Analysis of Legal and Professional Issues

Question: Discuss about the Analysis of Legal and Professional Issues. Answer: Introduction As is the case with any other healthcare professional, the nurses engaged in this profession have to practice as per the statues given by the state and the federal statutes, which are full of complexities. But, the adherence to such statutes is crucial in order to make the ethical decision and to fulfill their responsibilities. And due to the growing advancements in the medical practices and technologies on daily basis, the healthcare professionals are often required to face the challenges of making the ethical decisions, which has not been provided by the given statutes for such new procedures or practices (Nursing Career Tips, 2017). Due to this, the nurses are required to take all the precautions in making any decision, so as to reduce their chances of legal liability. In addition to this, the ethical implications of such decision is also to be considered and it has to be ensured that their acts do not result in a harm to the patients and are in the best interests of such patients. Even though from a distance, it might seem that such decisions are pretty straightforward, but in most of the cases, it is exactly the opposite and at times, the legal decision may not be an ethical one, and vice versa (Nursing Career Tips, 2017). In Singapore, the statutes like the Mental Capacity Act, 2000, along with the common law principles of obligation, beneficence, autonomy and equity provide the guidance for the nurses in their decision making process, regarding the patients (Loke Thirumoorthy, 2015). Relevant Facts In the given case, B is a 56 year old patient, who is on heavy dosage due to his terminal illness. The extra dose which is given to him, to relive him from pain, is disliked by B. For this reason, he wants his doctor to stop the dose, as he believes it to be pointless. Legal and Ethical Issues The key issue in this case faced by the nurses is to decide if such treatment should be continued and be provided to the patient, against his will, or should it be stopped. To resolve this issue, the concepts of obligation, beneficence, and autonomy, given by the nursing boards in Singapore and Australia have to be used. Rules Obligation The principle of obligation states that it is the duty of the nurses to make certain that the patient is given the best quality treatment. And to take the best interest action, the nurses have to make sure that the patient receives whatever treatment is essential for such patient (Humphreys, 2011). So, if the doctor believes that the extra dose of medication is necessary for the patient, to relive him of the pain and the removal of such dose would result in distress to B, then as per the principle of obligation, the medicine should be continued. Beneficence The principle of beneficence puts a duty over the healthcare practitioners to form good relations with their patients (Elliot, Ho Lim, 2010). The rationale behind this principle is to enable the patient in developing a sense of trust towards such healthcare practitioner, so that the patient can bestow the necessary faith over the practitioner (Ho, 2016). But, if we apply the beneficence principle in case of B, than the principle of obligation, to act towards the patients best interest would be compromised. Autonomy The principle of autonomy addressed the concept of independence. As per the concept of independence, the patient has to be given the independence of making his decisions (Kaan Liu, 2006). So, applying the autonomy principle in case of B, he has to be given the independence to make the decisions he wishes. The ethical code of practices for the nurses dictates that the patient has to be presented with the requisite details, which could help the patient in determining their condition and making the decision to address the issue. Though, if this principle is applied in case of B, he would be left prone to distress due to extreme pain. Relevance of Issue The conflict issues which the nurses have to come across, while discharging their duties, is amongst the major issues arising in the professional healthcare and medical practices. The nurses often reach at an impasse where the decision regarding which approach is the correct one, to address the particular issue, becomes a dilemmatic decision. For the case of B, the decision of doctor, regarding the continuation of the dosage, cannot be critiqued as correct or incorrect, due to the reasons provided for the same. Though, the reasoning behind this decision can be and has to be analyzed. B has all the requisite knowledge about his terminal illness, and is also aware of the fact that the dosage provides him only a temporary relief. Reasonable Approach Had the illness of B not been terminal, the rationale behind the