Professional, Ethical & Legal Issues In Healthcare: A Discussion

Ethical Situation

Discuss about the Professional, Ethical & Legal Issues in Healthcare.

The advancement of medical science has brought forth multiple changes in the healthcare sector in keeping with the changing trends and needs of the hour. The modifications and drastic measures that are revised from time to time support for the economic as well as health wise prosperity of the citizens of a nation. The alterations and changes prior to coming into force have to face several intermittent stages of abiding by the ethical issues and legal implications so as to ensure optimum outcomes in the concerned population. Therefore, the measures adapted to culminate in harboring maximum possible benefit out of a clinical situation are often shrouded with few questions and circumstances that account for ethical dilemma (Lo, 2012). This necessitates the healthcare providers encompassing physicians, nurses, paramedics and other supporting staff to strictly work in compliance with the existing code of conduct, guidelines and legislations to render quality healthcare facility to the distressed patients without violating the ethical and legal principles. The shared decision making in this regard have been indicated as an essential virtue to translate the conceptions into actual clinical practice (Elwin et al. 2012).

The following assignment will be based on a scenario concerning a terminally ill cancer survivor that provides an example of ethical dilemma. The discussions will be done in accordance with the given scenario following the ethical, legal and professional aspects of a practice based situation. Further application and evaluation of the bioethical principles involving autonomy, justice, beneficence, and non-maleficence will form the basis of the logical discussion. Philosophical theories such as deontology and utilitarianism will be considered for understanding the situation pertinent to the given scenario. These theories and principles will be interlinked to the case situation to get an insight into the relevant scenario.

During the course of my clinical practice as a nursing professional I encountered a situation that had put me into ethical dilemma. Ms. Ann was diagnosed with cancer and was brought to the hospital for the treatment of her ailment. However, her family members were very much concerned about Ms. Ann and insisted that this harsh truth of cancer diagnosis be concealed from her in an effort to allay her emotional distress of being informed to be diagnosed of a life threatening disease like that of cancer. The end of life decisions and treatments for such patients is therefore imperative to foster best possible care (Bossaert et al. 2015).

Discussion

The reason I chose to discuss this particular instance is that the decisions and subsequent care and treatment regime for people suffering from debilitating and serious illness like that of cancer, AIDS and others have been a matter of serious concern for the healthcare providers globally. These people particularly the nurses are challenged to take independent and case appropriate measures to provide maximum relief to these terminally ill patients without breaching bioethical principles and inflicting any sort of harm. Thus proper awareness and knowledge regarding the laws and professional as well as ethical issues will aid the nurses to act rationally and cope up with the demanding scenarios effectively (Walker and Colledge 2013).

The given case may be analyzed in the light of the ethical, legal and professional aspects of a practice based situation. Research reveals that oncology nurses routinely encounter situations of ethical dilemma while caring for advanced cancer patient specifically relating prognosis related communications. The nurses experience situations of uncertainty and barriers in providing end of life care healthcare service and hence clarifications regarding their roles and responsibilities to counteract such incidents are required. The most commonly reported ethical dilemma involves uncertainty and hindrance to truth telling (McLennon et al. 2013). Similar encounter is reported in case of Ms. Ann, a cancer patient where the family members are found to persuade the nursing professionals to refrain from uttering the truth to the patient for preventing further mental complications mainly. Interdisciplinary education may contribute to mitigate the issues faced by the nursing professionals. Therefore, in this matter global bioethics may be consulted to attain a level of consensus through constructive dialogues and negotiations. Both bottom-up as well as top-down approach of interaction may be suitable in such cases (ten Have and Gordijn 2014). All the virtues and guiding principles need to be properly addressed in each of the cases to provide an effective solution to the demanding problems. The given scenario will be discussed in such pretext.

