Legal and Ethical Principles in Clinical Decision Making

Tom’s Case Study 1
TOM’S CASE STUDY
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Tom’s Case Study 2
Introduction
Tom is an Aboriginal whose living conditions have worsened lately. The family takes
him to the hospital where the nurse checks his status. Tom is not open to the nurse since she is a
native Australian and not an Aboriginal. The nurse invites an Aboriginal specialist who Tom
tells his view about his health conditions. At first, Tom refuses to get a life-ending morphine
injection. His conditions worsen by the day. The family takes him back home where he spends
time with family members, friends, and the traditional healer. Tom's situation reaches a critical
state where the family makes him to the hospital to receive the terminal health care. Tom and the
wife agree, but the daughter declines to the life-ending morphine injection. This paper looks at
the pharmacology of morphine and legal and ethical principles in clinical decision making.
Furthermore, the article explores the essence of shared decision and the factors impacting the
issuance of palliative care for the Aboriginals.
Pharmacological issues in the case study
Tom is suffering from a life-limiting disease. The disease limits the life of an individual.
People who have epilepsy are likely to die. The nurse at the hospital suggests that Tom is
injected with morphine to reduce his pains. Tom declines and later agrees. Morphine is an opioid
which induces analgesic conditions in the patients (Tapp et al., 2017). Morphine is one of the
most effective painkillers in the medical world. Health practitioners recommend it to patients
suffering from hypertension. The drug also reduces pain in road carnage patients (Tapp et al.,
2017). Furthermore, the drug relieves cancer patients of depression.
Legal and Ethical Principles to Clinical Decision Making
Legal and ethical principles conflict when Tom decides to seek for the end of life care.
Tom's wife, who is the enduring Guardian, respects the patient to request for a morphine

Tom’s Case Study 3
injection. On the other hand, the daughter, who is the attorney, objects the decision of the father.
Tom passed all the requirements of looking for Morphine injection. Tom's decision was an
informed one. He accepted the consequences of termination of life. Tom knew that the care
involved an infusion of morphine. Additionally, he knew about the harms involved in his
decision.
The legal requirement for such a weighty decision requires the following steps. Firstly,
the doctor and the patient must meet to discuss the consequences of the termination of life care
(Tapp et al., 2017). Secondly, the patient signs an agreement affidavit to reaffirm the choice
(Singh et al., 2017). Several ethical issues influence the patient's decision-making process.
Firstly, the act of the physicians and relatives to allow the patient to make a decision respects the
principles of Autonomy (Greenfield and Jensen, 2016). However, clinicians must exercise
caution not to harm the patients. Hence, the physician obeys the law of non-maleficence
(Bossaert et al., 2015). Furthermore, the doctor should administer treatment that primarily
benefits the patient. The other ethical principle in decision making is the self-motivation and
determination (Friedman et al., 2015). The policy complements the principle of Autonomy.
However, the system of inbuilt motivation is closer to the act of allowing the patient to make
their own decisions.
The essence of Shared Decision Making
Shared Decision making refers to the recognition of the patient's rights (Fassbender,
2018). The nurses should educate the patient on the available medical solutions. Furthermore, the
health practitioners should be at liberty to choose the best mode of treatment that suits their
interests. The insightful opinions by the physicians about the various treatment options are very
essential. The physician should be frank and inform the patient of the uncertainty in the results of

Tom’s Case Study 4
the treatment options. Shared decision making is critical in two key categories. Firstly, is when a
range of treatment options are plenty for a given disease (Giesbrecht et al., 2016). Secondly, is
whereby, the result of the treatment is not apparent (Giesbrecht et al., 2016). Tom decides to
accept the morphine injection.
The nurse must explain the consequences of that particular decision. The wife is the
guardian while the daughter is the attorney. The art of shared decision making improves the
interactive relationship between the patients and health practitioners (Greenfield and Jensen,
2016). The clinician should fully clarify the treatment options to the patients. However, the
health professional should not treat the patient out of their own treatment choices. The
combination of the two points enables a smooth process of decision making.
Shared decision making relies on ethics to urge doctors to properly teach patients on the
available modes of health care options. The decision making is an essential aspect of medical
attention since both patients and clinicians take part in the conversations. In the process of
decision making, patients and nurses have different roles. Nurses, such as Sarah, in Tom's case,
have the duty to diagnose the patient and offer medical attention. On the other hand, needs to
choose the suitable mode of treatment. The patient needs to consider issues such as medical
history and their own choices before making any health conditions.
Before a patient can make an informed decision, the health practitioners need to enlighten
them on various aspects of treatment models. The physicians should guide the patient in
acquiring the knowledge of the aftermath of a medical decision (Koski et al., 2017).
Additionally, the clinicians should tell the patients about the consequences of the decisions that
they decide to take (Laidsaar-Powell, Butow, Boyle and Juraskova, 2018). After the patient has
made the all-important decision, the clinician gives them the shared decision form to fill