decision of the doctor, would have been taken to be quite strong. But, the condition of B has to be given importance, along with his wishes. Even though the nurses can support him in understanding the implications of his decisions, but the final decision has to be made as per the wishes of B. Legal and Ethical Issues Due to the grave mistake of RN Z, in administering the correct syringe, the patient C got a cardiac arrest. In this situation, the key issue relates to the concept of negligence. Negligence occurs when a person owes a duty of care towards another person and fails to discharge the duty of care, which results in a harm or loss to the other person Trindade, Cane Lunney, 2007). To establish negligence, the elements of negligence have to be established (Kennedy, 2009). These include the duty of care, the breach of this duty of care, the resulting harm or loss to the other party, the loss being significant and the direct causation (Gibson Fraser, 2014). In this case, RN Z owed a duty of care towards C, and this duty was breached when the syringes were exchanged, the cardiac arrest was the loss of significant nature, and as the nurse was responsible to ensure the correctness of the syringes, the causation is established. So, by interchanging the necessary medicine negligently, which resul ted in grave consequences for C, the tort of negligence occurred (Latimer, 2012). A noteworthy point here is that RN Z was unaccompanied to the cubicle by ED, which could have ensured the appropriate administration. The nursing malpractice, as well as, nursing negligence takes place when an injury, harm or loss is sustained by the patients as a result of the failure of the nurses in compliance of their duty (Grant Ballard, 2013). In other words, the negligence in nursing takes place when the duty of care, which was owed by them, towards their patients, is breached and such a breach results in harm to their patients (Amused, 2016). In both Singapore and Australia, the nursing negligence is considered as being more than a mere error or a mistake. The Nursing Board of Singapore has presented a Code of Conduct, to be followed by the nurses to ensure that the patients are provided with quality care (Singapore Nursing Board, 2017). The Nursing and Midwifery Board of Australia also provides the Professional Conduct Standards to be followed by the nurses (Nursing and Midwifery Board of Australia, 2017). Relevance of Issue It is crucial for the nurses to fulfill their duty of care towards the patients (Young, 2009). Even the smallest of errors or mistakes could result in grave situations as has been seen in the case of C. The nurses have to be accountable for their actions and have to ensure that the care which they provide to the patients is of the best quality (Hughes, 2008). It is the obligation of the nurses to make sure that they seek the necessary advice from the supervisor or the charge nurse, before providing the care to the patient. So, it was the duty of RN Z to follow the action plan and the guide which was provided to her by her superiors, without making any mistakes. Often the nurses go forward with the discharge of their duties, and fail to wait for the necessary supervision, which increases the risk of cases under negligence. So, it has to be ensured by the nurses that until and unless they receive the requisite guidance from their supervisors, they should refrain from taking any actions (Urden, Stacy Lough, 2014). Moreover, the guidelines given by NBV, regarding the delegation and supervision, the nurses are required to delay the treatment until their supervisor can guide them. Moreover, for the actions and decisions made during the course of work by nurses and the midwives, they have to be held accountable for the same as per these guidelines. And such actions are inclusive of the nurses personal efficiency for providing the care. The accountability given under the code is both legal and ethical (Nursing and Midwifery Board of Australia, 2008). Reasonable Approach In the given case, RN Z should have delayed the treatment till the time the requisite supervision was available in the ED. In case when such a delay was not possible, RN Z should have taken extra care in ensuring that no mistake took place due to the seriousness of the situation. Since, the negligent actions of RN Z proved fatal for C, who was the sole earner in the family, she would have to compensate the family of C, for their loss. Professional Issue The major issue relates to the reporting of professional malpractices in the system (Dove et al. 2010). In the given case, there is ample amount of evidence against M, which shows that she indulged in professional malpractices which have major negated impact over the quality of care she provided. But, if the evidence present against M is presented, she would lose her