Ethical Considerations in Healthcare
Question
Assignment Description:
The following specifications are required for this assignment:
• Length: 1500 words; answers must thoroughly address the questions in a clear, concise manner.
• Structure: Include a title page and reference page in APA style. These do not count towards the minimum word count for this assignment.
• References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.
• Don’t forget to do an introduction and a conclusion and make sure your Turnitin score is <20%.
Read the case study presented at the end of Chapter 8 (Guido, p.133) which begins, “The patient was hospitalized for extreme low back pain…”
• Was there informed consent for the initial medications given to the patient?
• How would you determine that informed consent had been given for the MRI and the medications needed for sedation for the test?
• Was the informed consent deficient to the degree that there was a lack of informed consent for the patient for the second dose of medications?
• How would you decide this case?
Read the case study presented at the end of Chapter 9 (Guido, p. 150) which begins, “Jimmy, a Floridian, has undergone two liver transplants.”:
• What questions would you anticipate the judge to ask Jimmy to ascertain his level of maturity, understanding of the full consequences of his lack of action, and possible alternative reasons for requesting that he be allowed to make his own medical decisions?
• How should the judge evaluate the mother’s response to her son’s request?
• Does the state of residency factor into the judge’s decision?
• Are there additional issues that should be addressed prior to deciding the outcome of this case?
• How would you decide the case?
Jimmy Chang, a 20- year- old college student, is admitted to your institution for additional chemotherapy. Jimmy was diagnosed with leukemia 5 years earlier and has had several courses of chemotherapy. He is currently in an acute active phase of the disease, though he had enjoyed a 14- month remission phase prior to this admission. His parents, who accompany him to the hospital, are divided as to the benefits of additional chemotherapy. His mother is adamant that she will sign the informed consent form for this course of therapy, and his father is equally adamant that he will refuse to sign the informed consent form because "Jimmy has suffered enough."
You are his primary nurse and must assist in somehow resolving this impasse.
• What do you do about the informed consent form?
• Who signs and why?
• Using the MORAL model, decide the best course of action for Jimmy from an ethical perspective rather than a legal perspective.
• Now decide the best course of action based on a purely legal perspective.
• Did you come to the same conclusion using both an ethical and a legal approach?
SEE CASE STUDIES BELOW:
You be the Judge: Chapter 8 page 133.
The patient was hospitalized for extreme low back pain so intense that he could not be scheduled for a magnetic resonance imaging (MRI) until his fifth hospital day. His physician explained to him that the Dilaudid and Ativan he would receive the next day to numb his pain for the MRI could cause respiratory depression or arrest in patients like himself who were on high doses of opiates. The patient agreed to be given the medications. At 8:15 A.M. the next day, a nurse gave the patient the medications, but the MRI had to be postponed. With the physician’s new orders and the patient’s verbal consent, the nurse gave a second dose of the same medications at 11:30 A.M. About 5:00 P.M., the patient became stuporous. Vital signs were taken, oxygen was initiated, and Narcan was prepared for injection. At 6:00 P.M., the critical care code team was called, as the patient was in full cardiopulmonary arrest. The patient was successfully resuscitated and was discharged the next day. The patient then sued, claiming residual psychological symptoms and failure to obtain valid informed consent for the second dosage of medications administered at 11:30 A.M.
1. Was there informed consent for the initial medications given to the patient? 2. How would you determine that informed consent had been given for the MRI and the medications needed for sedation for the test?
3. Was the informed consent deficient to the degree that there was a lack of informed consent by the patient for the second dose of medications? 4. How would you decide this case
Chapter 9 page 150
You Be the Judge
Jimmy, a 15-year-old Floridian, had undergone two liver transplants. An only child, he lived with his mother, a single parent. He was prescribed immunosuppressant drugs that caused severe debilitating side effects in an attempt to prevent his body from rejecting the second liver transplant. Understanding that his life expectancy was limited and that the medications were causing the debilitating side effects, Jimmy elected to stop taking the immunosuppressive medications. When his attending physicians discovered that he was no longer taking the prescribed medications, they instituted court proceedings against his mother for child endangerment. Jimmy was readmitted to the hospital at the same time in an attempt to ensure that he restarted the immuno-suppressive mediations. A juvenile court judge held separate meetings with Jimmy, his mother, and the health care team in an attempt to resolve the issue. His mother, at her meeting with the judge, expressed anguish as she felt that not taking the medications would hasten her son’s death, but she was also resolved to the fact that she felt he was mature enough to fully under-stand the consequences of his non-actions. Jimmy assured the judge that he understood the consequences of his non-actions, but he was tired of taking medications that merely increased his pain and suffering and wanted, as stated in his final comment, “some time to be free of pain. I am going to die anyway.” The health care team were unable to assure the judge that taking the medications would greatly increase Jimmy’s longevity.
