Lawand Ethics in Health
Thelaw and legal requirements in healthcare are greatly attractingattention worldwide. It is effective that all professionals in thehealth care field understand the different ethical and legalprinciples and laws so that they effectively treat their patients. Inthis paper, I identify of the different forms of treatment phasesthat present themselves in the case. I strive to bring out theethical and legal concerns and consequences using the deontology andutilitarianism principles and relate them to the concepts ofautonomy, the duty of care, beneficence, non-maleficence, andjustice. Lastly, I will evaluate the tort and battery law associatedwith the case.
Lawand Ethics in Health
Thehealth care field is multifaceted. Professionals in this field facenumerous laws, regulations and practice standards, which govern theircontact with patients. It is essential for these experts tounderstand the legal and ethical implications that not only affectthem but also their patients. Consequently, they will strive to abideby a specific code of conduct and ethical standards, which regulatesa patient’s personal decision pertaining to their health.Therefore, health care professionals must strive to safeguard theserights using proper and extensive planning and thinking. Even thoughpatients are allowed to make decisions concerning their health, thereare instances that allow health care professionals to intervene.These occurrences relate to a patient’s inability to exercise theirpersonal legal rights due to detrimental mental or physical health.In such situations, it is necessary for health care professionals tocome up with the best possible decisions that will save theirpatient’s life. In this paper, I will evaluate Tim’s treatment inthe emergency department and focus on discussing the legal andethical implications that arise in the case study. I will usedeontology and utilitarianism and relate them to autonomy, the dutyof care, beneficence, non-maleficence, and justice to determine thereasons and consequences behind this treatment and discuss theeffects of battery and tort law that arise from the case.
Thecase revolves around a man named Tim who is 32. After a fight thatoccurred at the weekend football match where he was a spectator, hegained admission through the emergency department. A thoroughexamination revealed deep scalp lacerations, a dislocated shoulder,and severe bruising to his upper body and face. Due to the busynature of the emergency department, Tim did not receive prompttreatment making him uncooperative and noisy after a certain amountof time. He then underwent an operation and upon waking up, he seemedstable but postoperative observations became difficult on the nursingstaff due to his drowsiness and noncompliance. After two hours, Timclaimed he wanted to return to the game since his team needed him toplay despite him being a spectator. The doctor and registered nurseon duty attempted to convince Tim to stay but he did not want tocomply. Due to the unusual behavior, the doctor ordered theadministration of intramuscular morphine since he attributed it topain. However, Tim insisted he was fine. Despite this, the registerednurse enacted on the order and injected Tim with morphine with theaid of a nursing assistant and another registered nurse who were toprevent Tim from struggling. In the course of the administration,the needle broke making it necessary for another surgery thatprolonged Tim’s hospitalization by four weeks.
Tounderstand the reasons and consequences associated with Tim’streatment, it is proper to look into the different legal and ethicalimplications of the care using ethical and legal principles. Theseethical principles include deontology and utilitarianism, as well as,beneficence, non-maleficence, justice, autonomy and duty of care(Airth-Kindree & Kirkhorn, 2016).
Accordingto Vryonides etal.(2015), deontology represents duty-based actions and do not relate toany form of consequence, happiness, or reward. Schrems (2013) claimshumans are rational beings. They also have moral worth, freedom, andgood will. Consequently, they perform actions because of obligationand should have the free will to formulate moral judgments. They alsoact using a common model of moral rules and maxims, which requiresthem to carry out ethical duty. Vryonides etal.(2015) note that an ethical action depends on the intentionsassociated with a given decision instead of the resultant outcomes.
Onthe other hand, Aliakbari etal.(2015) claims utilitarianism promotes any situation’s greatestpossible good. In other words, the value of any given actionundergoes characterization due to its usefulness and places criticalemphasis on the consequence or outcome. Similarly, a morally rightaction leads to pain absence (happiness), whereas when wrong resultsin pain (unhappiness), which are intrinsic values. In agreement withHattingh (2015), freedom from pain and pleasure are the mainattributes desired as ends in accordance with the utilitarianismprinciple. However, the relationships between any action and eitherits unhappy or happy outcome relies on the everyday circumstancesthere is no absolute moral principle or independent under theprinciple of utilitarianism.
