Ms. Christine Jones was 34 year old female who was brought to the emergency department of hospital with several serious injuries after a massive motor vehicle accident where she lost her partner also. During the diagnosis her pregnancy had been found and it created some ethical as well as legal issue to continue the treatment of the patient and it opened the door of possibilities of serious health issues for the patient in future. Several laws and acts were associated with this case study.
The first law, which has been identified at the primary stage of her treatment procedure, was Guardianship and Administration Act 1990 of Western Australia which has been revised in the year 2005 with some add-ons (Kidson?Gerber et al., 2016). This law applies to the provision of medical treatment to the person even if they are 18 years or above who are represented by their guardian. According to this law, guardian can be appointed or involved in order to initiate the medical treatment or take any vital decision regarding the treatment of the patient (Khoury & Khoury, 2015). If the patient is incapable of looking after his/her health, then guardian should be involved prior taking medical decisions. Again, under the same act, in case of emergency where the consent of guardian is not achievable and doctors find the patient is not competent to consent to treatment, in those cases waiting for the consent from the guardian may not required. Apart from the parents or spouse, guardian can be anyone who is the nearest relative or having close personal relative of the patient.
Another law or act which is directly associated with the case study is the Advanced Healthcare Planning Legislation of WA Government of the year 2006. Under this law, if a mentally-competent patient refuses to take treatment or refuses to sign for a written consent to precede treatment then doctors cannot have the right to proceed further until the consent has been validly obtained. Under this law, if a person refuses to continue or proceed for any non-urgent treatment considering the future health outcome or provision of any other then the doctors cannot force them to go ahead with the treatment. During 2006, WA government introduced this Advanced Healthcare Planning Legislation into the WA parliament which states that an adult, who is of sound mind, will be able to make any advanced health directive considering the future health matter (Wernham & Teutsch, 2015). They will also be able to take medical decisions on non-urgent basis. Prior to transferring the patient to the operation theatre the consent from the patient is highly required if he/she is competent.
In this case, Ms Jones was brought to the hospital unconscious and she was not accompanied by any of her legal guardian. Details of her mother was found in her contact list and so, it was important to contact her as guardian, in order to obtain the consent for all necessary medical intervention needs to be performed prior to the arrival of her mother. According to the identified Guardianship and Administrative Act of 1990, which has been revised in the year 2005, it was necessary to involve guardians’ consent when the patient is not competent or unable to communicate for any medical procedure (Lamont, Stewart & Chiarella, 2016). Due to this, her mother was contacted by the hospital authority. Again, 2 days post the accident, when Ms Jones regained her consciousness she was informed that she had a fractured femur and along with that her pregnancy test also showed positive result. To treat the fracture femur, the first option was surgery for open reduction and internal fixation (ORIF) and second option was to begin conservative treatment as there were risks associated with the surgery for her pregnancy. The patient did not want to do anything that harms the baby inside her womb and so she did not want to go ahead with surgery. The doctors could not proceed further or force her against her decision as under the Advanced Healthcare Planning Legislation of WA government (2006) non-emergency patients have right to refuse medical treatment (Badland et al., 2014). This act played a vital role in her treatment procedure.
While treating Ms Jones, various ethical issues were involved in the treatment process. The first ethical issue the nurses faced to inform the patient about the loss of her partner in the accident. The patient was injured and she was looking for her partner prior taking any decision regarding her health and so informing the patient about the death was quite challenging for the nurses. But, the most important ethical issue was convincing her for the surgery. She was reluctant and refused to go ahead for surgery as she did not want to harm her baby that may occur during surgery. Again, according to the Advanced Healthcare Planning Legislation of WA government (2006), patients have right to refuse medical treatment considering the future health outcome (Carter, Detering, Silvester & Sutton, 2016). Due to this reason, nurses could not force the patient to take surgery to cure the fractured femur internally. During the morning shift, I also realized to it was a major issue to convince Ms. Jones for surgery.
When I was there in the shift and witnessed the whole scenario and came to know that Christine is reluctant to harm her unborn baby which might occur due to surgery. It was difficult for me to make her understand anything as she was in grief due to the sudden and unexpected death of her partner. She was emotional at that time which was very crucial stage for any people and at that time people hardly can take any rational decision. The conservative treatment procedure which was the second option was not efficient enough to produce the best long-term outcome because in future, the patient would face issues regarding pain. In this situation her mother wanted to talk to me personally. I think communication can be the best way in resolving the issue. Communication strategies have the capability to influence and empower individual to take healthier decision in their life (Jameton, 2017). Effective communication strategy in healthcare can be achieved by developing community campaign, group discussion etc (Preshaw, Brazil, McLaughlin & Frolic, 2016). In this case, having a group discussion along with her mother and Christine could be the best way to inform her about negative sides for not having surgery. It can be the best way to convince her however, Christine has to take the ultimate decision and doctors and nurses cannot make her bound on taking any particular decision.
References
Badland, H., Whitzman, C., Lowe, M., Davern, M., Aye, L., Butterworth, I., … & Giles-Corti, B. (2014). Urban liveability: emerging lessons from Australia for exploring the potential for indicators to measure the social determinants of health. Social science & medicine, 111, 64-73.
Carter, R. Z., Detering, K. M., Silvester, W., & Sutton, E. (2016). Advance care planning in Australia: what does the law say?. Australian Health Review, 40(4), 405-414.
Jameton, A. (2017). What moral distress in nursing history could suggest about the future of health care. AMA journal of ethics, 19(6), 617-628.
Khoury, B. S., & Khoury, J. N. (2015). Consent: a practical guide. Australian dental journal, 60(2), 138-142.
Kidson?Gerber, G., Kerridge, I., Farmer, S., Stewart, C. L., Savoia, H., & Challis, D. (2016). Caring for pregnant women for whom transfusion is not an option. A national review to assist in patient care. Australian and New Zealand Journal of Obstetrics and Gynaecology, 56(2), 127-136.
Lamont, S., Stewart, C., & Chiarella, M. (2016). Decision-making capacity and its relationship to a legally valid consent: ethical, legal and professional context. J. Law Med., 24, 371-386.
Preshaw, D. H., Brazil, K., McLaughlin, D., & Frolic, A. (2016). Ethical issues experienced by healthcare workers in nursing homes: Literature review. Nursing ethics, 23(5), 490-506.
Wernham, A., & Teutsch, S. M. (2015). Health in all policies for big cities. Journal of Public Health Management and Practice, 21(Suppl 1), S56.
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