job, which would result in failure of her looking after her children. As per the Australian Code of Professional Conduct for Nurses Conduct Statement 2, the nurses have to base their practice on the professional standards, in addition to the broad health system (Nursing and Midwifery Board of Australia, 2008). This code determines that the nurses have the duty of protecting the interest of their colleagues, their partners and their family members as per the broad standards of Safety, Quality and Accountability in Healthcare (Gastmans, 2013). Information management, documentation, open disclosure procedures, and incident reporting are some of things involved in such practices (Huber, 2013). The most significant responsibility of a nurse is to provide safe and competent nursing care (Boyd, 2008). A situation which can result in negated impact over the professional standards or a situation where a questionable, unlawful or unethical practice is required to be reported to the authority or the concerned person. In case the issue remains unresolved, it becomes the duty of the nurses to intervene and protect the rights of patients by ensuring that quality care is provided. And the external authorities can be notified in case the internal process fails in solving the situation. Australian Code of Professional Conduct for Nurses Conduct Statement 4 provides similar provisions (Nursing and Midwifery Board of Australia, 2008). Relevance of Issue In this case, M used to steal the controlled medicine which was crucial for the patients. Such practices have a negative impact over the quality of care and the health of the patients. Moreover, patients lose the trust and faith in the nursing practices. There is a clash between the personal duties, and the professional and ethical obligations, which presents an ethical dilemma. Reasonable Approach The professional ethics have to be given the priority over the personal obligations in such situations. So, irrespective of the impact which would be on the personal life of M, the matter has to be reported. This becomes importance due to her denial regarding the involvement in this matter. As she was given a warning regarding this issue, beyond which the problem persisted, it became sufficient and mandatory to report the issue. Additionally, the compliance too the professional standards is also needed, so M has to be reported. Ethical and Professional Issues The key issue of this scenario relates to the decision of the medical practitioners against the patients will (Tong Robert, 2007). In case a patient is unwilling in getting the medical treatment, it becomes the duty of the medical practitioner to make certain that the best efforts are made to make the patient aware about the impact of his decision, by explaining about the disease, the treatment and its necessity (Parahoo, 2014). For the individuals in Singapore, guidelines are provided through the Mental Capacity Act, 2008, for such persons who are in the position of making a decision for others, who suffer from medical incapacity, which could be either permanent or temporary. As per this act, the decision made for the other person has to be in the best interest of such other person and prior to making such a decision, the best efforts have to be made for making the individual understand the situation and for taking the decision themselves (Singapore Statutes Online, 2017). Relevance of Issue Medical practitioners often face a dilemma in making the decision regarding which one is reasonable, as they are bound by the principles of obligation, beneficence, and autonomy (Lillemoen Pedersen, 2013). As occurred in case of B, no decision could be said to be the best one, due to the variance in view point of the medical practitioners and the patient. The practitioner has to act in the best interest and at the same time has to ensure that additional costs and time are not incurred (Shirvington, 2017). And due to the increasing cases of legal actions being brought in this regarding, finding a balance between the two becomes more difficult. This is coupled by the burden of proof over the practitioners to prove the reasons for going against the will of the patients. Reasonable Approach Since D is refusing to take the needful treatment for his heart condition, the doctors have to take the necessary steps needed to ensure that D is aware of the significance of this treatment and the resulting impact of not undertaking such a treatment. The family member or carer can also assist in this, so the son of D needs to help the doctors in making D understand the significance of the treatment. As this treatment would relive D from his disease permanently, which was not the case for B the doctors should go ahead with the treatment, in the best interest of D. Conclusion The preceding parts highlighted the various issues