Question:
Discuss about the Case Study of Nursing Ethics And Law.
Ethics refers to the moral principles, morals and values that are set to guide and govern a certain specific group of people (Shafer-Landau, 2014). A law is a system or rules and regulations that are created by society or group leaders (e.g. government) and are officially enforced to the people to govern and regulate their behavior and actions. Therefore, in this case study I will be discussing the ethics and laws in nursing but in reference to the information in the case study. The case study involves a registered nurse, Dr. Lin and three people, Sofie, Cindy and Joseph. Sofie is the immediate patient of Dr. Lin and RN Kiki while Joseph and Cindy are husband and daughter to Sofie respectively. Dr. Lin performs cosmetic operations to Sofie while RN Kiki’s responsibility is to attend to Sofie on a regular bases. In this essay, I will be discussing the ethical issues that any of the parties may have breached and the laws that they may have broken, especially DR. Lin when he insisted and decided to operate on Sofie even after the nurse discovered that her health was deteriorating which later caused the death of Sofie.
Joseph and Cindy would sue Dr. Lin for negligence. Apparently, having known Sofie for many years, the doctor was already aware of her health condition, i.e. about her confusion status, the abnormal rise in her body temperature which indicated signs of urinary tract infection. However, when sofie decided to undergo abdominoplasty surgery and the day came, the doctor still went on to operate on her even after being told about her conditions’ further deterioration assuming that everything would be okay. The proof for this situation was clear when sofie showed her confusion rate during the day of the surgery. When she reached the hospital and was placed on the surgery bed, she asked Joseph and Cindy she was in the hospital that day which indicated that she never knew what she was doing. Also, Sofie failed to sign the consent forms to authorize the surgery before the surgery begun. The standard of proof needed in this case should be of high quality to be able to convince the court of the laws that were broken due to the doctor’s negligence (Lostun et al, 2016 and Murthy, 2007) which later led to post-operative infection and sepsis that caused Sofie’s death.
However, if Dr. Lin was to be reported, he would also require some defense evidence. The doctor would have provided the pre-operative consent form that was signed by Joseph, Sophie’s husband giving Dr. Lin permission to operate on her. Such a form was meant to show that Joseph was okay with the doctor operating on Sofie even with her current health condition. In such a situation the legal condition of the law states that a patient’s husband or wife is allowed to sign the consent forms in case the patient is not in a condition to do so on their own. In this case, Sofie had already slept on the surgery bed without signing the pre-operative consent form but the RN nurse noticed it before the actual surgery was began and asked Joseph the forms which he did. Therefore, if Dr. Lin is capable of providing the evidence, it will certainly be considered and argued that he followed the law.
Every case has different possible outcomes according to a person’s view of the situation (Svider et al, 2013). One of the outcomes that may arise is that, the law may rule in favor of Joseph and Cindy. The law can take into more consideration the fact that Dr. Lin is a well experienced surgeon and that he knows the law that govern his practice better than the patients or the patient relatives. Therefore, he must have known better about the effects and consequences of operating on Sofie with her current health condition and complications. Also, the law may consider that fact that a surgery operation begins exactly when a patients is given aesthetic to induce sleep during the surgery (Reilly et al, 2013). Therefore, the law can rule in favor of Cindy and Joseph by arguing that Dr. Lin had already begun the surgery before the preoperative consent forms were signed by either the patient or immediate relative/partner. On the other hand, the law can rule in favor of Dr. Lin by placing the blame on Joseph who signed the consent forms while being aware of his wife’s condition. Additionally, he was the one who brought her to the hospital to undergo the surgery. Therefore, he should have known that the probability of the operation increasing Sofie’s complications and deteriorating health would be higher if she underwent the surgery.
Principle of autonomy which states that every individual has the right to make his/her own choice (Shafe, 2014).in this case, Sofie had the right to make the choice of either to go on with the surgery or to wait until she felt better. Sofie exercised that right by choosing to go ahead with the surgery though she did not get the chance to sign the consent forms.
Beneficence principle that says that every person should be in a position to act in the best interest of another (Beauchamp et al, 2009). The principle is applied to both the doctors, nurses, patient’s immediate relatives and partners encouraging them to be capable of making the right choices for the patients, i.e. that which will cause no harm to them but rather be beneficial. In this case, Joseph portrayed to have Sofie’s best interest in mind when he thought about waiting till Sofie was better to do the surgery. The RN Kiki also exercised this principle by being concerned about Sofie’s health condition and deterioration and advised Joseph to take her to a General Health practitioner. However, Dr. Lin did not show much of Sofie’s best interest when he insisted and decided to operate on Sofie even after realizing that her condition was worse on the operation date, i.e. she seemed more confused than before.
