Ethical Trends in Healthcare - Essay Example

TREND: A CASE STUDY OF RODA, A FOUR YEAR OLD ADMITTED AT MATER HOSPITAL. INTRODUCTION Nurses are health professionals that are involved in direct contact with patients. In some instances during their delivery of duties, nurses may be faced with an ethical dilemma that goes against their ethical decision making models to a right decision. Such a medical scenario forces nurses to break nursing ethics, regulations and patients medical rights. These scenarios on ethical decisions regard: disclosure of information to patients, patient’s rights to receive accurate and understandable information on their care, available treatment options and ability of a patient to take part in decision about their medical care. This essay outlines and discusses in detail a case of Roda, a four year old, who was treated in Mater hospital, industrial area, along Mombasa-Nairobi highway. Roda had slid and fallen in the house. Prior to this event, she had began to weave and stumble, developed difficulties in handling her urine secretions, foamed at the mouth and finally had developed a double vision. The house help had taken her to Mater hospital where her single mother had been admitted following a heart attack and diabetic coma. CAT scans were done; Magnetic Resonance imaging (MRI) was performed followed by a neurosurgery to remove a malignant brain tumor. All these medical procedures were performed without the consent of her mother, although the house help had informed the nurses that Roda’s mother had been admitted in the same hospital. Nurses didn’t inform Roda’s mother that her daughter had been hospitalized. Roda’s mother learned about her daughter’s ill-health when she was discharged through her house help. This discussion highlights conflict between the veracity and non-malificence principle, relationship between autonomy and informed consent and strategies that a registered nurse could implement. Ethical decision making is a function of merits, risks and social concerns in the field of nursing. Ethical decision making is guided by principles of veracity and non-malificence. According to Johnstone (2004, p.29) non-malificence conforms to obligation or a moral duty not to injure or cause ‘harm’ to others. A ‘medical harm’ has a large definition domain in the nursing field and incorporates the following; carrying out a medical procedure without the consent of a patient or family members; failing to provide adequate teaching and counseling to patient on proposed recommended medical procedure; failing to provide information on effects of the medical procedure in place and medical risks involved. The principle of veracity is violated. In many urgent medical instances, veracity principle is not followed. Pediatric intensive care unit (PICU), where Roda had been admitted, is an area where health professionals are supposed to weigh the balance between ethical standards and immediate medical needs of a patient. Children can participate in medical decision making (Alderson, 1993) but Roda was not in a position to take part. Parent’s role in ethical issues regarding treatment of their children is important (Taylor, 1999). Critically ill children require immediate decisions to be made either by the health professional, the patient if able to or with involvement of the parents. In severe cases like Roda’s, the immediate issue was to save her life. The recommendation of health professional for Roda to undergo CAT scans and be sent to MRI for further investigation was to verify a diagnosis, a suspected malignant brain tumor or a brain stem tumor. PICU has its own rules and regulations and does not allow parents to sit beside their children. A case of non-malificence occurs. It is in the best interest of a health professional to do what they suspect to be rational. This may even involve making ethical decision for the patient and the parent. In Roda’s case, the process of educating her mother, a receptionist in a computer firm, on the medical position of her daughter would have spent valuable time that could have brought a great difference towards the medical response of Roda. Apart from initial diagnosis, further analysis were needed in order to arrive at a proper diagnosis where the registered nurse could take charge of the situation and inform her mother on the observed medical condition, their effects, how the condition could be medically dealt with and any options of treatment that could be administered. Roda was not a referral patient where the nurse could discuss with the patient or parent immediately. The principle of non-malificence and veracity conform to patients who are medically stable and are in a position to make a valid informed decision. Roda was under-age and her mother who was undergoing treatment, even if consulted to take part in the decision making process, could not make a decision or give a consent that could pass the litmus test of validity. The mother was not in a position to make a right decision or could make it and later, if things went wrong, deny having signed it in a medically fit condition. Legal responsibilities would then have fallen on the nurse. Therefore, confidentiality is deemed to occur until a time when the health professional would have carried out a valid diagnosis and the parent’s is composed and in a position to make a valid informed consent after being educated on their child’s medical position according to their observations on investigations. Autonomy is a person’s ability to make or exercise self-determining choice (Johnstone 2004, p. 38). It is a product of an informed decision on the merits of a medical procedure and risks likely to be incurred. Violation of principle of autonomy leads into corresponding violation of other ethical principles like non-malificence, beneficence and justice (Johnstone 2004, p. 37) and undermines informed consent. A patient or parent is able to make informed consent if they are in a medically fit position. Roda’s mother was not aware of CAT scans, MRI and neurosurgery. No one had made an effort to inform her, in order to take an active part in the medical care of her daughter. Due to Roda’s mother’s illness, that involved a heart attack and diabetic coma, it presented a scenario where her possible informed consent could not have been termed as informed. Roda’s mother, a receptionist in a computer firm could have taken more time being explained that her daughter’s ill-health was not as a result of the fall but by another predisposing factor. Following Forrester and Griffiths recommendations (2005), even in scenarios where patients have signed the informed consent form, they are not exempted from taking a legal action in assault or battery if they were ‘insufficiently informed’. Nursing field has so many dilemmas that require taking risks to save lives. It is a call of duty. There was also a high possibility that the mother could have given consent to any medical procedure, after all, she could easily have suggested the health professional do all within their abilities to safe her daughter. From assessment of the decision making model, it is clear there was an ethical dilemma. The registered nurse had to identify that Roda’s mother would be affected by the dilemma. All neurosurgeons, their assistants and nurses, who took part in the Roda’s case, were directly involved. The nurses needed to be illustrative that the decision was done for Roda and her mother. They were not in a position to be actively involved according to protocols of medical ethical principles. The principle of autonomy was violated but to the advantage of Roda and her mother. It is all they could have recommended if they were in a position to do so. The registered nurse should stick to the ethical principles. A medical condition is not a situation to take for granted. Failing to attend to a patient in the hope of securing an informed consent draws a negative publicity if media finally gets involved to cover the case. Either way, it has legal responsibilities attached to it. The nurse, as a witness to the patient’s signature on the consent form and an advocate for the patient’s medical treatment, should ensure the patient has been given adequate information about the disease. The nurse should take an active role in informing the mother about any medical step to be taken, the advantages of the medical intervention process, the risks involved and available treatments. The mother is ill and the teaching should be tailored to suit her medical condition. Inputs of counseling should also be considered. The nurse should also explain why the other medical procedures are limiting as far as the current medical procedure is concerned. The nurse should have the patient’s recovery plan in education of the parent. The nurse should use the information on the patient’s medical development and progress to educate Roda’s mother on her daughter’s current medical position. The education should comprise details on malignant brain tumor, how it would be dealt with and all possible surgeries to be done. The registered nurse should also visit the possibility of partial or complete paralysis. In this regard, the nurse should also explore possibilities of sensory changes that may involve visual impairment or changes in personality depending on severity of the brain tumor and how far the medical procedure is likely to be successful. The nurse should also address the issue of fatal bleeding during surgeries to repair the damaged brain. These issues should be addressed, without giving the parent false hopes. Parents feel cheated when the outcome of their patient, say death, doesn’t reflect any valid teaching they had received. The registered nurse can also consult relevant other nursing associations or journals to get expert information on the case or related cases and how they were overcome. In conclusion, the registered nurse, as an advocate of the patient, should apply ethical principles according to ethical decision making models to avoid legal responsibilities. The decisions that the registered nurse implements should be compatible with their hospital policies, mission and in line with nursing ethics of practice. The registered nurse should not break ethics, regulations and patient’s rights. The nurse should educate, counsel and morally support family seeking clarification of any information regarding the patient. List of References: Alderson P1993, Children's consent to surgery, Open University Press, Buckingham. Beauchamp T & Childress J 2001, Principles of biomedical ethics, 5th edn, Oxford University Press, Oxford. Brody, H 1981, Ethical decision in medicine, 2nd edn, Little Brown & Co., Boston. Forrester, K & Griffiths, D 2005, Essentials of law for health professionals, 2nd edn, Mosby, Sydney. Johnstone, MJ 2004, Bioethics: a nursing perspective, 4th edn, Churchill Livingstone, Sydney. Taylor DC 1999, ‘Treating children and adults: whose body is it anyway?’, European Child & Adolescent Psychiatry, vol. 8, issue 4, p315, viewed 12 August 2006, EBSCOhost database Academic Search Premier, item: AN 4689647. Read More