Autonomy and justice are the two most essential virtues of bioethical principles. Autonomy upholds the privacy and confidentiality of the affected individuals or the patients receiving care under the guidance of the healthcare worker in a specific clinical setting and infrastructure. Provision of sufficient information without suppression of facts to enable them to make informed choices is an important prerequisite of such principle (Beauchamp 2016).  On the other hand justice emphasizes on equal worth of persons and fair opportunity for all and is guided by a moral obligation to entitlement (Cole, Wellard and Mummery 2014). Customarily patient advocacy has recently been reinforced in the nursing codes of conduct, codes of ethics and standards for practice to promote resolution of these issues in the clinical practice.

Autonomy and Justice

In the given context Ms. Allen’s privacy and confidentiality was effectively maintained thus providing evidence for acting in conformity with the autonomy principle. However concealment of facts was done in this case in an effort to do good to her without taxing her with the harsh truth about her prevailing clinical condition. Her family members were fully aware about her clinical condition and they only appealed the nurses of not telling her the truth. No discrimination was performed in treating the patient and therefore justice was adequately protected. In a holistic approach for patient management and treatment strategy a patient and family centered care model has been recommended to better understand the clinical outcomes in such patients. Coordination and communication among all the components involved is thus suggested as integral to patient recovery (Hood 2013). Therefore, in the said case a little violation of autonomy principle was observed due to truth concealment from the patient although justice was provided to the utmost.

In nursing practice consideration of three key aspects of care, vulnerability and dignity have been highlighted as ethical approaches to maintain, protect and promote the self worth of the patient. This has been observed as a foundation for argument based nursing ethics framework (Gastmans 2013). This philosophy may be corroborated with the given case study where the nurses refrained from uttering the truth regarding the diagnosis of cancer in Ms. Ann due to the potential vulnerability of her from actually getting to know the significance of her clinical findings. Care was also properly addressed in terms of provision of moral support to the patient without actually making her aware about the graveness of her ailment. Dignity of Ms. Ann was maintained throughout the treatment regime by virtue of ethical and legal compliance to the professional codes of conduct as referred to in the Singapore Nursing Board guidelines related to Code of Ethics and Professional Conduct for the nurses (Anon, 2016).

Another aspect of the healthcare sector emphasizes on the active participation of the end users of healthcare commonly referred to as the patients, consumers or public into decision making in both economic and therapeutic fields thereby rendering crucial implications for maintaining the rights of the patient. The rights of the patients include equal access to healthcare from all quarters of the healthcare facility. The right to accept or deny treatment in conjunction with other rights such as formulation of advance directives is yet another key component of the prospective rights to be enjoyed by the patient. The right to information and communication prior to receiving therapeutic interventions is a vital necessity for the patients for procuring enough information related to the health that might affect the recovery process (Johnstone 2015). Thus the rights of the patient in the particular case were protected as far as practicable by accounting her physical treatment modalities and not just emphasizing her individual decision making ability and choices in receiving specific care. Quality care provision was not particularly compromised in the given case although informed decision making was quite limited with an effort to mitigate her psychological distress from knowing the actual truth.

Consideration of Key Aspects of Care

As per the empirical research findings, the salient features pertaining to healthcare facility include clashing of ethical principles, issues associated to communication, dearth of resources and quality of care provision. Improved ethics education for care providers will offer better service provision facility within a healthcare setting according to such research (Preshaw et al. 2015).

Another crucial principle related to bioethics encompasses beneficence where the caregivers are under the obligation of providing maximum benefit. The aim of the caregiver relies on evaluating the risks and benefits properly in order to provide optimum care. Promotion of well-being is the chief objective of beneficence. The intention of doing good and what is necessary for the patient is the motto of the service providers in abiding by this virtue (Rocco et al. 2014).