This principles may raise some conflicts in the minds of the parties according to their positions and relationships with the patient. For instance, doctors have different reasons and methods of considering these two principles compared to the patients’ relatives and partners (Huxtable, 2013). In this case study, Joseph would be conflicted between protecting Sofie and her health by denying her from undergoing the surgery or make her happy and allow the surgery to be done (which is the decision that she made on her own) but put her health in danger. This would make him be conflicted from adhering to the autonomy or benefice principle (Christen et al, 2014). Additionally, the doctor would be conflicted to either go ahead with the operation after Sofie made the decision to go ahead with it, or not to operate by putting her health in arms way/danger. This means that he would be confused about which principle to adhere to, whether autonomy or benefice principle.
According to Kerridge et al, 2013, the conflict or confusion experienced by the parties can be solved if all these parties are able to recognize and understand both ethical and legal implications that may arise as a result of their practice or decision. However, they should also be able to differentiate between the two aspects (ethics and law) that may cause those consequences. As for Joseph, he should be able to differentiate between being a husband a play his role or being just a supporter to Sophie. Which means that he should know and understand the consequences if he acted as a husband and kept her health and life a priority (law) or be her supporter and allow the surgery even with her condition (ethics). As for the doctor, he should be ready to point out the consequences of his negligence (Pandit et al, 2009 and Rao, 2009))(law) which could cause death and infection and the consequence of quality care and beneficence principle (ethics) which was to allow Sofie make the decision to go ahead with the operation even with her condition. By identifying, understanding and practicing all of these ethical and legal issues, the parties can be in a better position to make the right decision that adheres to both the ethical and legal principles in medicine and nursing (Stepanov et al, 2013).
Conclusion
Ethics and laws are basically a set of rules, regulations and principles that are meant to govern and direct the behavior and actions of a group of people. Their main aim is to ensure that all the group members behave evenly and if not, they are punished equally. The ethical and legal issues governing the medical world all revolve around ensuring the safety of a patient’s health. In the case study, the doctor should have though better about the consequence that may arise if he failed to practice any other ethics and laws that govern his practice. However, Joseph and Cindy should also have known about the possible effects of the surgery to Sofie’s health. The nurse should have insisted on taking Sofie to a GP doctor which would indicate her desire to provide quality and effective care to her patient. All these parties ended up assuming and ignoring many aspects which later led to Sofie’s health deterioration hence her death.
References
Christen, M., Ineichen, C., & Tanner, C. (2014). How “moral” are the principles of biomedical ethics?–a cross-domain evaluation of the common morality hypothesis. BMC medical ethics, 15(1), 47.
Huxtable, R. (2013). For and against the four principles of biomedical ethics. Clinical Ethics, 8(2-3), 39-43.
Kerridge, I., and Stewart, C., (2013). Ethics and law for health professionals. Journal of Australia, Vol 99, No. 7.
Lostun, A., Keresztesi, A., Hainarosie, R., & Lostun, G. (2016). Medical Negligence–is There a Defined Pattern?. REVISTA DE CHIMIE, 67(12), 2425-2428.
Murthy, K. K. (2007). Medical negligence and the law. Indian J Med Ethics, 4(3), 116-8.
Pandit, M. S., & Pandit, S. (2009). Medical negligence: Coverage of the profession, duties, ethics, case law, and enlightened defense-A legal perspective. Indian journal of urology: IJU: journal of the Urological Society of India, 25(3), 372.
Rao, S. J. (2009). Medical negligence liability under the consumer protection act: A review of judicial perspective. Indian journal of urology: IJU: journal of the Urological Society of India, 25(3), 361.
Reilly, B. K., Horn, G. M., & Sewell, R. K. (2013). Hearing loss resulting in malpractice litigation: what physicians need to know. The Laryngoscope, 123(1), 112-117.
Shafer-Landau, R. (2014). The fundamentals of ethics.
Stepanov, N. A., & Smith, M. K. (2013). Double standards in special medical research: questioning the discrepancy between requirements for medical research involving incompetent adults, and medical research involving children. Journal of law and medicine, 21(1), 47-52.
Svider, P. F., Keeley, B. R., Zumba, O., Mauro, A. C., Setzen, M., & Eloy, J. A. (2013). From the operating room to the courtroom. The Laryngoscope, 123(8), 1849-1853.
Beauchamp, T. L.,&Childress,J. F., (2009). Principles of Biomedical Ethics, Sixth Edition, Oxford University Press, – Medical – 417 pages.
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