Question:
Discuss about the ASBH Clinical Ethics Consultation System.
The essay deals with the case study of Henry that involves the ethical dilemma pertaining to two different roles. The aim of the essay is to establish clear perspective on the issues identified from the case study and recognise the own alternative perspective. Further the essay discusses the ethical issues from the perspective of human dignity that needs to be respected, code of ethics, professional standards, ethical theory, and the principles of health care ethics. Lastly, the essay recommends the strategies for professional practice.
In the given case study, Henry is a physiotherapist for 8 years and work along with the orthopaedic surgeons, a podiatrist, a rheumatologist, a radiologist, and a massage therapist. He has been treating the Jim, a 73 year old man, following bilateral knee replacements. After Jim showed little improvement in mobility his wife complaint to Henry that Jim is not following the exercise program at house. Henry decided to discontinue the treatment of Jim and suggested to refer the message therapist. However, Sally the practice manager perceives this act of Henry would lead to loss of organisation’s reputation. On the other hand, he informs Sally that one of the surgeons arrives at the workplace in drunken state. He comes smelling alcohol even during surgery. Sally is working on this matter.
In the given case study the ethical issues at stake are beneficence of patients and maleficence, breach of code of conduct, human rights, professional standards and clinical negligence. From an alternative perspective, it can be said that Henry has met other criteria of ethical framework that is prioritisation (Bryant et al., 2014). He considered other awaiting patients to be his first priority instead of Jim. This decision is in accordance with ethical framework but keeps other ethical issues at stake.
From the perspective of the Physiotherapist, discontinuing the treatment of Jim by Henry can be called a clinical negligence. According to Breen & Weisbrot (2015), negligence is the breach of the duty of care, which may cause damage to the patient’s health. It may lead to claims against the physiotherapist. Discontinuing the treatment of Jim may have adverse consequences as Jim had not completely recovered. He needs greater attention till his mobility has increased. Referring to massage therapist at this stage may increase the rate of complication. Henry should have first conducted the assessment of Jim to know the condition of his knee and reason for patient’s unwillingness to perform exercises. Henry in the quest to attend other awaiting patients neglected the care for Jim. It may worsen the Jim’s condition. It can be interpreted that the ethical principle of beneficence was no followed by Henry. According to Butts & Rich (2015), beneficence is the action that promotes the well being of the patients. Henry did not serve in the best interest of the patient. Henry also seems to breach the ethical principle of non-maleficence because without evaluating the need of massage therapist, he discontinued the treatment. According to Tarzian et al. (2015), non-maleficence is the use of treatment that does no harm the patient.
The act of surgeon arriving at the workplace smelling alcohol is the breach of the code of conduct for doctors in Australia developed by the Medical board. The code of conduct and professional standards emphasise on professional behaviour of surgeons and doctors that demonstrates trust and respect to the patients (Medicalboard.gov.au., 2017). Doctors must not cross their professional boundaries. However, attending the work in drunken state involves a high chance of patient injury such as wrongful amputation, incorrect diagnosis, waking up during anaesthesia and others. Such injuries may lead to death of patient instead of promoting the well-being. It indicates the breach of the duty to take care of the patient. This harm could be avoidable as the treatment may be conducted by the intoxicated surgeon irrationally and that may be called for liability. It may lead to law suits and loss of hospital reputation by this kind of clinical negligence. Therefore, the ethical principles of nursing like beneficence, and non-maleficence are at stake in this case. Henry too breached the code of conduct of physiotherapists by not incorporating the safety and risk management of the patient. He denied the Jim’s access to physiotherapy that demonstrates lack of responsibility to attain optimal heath outcomes (Physiotherapy.asn.au, 2017).
From an alternative perspective, it can be said that what Henry did was an outcome of prioritisation. According to Nord & Johansen (2014), priority setting is an important aspects of the heath care setting. In the primary health care, prioritisation is necessary as it have significant implications for health care costs and the clinical outcomes. Medical professional prioritises the patent care, depending on the severity of the health condition, cost effectiveness and the patient’s benefits. In this respect it can be said that Henry may have perceived Jim’s conviction to be less severe when compared to his other awaiting patients. He may have been in situation where he wanted to balance the patients’ demands, with the expanding need of the preventive care of the chronic conditions. It is also the part of the ethical framework. In regards to this alternative perspective it can be said that Henry’s decision demonstrates ethical behaviour (Grace, 2017).
According to the Universal Declaration of Human Rights (1948), medical professionals are ethically obliged to protect the human rights and the dignity taking into account their vulnerability (Yamin & Norheim, 2014). In case of Henry, informed consent should have been taken. It is the right of the patient, to know about the pros and cons of the choice of the treatment. Jims consent was not taken before referring him to the massage therapist. On the other hand, Henry respected the rights of the other patients who appear to be in serious need of care when compared to Jim. However, Surgeon is disrespecting the community members and is acting against the professional integrity. Making mistakes in the patient care under the influence of alcohol is the breach of the code of conduct. It will create a culture of fear where the patients would fear seeking medical help. Since patient safety is at stake due to such patients, it can be said to breach the patients’ rights to healthy and safe environment (Hall & Bobinski, 2014).