In the context of the given scenario the virtue of beneficence was followed to the core by the healthcare practitioners since they engaged in doing utmost good for the patient by not revealing the harsh truth of cancer diagnosis. Their efforts were directed to alleviate the mental trauma and panic of the patients from the negative perception and knowledge regarding the ensuing conditions from disease. The fact concealment by the healthcare workers was done for the ultimate good of the patient in the given scenario considering the fact that the patient might be profoundly impacted on knowing the actual truth. Therefore for the sake of the good of the patient and allay the possibility for any sort of mental distress from information related to her diagnosis of cancer was kept secret from Ms. Ann. Apparently though it might seem that the beneficence was not maintained, but on closer inspection it will become evident that the decision for hiding the truth of cancer detection from the patient was correct and prudent in terms of gaining long term benefits out of such act. Research has underpins the importance of framing a uniform evidence based ethical infrastructure to facilitate better patient care and clinical outcome. Promotion of correct and case appropriate decision making abilities among the nursing professionals in their professional practice and research are also among the projected purpose of such study (Mallari, Grace and Joseph 2016). Hence the act of the nurses as observed in Ms. Ann’s case seems perfectly justified.

The act of inflicting the least possible harm in order to achieve a positive beneficial outcome is generally referred to as non-malfeasance. Harms and its effects are of pivotal importance in ethical decision making process during clinical practice. Research has highlighted on the unintentional short term and long term harm to be attributable to life saving treatment that enable the patient to recover from their diseased states quite peacefully without any hassle. The notion of doing less harm than doing more good forms the core ideology of this bioethical principle. This virtue in addition to other bioethical virtues guiding the moral code of conduct in a practicing medical professional needs proper evaluation and fixed set of principles to ease the task of the healthcare workers with their regular clinical discourse. Research has highlighted the need of planning ethics content in nursing curricula to improve moral sensitivity and moral reasoning among the students (Park et al. 2012). The nursing outcomes classification (NOC) has been indicated as a valid measurement technique to assess the situation of the terminally ill patients suffering from cancer possessing chronic or acute pain within a palliative care unit (Mello et al. 2016).

Patient Rights

In the given scenario, the nurses with the complete support and informed consent from the family members of Ms. Ann, a cancer patient made utmost effort to inflict least amount of harm to her. Their approach may be attributed to the fact that in order to prevent the risk of developing immense stress and agony from knowing that Ms. Ann was suffering from the incurable and grave disease of cancer, the nurses following repeated appeal from her family members refrained from exposing the truth to the patient. This was done for all good of the patient so that she does not suffer from further complication as a consequence to her diagnosis. Although the nurses are exposed to a situation of ethical dilemma under such circumstances, yet they are found to do commendable jobs by taking measures of not doing harm to the patient. Bolstering ethical awareness is of surmountable significance under such conditions to recognize and acknowledge the unique interests and wishes of the individual patients receiving care under medical supervision of the nurses (Milliken and Grace 2015). Further in the context of hospital setting safety education programs within an organizational framework effective safety nursing activities has been recommended to usher awareness pertaining to patient safety culture (Kang and Park 2016). Hence taking into consideration of the above criteria, the conduct of the nurses in the given scenario was found to be in line with the principle of non-malfeasance.

For nursing practice, abiding by the existing rules and legislations is widely reckoned as an essential prerequisite to determine the accountability of the practicing nursing professional by virtue of predefined set of competency standards that are commonly followed in most of the nations worldwide. These laws serve to act as sources of guidance for the nurses in medico-legal cases and also set limitations to independent nursing actions. Maintenance of standards of nursing practice along with differentiation being made between the nurses’ responsibilities from other healthcare professionals is also the function of the laws concerning nursing practice. Nursing laws are generally the outcome of statutes or legislation that are stringently regulated and amended from time to time by a governing authority (Krautscheid 2014).

In nursing practice, serious violation of the relevant laws often leads to criminal or legal prosecution depending upon the seriousness of the situation. Breach of conduct in professional nursing practice often accompanies situation where safety, privacy, confidentiality and dignity of the patients are not adequately addressed thereby paving the ways for criminal prosecution. Nurses are generally held accountable for making sound, professional judgments, anticipating foreseeable damage and being answerable for the actions. For achieving the optimum clinical outcomes relevant to a particular case a holistic mode of treatment strategy is recommended. Collaborative approach for improvising treatment schedule in coalition with the moral and ethical principles endeavor to harbor maximum benefits in clinical nursing practice (Grace 2013). Other guiding principles and standards for practice in nursing emphasizes on proper documentation of medical records, strict monitoring of the drug administration and undertaking a person centered care approach unique to each patient to ensure quality healthcare service. Maintenance of privacy and confidentiality of the retrieved patient data in keeping with the human rights and informed consent protocol are the two vital legal considerations in nursing practice and the Human Rights Act (1998) and Data Protection Act (2003) may be referred in this context (Mair 2014). In the given scenario all the legal implications were followed adequately to ensure the best possible clinical outcomes in the cancer patient.

