Ethical and Legal Issues in Nursing are applicable for any nurse, from beginner to expert. They are often considered as the vital part of nursing. This assignment will discover ethical and legal implication of the nurse who disguises the information of the lethal ill patient at the request of his family. The family does not want the nurse to notify the patient about the lethal nature of his disease. The family also desires that the nurse should not tell the patient about the medications prescribed to him.
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Johnstone (2011, p 21) says that nursing professional is very uncertain. The nurse is always in dilemma whether she should cooperate with the family or not. Now the questions that arises here is that if the nurse does not disclose the truth to the patient then what would be the legal implications. Moreover, the nurse is uncertain whether she would go after the wishes of the family or not. In the following discussion, I will look at the ethical principles and legal implications of hiding information from the patient and administering morphine without his information or approval.
According to WHO, palliative care is defined as an approach that helps in improving the quality of life of the patients and their families facing the problem associated with life-threatening disease. Patients need a palliative care to support their long and slow treatment procedure Tang, (2006, p. 360). It is focused on providing comfort and relief from the pain and the other distressing symptoms of a serious illness. It integrates the psychological and spiritual aspects of patient care. It offers a support system that helps patients to be lively as much as possible until death. It also provides a firm support to the family to cope up with the patient illness and also includes bereavement support for the family.
Palliative care uses a team approach to handle the needs of the patients and their families. It is a team based effort of care giving and it is also responsible for initiating the concept of dedicated palliative care development team. The team includes doctor, nurse, massage therapists, nutritionists and pharmacists. A number of medical professionals from different fields of medical sciences are constantly working on developing and designing new measures to provide the best palliative care to the patients who are suffering from serious illness. All the principles of the palliative care must be applied from the time of diagnosis. Palliative care is often associated with terminal diseases like Cancer and AIDS but now the concept has been changed. There are various palliative regimes which are applicable for other diseases, such as cardiac or renal disease, so as to help the patient to cope with the suffering (Johnson et al. 2011). Sometimes, a term ‘Long term care’ is used to describe the palliative care.
(Hodkinson 2008) state that
“The therapeutic nature of this nurse–patient relationship is a central concept in nursing. The most important issues related to this bond are disclosure of truth, kindness and communication.” The patients who are suffering from terminal illness generally prefer to hear the truth but they wish it to listen to it in a receptive way (Maria, Ann & Anna 2011).
Autonomy– The main principle of autonomy is that the patient should have adequate information about his condition so as to make a significant choice of treatment (Moulton & King 2010). The nurse should properly converse with the patient and make sure that the patient is well aware of all available treatment options (Johnstone 2011). (Collis 2006) suggested that before disclosing the information to family members it is must to seek the patient’s consent. It expresses the respect for their autonomy. The nurse should consider patient’s autonomy before administering morphine.
(Starzomski 2009) noted,
“Patients and families from diverse communities have different beliefs about autonomy and may not envision disclosure of information in the same way as their health care providers. In these cases this is an area that needs to be carefully explored with patients to ensure their wishes are respected and they are included in the information process in the way that they wish to be.” In this scenario nurse should communicate with the family members in order to convince and find out their preferred way to disclose the diagnosis and prognosis of disease.
Beneficence- The principal of beneficence as a ‘do good’ describes applications of interventions that are carried out by nurse and physician for the benefit of patient .It also include the protection of right of health service consumer (Staunton & Chiarella 2008). Health professional should treat the person ‘autonomously’ and prevent him/her from harm and care provider should also aware of legal implication of action taken(Ulysse, Balicas & Yiquing 2011). Telling truth is not harmful for patient it will cause the peaceful death(O’Sullivan 2009). The health professional should motivate the family introducing them the benefit of therapeutic discloser and harmful effects of concealing information e.g. administer medication without consent.
Justice -Justice described as treat everyone ‘equally and fairly’. It is a primary phenomena in resolving ethical dilemmas .It required to be supplemented by providing good care to health service user (Botes 2000).In order to apply justice health professionals provide care evenly to all the patients in hospital not patient and family.
Non – maleficience – This principle is based on the phenomena of ‘does no harm’ for example in health care when privacy hard to maintain for research or study purpose then health professional ensure that they do not disclose the patient’s personal details .This principal helps in prevent the occurrence and possibilities of harm. Nurse should access the risk of interventions that she /he is doing.(Ford & Reutter 1990) .It also refrain the nurse from the intentional commission of a wrongful act.(Carlson et al. 2010)
In many communities for instance Muslim and Indian cultures diseases are perceived as a family matter. Decision making is also “family centered” so withholding truth is not rare practice. Therefore beneficence and non-malfeasance play vital role in their moral values as compare to patient right to consent in western countries (Pentheny et al ,2011).
It is also encouraged that in case of a dilemma a professional should seek help from their regulatory body or councils which can guide them towards a legally and ethically rightful path Hui, (2010, p.76).
LEGAL AND ETHICAL IMPLICATIONS
Ethics and legal implications are very closely related with each other. Ethics deal with the standards of conduct and ethical judgement whereas legal issues deal with nursing practise which includes licensing, nurse practice acts and standards of care (Chaloner 2007).
According to Criminal Code (Palliative Care) Amendment Bill 2003,
“Section 282A does not address consent. The administration of medical treatment including palliative care is already governed by a legal regime. If a person has capacity to decide their medical care the patient will consent to their medical treatment. Unauthorised administration of medical treatment would be assault”.
AMA Queensland emphasize that health professionals should respect the ‘autonomy’ terminally ill patients in order to refusal and acceptance of their medical treatments.