which can arise in the medical professional before the healthcare professionals. Such issues can occur due to the personal relationship amongst the nurses or the relationship of the nurses with their patients. The key decision relates to taking the decision for the patient, by the medical practitioners in cases where the patient is unable to make the requisite decision. The medical practitioners have to maintain a balance between the quoted principles and there is also a need to adhere to the statutes and the codes given in this regard, to ensure that the image of the practitioners is not ruined. The nurses have to be held accountable for their actions, and in cases of negligence, they have to be held responsible. They also have to follow the instructions and wait for the instructions of their supervisors. In case these things are not done, as was seen in the scenarios highlighted above, it could prove fatal for both the patients and the nurses. References Amused. (2016). What is Negligence?. Retrieved from: https://www.ausmed.com/articles/what-is-negligence/ Boyd, M.A. (2008). Psychiatric Nursing: Contemporary Practice (4th ed.). Philadelphia: Lippincott Williams Wilkins. Dove, J.T., Brush, J.E., Chazal, R.A., Oetgen, W.J. (2010). Medical Professional Liability and Health Care System Reform. Journal of the American College of Cardiology, 55(25), 28012803. doi: https://dx.doi.org/10.1016/j.jacc.2010.03.028. Elliot, J.M., Ho, W.C., Lim, S.S.N. (2010). Bioethics in Singapore: The Ethical Microcosm. Singapore: World Scientific Publishing Co Pte Ltd. Gastmans, C. (2013). Dignity-enhancing nursing care A foundational ethical framework. Nursing Ethics, 20(2), 142-149. Gibson, A., Fraser, D. (2014). Business Law 2014 (8th ed.). Melbourne, Pearson Education Australia. Grant, P.D., Ballard, D.C. (2013). Fast Facts About Nursing and the Law: Law for Nurses in a Nutshell. New York: Springer Publishing Company. Ho, W.C. (2016). Juridification in Bioethics: Governance of Human Pluripotent Cell Research. Singapore: World Scientific Publishing Co Pte Ltd. Huber, D. (2014). Leadership and nursing care management (5th ed.). Missouri: Elsevier. Hughes, R.G. (2008). Nurses at the Sharp End of Patient Care. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK2672/ Humphreys, M. (2011). Nursing the Cardiac Patient. Hoboken: John Wiley Sons. Kaan, T., Liu, E.T. (2006). Life Sciences: Law and Ethics: Recent Developments in Singapore. Singapore: Academy Publishing. Kennedy, R. (2009). Duty of Care in the Human Services: Mishaps, Misdeeds ad the Law. Victoria: Cambridge University Press. Latimer, P. (2012). Australian Business Law 2012 (31st ed.). Sydney, NSW: CCH Australia Limited. Lillemoen, L., Pedersen, R. (2013). Ethical challenges and how to develop ethics support in primary health care.Nursing ethics,20(1), 96-108. Loke, P., Thirumoorthy, T. (2015). Medicine, Law, Professional Regulation And Ethics. Singapore Medical Association News, 47(11), 18-19. Nursing and Midwifery Board of Australia. (2008). Code of professional conduct for midwives in Australia. Retrieved from: https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2F1355amp;dbid=APamp;chksum=Mm624fvql2ZEKdEmT3l2ng%3D%3D Nursing and Midwifery Board of Australia. (2017). Professional standards. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx Nursing Career Tips. (2017). Legal and Ethical Issues in Nursing Explained. Retrieved from: https://nursingcareertips.com/legal-and-ethical-issues-in-nursing-explained/ Parahoo, K. (2014).Nursing Research: Principles, Process And Issues (3rd ed.). New York: Palgrave Macmillan. Shirvington, V. (2017). Avoiding A Breach Of The Professional Conduct And Practice Rules. Retrieved from: https://www.lawsociety.com.au/cs/groups/public/documents/internetcontent/026321.pdf Singapore Nursing Board. (2017). Code Of Ethics And Professional Conduct. Retrieved from: https://www.healthprofessionals.gov.sg/content/dam/hprof/snb/docs/publications/Code%20of%20Ethics%20and%20Professional%20Conduct%20(15%20Mar%201999).pdf Singapore Statutes Online, 2017). Mental Capacity Act. Retrieved from: https://statutes.agc.gov.sg/aol/search/display/view.w3p;query=DocId%3A7f933c47-8a34-47d1-8d0a-0a457d6fa1c2%20%20Status%3Ainforce%20Depth%3A0;rec=0;whole=yes Tong, S.F., Robert, C. (2007). A Patient Who Refused Medical Advice: The Doctor And The Patient Should Look For A Common Ground. Malaysian Family Physician, 2(3), 110113. Trindade, F., Cane, P., Lunney, M. (2007).The law of torts in Australia (4th ed.). South Melbourne: Oxford University Press. Urden, L.D., Stacy, K.M., Lough, M.E. (2014). Critical Care Nursing: Diagnosis and Management. Missouri: Elsevier. Young, A. (2009). Review: the legal duty of care for nurses and other health professionals. Journal of Clinical Nursing, 18(22). doi: 10.1111/j.1365-2702.2009.02855.x.