Legal And Ethical Issues In Organization

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Running head: LEGAL AND ETHICAL ISSUES
LEGAL AND ETHICAL ISSUES
Name of the Student
Name of the university
Author’s note

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1LEGAL AND ETHICAL ISSUES
Introduction
The assignment is about an aboriginal patient who had been suffering from an ulcer. On
attending the physician, he was recommended to a nurse who used to visit several times a week
to take a follow up of the ulcer and change the dressing. While receiving treatment from the
hospital as well as the physician, the aforesaid patient suffered from several ethical and
discriminatory issues. For example, he was not provided any referral of refusal of treatment. He
felt vulnerable and isolated within the hospital. Although he was attended an RN, lack of proper
follow-up, the condition of the leg ulcer deteriorated leading to a partial amputation of the leg.
This report will focus on the ethical and legal issues associated with this case study along
with the possible recommendations.
Health care and Law (Part 1)
This case study focuses on an old aboriginal patient who was suffering from a painful
swollen ulcer. He had to seek medical help for treating his ulcer several times and also had to
take referrals like a frequent visit from community nurses. In this entire curse of treatment, there
had been several instances where human rights or rights to receive culturally safe care has been
breached. It is evident from the case study that RN Allison, had found out that both the Murrays
had been obese and she made it in a judgmental manner. She also chalked out a diet plan for
them without because they might not afford those products.
However, it was evident that RM Allison, made several visits to the patient’s home based on
GP’s referrals. It has been stated in the Australian charter of Health care rights, it can be stated
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2LEGAL AND ETHICAL ISSUES
that patients have the right to receive health care services from home if needed. Home-based
health care needs are especially needed in case of pressure ulcers or surgical wounds (Australian
Commission on Safety and Quality in healthcare, 2017). Furthermore, it can be said that Murrays
were informed repeatedly about the deteriorating condition of the pressure ulcer, yet they were
reluctant to abide by all the instructions. For example, RN Allison, warned them about the risk
factor of obesity.
Health care and Law (Part 2)
It is evident from the case study that the patients refused treatment from the physician
and was convinced when they were educated about the self –management of the wounds. In this
context it can be said, that it was justified from the RN’s side, to teach patients about the various
self-management strategies. The patient and the family must be provided with the knowledge
bout wound care to prevent strenuous transportation and the cost. This can be accomplished by
supporting the patient to make choices about their treatment (Lindsay et al., 2018). Looking at
the predisposing factor, as to why Mr. Murray was reluctant to visit the doctors and prefer self-
activities needs to be explored. Mr. Murray refused treatment, as he felt that his self-esteem,
dignity, and integrity was at stake, while he was being admitted to the hospital. The right to
refuse treatment is the fundamental principle of liberty that should be honored for every patient.
Hence, getting annoyed with the decision of the patient and avoiding duty directly breaches this
model act. A physician should be very well aware of the consequences of treatment refusal and
should have convinced the patient to adhere to the treatment regimen. The physician should have
remembered that empathetic patient-doctor communication is the ultimate key to compassionate
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3LEGAL AND ETHICAL ISSUES
care. Mr. Murray could have been empowered by the doctor to participate in their health and
wellbeing.
Culturally safe nursing practice
The case study has revealed that, on the deterioration of the ulcer, Murray was driven to
town for treating the ulcer. Mr. Murray was not referred to any aboriginal `health worker and nor
was he connected to an aboriginal Health worker, nor was he connected to the National
aboriginal community-controlled service. There had been a growing body of references that have
focused on how discrimination can harm the health of an individual (Shepherd et al., 2016).
Health care professionals should ensure that they provide culturally safe care to patients. It has
been stated that indigenous people often find it difficult to get access to mainstream health care
services (Davy et al., 2016). Indigenous people might feel hesitant to approach the non-
indigenous health care workers and hence indigenous patients can be referred exclusively to
indigenous patients. Due to premature discharge from the hospital and their reluctance to attend
non-indigenous health care services, they are more likely to suffer from health care issues like
cardiovascular problems, ulcers, diabetes, and other chronic health issues. This practice is also a
part of culturally safe care. Additionally, indigenous health care services included in the review
actively engage with the local indigenous people. They are in a better position to address the type
of social and cultural determinants of health faced by the indigenous communities.
Legal issues: Medical negligence
It can be understood from the case study that after Mr. Murray was being discharged
from the hospital a follow-up letter from the city hospital was sent to him. No personal phone

