Legal and Ethical Issues in Healthcare

This article discusses the legal and ethical issues faced by medical practitioners in providing healthcare. It explores the principles of autonomy, beneficence, non-maleficence, and justice in making ethical decisions. The article analyzes a case study involving a nurse and a teenage patient seeking contraception, and examines how these principles can be applied in practice. It provides insights into the importance of respecting patient autonomy while ensuring their well-being and the fair distribution of resources.

Running head: LEGAL AND ETHICAL ISSUES 1
Name
Student Number
Coordinator’s Name
Assessment Task 3 Essay
School of Nursing & Health care
Semester 1, 2019
Course Name
Number of Word

LEGAL AND ETHICAL ISSUES 2
1. Introduction
Medical practitioners are confronted with minor and major ethical choices while providing health care to
persons from diverse and pluralistic society. In such scenarios, there is need for a moral guideline
universally accepted across several cultures in making the ‘best’ choice. Such a guideline was developed
in 1969 by Beauchamp and James who articulated principles to be followed in making informed ethical
decisions. These principles are respect for autonomy, beneficence, non-maleficence and justice (Niven,
Leigh & Stelfox, 2016). These principles will be key in coming up with the solution to the case provided
below.
Taylah a student aged 14 years from Dene visits the sexual health nurse requesting for contraception. In
the discussion between the nurse and Taylah, the nurse identifies issues such as, Taylah being diabetic,
Taylah having self-esteem and body image issues which is evidence in her sexual activity of having
sexual intercourse with random boys at a party while drunk. The decision to be made by the nurse is
serious because it directly affects Taylah health and it would be a crucial step in changing the direction of
Taylah’s life.
The nurse has to make a decision whether to provide Taylah with the contraceptives or not in
consideration of the principles of Tom Beauchamp and James Childress. Should the nurse give Taylah the
contraceptives or not? and what are other solution? These are some of the questions this paper attempts to
answer in relation to the four ethical guidelines.
2. Analysis of the case
2.1 Principle of autonomy
The principle of respect for autonomy dictates that all individuals have the right to undertake decisions
and choices in developing their life plan. Based on the principle of respect for persons, this principle
dictates that every person is responsible of making informed decision as relation agents. This principle
that is intertwined with the principle of consent dictates that before the provision of any medical diagnosis
there is need to discuss the treatment with the patient who are to provide their consent (Moaddab et al.,
2015).
In the above case of Taylah the nurse has a prima facie duty of respecting the autonomy of Taylah, who is
seeking contraceptives in order to avoid pregnancy. According to Beauchamp and Childress for a
patient’s autonomy to be respect the medical practitioner must ensure that the patient understands their
action and they are capable of making a free choice without any coercion or external influence (Williams,

LEGAL AND ETHICAL ISSUES 3
& Graham, 2003). In the case of Taylah there is an influence from friends who she wants to imitate hence
the statement “I just want to be normal,” referring to the friends.
The nurse in this case according to respect of autonomy is supposed to inform Taylah of all the outcome
of using the contraceptives and if there is a better solution to giving Taylah the contraceptives the nurse
should inform Taylah then after her consent the nurse can proved the medication. This should be done
without pressuring the patient in any way.
Some of the factors that the nurse should consider in determining whether Taylah is competent enough to
make the treatment decision are, her ability to express preference, her ability to understand the current
situation and its consequences, her ability to give reasons that are rational and her ability provide risks
and benefits of her decision (Beauchamp, 2019). In this scenario Taylah is 14 years old and a student
meaning that she is able to understand the decision that she is about to make. Furthermore, she informs
the nurse that she doesn’t want her mother to know indicating her awareness of the situation. If the view
of the nurse and the patient is different regarding administering the solution, the nurse is not supposed to
render the patient incompetent (Beauchamp, 2016).
If the nurse thinks that Taylah is not competent enough since she lacks self-control and is reckless when it
comes to her health issues evidence by her random sexual activity in the party, she can decide to consult
Taylah’s living will or any surrogate decision maker in this case Taylah’s mother or father.
This principle of autonomy can however be ignored by the nurse if she can prove that Taylah’s ability to
make decision has been affected by an illness or her current situation and her decision to take the
treatment could lead to further irreversible consequences based on the principle of beneficence.
2.2 The principle of Beneficence
This principle requires that medical practitioner provide a medical service that is of benefit to the patient.
This means that the actions that are taken by the doctor should be towards removing any harm from the
patient. This principle has also been interpreted by some scholars to mean carrying out actions that further
the patients interest (Micek, 2016). This thought of furthering the patients interest is supported by the
principle of autonomy though it can be contrasted by the principle on removing harm from the patients
especially if the patient’s decision is likely to cause harm to them.
The principle of beneficence requires the nurse to be committing acts of kindness, charity and altruism
which entails the doctor doing more than expected, it entails the nurse being empathetic to the issues that
affect the patient (Macklin, 2015). This principle can in some cases collide with principle of autonomy if
the patient does not consent to an action that could be in their best interest.