Tom’s Case Study 5
(Laidsaar-Powell et al., 2018). Afterward, the physician can now go ahead to conduct treatment
on the patient.
The nurse must ensure that the patient has fully understood the types of treatments, their
positive and negative sides. Additionally, the patient must genuinely look at the procedure of the
treatment that they have chosen (LoBiondo-Wood and Haber, 2017). A patient that is at a critical
condition loses the ability to make a well-thought-out decision (Rogers and Student, 2017). As
such, the enduring guardian assists in the decision making (Rogers and Student, 2017). In the
rare occasion, the Attorney helps in the decision-making process.
Factors leading to the provision of Palliative Care
Palliative Care is the kind of attention aimed at patients that decide to undergo
termination care (Singh et al., 2017). A majority of patients take the responsibility to eliminate
suffering before death. Tom suffers a lot of health difficulties and decides to seek for Palliative
Care. Australian health department provides the care when the patient requests for it.
Additionally, the family members must consent to the decision by the patient. In Tom's case, the
wife, who is also the enduring guardian, accepts the conclusion of the husband to terminate the
life after Palliative care.
Aboriginals and other native Australians enjoy Palliative care when they are at last stages
of their lives. The care assists in social and cultural support of the patient (Singh et al., 2017).
Furthermore, the Palliative Care supports the patient to overcome both emotional and behavioral
weaknesses (Scholl et al., 2018). The care unit enables the patient to live in a society or to go
back to their original home. The palliative care assists the mobs, friends, relatives and traditional
healers to look after the patient (Scholl et al., 2018). In the case of Tom, the palliative care
enables the family to take him back to the country. Tom gets the opportunity to interact with

Tom’s Case Study 6
mobs before returning to the hospital. He later asks for termination of life care. Furthermore,
Palliative care enables someone to lead a fulfilling life until they die.
When an individual is on the homestretch of their lives, they need to accomplish various
projects. Some bedridden people always want to go back to the family members and share the
last moments. The aboriginals may long for their countries of origins (Rogers and Student,
2017). Before termination of life, one needs to discuss all the plans in mind with the family
(Fassbender, 2018). Additionally, one needs to return to the country of origin to bid farewell to
the kin.
The Palliative team assists the Aboriginals to understand their orientation of culture.
Additionally, the dying person is curious to understand what the family members think of them.
The aboriginal needs to follow the norms of death. The Palliative ensures that all these concerns
get attention from the government (Fassbender, 2018). The care team caters to the fare charges
that the relatives require going to the hospital to bid bye to the individual in the sick bed. The
team also looks for rental spaces for the married people. The virtues of the care group include
comfort, dignity, and morals (Fassbender, 2018). Furthermore, the care unit helps the relatives
and friends of the patient to fill the emotional gap that death brings.
Conclusion
Morphine is a painkiller that most health specialists recommend to Aboriginals suffering
from life-limiting conditions.The legal and ethical aspects are critical in any form of healthcare
delivery. Additionally, the art of shared decision making enables conclusive medical attention.
Palliative care is essential for the Aboriginals seeking for an ultimate end of life care. The nurses
should follow legal guidelines when treating patients. Additionally, the ethical principles of
Autonomy, beneficence, and non-maleficence are essential in the treatment field. Shared

Tom’s Case Study 7
decision making enables both patient and doctor to agree to come up with a health care decision.
Palliative Care is necessary since it allows for the relatives of the patient to know how to handle
the sick person.

Tom’s Case Study 8
References
Bossaert, L.L., Perkins, G.D., Askitopoulou, H., Raffay, V.I., Greif, R., Haywood, K.L.,
Mentzelopoulos, S.D., Nolan, J.P., Van de Voorde, P., Xanthos, T.T. and Georgiou, M., 2015.
European Resuscitation Council Guidelines for Resuscitation 2015: Section 11. The ethics of
resuscitation and end-of-life decisions. Resuscitation, 95, pp.302-311.
Fassbender, K., 2018. Consensus Development Conference: Promoting Access to Quality
Palliative Care in Canada. Journal of palliative medicine, 21(S1), pp.S-1.
Friedman, L.M., Furberg, C., DeMets, D.L., Reboussin, D. and Granger, C.B., 2015.
Fundamentals of clinical trials. Springer-Verlag.
Giesbrecht, M., Crooks, V.A., Castleden, H., Schuurman, N., Skinner, M. and Williams, A.,
2016. Palliating inside the lines: The effects of borders and boundaries on palliative care in rural
Canada. Social Science & Medicine, 168, pp.273-282.
Greenfield, B.H., and Jensen, G.M., 2016. Understanding the lived experiences of patients:
Application of a phenomenological approach to ethics. Physical Therapy, 90(8), pp.1185-1197.
Koski, J., Kelley, M.L., Nadin, S., Crow, M., Prince, H., Wiersma, E.C. and Mushquash, C.J.,
2017. An Analysis of Journey Mapping to Create a Palliative Care Pathway in a Canadian First
Nations Community: Implications for Service Integration and Policy Development. Palliative
Care: Research and Treatment, 10, p.1178224217719441.

Tom’s Case Study 9
Laidsaar-Powell, R., Butow, P., Boyle, F., and Juraskova, I., 2018. Facilitating collaborative and
effective family involvement in the cancer setting: Guidelines for clinicians (TRIO Guidelines-
1). Patient education and counseling.
LoBiondo-Wood, G. and Haber, J., 2017. Nursing Research-E-Book: Methods and Critical
Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
Rogers, A. and Student, M.N., 2017. A Cultural Safety Perspective on Palliative Care for
Indigenous Peoples.
Scholl, I., Hahlweg, P., Lindig, A., Bokemeyer, C., Coym, A., Hanken, H., Müller, V., Smeets,
R., Witzel, I., Kriston, L. and Härter, M., 2018. Evaluation of a program for routine
implementation of shared decision-making in cancer care: study protocol of a stepped wedge
cluster randomized trial. Implementation Science, 13(1), p.51.
Singh, N., Hess, E., Guo, G., Sharp, A., Huang, B., Breslin, M. and Melnick, E., 2017. Tablet-
based patient-centered decision support for minor head injury in the emergency department: pilot
study. JMIR mHealth and uHealth, 5(9).
Tapp, H., Derkowski, D., Calvert, M., Welch, M. and Spencer, S., 2017. Patient perspectives on
engagement in shared decision-making for asthma care. Family practice, 34(3), pp.353-357.