NSG2HEL Healthcare Ethics And Law

Question:

The goal of this assessment is to recognise and become attuned to the legal requirements and moral/ethical aspects of everyday care and to consider your role as a healthcare student and future healthcare professional. Moral justification is important in moral decision making. Apply legal principles, healthcare rights, ethical principles, moral theory, virtue ethics, and an ethic of care to frame your answers in relation to healthcare practice.
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Answer the following six short-answer questions. There is a scenario provided for each question and your task is analyse the case and discuss your answer to the question provided in relation to the case specifics and relevant legal and ethical concepts.
One

Jimmy is 58 year old Indigenous man who lives in a remote community. Jimmy receives dialysis 3 times per week, he knows that it is unlikely that he will receive a life changing kidney transplant, however, if he moved to the city, his chances would improve. Indigenous Australians living with renal failure should expect to wait longer to be placed on a transplant waiting list when compared to non-Indigenous Australians. This is true despite that fact that the incidence of end stage kidney disease (ESKD) for Indigenous Australians, especially in remote areas of Australia, is up to 20 times higher than comparable non-Indigenous peoples (Stumpers & Thomson, 2013). Devitt et al. (2017), in exploring Indigenous ESKD client’s views on transplant concluded that up to 90% of interviewees were interested in a transplant.

The transplant waiting list disparity has existed for 20 years and cannot be explained by the particular patient or disease related characteristics, however, the disparity is more pronounced for older people living in remote areas (Khanal et al., 2018). If Jimmy does make it onto the waiting list, the likelihood of him receiving a transplant is higher in the first year and is similar for non-Indigenous Australians; however, after the one year mark the transplant rate is significantly lower for Indigenous people (Khanal et al., 2018).

Identify and discuss the relevant ethical and healthcare rights issues highlighted in this case.
Two

Tara, a 15 year old girl approaches a health professional and seeks assurance from the health professional that her conversation will be kept confidential. The health professional assures her that unless there are compelling reasons ie. that the public will be at risk of harm, that the conversation would be confidential. Tara proceeds with her request for the ‘morning after’ pill as she is concerned that after having unprotected sex with her boyfriend that she may be pregnant. Tara is not taking regular oral contraceptives. Tara shares that her parents (who access the same health service) are ‘very religious’ and ‘don’t believe in premarital sex’, hence her seeking reassurance about confidentiality. Tara further states that her parents would be ‘disgusted’ if they found out she was seeking the morning after pill and would disown her. Tara has researched social media and online materials and has determined that there are no negative short (apart from a potential headache) or long term health consequences for her if she takes the pill. She tells the health professional, who is legislated to administer the ‘morning after’ pill, that “one of her friends has had the morning after pill and she was fine”, and she wants to have it too, just in case.

What are the legal and ethical principles raised in this case? Are there multiple perspectives to consider? Give reasons (drawn from the literature) for your answers.
Three

Mr Wu is a 68yr old man who has recently been discharged home from his local hospital emergency department. He was cleaning out his gutter and fell from his ladder. He was admitted for 28 hours for observation for a lower limb injury. During his hospital stay there was some concern raised regarding Mr Wu’s short term memory and he has been referred back to his GP for a follow up regarding assessment for possible dementia. One week after being discharged from the hospital Mr Wu receives a phone call from ‘RISE’ a dementia research organization. Mr Wu does not recall agreeing to participate in research, and he has no information on the research study from the hospital in his discharge paperwork. The research assistant (RA) on the phone advises that the hospital research team had provided his personal details to RISE. The RA asks Mr Wu if he agrees to participate in a 10 min phone interview regarding his recent hospital experience, he agrees. After 25 mins Mr Wu reports he is feeling tired and a bit muddled and is struggling to recall the details of his admission, his responses indicate that he is becoming a little agitated. The RA is keen for Mr Wu to continue as they are nearly finished, and he continues to ask questions, the interview is finished after 30 mins.

Did the conduct of this research follow accepted legal and ethical principles?
Four

Barry is 77years old, he has Type 2 diabetes which sometimes requires insulin, he has significant medical history and lower limb weakness following a stroke. Barry lives in Residential Aged Care. Barry has advised the RAC Facility and its staff verbally and in writing, that he does not want staff waking him in the morning to test his blood glucose levels. Barry justifies his request by explaining that he has trouble getting to sleep at night and enjoys sleeping in, he always eats breakfast late and believes early morning blood glucose testing is pointless. Barry has been awoken with a sharp sting on his toe at 0610 by a night shift nurse testing his blood glucose level. When questioned by Barry, the nurse advises him that she needed to test the blood glucose early as it was likely to be a busy morning and she was making sure it didn’t get missed because some staff would be off that morning attending mandatory training.

Discuss the merits of the nurse’s rationale for her care decisions with Barry that morning using relevant legal and ethical theory.
Five

Harold is a 57 year old man who has been diagnosed 18 months ago with Motor Neuron Disease. After discussions with his family, neurologist and GP Harold completed a Health Direction (Advanced Care Directive) 6 months ago which clearly states that if his health deteriorates that he does not want specific treatments to prolong his life such as antibiotic therapy and admission to intensive care. Harold has developed a chest infection in the last couple of days. This morning Harold’s wife finds him confused and disorientated. She calls an ambulance and he is transferred to the emergency department, a copy of his Health Directive is given to the Ambulance Officers. In the emergency department, Harold is unable to effectively communicate because of his current acute illness. Harold’s wife explains to the health professionals that Harold had in recent times come to terms with his diagnosis, and that he was looking forward to the upcoming birth of their first grandchild in approximately 5 months and an interstate family holiday after that. Harold’s wife expressed that she thought he would want to be treated for his severe chest infection, as the antibiotic therapy was likely to be effective.

Questions FIVE: In light of Harold’s written direction that refused antibiotics and intensive care treatment (within the Health Direction), analyse and discuss the most relevant ethical and legal considerations that the team of health professionals must assess to determine their next steps.
Six

A patient who suffers from depression and migraines attends a pharmacy to fill their prescription for a migraine medication. The medication is well known to have significant side effects including reducing circulation to limbs and its use can lead to gangrene if taken in high doses. The dosage regime was not clear on the prescription from the GP, the pharmacist did not contact the GP to clarify the dosage regime and the medications were dispensed by the pharmacist to the patient without dosage directions/limitations. The patient subsequently suffered gangrene in his left foot and required a below knee amputation.

Evaluate this case in relation to the legal frameworks for health care practice.

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