Health Care Ethics

Ethical issues in the case study

Ethics is an important ingredient in the existence of any society. The lack of ethics resorts in chaos and moral degradation. In the nursing profession, ethics will dictate the quality of service that the patient is likely to receive. As a nurse, one is bound to constantly encounter complex situations that require high levels of moral reasoning. Dilemmas like this often occur and nurses have to use their personal intuition to determine the action to take that is in the best interest of the patient. Various ethical issues arise in the chosen case study. A nurse Camilla is concerned about the welfare of her patient Sam. Sam is uncooperative making it hard for Camilla to monitor his vitals. In addition, Sam has removed his IV and slamming insults on Camilla. The medical team resolves the issue by ordering Sam to be placed in physical restraints. Julia, the nurse in charge informs Camilla to concentrate on assisting other patients who are in much need of her services and ignore Sam a drug patient with a history of multiple admission to the hospital. One of the ethical issues is resource allocation. Julia advice Camilla to put her energy on other patients who need her expertise as the hospital is short staffed. Patient’s freedom and medical practitioner control is another ethical issue that arises. There is a violation of Sam’s freedom as the medical team forcefully uses restrains on him disregarding his opinions. Lastly, there is the ethical issue related to dealing with drug patients with multiple admission.

Ethical perspective on the issue

The decision to place Sam in restrains is ethically wrong. Patients have rights based on the law that every medical practitioner must respect. Informed consent is one of them. Informed consent views the patient as a rational being capable of making his or her own decisions. The medical providers work is to provide the patient with recommendations on forms of treatment but it is up to the patient to make the final decision (Informed Consent, 2017). In the event that the patient is unable to make a rational decision, their family or a person authorized by the patient should be contacted. There are also procedures that govern the use of restraints. Salmon (2013) argues that medical practitioners should use restraints as the last resort. Before the use of restraints all other avenues should be explored and in the event that restraints are the only option, it should be carefully documented (Salmon, 2013). Restrains use should be at a minimum. Their risks associated with the use of restrains as injury to the patient, pneumonia, and agitation. Furthermore, the patient suffers emotionally and may develop a negative attitude towards hospitals.

Alternative perspective

Freedom vs. control is one of the ethical issues that nurses encounter. A patient has the right to determining the quality of health care that he or she is to receive from a medical practitioner. This means that the patient can agree or disagree on the treatment suggested by the medical caregiver. Although this is normally the case, there are exceptions to this rule. In the event that the patient’s decision will bring harm to them, it is up to the nurse to determine the best course of action. Morals play an important role in determining decision and action taken. In the case of Sam, the medical team evaluates that the patient is in no condition to make an informed decision. The medical team also establishes that the patient is aggressive with the possibility of harm. The viable solution is to place the patient into restraints. According to Ann Gallagher (2011), she is better off explaining why she placed restraints on a patient rather than explaining why the patient has a fracture. Medical institutions argue that restraints are important as they important as they protect the dignity of the patient, ensure safety and provide a conducive environment to work in.

Perspective in relation to human dignity

Dignity has to do with recognition of an individual’s value and status. A person being dignified is being given the required respect and honor. An individual is accorded dignity for being human and from the fact that the source of dignity is a human. Dignity requires one to have virtue. Thomas Aquinas was a prominent scholar devoted most of his scholarly work on understanding the workings of the society on dignity. Aquinas views dignity as a virtue that should be universally possessed and freely given by every human being (Jones, 2015). Actions that befit dignity is doing onto others what same action we except done to us. Dignity cannot be quantified as it varies from culture to culture but all across share the same basic principles of showing affection. Dignity does not only involve showing respect to people but also respecting their views, opinions, and decisions (Stratton, 2015). Dignity is an integral quality for a nurse. Nurses spent much time with patients seeking medical care and their conduct will determine the attitude the patient develop toward the overall medical institution. The medical environment is challenging and at times nurses find it overwhelming to provide their best to the patients. It is important to note that when one does not uphold dignity it negatively affects others (Stratton, 2015). In the case study, Sam’s actions show lack of dignity to both himself and his environment. His actions make the hospital environment unsafe to work in. The medical team restrains him to protect his dignity and others around him. Sam is not himself as he is suffering from psychosis. Therefore, his actions are fuelled by the drugs in his system and would in his normal nature not act that way.