As per my future professions code of conduct, which is nursing, there are eight code of ethics to be implemented in practice. The most appropriate one to discuss the ethical issues indentified in the case study includes the “Nurses value respect and kindness for self and others”, “informed decision making”, “culture of safety in nursing and health care”, and lastly “value a socially, economically and ecologically sustainable environment promoting health and wellbeing” (www.nursingmidwiferyboard.gov.au, 2017). Performing surgeries under the influence of the alcohol intoxication is not called valuing the patients’ dignity. Mistakes in surgeries may lead to patent death. It is not the act of respect and kindness of self and others. This act of surgeon does not also demonstrate creating the culture of safety or ecologically sustainable environment. Henry did not make the informed decision by consulting with Jim. He discontinued the treatment simply based on Information given by Jim’s wife that there is little improvement in mobility. Despite knowing that Jim had stopped exercising for his knees, Henry did not conduct any risk assessment. It does not promote the well being of the patients as per the code of ethics for nurses in Australia. In nursing profession, it is crucial to recognise the powerful contribution of human rights in improving the health outcomes. Nurses are obliged to recognise, and respect the human right to promote the well being of the patients to the highest attainable standards of the health (Nursingmidwiferyboard.gov.au, 2017). In this aspect it can be said that the Surgeon was neglecting his professional duties and as working in a manner that increases the vulnerability of the patients.
According to Utilitarian theory, an action is weighed by the greatest amount of good it brings. As per this theory if an action leads to welfare, safety and happiness, then it can be called an ethical action (Chadwick & Gallagher, 2016). Considering the action of the surgeon in the case study, performing duty of care under the influence of alcohol does not seem to generate the greatest good. Instead, it holds harmful consequences. Similarly, Henry’s decision to discontinue the treatment, without even evaluating the patient’s knee condition does not seem to be an act that generates greatest good. Henry may have felt that referring Jim to massage therapist may enhance the mobility issues. In that way, Henry can care for other patients whose needs are of greatest priority to him. It will promote well being of both Jim and other awaiting patients. However, Henry should have well assessed the harms and consequences of his decision. Overall, it can be said that the action of the surgeon causes the ethical issues to be at stake more than the actions of Henry.
There are various strategies to overcome the ethical issues at stake. In the context of nursing code of profession standards in Australia, it is necessary to practice in safe and competent manner. Health care decision should be taken in accordance with the standards of profession. It is recommended to take any action in health care after explaining the patient about the alternate care and highlighting its advantages and disadvantages. It will help the patients to make healthy choices (Parahoo, 2014). It is recommended for the health care providers to reach out to the seniors and mentors to seek assistance on handling of ethical issues. Further, in case of breach of code of professional conduct, the organisation must impose a strict penalty such as cancelling licence or suspending from work. Such disciplinary action is applicable for surgeon in the case study. The hospitals must participate in sponsoring the ethics journal and books club to focus more on ethics. Further, regular auditing is required in hospitals to ensure that the practioners are maintaining the code of ethics.
In the health care, ethics and the quality of care are the main drivers for health care organisation. In the essay, both surgeon and Henry although have different roles as the health care professionals, have performed actions for which the ethical issues such as patient dignity, beneficence, maleficence and human rights were at stake. From the perspective of nursing code of ethics, professional standards and the utilitarian theory, the actions of surgeon in the case study was unethical. This type clinical negligence can cause patient harm and death. Henry on the other hand, performed his duty of care by priority setting but fail to address the physiotherapy needs of Jim. The ethical issues can however be addressed by following the code of ethics strictly and the organisation is recommended to have stringent policy against act of clinical negligence and unethical behaviour.
References
Breen, K. J., & Weisbrot, D. (2015). Medical negligence system must change. The Medical journal of Australia, 202(11), 574-575.
Bryant, J., Sanson-Fisher, R., Walsh, J., & Stewart, J. (2014). Health research priority setting in selected high income countries: a narrative review of methods used and recommendations for future practice. Cost Effectiveness and Resource Allocation, 12(1), 23.
Butts, J., & Rich, K. (2015). Foundations of Ethical Nursing Practice. Role Development in Professional Nursing Practice, 117.
Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Palgrave Macmillan.
Grace, P. J. (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.
Hall, M. A., & Bobinski, M. A. (2014). Health care law and ethics. Wolters Kluwer Law & Business.
Medicalboard.gov.au. (2017). Medical Board of Australia – Good medical practice: a code of conduct for doctors in Australia. Medicalboard.gov.au. Retrieved 20 October 2017, from https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx
Nord, E., & Johansen, R. (2014). Concerns for severity in priority setting in health care: A review of trade-off data in preference studies and implications for societal willingness to pay for a QALY. Health Policy, 116(2), 281-288.
Nursingmidwiferyboard.gov.au. (2017). Professional standards. www.nursingmidwiferyboard.gov.au. Retrieved 20 October 2017, from https://ww.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Parahoo, K. (2014). Nursing research: principles, process and issues. Palgrave Macmillan.
Physiotherapy.asn.au. (2017). APA Code of Conduct. www.physiotherapy.asn.au. Retrieved 20 October 2017, from https://www.physiotherapy.asn.au/DocumentsFolder/APAWCM/The%20APA/Governance/Code_of_Conduct_V2013.pdf
Tarzian, A. J., Wocial, L. D., & ASBH Clinical Ethics Consultation Affairs Committee. (2015). A code of ethics for health care ethics consultants: journey to the present and implications for the field. The American Journal of Bioethics, 15(5), 38-51.
www.nursingmidwiferyboard.gov.au. (2017). Code of Ethics for Nurses in Australia. www.nursingmidwiferyboard.gov.au. Retrieved 20 October 2017, from https://www.nursingmidwiferyboard.gov.au/search.aspx?q=code%20of%20ethics%20for%20nurses/5_New-Code-of-Ethics-for-Nurses-August-2008.pdf
Yamin, A. E., & Norheim, O. F. (2014). Taking equality seriously: applying human rights frameworks to priority setting in health. Human Rights Quarterly, 36(2), 296-324.
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