or not

vNo proper assessment was done to identify the stage of cancer or severity

vNo attempts to diagnose the cause behind deterioration of Mrs. Melon’s condition

Ethical Concepts linked to the Scenario ( Slide 3 )

Ethi cal principle of beneficence : It is defined as the ethical principle of doing good or acting in the best interest of patients. In the context of palliative care, beneficence implies relief from symptoms that impair quality of life (Akdeniz, Yardımcı & Kavukcu, 2021)

Link with the case scenario: In the case scenario, no act of beneficence was initiated as no attempts was made to regular assess patient or evaluate the cause behind deterioration in her symptoms

Ethical Concepts linked to the Scenario ( Slide 4 )

Ethical principle of non-maleficence: It is the obligation of not inflicting any harm on the patient. It involves providing good medical care to prevent any kind of harm or deterioration of symptoms(Varkey, 2021).

Link with the case scenario: The case study shows no attempts to identify the cause behind deteriorating symptoms. No blood test, vital signs or medical examination was ordered to identify the cause behind deteriorating signs in patient. Moreover, do not resuscitate order was initiated which further affected survival of patient

Tort of Negligence (legal issues) in the Context of the Case Scenario ( Slide 5 )

The issue seen in the case scenario comes under the tort of negligence when one party has the duty of care towards other party and he fails to take appropriate action to prevent any harm or damage to patient (Cheluvappa& Selvendran, 2020).

The main rationale for the same is that the doctor’s negligence contributed to the death of patient and failure to complete duty of care was the main reason behind the same.

The death of patient reflects that the extent of damage and the breach of duty of care

Violation of Patient Autonomy during Decision-making ( Slide 6 )

• The patient autonomy is violated in the case scenario as the doctor initiated do-not-resuscitate (DNR) order without discussing with family members.
• Mrs. Melon’s daughter took legal action and alleged that no one discussed about the possibility of do-not-resuscitate order
• The situation reflects violation of patient autonomy, which is the right of patients to make informed decisions about their health (Motloba, 2018).

Relevant Nursing Legislations and Standards linked to the Scenario: ( Slide 7 )

The relevant nursing professional standards that were violated in the case scenario included:

NMBA standard 2.5: It states that the RNs should advocate on behalf of patient and respect their autonomy and legal capacity

Standard 4: It conducts assessment that are holistic and culturally appropriate

Standard 7.1: Evaluates and motor progress towards expected goals (NMBA, 2016)

Ethics of Fidelity in the Intervention ( Slide 8 )

The final principle of ethical decision involves fidelity which involves addressing a person’s ability to be truthful in their relationship (Akdeniz, Yardımcı & Kavukcu, 2021).

However, such loyalty was missing as no attempts was made to provide comfort or relaxation to patient

It involves commitment and trustworthiness to engage in care.

Alternative Course of Action During the Scenario (Slide 9 )

In case of similar situation, the following alternative course of action could be implemented: 

• Firstly, routine vital sign assessment, diagnostic test and monitoring of patients should be prioritized
• In addition, in case of deterioration of symptoms, escalation of care should be initiated and the patient’s family member should be actively notified about the patient’s health status
• The decisions surrounding treatment related to end of life should be done based on discussion with patient and family members to preserve patient’s autonomy (Houska & Loučka, 2019).

Evaluation of Outcomes ( Slide 10 )

The evaluation of outcomes can be done in the following ways:

• Regular update about patient’s health status and discussion with the clinical team
• Active escalation of care in case of deterioration of symptoms
• Patient satisfaction and low chance of conflict with family member’s when patient’s autonomy and preference is preserved during decision making

Conclusion ( Slide 11 )

• To conclude, the ethical decision making model is an appropriate framework to identify ethical dilemma, evaluate different concepts and engage in decision-making process.
• The report identified breach of ethical principles such as autonomy, beneficence and tort of negligence.
• It is recommended that physicians and nurses take active role to consider patient’s preference during care.

References ( Slide 12 )

Akdeniz, M., Yardımcı, B., & Kavukcu, E. (2021). Ethical considerations at the end-of-life care. SAGE Open Medicine , 9 , 20503121211000918.

Australian Law Reform Commission. (2015). Negligence. Retrieved from: https://www.alrc.gov.au/publication/serious-invasions-of-privacy-in-the-digital-era-alrc-report-123/7-fault/negligence/

Bifarin, O., & Stonehouse, D. (2022). Beneficence and non-maleficence: collaborative practice and harm mitigation. British Journal of Healthcare Assistants , 16 (2), 70-74.

Cheluvappa, R., & Selvendran, S. (2020). Medical negligence-Key cases and application of legislation. Annals of Medicine and Surgery , 57 , 205-211.

Houska, A., & Loučka, M. (2019). Patients' autonomy at the end of life: a critical review. Journal of pain and symptom management , 57 (4), 835-845.

Mok, W., Wang, W., Cooper, S., Ang, E. N. K., & Liaw, S. Y. (2015). Attitudes towards vital signs monitoring in the detection of clinical deterioration: scale development and survey of ward nurses. International Journal for Quality in Health Care , 27 (3), 207-213.

Motloba, P. D. (2018). Understanding of the principle of Autonomy (Part 1). South African Dental Journal , 73 (6), 418-420.

Registered Nurse Standards for Practice

NMBA (2016). Registered nurse standards of practice. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Pettersson, M., Hedström, M., & Höglund, A. T. (2020). The ethics of DNR-decisions in oncology and hematology care: a qualitative study. BMC Medical Ethics , 21 (1), 1-9.

Schofield, G., Dittborn, M., Huxtable, R., Brangan, E., & Selman, L. E. (2021). Real-world ethics in palliative care: a systematic review of the ethical challenges reported by specialist palliative care practitioners in their clinical practice. Palliative medicine , 35 (2), 315-334..

Thiele, L., Flabouris, A., & Thompson, C. (2020). Acute clinical deterioration and consumer escalation in the hospital setting: a literature review. Resuscitation , 156 , 72-83.

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice , 30 (1), 17-28.

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