Questions
1. What questions would you anticipate the judge to ask Jimmy in order to ascertain his level of maturity, under-standing of the full consequences of his non-actions, and possible alternate reasons for requesting that he be al-lowed to make his own medical decisions? 2. How should the judge evaluate the mother’s response to her son’s request? Is she really supportive of his decision? 3. Does the state of residency factor into the judge’s decision?
4. Are there additional issues that should be addressed prior to deciding this outcome of this case? 5. How would you decide the case?
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Solution
Ethical Considerations in Healthcare
Do patients have rights? One of the key ideas in healthcare is to protect and promote the welfare and health of patients. Medical practitioners must adhere to the ethical issues of healthcare in such action. Ethical considerations in healthcare are the guiding principles that provide an orientation in the modes that the medical practitioners can operate to ensure the welfare and well-being of the patients remains paramount (Olejarczyk & Young, 2019). Four main principles exist in the code o ethics; justice, autonomy, beneficence and non-maleficence.
The belief that each patient has a right to make his or her own decisions is autonomy. Autonomy ensures that before subjecting the patient to any medication, their consent has to be adhered to at all times. Beneficence principles ensure that any procedures that patients are subjected to should benefit them. Non-maleficence principles insinuate that Patients have the right to no harm and ensure that all the activities that patients are subjected to cannot harm them whatsoever. However, adherence to the non-maleficence principle sometimes becomes challenging, especially if the patient has stopped taking medication, thus jeopardizing his life or withdrawing life support. Justice is an ethical consideration allowing equal and fair treatment of all the patients regardless of the societal stratification levels (Olejarczyk & Young, 2019). The paper below provides judgments on several cases based on adherence to the codes of ethics.
Replies to Case Study 8
Was there informed consent for the Initial Medications Provided to the patient?
Informed consent communication between the patient and the practitioner mainly permits care or administration of a given medication. From the case study, there was informed consent for the provision of the initial medication. The consent is confirmed when the physician explains to the Patient that Dilaudid and Ativan t were to be provided the next day and a postponement of the Magnetic Resonance imaging due to the fear of experiencing respiratory depression for the patients of his kind. The patient then agreed that he would be given medication at 8:15 the following day. I, therefore, affirm that there was informed consent in the initial administration of the medication.
How would you determine that informed consent is given for the MRI and the medications needed for sedation for the test?
Looking through the Heath Records of the Patient. Due to the critical nature of magnetic resonance imaging, the agreement is often indicated in the health records, which can act as evidence of informed consent.
Verbally confirming with the patient over informed consent. Usually, the agreement is first verbally comprehended before being written down. Therefore, verbally asking can prove an effective determination of informed consent.
Was the Informed Consent Deficient to the Degree that there is a lack of informed consent for the patient for the second dose of the medication?
According to Bester et al. (2020), there are certain instances that the right to informed consent can be violated and compromised. Some of the instances where the right to informed consent can be compromised are; when the life o the patient is at risk and the prevailing procedure can prove effective in improving the condition of the patient and when the procedure presents minimal to no risks. For the patient within the case study, the uninformed consent is carried out due to the extreme state of the patient. The physician records that the patient had become stuporous. The patient was hypoxic, and the patient was in cardiopulmonary arrest. The manifestations exhibited by the patient are so critical that waiting for the patient's adherence can jeopardize the situation and even lead to death. Therefore, the informed consent was deficient in that there was a lack of informed consent for the patient for the second dose of the medication.
How would you decide on the case?
I would decide the case in favor of the practitioners. The decision not to inform the patient of the procedure was for the patient's benefit, taking into consideration the patient's state at that time.
Chapter 9 Case Study
What questions would you anticipate the judge to ask Jimmy to ascertain his level o maturity, understanding the full consequences on the lack of action and possible alternative reasons for him to be allowed to make his own reasons based on medication?
Firstly, the likely question that the Judge would ask Jimmy is whether his age allows an individual to make their own decision, however good they may be. The second question that the Judge would ask is the instances in which the autonomy rights are violated in a clinical setup. The last question that the Judge would as is the importance of medication adherence because lack of adherence to the medication would increase his chances of going to the grave.