LEGAL AND ETHICAL ISSUES 4
In this case, Taylah is seeking for contraceptives in avoiding pregnancy, in addition, she has a risk taking
behavior which means that she will continue with her sexual activities as she has been doing without
using protection which could lead to Sexually Transmitted Diseases (STDs) and Sexually Transmitted
Infections (STIs). In this case of principle of beneficence, the nurse is supposed to make a decision that
will of benefit to Taylah.
Beauchamp and Childress do not provide room for violation of the principle of autonomy unless in
extreme situation and emergencies or the exceptions explained above in this paper. In Australia an action
of administering treatment to a patient without their consent could lead to legal charges in court of assault
and battery (Spike & Lunstroth, 2016).
In this case, in order to respect the autonomy of Taylah, the nurse should give her the contraceptive yet
the principle of beneficence dictates that she goes beyond the bare minimum in finding ways of helping
her without violating the principle of autonomy. This principle of beneficence is supported by the
principle of non-maleficence.
2.3 Principle of Non Maleficence
Fundamentally the purpose of heath institution is to ensure that their patients are treated and relieved of
the illnesses that they have. Medical ethics origin can be traced back to Hippocratic Oath; this oath has
various theories in medical practice with its core idea being “do no harm.” This idea that Beauchamp and
Childress translate into a principle is very important and the basic rule of any medical practitioner. This
principle however has been contrasted with some scholars arguing that most of the routine activities by
the doctors are harmful to the patients such as carrying out surgeries and provision of experimental drug
(Saunders, 2017).
The principle of non-maleficence requires the medical practitioner to avoid the creation or induction of
harm or injury to the patient by either forcing the patient to take the treatment or omitting an important
part of the treatment. Even though there are bound to be medical failures within practice, this principle
emphasizes on the need of protecting the patient against harm (Pieper & Thomson, 2016).
In the following case of Taylah the nurse should come up with a solution that will comply with this
principle, this could be refusing to give Taylah the contraceptives and sending her to a psychologist
instead to help her realis her self-worth and make her understand the need to be proactive when handling
sexual issues. This however, is faced by another challenge, both the principle of beneficence and non-
maleficence advocate for the respect of the patient’s autonomy which means that if she undertakes this
treatment yet Taylah does not consent to it, the nurse would be carrying out an illegal activity. Therefore,

LEGAL AND ETHICAL ISSUES 5
any solution that is to be taken by the nurse is supposed to in support of the principle of autonomy yet is
aimed at ensuring that no harm will come to Taylah.
2.4 Principle of Justice
The principle of justice is based on fairness by the medical practitioner, this means that every person is
entitled to what is due to them which is fairly distributed. This principle that is sometimes pegged on
Aristotle’s saying “giving to each what is due “implies that there are limited resources yet everyone is
supposed to be treated fairly implying all of the patients receiving treatment. In the case that the resources
are very limited this principle determines the person who is supposed to be prioritized (Ter, 2015).
In the case of Taylah and the nurse, Taylah is liable to receiving the contraceptives that she has
requested. There are no indications of limited amount of the contraceptives which would warranty the
nurse failing to give her the contraceptives, perhaps the question would be what criteria could the nurse
use to select priority of those who needed the contraceptive more relative to her need.
This principle does not look into the autonomy of the patient unlike the other three principles which
means that if the nurse wanted to deny Taylah the contraceptives without facing any legal issues she can
tag her decision on this principle. By doing so she would have enforced the principle of beneficence and
non-maleficence circumventing the principle of autonomy (Winter, 2018).
Distributive justice advocates for justice in the aspect that equal individuals deserve equal treatment,
which means that just like any other fourteen-year-old would be given contraceptives so should Taylah.
This criterion however fails to look into other factor that could measure the worthiness of receiving
priority (Dennis et al.,2016). Beauchamp and Childress establish the following criteria for distributive
justice. Everybody should be provided with equal share according to need, effort, merit contribution and
free market exchange.
Beauchamp and Childress reference other philosophers in determining how the resources are distributed
in reinforcing their principle. A consequentialist approach to justice entails distributing a resource in a
manner that will produce the best outcomes and most happiness on the involved parties (Gallo et al.,
2018). John Rawls however suggest that medical resources should be distributed according to principles
that every person agrees to such as allocating the resource to the person who needs it the most (Chervenak
& McCullough, 2016).
Following the consequentialist approach, the action by the nurse should leave both the nurse and Taylah
happy, ensuring that the contraceptives are allocated to those who need them the most according to John
Rawls (Hammersley, 2015).

