Legal and Ethical Issues in Healthcare: A Case Study of Ms. Christine Jones

This case study discusses the legal and ethical issues involved in the treatment of Ms. Christine Jones, who was brought to the hospital with serious injuries after a motor vehicle accident. The study identifies two laws, Guardianship and Administration Act 1990 and Advanced Healthcare Planning Legislation of WA Government 2006, and discusses their application in the case. The study also identifies ethical issues and suggests strategies to address them.

Overview of the incident
Ms. Christine Jones was 34 year old female who was brought to the emergency
department of hospital with several serious injuries after a massive motor vehicle accident
where she lost her partner also. During the diagnosis her pregnancy had been found and it
created some ethical as well as legal issue to continue the treatment of the patient and it
opened the door of possibilities of serious health issues for the patient in future. Several laws
and acts were associated with this case study.
Identification of the first law
The first law, which has been identified at the primary stage of her treatment
procedure, was Guardianship and Administration Act 1990 of Western Australia which has
been revised in the year 2005 with some add-ons (Kidson‐Gerber et al., 2016). This law
applies to the provision of medical treatment to the person even if they are 18 years or above
who are represented by their guardian. According to this law, guardian can be appointed or
involved in order to initiate the medical treatment or take any vital decision regarding the
treatment of the patient (Khoury & Khoury, 2015). If the patient is incapable of looking after
his/her health, then guardian should be involved prior taking medical decisions. Again, under
the same act, in case of emergency where the consent of guardian is not achievable and
doctors find the patient is not competent to consent to treatment, in those cases waiting for
the consent from the guardian may not required. Apart from the parents or spouse, guardian
can be anyone who is the nearest relative or having close personal relative of the patient.
Identification of the second law
Another law or act which is directly associated with the case study is the Advanced
Healthcare Planning Legislation of WA Government of the year 2006. Under this law, if a

mentally-competent patient refuses to take treatment or refuses to sign for a written consent
to precede treatment then doctors cannot have the right to proceed further until the consent
has been validly obtained. Under this law, if a person refuses to continue or proceed for any
non-urgent treatment considering the future health outcome or provision of any other then the
doctors cannot force them to go ahead with the treatment. During 2006, WA government
introduced this Advanced Healthcare Planning Legislation into the WA parliament which
states that an adult, who is of sound mind, will be able to make any advanced health directive
considering the future health matter (Wernham & Teutsch, 2015). They will also be able to
take medical decisions on non-urgent basis. Prior to transferring the patient to the operation
theatre the consent from the patient is highly required if he/she is competent.
Application of the chosen laws
In this case, Ms Jones was brought to the hospital unconscious and she was not
accompanied by any of her legal guardian. Details of her mother was found in her contact list
and so, it was important to contact her as guardian, in order to obtain the consent for all
necessary medical intervention needs to be performed prior to the arrival of her mother.
According to the identified Guardianship and Administrative Act of 1990, which has been
revised in the year 2005, it was necessary to involve guardians’ consent when the patient is
not competent or unable to communicate for any medical procedure (Lamont, Stewart &
Chiarella, 2016). Due to this, her mother was contacted by the hospital authority. Again, 2
days post the accident, when Ms Jones regained her consciousness she was informed that she
had a fractured femur and along with that her pregnancy test also showed positive result. To
treat the fracture femur, the first option was surgery for open reduction and internal fixation
(ORIF) and second option was to begin conservative treatment as there were risks associated
with the surgery for her pregnancy. The patient did not want to do anything that harms the
baby inside her womb and so she did not want to go ahead with surgery. The doctors could

not proceed further or force her against her decision as under the Advanced Healthcare
Planning Legislation of WA government (2006) non-emergency patients have right to refuse
medical treatment (Badland et al., 2014). This act played a vital role in her treatment
procedure.
Identification of ethical issue
While treating Ms Jones, various ethical issues were involved in the treatment
process. The first ethical issue the nurses faced to inform the patient about the loss of her
partner in the accident. The patient was injured and she was looking for her partner prior
taking any decision regarding her health and so informing the patient about the death was
quite challenging for the nurses. But, the most important ethical issue was convincing her for
the surgery. She was reluctant and refused to go ahead for surgery as she did not want to
harm her baby that may occur during surgery. Again, according to the Advanced Healthcare
Planning Legislation of WA government (2006), patients have right to refuse medical
treatment considering the future health outcome (Carter, Detering, Silvester & Sutton, 2016).
Due to this reason, nurses could not force the patient to take surgery to cure the fractured
femur internally. During the morning shift, I also realized to it was a major issue to convince
Ms. Jones for surgery.
Strategies and techniques to address the issue
When I was there in the shift and witnessed the whole scenario and came to know that
Christine is reluctant to harm her unborn baby which might occur due to surgery. It was
difficult for me to make her understand anything as she was in grief due to the sudden and
unexpected death of her partner. She was emotional at that time which was very crucial stage
for any people and at that time people hardly can take any rational decision. The conservative
treatment procedure which was the second option was not efficient enough to produce the

best long-term outcome because in future, the patient would face issues regarding pain. In
this situation her mother wanted to talk to me personally. I think communication can be the
best way in resolving the issue. Communication strategies have the capability to influence
and empower individual to take healthier decision in their life (Jameton, 2017). Effective
communication strategy in healthcare can be achieved by developing community campaign,
group discussion etc (Preshaw, Brazil, McLaughlin & Frolic, 2016). In this case, having a
group discussion along with her mother and Christine could be the best way to inform her
about negative sides for not having surgery. It can be the best way to convince her however,
Christine has to take the ultimate decision and doctors and nurses cannot make her bound on
taking any particular decision.

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