Inagreement with Hughes & Lane (2016), autonomy entails anindividual’s capacity to self-determine. It allows people to makepersonal decisions independently, which attract respect from others.In the health care field, a patient’s autonomy involves theattaining of informed consent regarding treatment, accepting apatient’s rejection of treatment, as well as, the patient’streatment options (Johnstone, 2016). However, it is significant toobserve that the right to respect a patient’s autonomy is notoutright. In situations where they can harm or endanger others, forinstance, through using violent acts, patients lose theself-determination rights (Hughes & Lane, 2016).
Inagreement with Hutchinson etal.(2014), the duty of care enables professional health care workers tominimize the degree of injury or harm experienced by patients.Despite this, the duty to care may go against the wishes of a clientmaking it an act of balance. Therefore, health care professionalsshould know how to exercise a balance between the patient’s safetyand that of other patients, as well as, their personal rights.McElroy (2011) points out that there are various characteristicsassociated with the duty of care in health care. These may be ethicalor professional, personal-based, legal, community-based, andorganizational. Once health care experts understand thesecharacteristics, they will provide their patients with thebest-needed treatment.
Generally,Kulju etal.(2016) claim beneficence involves charitable, kind, and mercifuldeeds. In a nursing point of view, beneficence is the action thatnurses take, which are beneficial to patient. Consequently, itfacilitates client well-being. According to Taylor (2014), theseactions may involve obvious interventions, which may include thelifting of a patient’s bedside rails to avoid further injuries thatmay result from falls. Sometimes, nurses may face ethical dilemmas,especially when trying to make decisions that lie between thebeneficence principle and respecting the autonomy(self-determination) rights of a patient. Nurses may choose to act inmanners they consider beneficial to a patient instead of allowingtheir patients to exercise their self-determination. The premeditatedoverruling of any patient’s self-determination in such a manner ispaternalism (Haahr, Norlyk & Hall, 2014). However, healthprofessionals must contemplate paternalistic action values carefullyand establish whether these actions truly relate to a patient’sbest interest. Hattingh (2015) notes justified paternalism regularlyinvolves matters related to patient safety.
Aleksandrova-Yankulovska(2016) claims non-maleficence is a command to do no harm. The conceptis paired regularly with the beneficence theory despite them beingdifferent. Beneficence commands actions that benefit others, whilenon-maleficence comprises of refraining from acts that may cause harmto others (McAllister etal.,2016). It is apparent that non-maleficence has numerous health careimplications. They include the avoidance of negligent care, makingresolutions that associate with withdrawing and withholding treatmentalongside the delivery of heroic or extraordinary treatment(Sinclair, Papps & Marshall, 2016).
Further,justice is a health care ethics principle and virtue. It forms thebackground of a duty-centered moral reasoning form of ethicalframework (Meadowcroft, 2015). Therefore, the justice viewpoint israther broad in the ethical field. It represents the fair burdens andbenefits distribution (Taylor, 2014). As far as principlism isconcerned, justice represents the allocation of limited health careresources (Kulju etal.,2016). Often, resolutions are needed to provide answers as to whetheran individual has health care rights. Likewise, they are needed topinpoint who needs to pay for treatment costs.
Inagreement with Ramanathan (2014), the law of negligence and batteryunder tort law is the foundation of most of the lawsuits filedagainst hospitals, their staff, and health care professionals. Theprimary objectives of tort law include deterrence, compensation, andcorrective justice. Therefore, tort law as stated by Ramanathan(2014) aims to restore a plaintiff to a position that they would haveenjoyed if the defendant did not show negligence or a form ofbattery. However, it is evident that not every medical error isnegligent. Aleksandrova-Yankulovska (2016) points out that eventhough patients suffer bad consequences resulting from medicaltreatment, they do not have automatic rights related to compensationsuing. Medical errors are only negligent if health care practitionershave not taken reasonable care. Under the law, doctors do not need toact perfectly, instead, they should take reasonable care whenadvising and treating their patients.