Ethical and legal implications in palliative care are very significant because it is an end stage treatment where majority of patient are moving towards an impending death. It is a legal right of every Australian citizen to have complete and correct information about their medical situation. Because of this entitlement professionals delivering palliative care and family members of the patient involves in legal and ethical dilemma. Where they are not sure which course of action would be appropriate in both ethical as well as legal manner. Due to these legal issues and emotional disturbances families of the patient and patient itself undergo a lot of stress and psychological trauma. It is also agreed by many experts of palliative care that increased stress would also impact the ability of the patient to cope with the trauma Oonagh (2009, p.123).
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In this case study patient is facing an impending death from cancer and terminal diagnosis of cancer which will brings her life to the end. This result in deteriorating in her physical health and she may ask question about her situation and prognosis of the disease. With an adult patient it is relatively important to understand the concept of death and disease and they can take a realistic approach towards it by spending their remaining time in a productive manner saying good bye to dear ones and taking care of all formalities before meeting a demises. (ACMA 2011). It is very complicated to reveal the information opposite to relative’s desires (Cavanna et al ,2009)
In this scenario, the wishes of the family to hide information from the patient is not unusual.Ethically it looks wrong for a health care practitioner to lie to the patients regarding her medical situation and not inform her about her forthcoming death. There might be things which she wants to do before dying if she would have been informed. There is also legal implication with the fact that a patient is being treated without her consent and it is also violation of the law which gives a patient right to refusal for treatment on her body. For example many patients want to sign DNR (Do Not Resuscitate) forms to ensure that no attempts should be made to revive them if they are close to death. In this case study patient is being denied of this right as well Hanson (2002). If by family here it is implied that her legal guardian wishes to keep this information hidden from the patient, then according to Giacalone (2007, p.368) the nurse is not legally bound to honour their desires to do so would run counter to the law etc.
Prima Facie it is a clear case of violation of constitutional rights of a patient if nursing professional does not inform the patient about her medical condition and learn her desire and judgment in designing and developing her future treatment and palliative care plan. According to Australian constitutional law the patient have the first right on information regarding his medical condition and it is on his discretion that with whom this information should be shared. If a patient expressively states that he doesn’t wish to share his medical information with his family then it is legal obligation of hospital and medical professional to maintain the wish of the patient. Law handbook Victoria recognizes another law governing certain aspect of hospital care and ethical issue. This law is known as doctor patient confidentiality law this state that medical practitioner doctor, nurse or a paramedical personnel cannot divulge information about his patient to a non related person or a person without patient’s medical attorney until and unless directed by the court of law. . This regulation ensures that dignity and privacy of the patient is maintained and there is no legal or ethical negligence from the doctor in the entire transaction Vickers, (2004, p.232).
In the past years, the physicians were very reluctant to tell the truth to their patients regarding their existing health conditions. On the other hand, in these times the patients do want their physicians to tell them the truth about the diagnosis and the medical therapies. According a survey conducted almost three decades ago, it has been cleared that 97% of the physicians felt that it is correct to tell the truth to the patients regarding all the relevant aspects of their illness which includes the nature of the illness and its expected outcomes. Sometimes it is seen that there is psychological impact on the patient’s mindset and it’s really hard for them to cope with such a stressful situation (Kendall 2006). In such a situation, palliative care specialists can be proved quite helpful as they can provide resources to help the patient and his family deal with emotions that come with a serious illness. They may provide counseling, organize family meeting or make referrals to mental health professionals if needed (Bush & Bruni 2008). However, if the conditions are presented in an undignified manner then it is possible that it may create a negative picture of the situation in the patient’s mind and in that case it is obvious that the sufferings and stress of the patient would increase instead of decreasing and the patient may lose the hope to live (Li et al. 2008). Tuckett suggests that it is necessary to understand the mental state of the patient before passing on the entire information to him. The final decision is made by the doctor and his medical team regarding the disclosure of the truth to the patient after analyzing all his mental status (2012). Even the court of law has approved this argument that if the doctor and his medical team prove with an evidence that the information would have a devastating effect on the patient then they have a full power to hide the information from the patient or they reveal the truth to the patient when they believe it is appropriate time to tell Seymour (2004, p. 165). On the other hand, it may be possible that the patient does not want to listen to the information regarding his health but in such a situation it is the duty of the physician to provide the basic information to the patient (council 2004).
IMPACT ON NURSING PRACTICE
When the medical practitioners communicate with the patients, being honest is a fundamental way to develop trust and respect for the patient. Patients show a great deal of trust in their physician and they may feel deceived if they discover that there is lack of honesty by the physician. But, sometimes a situation arises when the physician thinks that disclosure would create a harmful effect on the patient and it may be validated to hold back the truthful information in that case. (Robinson January-February) explains that sometimes holding back the truthful information from patient may lead to feeling of regret in the health care providers. It can also be one of the main reasons of moral distress on them. (Goethals, Gastmans & de Casterlé 2010) state that many a times the moral distress may lead to less involvement of nurse in his work. It can also cause some kinds of health problems which may eventually leads to resignation from job. Ulysses et al (2011) asserts that in health practise the therapeutic nondisclosure may lead to frustration which in turn affects the practitioner’s responsibility towards his patient and his family.
Many types of complex situations are often faced by several nurses throughout their professional life. Some professionals consider such types of suffering more badly than death. It is totally unfair to withhold the truth from the patient about his existing health conditions, especially when the patient is capable enough to give the consent about various medications and procedures. According to the constitution of Australia, it is not at all acceptable to claim the life of a person for any medical reason and direct any medications without his consent. This case study has proved very beneficial in developing a very in depth understanding of the various medical laws and legal problems which are faced by the health professionals. It should be the duty of every medical professional that in any situation he should not break any of the legal obligations. It also provides detailed information about the various significant steps that should be taken to handle these types of ethical dilemmas.
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