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4LEGAL AND ETHICAL ISSUES
call or personal visit was made from the hospital side, due to which Mrs. Murray failed to assess
the importance of the condition and did not go for the checkup. A doctor can be held negligent if
proper instructions are not given about the management strategies or the physical care that is
required and need for an urgent reporting if any untoward complication occurs, after the
discharge. It has been stated by Lewis, Samperi and Boyd-Skinner, (2017), that follow-up –calls
for post-discharge hospital patients have been found to reduce the rate of hospital admissions.
Again, it is also a cost-effective method that does not require in physical labor. In such, a phone
call can be made from the hospital along with the letter informing about the necessity of a
follow-up checkup to Mrs. Murray. When Murray was admitted to the hospital, he felt
vulnerable, alone and isolated.
Since, Murray signed himself out of the hospital and went to stay with the family, where he was
staying initially, Murray’s physician was annoyed by this action and refused to treat him
anymore. Patients are allowed to refuse any medical treatment as long as they have an
understanding of their particular medical condition and the potential risk and the benefit that they
had been assuming. Before commencing with any treatment, a physician should seek consent
from the patient to continue with the treatment (Jackson, 2016). A patient can certainly withdraw
treatment if he /she perceived any harm related to the treatment or finds that his dignity is at
stake. In this situation, the hospital staff failed to provide culturally competent care to the patient,
which compelled Mr. Murray to drop out of the treatment and leave the hospital premises. It has
been stated by () that many of the aboriginal patients avoid using the mainstream services as they
feel that they suffer from low self-esteem, realizing the fact, that they are not being valued for
their ethnic background. Recruitment of culturally competent health care workers can reduce the
number of dropouts from the treatment. It was found that the treating physician refused to treat
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5LEGAL AND ETHICAL ISSUES
the patient further. In this context, it is essential to mention, that in the Tort law, a duty of care is
imposed on a health care professional who requires adherence to standards or reasonable care
while he was performing any act that could harm others. Breaching of any of the duties directly
leads to medical negligence (Water et al., 2017). It should be remembered that the profession of
medicine is considered as a noble profession and hence a doctor is often figured in the scheme of
a god. Hence, the expectation of the patients are two folds, hence the hospitals and the health
care professionals are expected to provide medical treatment with full knowledge and skill at
their command and they will not do anything for harming their patient. Hence any intentional
fault from the doctors can be termed under medical negligence. In this case study, the physician
should have asked for consent from the patient and should have continued with the treatment.
The doctor could have enquired about the reason for his premature discharge from the hospital
(Jackson, 2016). In case of breaching of duty of care legal proceedings might follow, followed
by compensation for the suffering and the pain, the psychological suffering or both.
Bioethical principles
Health care is a field where instances arise where ethical breaches often take place and
health care professionals often face ethical dilemmas. Beuchamp and Childress have proposed
four ethical principles, based on which an ethical decision can be made Childress & Beauchamp,
(2001). The principles that are commonly used in healthcare are beneficence, maleficence,
justice, and autonomy. Discussing now maleficence, negligence can be considered as harm.
Although there is a large number of ways in which harm can occur, organizations also have a
large number of protocols for protecting patients, their families, and the communities. In this
case study, it has been stated clearly, that the physician who was attending Murray refused to
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6LEGAL AND ETHICAL ISSUES
treat him anymore, which might indicate that, Mr. Murray was left isolated and exposed to harm.
Being a physician, it was the doctor's duty to treat patients and keep their interests in the first
place. There is no room for any personal emotions here, hence a therapeutic relationship should
be established with the patient, irrespective of the caste, creed, and ethnicity of the patient.
Another important bioethical principle that can be applied to this case is ' beneficence'. One of
the acts of beneficence has been displayed by RN Allison, who had decided to visit patients
place, inspire of having no referral from a physician, as an RN requires referrals from a physician
to make home visits for patients. The main element of beneficence is that patients should be kept
away from harm, and anything harmful to the patient (Kangasniemi, Pakkanen & Korhonen,
2015). The leg ulcer in the patient could deteriorate on leaving it untreated.
Also, a patient should be educated about his healthcare conditions. In this case, it can be seen
that the patient was not followed up properly after the discharge. Autonomy as a concept of
bioethics, states that a patient should be self-ruling and should be allowed in the decision-making
process of his treatment (Scott, 2017). However, two conditions have to be met for autonomy.
Whether a patient is competent enough time take decisions. Health care professionals are
ethically obligated to communicate every detail to their patients irrespective of their ethnicity
and linguistic barrier.
The last bioethical principle states that justifiable care should be provided to the patients. Access
to low healthcare and various barriers to medical care access to a high quality of health service is
the central focus for both the rural and the urban indigenous people. The ethical values of the
aboriginals are based mainly on autonomy, pluralism, holism, community or family-based
decision-makers and maintenance of the life quality. The aboriginal cultures also believe in the