Withreference to the case study, the discussion of Tim’s treatmentduring his hospitalization period takes different phases. In thefirst phase, it is necessary to evaluate the treatment period fromthe time Tim arrived into the emergency department. The secondtreatment phase involves the actual surgery care offered to Tim.Lastly, the third treatment phase should consider the patient’spost-operative treatment and recovery period. However, more emphasisshould be placed on the methods adapted when administering theintramuscular morphine injection. It is necessary because thesemethods resulted in the breaking of the injection’s needledemanding additional surgery, as well as, extended hospitalization.
Duringthe initial emergency department phase, Tim’s treatment lined upwith the normal activities encountered at any busy emergencydepartment. It is apparent the hospital activities were demandingsince they were experiencing active ambulance traffic and abundantadmissions. Nevertheless, they managed to test Tim for any trace ofalcohol and drugs. Upon assessment, it was discovered that hesuffered from extensive upper body and face bruising, deep scalplacerations, and a dislocated shoulder.
Themost probable legal or ethical concerns that apply to this treatmentphase include the duty of care (Aleksandrova-Yankulovska, 2016).Therefore, it is appropriate to consider the serious nature of Tim’sinjuries and determine whether any further treatment holdups wouldpose severe dangers to the patient’s well-being and health. Despitethe fact that he had to wait for his surgical procedure, the casedoes not provide insights as to whether Tim experienced anyunfavorable effects during the initial treatment period. Schrems(2013) claims that it is typical for the emergency department workersto place priorities on patients depending on their injury or illnessdegrees, as well as, the possibility of a life threateningoccurrence. As noted by Taylor (2014) in case of negligence, apatient’s well-being and health may be in jeopardy. Accordingly,matters of ethical or legal concerns may arise at this phase ifevidence indicated negligence or an oversight.
Thenext surgery treatment phase depended on the results of the patient’sexamination gathered during his emergency admission emergency. Aftersurgery, Tim was argumentative and irrational during his recoveryperiod, which may be attributed to the amount of pain and shock hesuffered from due to his serious injuries. Ethical and legal concernscan arise if there was evidence showing that Tim went throughinappropriate or pointless surgical procedures. If such an incidentoccurred, Kulju etal.(2016) claims it is justified to pursue a legal or ethical case sinceinadequate surgery may cause further harm to a patient. However,looking at the evidence presented in the case at this stage, therewould be no need for any ethical or legal consequences. Taylor (2014)claims that according to the beneficence principle, surgery provedadvantageous and essential in the treatment of Tim’s injuries.
Thelast treatment phase involved Tim’s post-operative treatment. Thephase forms the background of major concern attracting both ethicaland legal concerns. Particularly, issues arise after the decisionmade to administer the intramuscular morphine injection. Through theprocess, Tim was exposed to harm and more pain when the injectionneedle broke because he was struggling to resist. The patient showeduncooperative and irrational behavior when he demanded to leave thehospital without the ordered injection. During this period, Timshowed signs of confusion by claiming he wanted to go and play in thegame despite him being a spectator. In agreement with Schrems (2013),such irrational behavior indicates that a patient cannot make sounddecisions that will ensure his health. When the doctor witnessedthis, he attributed it to the amount of pain Tim felt from hisprevious surgical procedure and his degree of injuries.