How should the Judge evaluate the mother's response to the child's request?
The Judge should evaluate the mother’s response by confirming her actions towards the suggestions presented by the son to stop taking the immunosuppressant medication in a claim that it relieved him of pain and that he would eventually die due to the reduced life expectancy. From the case study, the mother appears to agree and supports the son’s decision of not taking medication.
Does the state of residency factor in the Judge's decision?
The residency factor does not play a role in the Judge's decision. The Judge's decision is based on the claims provided by the practitioners over the lack of accountability of the mother towards the child. Additionally, a 15-year-old boy is considered a minor in Florida whose consent cannot be obeyed. Therefore, the residency factor has no role in the execution of the judicial role of the Judge.
Are there additional issues that need to be addressed before deciding on the case?
Firstly, the mother should understand that the child is below 18 years of age thus immature regardless of how mature the child might sound. Understanding immaturity, therefore, means that the child should not be allowed to make any decisions. Secondly, there is a need for enough enticement on the importance of medication adherence. However painful the immunosuppressants proved to be, medication adherence can prove effective in the long-term management of pain.
How would you decide on the case?
I would decide the case in favor of the practitioners. The ruling in favor of the practitioners is their concern for the patient's wellness. The concern is shown by suing Jimmy's mother for failure to ensure the sons' adherence to the prescribed medication.
Case study 3
Jimmy’s case
What do you do about the informed consent form?
The consent form needs to be signed by both the mother and the father if the patient is below 18 years or in a state that cannot make valid decisions. From the information provided in the case study about Jimmy's case, disagreement between the parents calls for Jimmy to sign the informed consent form. Jimmy is 20 years old and considered old enough to decide what can be done.
Who signs the Consent Form and Why?
The consent form needs to be signed by the parents. With the dilemma due to the disagreement between Jimmy’s parents, Jimmy will be the subject to signing the form. The reason why Jimmy is vulnerable to signing the form is due to the act that he is no longer a child, 20 years and can make reasonable decisions.
Using the moral Model, decide on the course of action based on the ethical perspectives.
The ethical model of solving an ethical dilemma is divided into four perspectives; the principal approach, rule of the consequences approach, the virtue approach and the moral sentiment approach. According to the information provided in the case study, the consequence approach as moral perspective is the recommended approach. The approach states that decisions are made based on the likeliness of the outcomes (O’Toole, 2018). The likely outcome from Jimmy's chemotherapy sessions is improving his leukemia condition, thus increasing his life expectancy. The course of action regarding this perspective is signing the form for both parties (mother and father).
Use the legal perspective to determine the course of action.
The legal perspectives insinuate beneficence as the ethical consideration. The legal perspectives state that if the intended action can prove effective or remedy the presenting condition, it should be followed (O’Toole, 2018). From the case study, the improvement act that is needed is the improvement in the health of Jimmy. The policy has proven effective for the past 5 years, and the continuation can still be effective. Therefore, the action initiated by implementing the ethical perspective pushes the father to sign the form. However much pain is experienced, the long-term effect improves Jimmy's condition and increases life expectancy.
Did you come to a similar conclusion implementing the ethical and legal perspective approach?
I dawned at a similar conclusion that fostered the father to alleviate the burden of the difference in opinions with the wife to uniformly accept signing the form meant to promote their son Jimmy's welfare.
Conclusion
In conclusion, ethical considerations play a crucial role in promoting patient health and welfare. Autonomy and informed consent are critical principles in the administration of medical facilities; they play a significant role in determining the orientation in which medical procedures and issues should follow. In some o instances, the right to informed consent is violated. Examples of instances in which the right to informed consent is violated are when the purposed procedures present minimal harm and when the patient is extremely affected, and the health is in jeopardy.
References
Bester, J., Cole, C. M., & Kodish, E. (2020). The Limits of Informed Consent for an Overwhelmed Patient: Clinicians’ Role in Protecting Patients and Preventing Overwhelm. AMA Journal of Ethics, 18(9), 869–886. https://doi.org/10.1001/journalofethics.2016.18.9.peer2-1609.
O’Toole, B. (2018). Four ways people approach ethics. A practical guide to reaching consensus on moral problems. Health Progress (Saint Louis, Mo.), 79(6), 38–41, 43. https://pubmed.ncbi.nlm.nih.gov/10339231/
Olejarczyk, J. P., & Young, M. (2019, March 18). Patient Rights And Ethics. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538279/
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