Legal and Ethical Issues in Healthcare: A Case Study in Nursing

This essay discusses the legal and ethical issues in healthcare using a case study in nursing. It covers the importance of obtaining valid consent, the legal foundation for informed consent, and the conflict between laws and ethical principles. The essay also explores the ethical decision-making model of Kerridge and provides a conclusion.

RUNNING HEAD: CASE STUDY-NURSING
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Introduction
There is no collection of values in stone. They are evolving as society’s attitude shift.
When societal norms and educational standards changed half a century ago, the medical
profession shifted from doctors know the best to patients opinion must be taken. Many
clinical and government health relationships involve ethical and legal problems. The usual
outstanding health care processes never recognize or correctly manage many potential causes
of ethical and legal problems. The main aim of this essay is to provide brief details of
legislations and ethical principles, which applies to the given scenario. This essay will
describe the legal remedy against Dr. Lin that the Adam, Sue and Bryan have as well as the
standard of evidence. It will further portray the answers or defence Dr. Lin might argue. This
essay will also describe the conflict between the laws and the principles of ethics.
Legal Issue
Consent plays a vital role in healthcare. To obtain consent in healthcare is important
for patient autonomy and right to self-determination (Bylstra, 2017). A consent is said to be a
valid consent when sufficient information relating to treatment has been given to the patient
which is also known as informed consent, when it is voluntarily given and patient understood
the information given to him (O'regan, 2019). The legal foundation for informed consent if
focused on the assumption that every adult and sound minded person has the right to
determine what to do with his or her own body; and a surgeon who conducts a procedure
without the approval of his or her patient commits an attack for which he or she is responsible
for damages (Khan, Capps, Sum, Kuswanto, & Sim, 2014). Under the law doctor who acted
negligently is held liable under either medical negligence or assault/battery i.e. treating
patient without obtaining their consent as well as potential criminal liability (Mcdonald &
Then, 2019).
The presumption in law and clinical practice is that, unless otherwise demonstrated,
all adolescents are able to agree to or refuse treatment (Joly & Knoppers, 2014). The doctors
must not find the individual to be inadequate until all the appropriate medical data concerning
the disease and therapy of the patient has been provided to the latter. However, if the patient
lack the capacity to give consent then doctor in good faith can treat the patient. Chapter 177A
of the Mental Capacity Act 2008 describes requirements for creating therapy and care choices
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for patients lacking capability (Dimond, 2016). This legislation seeks to tackle the need for
people who are unable to create choices themselves to decide and behave on behalf of them
(Kong & Keene, 2018).
In the case of Sideaway v Board of Governors of the Benthlam Royal Hospital and
Maudsley Hospital (1985) 1 ER 643, the bolam test was applied for medical advice. In this
case the plaintiff suffered from acute pain in her neck and arms. Her neurosurgeon obtained
her consent for decompression of the cervical cord, but did not mentioned the reality that the
decompression triggered paraplegia in less than 1 percent of instances. However, the surgery
was successful but after spinal surgery, she created paraplegia. It was hold by the court that
consent did not require a detailed explanation of possible side effects. It was discovered that
the surgeon did not tell the complainant that the procedure was not essential and was in
reality voluntary. It was also discovered that while she was advised of the danger of nerve
roots harm, she was not adviced of the danger to the spinal column that was less probable but
possibly more severe. It was also recognised that if the complainant had known about these
facts, she would not have had the surgery. The House of Lords upheld the decision of lower
court on the basis that if the accountable medical view endorsed the course of action, this was
adequate to fulfil the obligation of care entrusted to the patient by the physician.
Similarly, if Adam, Sue and Bryan wish to file a suit against the doctor then they must
ensure that the doctor owned duty of care towards the patient and he acted negligently. They
need to prove that their mother was incapable to give consent and they already informed
about the same to the doctor, still doctor did the surgery. In addition, the consent form was
not filled prior to the surgery as this act of doctor shows negligence on his part.
While in defence, it can be shown by the doctor that he in good faith performed the
surgery as per the considering the patient’s condition. Doctor on his part obtained consent
from the patient before the surgery and the patient in response nodded her head, which gave
presumption to implied consent.
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Ethical Issue
Medical ethics includes examining a particular issue, generally a clinical situation and
using principles, facts and reasoning to determine what should be the best course of
intervention (Zetler & Bonello, 2011). Most of the ethical issues, such as determining right
from incorrect, are relatively simple. However, others may also be more perplexing, such as
choosing between two rights- two beliefs that clash with each other-or choosing between two
distinct valuation structures, such as the patient versus the doctor (Michael, SN, & Wai-Ioon,
2010).
Many specialist ethicists suggest that four fundamental values or doctrines be used to
determine ethical problems (Campbell, 2013). These are autonomy, justice, benevolence and
non-benevolence. The two values of bioethics applicable to the present scenario are
autonomy and benevolence & non-benevolence. Patient autonomy must be regarded as a
basic concept in medical ethics (Beauchamp & Childress, 2009). Patients have right to have
precise and adequate information to decide their own medical management choices. In
general, patient autonomy refers to obtain consent of patient prior to treatment. A significant
aspect of patient autonomy is to ensure that patient grant their necessary permission to any
therapy or surgery before they undergo such therapy or surgery. This includes patients having
known and grasped the advantages and dangers associated making voluntary choices about
their medical care. Ethical Code and Ethical Guidelines of Singapore Medical Council
defines about the informed consent. It is duty of every doctor to obtain valid consent either
from patient or their relative. Similarly, in the instant scenario, before surgery, the sally shook
her head and verified the surgery in at multiple instances. The concept of autonomy applies to
this situation as the doctor obtained the consent of the patient.
Whereas the concept of benevolence and non-benevolence generally are based on the
importance of what is beneficial for the patient. The first is the useful necessity to advance
the patient’s benefit. The second is the need to avoid doing what affects the patient value.
Similarly in the current scenario the surgery was performed by the doctor with the view to
treat the patient in due time and in good faith. The main purpose of the surgery was to cure
the patient thus the doctor did surgery for the benefit of the patient.
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In the current situation, the main conflict can be between patient autonomy and
benevolence & non-benevolence. The doctor although did all the relevant formalities on his
part and obtained valid consent from the patient. What the doctor did was to treat the patient
within due time. While if the doctor had refrained from doing treatment (non-benevolence)
might save her life and she might live longer, which was though not certain. The doctor in
defence can proof that the principle of autonomy was followed. Whereas by while the
claimants can claim that to reduce the risk and possible outcome of surgery (non-
benevolence), if the surgery was postponed.
The ethical decision-making model of Kerridge offers a systematic method of solving
ethical dilemmas. Kerridge model provides various methods for solving ethical problem
(Kerridge, Lowe, & Stewart, 2013). The first method as per this model is resolve dispute
between the clinical professionals and patients or their relatives through mediation process. In
this dispute is resolved between the parties by the expertise. However if the dispute is not
resolved through this process the parties can file suit against the other party. The other way to
resolve the conflict of parties is to take help of clinical ethics consultation, which enhances
the quality of ethical decision-making.
Conclusion
Concisely it can be said that consent plays a vital role in health care. Before operating
any patient it is the duty of medical staff and doctors to obtain valid consent from them, this
process is also known as patient autonomy. As per the Singapore medical guidelines the
doctors has the authority to take decision on behalf of patient in good faith, looking into the
severity of condition of patient. Thus to establish a case against such medical practitioners,
claimants are required to prove negligence on their part beyond reasonable doubt. However,
in case of conflict between the parties matters can be resolved through various methods as
describe in Kerridge et all (2013) model.
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Bibliography
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