Conclusion

The case of Ms. Ann can be further analyzed on the basis of the deontological philosophy of normative ethical theory. It states that right or wrong actions do not account for the consequences; instead they act as indicators of agreement with moral norms and rules. Intention is the matter of consideration in such theories to judge the rationality of a particular task. In short actions determine the goodness or badness out of a scenario. Telling the truth and keeping promises are perceived as integral to comply by a set of moral decorum even for situations where harm might occur. Democratic professionalism has been detected as an important contributing factor in establishing social justice in this regard (Thompson 2014).  

Following the given case scenario, the deontological philosophy was not fully satisfied as the nurses intentionally refrained from telling the truth to the patient regarding her cancer diagnosis. It was a conscious decision on the nurses’ parts to not reveal the truth with a specific purpose of reducing and mitigating the burden of psychological distress in the patient. Thus this theory of judging the moral rightness of an act in terms of the intrinsic moral value of the act itself through deontology was found to be incongruent and inconclusive in Ms. Ann’s context.

Deeper probe into the theories guiding the ethical conduct of a person and pertinent to healthcare settings in case of the practicing nurses, the concept of utilitarianism may be considered for discussion. It is based on the principle that an action is morally right if it has the ability to generate greater amount of good or happiness than any other possible act. Thus the moral worth of an action is solely determined by its contribution to overall utility (Qi, Xu and Shan 2013). Production of the greatest amount of good for the greatest number of people is another key feature of the utilitarianism philosophy and essentially adopts a teleological approach to ethics and supports in favor of judging an action based upon its consequences. Careful, objective and impartial evaluations of the consequences are some of the other vital concepts relevant to this theory (Alligood 2013).

Ms. Ann’s case study corroborates with the philosophy of the utilitarianism where actions were very much intended to harbor optimum benefits from concealment of truth from the patient to do ultimate good to her. Such decisions reflected upon bringing happiness and relief to majority of the persons involved in the case encompassing the patient, her family members and the attending healthcare providers. The patient did not have to face the trauma of knowing the truth while the family was relived of not informing their loved one about the tragedy of the terminal illness. The nurses were also happy to perform to the best of their capability of what was expected out of them under such demanding scenario.

Conclusion

In fine assessing from the situations that had thwarted the nurse to encounter a perception of ethical dilemma, a proper feedback in handling similar scenarios may be obtained. The nurse performed case suited responsibility through prudence and pragmatism to ensure the best possible remedy and benefit for the patient named Ms. Ann diagnosed with cancer without doing any harm that might have repercussive outcomes in future. Thus beneficence and non-maleficence virtue was accurately addressed. Justice was done in this case as it was fair to make the patient unaware about her specific problem for her own good as disclosure of the actual reality might delay her chances of recovery and put her into more complication because of potential risks of psychological setbacks (Cherry and Jacob 2015). The right action for the immediate good of the patient was done through concealments of the facts pertaining to her medical condition that was in line with the philosophical theory of utilitarianism. However the near and dear ones of the patient comprising of her family members were made aware about her situation and obligatory duty by the nurses was performed in compliance with the deontological concept. Self dignity and rights of the patient was also maintained in the clinical handling situation that may be rationalized in the context of preservation of autonomy (Kuhse and Singer 2013). Hence, overall consideration of the patient circumstances pertaining to the given scenario provides insightful knowledge regarding patient handling appropriate to a specific case and in offering evidence based care in clinical setting. The professional codes of conduct, ethical and legal issues in healthcare are thus imperative to provide maximum healthcare utility for patients demanding critical care services facilitating the possibility of recuperation in such cases.

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