Otis Chronic Leukaemia Case Study Sample

Ethical Decision-Making Framework - Question 1

Otis is a 15-year-old child who suffered from chronic leukaemia and had previously undergone chemotherapy for 2 years. He was a regular patient at the oncology ward and all his treating team considered him to be an intelligent young person who fully understood his condition and treatment. Eight months ago, his leukaemia showed signs of going into remission. However, recent test results show that his condition has relapsed. At his most recent appointment, his medical practitioner informed Otis and his parents that a bone marrow donor had been found on the bone marrow donor registry. She said that if Otis received a bone marrow transplant and it was successful, his chances of being cured were significantly higher than if he went through additional rounds of chemotherapy. However, Otis’ parents objected strongly to Otis receiving the transplant as they did not believe in such treatment and did not want Otis exposed to new risks. Otis was quiet during the appointment. Later on, when his parents and medical practitioner had left the room, he said to the nurse that he understood the risks and wanted to receive the treatment. He said, ‘I’m too young to die. Please give me any treatment that might cure me’.

Apply the ethical decision-making framework to this scenario.

Ethical Decision-Making Framework - Answer 1

The application of the ethical decision making framework in the case of Otis would have to be broken down into six key steps.

The first step would relate to the identification of the problem, where the dilemma would have to be outlined in a clear and concise manner. The dilemma here was that while Otis was ready to receive the treatment citing how he was too young to die, his parents were not willing to engage Otis in bone marrow therapy stating how they did not want him to be exposed to new risks.

The second step in the ethical decision making framework relates to the collection of information. All the necessary information regarding the risks of a bone marrow transplant would have to be collected along with the relevant reasons behind the justifications put forward by Otis as well as his parents.

The third step would be stating the options available in a comprehensive manner to both Otis and his parents. The doctors’ opinions on why the bone marrow transplant would significantly increase his chances of becoming cured would have to be clearly put forward to Otis and his parents. The relevant risk factors and how the situation could go wrong would also have to be placed in a comprehensible manner before Otis and his parents to ensure a clear understanding of the benefits and the risks involved.

The fourth step would be to apply the ethical principles of reasonableness and moral correctness to the situation (Roshanzadeh, Vanaki & Sadooghiasl, 2019). It would have to be considered that Otis was only fifteen years old and had a considerable amount of his life left ahead of him. More importantly, while his parents were against taking up the bone marrow transplant in the wake of Otis being exposed to additional risks, Otis himself was willing to undergo the treatment and stated how he would be okay with any treatment that would cure him.

The fifth step within the ethical decision making framework would be to make the decision. Considering how Otis was under the age of eighteen and would be considered a minor, his parents’ decision would have to be factored in. However, the doctors and the nurses would have to clearly state the risks and the possible benefits that the bone marrow transplant entailed. The fact that a donor was also available would also have to incorporated, but the final decision would certainly rest in the hands of Otis’ parents.

The fifth and the final step within the ethical decision making framework relates to implementing the decision (Leppänen, 2016). Whatever decision is made in the fifth step would have to be implemented and stuck to in the most ethically feasible manner. An effective incorporation of the principles of ethics along with the medical aspects involved in the bone marrow transplant would have to be ensured within the decision and its implementation that emphasises on a positive outcome for Otis. While it would be a given that every effort would have to be made to ensure that he is cured, the decision to go for the bone marrow transplant or not would eventually have to be taken by his parents owing to a number of implications including financial considerations, maintaining the treatment and dealing with a possible negative outcome of the treatment.

Ethical Decision-Making Framework - Question 2

Shawn is a registered nurse working at a regional hospital in Queensland. He started the job one month ago. The other two registered nurses who mainly work there are Jonte and MeiLing. Shawn usually works the shift before Jonte and therefore has noticed in the past week that Jonte has shown up late for work twice. Jonte also seems irritable when he shows up.