Perspective in Professional codes

Like another profession, nursing has regulations that govern practicing nurses. The professional conduct of nurses bares ten regulations that nurses must follow. These regulations when followed allow the nurse to deliver professional services to the persons under their care. In addition, these codes allow nurses to evaluate their work and ensure that they are working within the domain of that their profession allows. Performing duties outside the code of conduct contribute to unethical and unprofessional work (Code of Nursing Profession, 2010). One of the codes of professions requires nurses to perform their duties in a safe and competent environment. This means that a practicing nurse should be honest and know his or her limitation as in terms of expertise. In cases where the nurse is encountering a new experience that is not familiar, it is advisable that they consult their immediate supervisor. Recognizing and respecting the laws governing the profession are another important code of conduct that nurse is to follow. This code encourages nurses to understand the laws governing them to avoid engaging in activities that may affect their professional work. This also applies to recognizing the work of your colleagues and reporting unlawful acts that originate from them. This code mentions that witnessing unlawful acts without reporting is breaking the law. The most important code that governs nurses is the code that spells out their duty. According to this code, nurses are required to support the health of their patients (Code of Nursing Profession, 2010). This involves helping the patient developed the best-informed decision. The nurse is to seek additional help from other professions in aiding the patient make the best decision regarding their health. In the case study, Sam is denied this as the medical team does not do all in its power to aid Sam to make the right decision. Camilla on her part also fails to determine the cause of Sam’s agitation. They resort to restraints without establishing the root cause of Sam’s frustrations.

Perspective in Ethical theory

The utilitarianism theory is a theory that judges an action on the bases of the outcome with minimum considerations placed on the methods of achieving the outcomes. According to theorist that purports this theory, any action is good as long as the benefits associated with the action are great. In the case study, individuals have applied utilitarianism theory in two events. In the first event, the medical team places Sam in restrains citing security concerns. The action of placing Sam in restrains against his will is unethical though the medical team justifies the action by claiming that the outcome will be beneficial to everyone (Kay, 2015). The second event is when Julia tells Camilla to ignore Sam, as there are other patients in the hospital in need of her service. The medical team considers Sam’s condition a waste of time as he has been admitted to the hospital multiple times. Furthermore, his problem is drug-related, therefore considered self-inflicted hence the justification to ignore Sam. Utilitarianism theory suffers from major drawbacks. One of the drawbacks of the theory is the unpredictable nature of the outcome resulting from the action. One may perform a bad action with the justification that the outcome better but end up being disastrous and unbeneficial. The other drawback of the theory is that it encourages immoral behavior as individual justify their actions based on the outcomes.

Perspective in Health Ethics

Nurses should ensure that each patient under their care receives the best medical care that the institution can offer. The well-being of the patient’s health both physically and emotionally is the main objective of the nurse. Patients not only need their diseases attended to but also themselves. They need to feel safe and important. This objective falls under the jurisdiction of nurses. Diseases can be stressful and overwhelming to patients. The nurse should do all in their ability to ease the problems that the patient is going through by ensuring that the patient is comfortable while they seek medical assistance. In the case study, Camilla is portrayed to act as a professional. She is concerned about Sam’s well-being despite the patient’s bad attitude. The actions of Sam do not sway her away; she is determined and does not give up. After Sam refuses his vitals to be monitored and pushes Camilla away, she seeks help from the medical team. The medical team also is professional in their actions. They evaluate that Sam is a danger to himself and others around him. In addition, Camilla needs to check his vital to ensure that he is doing fine. The only way to do this is through using restraints. Restraints, in this case, are essential in ensuring that priority is given to Sam’s health.

Recommendation

The case study portrays the situations that are present in health institutions that nurses deal with in the course of their work. In most health institution, there is a limitation in medicine, medical equipment, and medical personnel among others. Therefore, medical supervisors make judgment calls on the utilization of these resources to achieve the maximum impact and help a maximum number of patients. In the event where the health facility has limited number of medical personnel, the medical practitioner will isolate cases that need immediate medical attention and locate a physician to these cases. In the case study, Julia notes that Sam is not in immediate danger and advises Camilla to concentrate her efforts on urgent cases as they have limited staff. Although on one point of view Julia is perceived as heartless and not minding Sam’s well-being as she refers to his as a ‘waste of time’, she is right. Camilla catering for Sam who is psychotic and uncooperative will only lead to wastage of time, which they currently cannot afford. Therefore, as medical practitioners are important to determine how one’s services will make the most impact. As for utilitarianism, theory advocates, at times actions need to be evaluated based on their outcomes. If the outcome is beneficial to the greater population, then the action is justified.

References

Code of Professional Conduct for Nurses in Australia. (2010). Retrieved from Nursing and Midwifery Board of Australia: http://www.nursingmidwiferyboard.gov,au/

Informed Consent. (2017). Retrieved from American Cancer Society: https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/informed-consent/legal-requirements-of-consent.html

Jones, D. A. (2015, 4 18). Human Dignity in Healthcare: A Virtue Ethics Approach. A Multidisciplinary Journal of Biotechnology and the Body, 21, 3-14. Retrieved from http://dx.doi.org/10.1179/2050287715Z.00000000059

Kay, C. D. (2015). Utilitarianism. Retrieved from http://sites.wofford.edu/kaycd/utilitarianism/

Salmon, N. (2013). Restraints: The Last Resort. Retrieved from https://lms.rn.com/getpdf.php/1897.pdf

Stratton, D. (2015). Dignity in Healthcare. Retrieved from https://www.ageaction.ie/sites/default/files/dignity_in_healthcare.pdf

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