Legal, Ethical and Professional Frameworks of the Nursing Professional System in Australia

Running head: LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
0
LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
Name of the student:
Name of the university:
Author’s note:

LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
Introduction
The aboriginals are indigenous people in the territory of Australia. One of the statistics has been
published by the government of Australia, in which it has stated that approximately 4,00,000
people in this territory are aboriginal people, which is almost 2% of the total population of
Australia (Malaspinas et al., 2016). The nurses in the territory have possessed a duty towards the
aboriginals to improve their health and it is also an integral part of their duty for helping the
indigenous people. The topic of this assignment is the legal, ethical and professional
frameworks, which has been underpinning the professional nursing in the territory of Australia.
In the given scenario, an old aboriginal man, Murray, has been suffering from the ulcers on his
leg. Community health registered nurse, namely Allison, has been appointed for treatment of
Murray. She has provided a diet list for improvement of health, which Murray has not followed.
Murray has again suffered from that problem and has been admitted to a hospital other than a
National Aboriginal Community Health Service Centre. The treating physician has refused to
continue to treat him for an ignorant reason. As per the policy, Allison can not help the patient
without the permission of the doctor. However, she has taught his wife about the dressing of the
infection area. Again, for a severe deterioration of his leg, a bilateral amputation has been
performed. There are some ethical and legal issues, which have arisen in that scenario. The aims
of this essay paper to explain the legal, ethical and professional frameworks of the nursing
professional system in Australia with a link to this scenario.
Discussion
The term cultural sensitive care and awareness is an essential part of the nursing profession
(Clifford et al., 2015). A respectable medical practice has been guided by a sincere determination
of accepting and meeting the cultural needs and frameworks of various patients, which has
obtained an excellent health outcome. It has required various matters such as the acquaintance,
admiration for and sensitivity in the direction of the cultural needs of the public, the
understanding and acknowledging the economic, social, cultural and behavioral factors, which
help to underpin such health of the individual at a community level (Bainbridge et al., 2015). It
P a g e 1 | 9

LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
has also required the process of understanding which one nurse’s own beliefs and culture, as well
as biases, should not influence the interactions with the patients and recommend the
improvement of the health of the patient and its outcomes.
In the given scenario, the registered nurse Allison has tried to fulfill the requirements of the
culturally sensitive care as she has done her duty with care and has forbidden Murray from
gaining his weight, that is, to control his obese, which is not suitable for his health.
In the Australian Charter of Health Care Rights, the government of Australia has provided the
rights of the patients as well as the other individuals to use the health system of Australia
(safetyandquality.gov.au., 2020). These prescribed rights are essential to confirm the time and
place of health care and it should be in high quality and safety. There are seven rights prescribed
in the Charter, which are discussed here. Firstly, the patient can access health care services in
accordance with their needs. Secondly, people have a right to accept a safe and high-quality
service for their health care. Thirdly, the care of the doctors and nurses in the health care system
should show respect and dignity towards his cultural values, beliefs. Fourthly, there must be an
appropriate communication between the nurses and patients. Fifthly, the patient has a right to
participate in the decision of their health care issues. Sixthly, they have a right to tell the health
system to keep the privacy and confidentiality of their personal information. Lastly, the patient
has a right to comment or complain regarding his health care (Trevena et al., 2017).
In the given scenario, Murray can exercise those seven rights, which is provided by the
Australian government. It is also the duty of the registered nurse Allison to help to fulfill these
rights of Murray. However, Allison has failed to show respect towards Murray when she has told
about the obese of Murray. It is her duty to provide a service, but when her senior doctor has
refused to treatment Murray she also refuses to help him. It is beyond the ethics of a nurse, as she
should provide service at any point. Though Allison has refused to provide services at the
hospital, she has tried to provide the best services to her patient Murray and has taught his wife
how to wash the infected area of the leg.
In the health care system in Australia, the consent, confidentiality as well as privacy of a patient
is an essential matter. The Code of Ethics of the Australian Medical Association has required
P a g e 2 | 9

LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
medical practitioners that they should preserve the confidentiality and privacy of the patients.
Section 95A of the Privacy Act 1988 has dealt with some guidelines of the privacy principles
regarding the health information of a patient in the territory of Australia. This section of this Act
has certified the Commissioners to commend the Privacy Principles guidelines in Australia,
which have been issued through the Chief Executive Officer of the National Health and Medical
Research Council as well as any other approved authority. The medical confidentiality means
such guidelines, which have limited access to information between the practitioner and his
patient. The Privacy of health care is ethics where the practitioner should keep the medical
information of a patient private (Chalmers, 2015). A patient can give his consent to the health
staff to access his health record.
In the given scenario, it is a legal duty of Allison to keep the confidential information of Murray
in private, as he is the patient of Allison. As a community nurse, Allison has obeyed her duty.
She has allowed the patient to choose the access of health information regarding his health issue.
According to the Common Law, the patients of the Australian territory, who are competent, can
give the consent as well as refuse the medical treatment of himself. This refusal should be
maintained and obeyed by the medical practitioners; otherwise, they may be held legally liable
(White, Willmott & Neller, 2019). The practitioner will be liable under the law of trespass and
the patient has a right that without his consent he should not be subjected to an offensive
procedure. The Medical Treatment Act 1998 (Vic), there is a mechanism to provide legal
recognition and execute such a Refusal of Treatment Certificate to the patient. However, it is
also an ethical duty of a nurse to convince the patient about his health condition and not to refuse
his treatment. She even can convince the family of the patient not to deny the treatment as it may
be caused to deteriorate the condition of the patient (Savulescu & Schuklenk, 2017).
In the given scenario, the physician of the city hospital has asked for the address of Murray for
another appointment to check his health condition. Murray has failed to provide so. After that,
when Allison has taught her wife how to clean and dressing the wounded area, then they do not
intend to seek any medical help. This is also one type of implied refusal of treatment on the part
of the patient. It is an ethical duty of the community nurse to convince Murray to consult with
P a g e 3 | 9

LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
the physician for his health condition. However, in this case, she does not do so as a community
registered nurse.
According to the Code of Ethics for Nurses in Australia, nurses should practice nursing ethically
and reflectively. The principle of the duty of care of a nurse is that she has possessed an
obligation or responsibility to avoid any act or omission that may be caused injury to the patient,
and the nurse can reasonably foresee it (Johnstone & Facn, 2019). The nurses should not violate
the duty of care towards the betterment of the patient. It means that a nurse should anticipate the
risk of the patient and should take care of protecting them, which is caused to deteriorate the
health of the patient. It is an ethical duty of a nurse to take care of her patient and save him from
the coming harm. All nurses are bound by the duty of care, and it is a fundamental aspect of the
professionalism of nursing (Kitson et al., 2014).
In the given situation, Allison has possessed a duty of care towards Murray as she is a registered
nurse of the community. It is one of the fundamental duties of the profession of a nurse to
maintain the duty of care towards his patient. The first time, she has done her work of dressing
and cleaning the infected leg of Murray with a duty of care. However, the second time, she
should ask Murray to consult with the doctor as she has to convince the patient and maintain the
duty of care towards the patient.
Medical negligence in the health care system of Australia means a consequence of the treatment
of a patient, which could have been avoided by the practitioner (Leslie et al., 2014). There are
four elements that may be needed to prove a medical negligence of a medical practitioner, such
as, firstly, a presence of duty of care on the part of the practitioner; secondly, a violation of that
duty by the practitioner; thirdly, the patient has suffered a harm in the health care as the
consequences of the violation or breach; and lastly, there should be a proximate relation between
the harm and the breach of such duty. In the case law, Rogers vs Whitaker 1992 it has decided
by the court of law that Bolam rule can be continued as an influential because a method of the
treatment of a patient or diagnosis him is negligent and will depend upon the medical standards,
which is only known to the medical practitioners. The provisions of the Civil Liability Act 2002
also approved medical negligence as a legal liability of the practitioners.
P a g e 4 | 9

LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
In this scenario, the doctor, as well as Allison can be liable for the medical negligence, as the
doctor of the city hospital has refused to provide treatment to Murray and it may be caused to
bilateral amputation of his leg later.
To understand the approach of the ethical assessment of such health care, there are four
bioethical principles of Beauchamp and Childress, such as autonomy, non-maleficence,
beneficence and justice (Watine, 2014). Autonomy in health care means the right of a patient for
making a decision about his own medical care without any influence from the health care
provider (Delaney, 2018). In this scenario, the patient, Murray has taken the decision not to
consult with the doctor. The bioethical principle, autonomy has been applied in the case. The
term non-maleficence means inflicting the least harm or non-harming of a matter, which is
possible for reaching towards a beneficial outcome (O’Hara, Taylor, & Barnes, 2016). In this
scenario, Allison has taken a non-maleficence step towards her patient, Murray. She has tried to
do every step in a non-maleficence intention, which is an ethical duty of Allison. The term
beneficence is one type of ethical principle, which has addressed the idea of the action of the
nurse promoting good for the patient (Lipworth, Stewart, & Kerridge, 2018). It is the duty of a
nurse to do best for the health of her patient. It is the ethical duty of a nurse. In this case, the term
beneficence will apply to the activities of Allison as she has done her every duty as a community
nurse towards Murray. When the doctor has refused to do treatment to Murray, then Allison has
taught his wife how to do dressing of the affected area of the leg. The term Justice in health care
is an intricate ethical principle. Health justice means to create equity in the community health
system by working as a community association to envisage a situation, which promotes health
(Delaney, 2018). In this case, for the refusal of the doctor, Murray has suffered an amputation of
his leg. Applying this ethical principle of justice in this case, Murray does not get justice, which
is opposed to the ethical principle of a nurse in the health care system in Australia.
Conclusion
In this given scenario, a community registered nurse has done her duty towards an aboriginal
man, Murray. She has tried her best for the treatment of Murray as even the doctor refuses to
provide treatment to the patient; Allison teaches the wife of Murray about the dressing of the
P a g e 5 | 9

LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
wounded and infected leg in the home. The main point in this scenario that there is a use of an
ethical, legal and professional framework of a nurse and a comparison between these and the
professionalism. Therefore, it can be concluded in this scenario that Allison as a nurse follows
her duties towards her patient, Murray and she has maintained various ethical and legal roles and
responsibilities to her patient.
P a g e 6 | 9

LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
References
Bainbridge, R., McCalman, J., Clifford, A., & Tsey, K. (2015). Cultural competency in the
delivery of health services for Indigenous people.
Chalmers, D. (2015). Biobanking and privacy laws in Australia. The Journal of Law, Medicine
& Ethics, 43(4), 703-713.
Clifford, A., McCalman, J., Bainbridge, R., & Tsey, K. (2015). Interventions to improve cultural
competency in health care for Indigenous peoples of Australia, New Zealand, Canada and
the USA: a systematic review. International Journal for Quality in Health Care, 27(2),
89-98.
Delaney, L. J. (2018). Patient-centred care as an approach to improving health care in
Australia. Collegian, 25(1), 119-123.
Johnstone, M. J., & Facn, P. B. R. (2019). Bioethics: a nursing perspective. Elsevier.
Kitson, A. L., Muntlin Athlin, Å., Conroy, T., & International Learning Collaborative. (2014).
Anything but basic: nursing's challenge in meeting patients’ fundamental care
needs. Journal of Nursing Scholarship, 46(5), 331-339.
Leslie, K., Bramley, D., Shulman, M., & Kennedy, E. (2014). Loss of chance in medical
negligence. Anaesthesia and intensive care, 42(3), 298-302.
Lipworth, W., Stewart, C., & Kerridge, I. (2018). The Need for Beneficence and Prudence in
Clinical Innovation with Autologous Stem Cells. Perspectives in biology and
medicine, 61(1), 90-105.
Malaspinas, A. S., Westaway, M. C., Muller, C., Sousa, V. C., Lao, O., Alves, I., ... & Heupink,
T. H. (2016). A genomic history of Aboriginal Australia. Nature, 538(7624), 207-214.
O’Hara, L., Taylor, J., & Barnes, M. (2016). The extent to which the public health ‘war on
obesity’reflects the ethical values and principles of critical health promotion: a
P a g e 7 | 9

LEGAL AND ETHICAL DECISION MAKING IN PERSON CENTERED CARE
multimedia critical discourse analysis. Health Promotion Journal of Australia, 26(3),
246-254.
Rogers v Whitaker (1992)[1992] HCA 58; 175 CLR 479
safetyandquality.gov.au. (2020). [Ebook]. Retrieved from
https://www.safetyandquality.gov.au/sites/default/files/migrated/Charter-PDf.pdf
Savulescu, J., & Schuklenk, U. (2017). Doctors have no right to refuse medical assistance in
dying, abortion or contraception. Bioethics, 31(3), 162-170.
The Civil Liability Act, 2002
The Medical Treatment Act, 1998 (Vic)
The Privacy Act, 1988 (Cth)
Trevena, L., Shepherd, H. L., Bonner, C., Jansen, J., Cust, A. E., Leask, J., ... & Hoffmann, T.
(2017). Shared decision making in Australia in 2017. Zeitschrift für Evidenz, Fortbildung
und Qualität im Gesundheitswesen, 123, 17-20.
Watine, J. (2014). Why would medical publishers not incorporate core bioethical values into
their Ethics Guidelines?. Biochemia medica: Biochemia medica, 24(1), 7-11.
White, B. P., Willmott, L., & Neller, P. (2019). End of Life Law in Australia.
P a g e 8 | 9