Ethicalconcerns arise as to whether or not the doctor in question has theduty of care when he ordered the intramuscular morphine injection.According to Kulju etal.(2016), it a doctor’s duties to identify the degree of painpatients feel just by observing their behavior during treatment.Therefore, the said doctor considered Tim’s injury extents and uponpondering on the surgery effects that the patient might haveattracted, he was to determine whether his irrational behavior wasdue to pain. Aliakbari etal.(2015) claims that pain and trauma are bound to manifest in apatients behavior making it the duty of health care professionals toidentify the signs. In this case, it is true that the non-maleficencetheory would compel this doctor to determine if any proposedtreatment may result in patient harm (Aleksandrova-Yankulovska,2016). Additionally, the beneficence theory would determine if thesaid treatment would in fact be beneficial to the recovery period ofa patient. Thus, the doctor is require to realize if his treatmentplan was in accordance with the duty of care, is harmless, and isbeneficial to his patient. As far as Tim’s protests are concernedregarding his unwillingness to take the intramuscular morphineinjection and his protests concerning his pain level, the doctor hasthe duty to consider Tim’s behavior. He is to determine whether hispatient was irrational rendering him mentally incapable of practicingautonomy. Vryonides etal.(2015) claims that health care professionals have the responsibilityto disregard patient wishes if they are either physically or mentallyimpaired. Therefore, the doctor instinctively made considerations andchose to order the intramuscular morphine injection grounded on hisadvanced medical practice and judgment related to patient behaviorand post-operative care.
Afterthe ordering of the injection, a registered nurse was responsible forthe act of intramuscular morphine injection administration. She thenasked for the help of another registered nurse and nursing assistant.However, this team was not concerned with the ethical consequences ofthe injection because the doctor made every decision concerning thematter by examining all the considerations. Even so, the team of tworegistered nurses and a nursing assistant was faced with legalconcerns. These concerns determined whether they would haverestrained Tim appropriately during the injection to prevent theneedle from breaking off. In agreement with Meadowcroft (2015), itbecomes difficult for nurses to restrain an irrational and strugglingadult patient. Thus, the health care workers in the case should havedetermined if they could restrain Tim effectively especially since hewas a thirty-two year old man with aggressive and unreasonabletendencies. The primary considerations would have involveddetermining whether they needed more restraining straps or additionalhelp before proceeding with the injection. Upon analysis of the case,it is apparent that the patient experienced harm due to the breakingof the needle. However, the legal consequences lie on whether thehealth care workers exercised the needed care when restraining anaggressive and strong patient. It also lies on whether negligence waspracticed due to the failure of the nurses to take the necessaryprecautions when dealing with an unreasonable patient who resistedtreatment.
Insummary, when analyzing the events of the case, it is evident thatTim’s treatment at the emergency department was normal. Therefore,it did not attract any definite legal or ethical ramificationsdespite the fact that he had to wait for some time before hissurgical treatment. The hospital prioritized his case as per hisinjuries seriousness. The injuries did not seem life threating afterthe necessary assessment clearing him of any drug or alcoholsubstances. Subsequently, the surgical phase was suitable anduneventful ensuring that it did not attract any legal or ethicalissue.
However,the doctor’s order to administer Tim with the intramuscularmorphine injection does raise ethical concerns. Despite this, thepatient appeared irrational and not in the right state of mind topractice autonomy. With this, the doctor managed to override hisprotests against the injection having concern only to Tim’swell-being. It is apparent that the injection was not meant tothreaten Tim’s health further and had the capacity to relieve hispain. The doctor’s decision can be justifiable since he could proveTim’s irrational behavior and relate it to the trauma he isexperiencing from the pain from both his injuries and the previoussurgical procedure. Therefore, Tim was in pain and not in the rightstate of mind to make decisions associated with his health at thatparticular time.
Lastly,the primary legal concern in the case study was linked to therefrainment of Tim when administering the intramuscular morphineinjection. It was apparent that the patient was a strong strugglingman who protested the injection in the first place. Thus, cautionwould suggest the integration of further restraint before theinjection process since the patient was struggling. Tim suffered direramifications, which raised non-maleficence concerns relating to theneglect to take further precautions to restrain Tim appropriatelybefore the injection process.
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