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7LEGAL AND ETHICAL ISSUES
values and the wellness within some of the domains of the life of humans. They are- mental,
spiritual, physical and emotional. An aboriginal patient not getting any of these in the
mainstream treatment is likely to refuse treatment.
Conclusion
Analyzing the case study, it can be said that breaching of the ethical principles of
autonomy, duty of care , Australian charter of Human rights have taken place, in many of the
instances. Mr. Murray was deprived of the basic rights of health care. Not only did he not receive
standardized care, but he was also marginalized by the treating doctor. No respect was paid to his
decisions and he was left untreated with a leg- all infected and infested. The health care
professional needed to be culturally competent enough to understand the determinants of Mr.
Murray’s condition and attend him with holistic care of approach.
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8LEGAL AND ETHICAL ISSUES
References
Australian Commission on Safety and Quality in healthcare, (2017). AUSTRALIAN CHARTER
OF HEALTHCARE RIGHTS. Access date: 5.2.2020. Retrieved from:
https://www.safetyandquality.gov.au/sites/default/files/migrated/Charter-PDf.pdf
Childress, J. F., & Beauchamp, T. L. (2001). Principles of biomedical ethics (p. 618). New York:
Oxford University Press.
Davy, C., Harfield, S., McArthur, A., Munn, Z., & Brown, A. (2016). Access to primary health
care services for Indigenous peoples: a framework synthesis. International journal for
equity in health, 15(1), 163. doi: 10.1186/s12939-016-0450-5
Durey, A., & Thompson, S. C. (2012). Reducing the health disparities of Indigenous Australians:
time to change focus. BMC health services research, 12(1), 151.
http://www.biomedcentral.com/1472-6963/12/151/prepub
https://web.b.ebscohost.com/abstract?
direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=01127438&AN=133009
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%2bY7DC3RKGPJWCVDmzTS2VP0bkqhpF82FJbM7kCJhA%3d
%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.a
spx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler
%26jrnl%3d01127438%26AN%3d133009014
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9LEGAL AND ETHICAL ISSUES
Jackson, E. (2016). ‘Informed Consent’to Medical Treatment and the Impotence of Tort. In First
Do No Harm (pp. 289-302). Routledge.
https://www.taylorfrancis.com/books/e/9781315582450/chapters/10.4324/978131558245
0-25
Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an
integrative review. Journal of advanced nursing, 71(8), 1744-1757.
https://doi.org/10.1111/jan.12619
Kendall, E., & Barnett, L. (2015). Principles for the development of Aboriginal health
interventions: culturally appropriate methods through systemic empathy. Ethnicity &
health, 20(5), 437-452. https://doi.org/10.1080/13557858.2014.921897
Lewis, E., Samperi, S., & Boyd-Skinner, C. (2017). Telephone follow-up calls for older patients
after hospital discharge. Age and ageing, 46(4), 544-546.
https://doi.org/10.1093/ageing/afw251
Lindsay, E., Renyi, R., Wilkie, P., Valle, F., White, W., Maida, V., ... & Foster, D. (2017).
Patient-centred care: a call to action for wound management. Journal of wound care,
26(11), 662-677. https://doi.org/10.12968/jowc.2017.26.11.662
O’Sullivan, B. (2013). Considering culture in Aboriginal care. doi: 10.1503/cmaj.109-4376
Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision
making?. BMC medical ethics, 13(1), 10. doi: 10.1186/1472-6939-13-10

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10LEGAL AND ETHICAL ISSUES
Scott, P. A. (2017). Ethical Principles in Healthcare Research. In Key Concepts and Issues in
Nursing Ethics (pp. 191-205). Springer, Cham. DOI https://doi.org/10.1007/978-3-319-
49250-6_14
Shepherd, C. C., Li, J., Cooper, M. N., Hopkins, K. D., & Farrant, B. M. (2017). The impact of
racial discrimination on the health of Australian Indigenous children aged 5–10 years:
analysis of national longitudinal data. International journal for equity in health, 16(1),
116. doi: 10.1186/s12939-017-0612-0
Water, T., Rasmussen, S., Neufeld, M., Gerrard, D., & Ford, K. (2017). Nursing's duty of care:
From legal obligation to moral commitment. Nursing Praxis in New Zealand, 33(3).
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