One afternoon Shawn notices that the stocks of wound dressings for the ward are low. He mentions this to MeiLing who says that it is Jonte’s responsibility. She says, ‘Oh well, we all make mistakes and I know he is going through a rough patch with his wife’. Shawn and MeiLing make sure the ward supplies are replenished. A couple of days later MeiLing confides to Shawn that Jonte almost administered the wrong dose of warfarin to a patient earlier that day. However, as MeiLing picked up on his mistake before the drug was administered, patient care was not compromised. Two weeks later after he finishes his day shift, Shawn leaves the hospital around 5pm. On the way home he stops into a local bar to meet a friend for a drink. When he arrives he sees Jonte at a table on the other side of the room. Shawn knows that Jonte is rostered on for tonight’s shift and can see that Jonte has his nursing uniform on under his jacket. Shawn notices Jonte is drinking fullstrength beer. Jonte leaves shortly after Shawn arrives. Apply the ethical and legal decision-making framework to this scenario. Do not consider the issue of negligence in your answer.

Ethical Decision-Making Framework - Answer 2

Considering the applicability of legality and ethics within the specifications of the situation provided in the case study, the correct decision would be to immediately notify the hospital management regarding Jonte’s behaviour. The Code of Ethics for Nurses in Australia is strictly enforced and prioritizes the delivery of care services based on protection of people and upholding their fundamental rights. The Value Statement 6 contained in the Code puts forward that nurses must always value a culture of safety when engaging with their professional obligations (Waubra Foundation, 2015). The fact that Jonte administered the wrong dose of warfarin to the patient is a serious issue of professional misconduct considering how he is a professionally registered nurse and the safety of the patient would have to be his primary concern. While the negative impacts were timely managed and controlled through the intervention of MeiLing, the situation certainly demanded a better sense of responsibility.

The stocks of wound dressing for the ward were also running low, which was a part of Jonte’s responsibility as a nurse working for the hospital. However, when Shawn mentions that same to MeiLing, MeiLing says that Jonte was having a rough patch with his wife and that everyone makes mistakes. It is another example of how professional irresponsibility could lead to serious negative outcomes for patients within the hospital, especially in terms of nurses are supposed to engage in informed decision making and ensure that the safety of the patients are never compromised. Furthermore, Shawn also sees Jonte drinking full strength beer prior to his night shift, an aspect that is strictly illegal and not tolerated within the laws of Australia and Queensland. There have been cases where nurses that have been found to be inebriated before their duties have been fined along with the slapping of charges of professional misconduct. The governing board for nursing within Queensland strictly puts forward that no registered nurse must show up at his or her duties while being drunk or inebriated above the permissible limits (Nursing and Midwifery Board Australia, 2020). It could lead to severe risk exposures for the patients as the implications within the health care industry are critical and need to be carefully managed by the professionals.

The most appropriate decision that Shawn could take in terms of the legality as well as the upholding of ethical principles of nursing would have to be reporting of the incident to the hospital management. While it could lead to negative repercussion for Jonte and add to his problems, it would be the right thing to do. Jonte’s behaviour could place the patients of the Queensland hospital at sever risks, and Shawn’s reporting of the incidents could certainly prevent them from occurring. The ethical and legal decision making framework warrants to maintain the greater good at all times, and reporting the incidents to the management would be the right thing for Shawn keeping in mind the actions and behaviors of Jonte.

References for Ethical Decision-Making Framework

Leppänen, J. (2016). Nurses experiences of ethical decision making in nursing.

Nursing and Midwifery Board Australia, (2020), Code of Professional Conductfor Nurses in Australia. Retrieved on: 3 June 2020 from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines/Guidelines-for-mandatory-notifications.aspx

Roshanzadeh, M., Vanaki, Z., & Sadooghiasl, A. (2019). Sensitivity in ethical decision-making: The experiences of nurse managers. Nursing ethics, 0969733019864146.

Waubra Foundation. (2015). Code of Ethics for Nurses in Australia. Available at: https://waubrafoundation.org.au/resources/code-ethics-for-nurses-australia/ (Accessed: 5 June 2020).

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