LEGAL AND ETHICAL ISSUES 6
3. Conclusion
In conclusion, the nurse is in strict situation where she is supposed to respect the autonomy of Taylah who
has requested for contraceptives yet it would be in Taylah’s best interest if she wasn’t given the
contraceptives (Micek, 2016). This is due to her low self-esteem, diabetes disease and sexual recklessness
which could lead her into having sexually transmitted diseases and infections.
The nurse’s decision should also enforce the other principle such as principle of beneficence and non-
maleficence which mostly support the principle of autonomy. The only principle that is not pegged to
autonomy is principle of justice which is on fair distribution of resources in relation to their availability or
the nurse could look into exceptions of principles of autonomy such as Taylah being incompetent as to
understand the implications of her actions.
In this case, the best solution by the nurse is to first explain to Taylah the implications of her using the
contraceptives in relation to her condition, after which she can suggest other means to solve Taylah’s
issues if she thinks that contraceptives are not the best solution. If Taylah changes her mind and seeks for
the alternative, then that will be good for the nurse otherwise if Taylah doesn’t listen to her she has no
option other than to give her the contraceptives or tell her to bring her mum for further discussions on the
basis that Taylah is not competent in making such a decision given her recklessness to her own health.

LEGAL AND ETHICAL ISSUES 7
4. Reference
Beauchamp, T. L. (2016). The principles of biomedical ethics as universal principles. In ISLAMIC
PERSPECTIVES ON THE PRINCIPLES OF BIOMEDICAL ETHICS: Muslim Religious Scholars and
Biomedical Scientists in Face-To-Face Dialogue with Western Bioethicists (pp. 91-119).
Beauchamp, T. L. (2019). A Defense of Universal Principles in Biomedical Ethics. In Bio law and Policy
in the Twenty-First Century (pp. 3-17). Springer, Cham.
Chervenak, F. A., & McCullough, L. B. (2016, June). Healthcare justice and human rights in perinatal
medicine. In Seminars in perinatology (Vol. 40, No. 4, pp. 234-236). WB Saunders.
Dennis, L., Fisher, M., Slavkovik, M., & Webster, M. (2016). Formal verification of ethical choices in
autonomous systems. Robotics and Autonomous Systems, 77, 1-14.
Gallo, L., Baxter, C., Murphy, J., Schwartz, L., & Thoma, A. (2018). Ethics in Plastic Surgery: Applying
the Four Common Principles to Practice. Plastic and reconstructive surgery, 142(3), 813-818.
Hammersley, M. (2015). On ethical principles for social research. International Journal of Social
Research Methodology, 18(4), 433-449.
Macklin, R. (2015). Can one do good medical ethics without principles?. Journal of medical ethics, 41(1),
75-78.
Micek, M. A. (2016). Ethical Dilemmas When Refusing Medical Treatment: Modernized Bioethical
Principle of Autonomy.
Micek, M. A. (2016). Ethical Dilemmas When Refusing Medical Treatment: Modernized Bioethical
Principle of Autonomy.
Moaddab, A., McCullough, L. B., Chervenak, F. A., Fox, K. A., Aagaard, K. M., Salmanian, B., ... &
Shamshirsaz, A. A. (2015). Health care justice and its implications for current policy of a mandatory
waiting period for elective tubal sterilization. American journal of obstetrics and gynecology, 212(6),
736-739.

LEGAL AND ETHICAL ISSUES 8
Niven, D. J., Leigh, J. P., & Stelfox, H. T. (2016, September). Ethical considerations in the de-adoption
of ineffective or harmful aspects of healthcare. In Healthcare management forum (Vol. 29, No. 5, pp.
214-217). Sage CA: Los Angeles, CA: SAGE Publications.
Pieper, I., & Thomson, C. J. (2016). Beneficence as a principle in human research. Monash bioethics
review, 34(2), 117-135.
Saunders, B. (2017). First, do no harm: Generalized procreative non‐maleficence. Bioethics, 31(7), 552-
558.
Spike, J. P., & Lunstroth, R. (2016). Using principles as a tool for understanding ethics cases. In A
Casebook in Interprofessional Ethics (pp. 31-44). Springer, Cham.
Ter Meulen, R. (2015). Solidarity and justice in health care. A critical analysis of their
relationship. Diametros, (43), 1-20.
Williams-Jones, B., & Graham, J. E. (2003). Actor-network theory: a tool to support ethical analysis of
commercial genetic testing. New genetics and society, 22(3), 271-296.
Winter, S. F., & Winter, S. F. (2018). Human dignity as leading principle in public health ethics: a multi-
case analysis of 21st century German health policy decisions. International journal of health policy and
management, 7(3), 210.