Health Law and Ethics: Consent, Hygiene, and Professional Misconduct

This assignment presents three case studies focusing on critical aspects of health law and ethics. The first case explores the legal and ethical considerations surrounding patient consent, specifically when a patient refuses to allow a medical student's observation during a gynaecology procedure. It e...Read More

RUNNING HEAD: HEALTH LAW AND ETHICS
Health law and Ethics

HEALTH LAWS AND ETHICS
Case Study 1
Introduction
Bedside teaching comprises a large role and provides an important tool for studying medical
schools globally in teaching curriculums. This educational activity is fully supported by
medical learners, trainees and educators. Studies indicate that bedside teaching offers
learning benefits in context, opportunities for role modelling, teaches transferable skills,
enhanced learner motivation, enhanced professional thinking and clinical skills integration,
problem solving ,decision-making and ethical difficulties. This case study deals with laws
relating to refusal of consent by patient to having a student observe.
Case Study
There is evidence, from patient’s perspective, which suggests that they generally have an
affirmative attitude towards being examined by medical students while they are hospitalized
(Buppert, 2017). Even during gynaecology procedures, patients are comfortable with the
presence of medical students. However, in some instances patient does not give their consent
to having a student observe or assist the procedure (Tobiano et al., 2017). The consent
process should take place in an environment where the patient does not feel pressure to give
permission and must take place before the student is engaged in the management of the
patient (Forrester and Griffiths, 2011). Since conditions in the medical condition of the
patient may alter over time, the student should be conscious of the need to obtain approval for
each case of care. The student should know that an ethical consent method offers security not
only to patients, but also to the health practitioners engaged in their care.
The functions set out in the Health Practitioner Regulation National Law, as in force in each
state (national law) is performed by The Nursing and Midwifery Board of Australia (NMBA)
(Pairman et al., 2018). The NMBA regulates the practice of nursing and midwifery in
Australia and is one of its main roles in protecting the public.
Ethical principles:
Medical undergraduates and physicians in training must need to improve patient’s medical
abilities in order to become better physicians, but by this kind of care patient may not be
benefit directly (Berman et al., 2014). An essential aspect of medical education is the
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participation of trainees in patient care. While educating physicians is perilous to society, an
ethical predicament results from the reality which, patients are unable to profit from and even
be damaged by physicians in practice and medical students involved in their upkeep (Hodge
and Varndell, 2018).
Some of ethical principles that should be kept in mind while dealing with consent matters are
as follows:
Benevolence:
The concept of benevolence is a range of welfare commitments, going from the negative
obligation not to hurt the beneficial obligation to do well. It has been seen that when learners
take part in their medical care, patient satisfaction does not reduce. Many nurses are prepared
to allow learners to take part in invasive processes and pelvic examinations, suggesting that
the balance of future advantages for themselves and society outweighs the hazards (Burkhadt
and Nathaniel, 2019).
Respect the decision of Individuals:
Many times, it has been seen that patient does not receive adequate information about the
trainee’s roles. Due to which in most of the cases patient refuses to give consent to the
medical student. Therefore, procedures are needed to guarantee patient’s meaningful
permission to participate in medical education. Patients need to be fully acknowledged about
the training status and understanding of all staff taking care of them, and they need to
understand the risk, advantages and substitutes. The closeness of permission to individual
processes is essential and there is inadequate blanket consensus when admitted. When a
patient refuses to give consent then the medical staff and doctors must respect patient’s
decision.
A 44-year old female who was having a gynaecology surgery refused the observant in
Operation theatre. Same situation happened with me during the training phase, wherein in the
context of this situation, our head of surgery restricted all the observant student and nurses
from the theatre due the Human Acts right which states everyone has human rights to
integrity and liberty of thought. As per morals, doctors should trail procedures founded on
decree and circumstance law, document what the government permits and act as titleholders
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for enduring requirements where there is a situation of further allowance. Therefore, in this
situation, our head followed the ethics and restricted students and observers from the
operation theatre.
Conclusion
From the above it can be concluded that in the healthcare industry, seeking approval is
crucial. It is essential that all healthcare practitioners at all times realize the significance of
following the procedure as otherwise legal consequence may arise. Respect should be at the
core of every choice made on behalf of both patient and professional. Consent improves the
ability of nurses to make informed choices about their situation and treatment and brings in
place safeguards that should lead to the best course of action for both the practitioners and the
patient concerned. Thus, it necessary to obtain consent of patient and in case they refuse the
participation of medical student then there decision must be respected.
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Case Study 2
Introduction
The main approach to minimize the spread of anti-biotic bacteria in hospitals is to improve
hand hygiene among healthcare staff, which is also being prioritized by Australian
Commission on Health Care Safety and Quality (ACSQHC). Poor hand hygiene adherence
among health care staff is strongly linked to the transmission of health related infections
(HAI) and is a significant factor in the spread of antibiotic-resistant bacteria in hospitals.
Risk linked with bad hand hygiene:
HAIs presents a sever danger to hospital admitted individuals and add to the financial burden
of healthcare:
 Micro-organisms are transferred easily in the hands of health employees.
 Effective infection prevention methods, such as enhancing compliance with hand
hygiene, can decrease HAIs.
 Research has shown that enhancing compliance with hand hygiene is about human
behaviour, organizational culture and management needs a multi- faceted strategy to
improve compliance with hand hygiene (Kramer et al., 2017).
Legislation relating to hand hygiene:
To overcome with the issue of hand hygiene and to safeguard the interest of patients, the
Public Health Act, 2005 was enacted with the object to promote and protect the health of
public of Queensland (QLD) (Forrester and Griffiths, 2010). The act offers the fundamental
safeguards needed by collaboration to safeguard public health. The government of QLD has
reinforced the current legislative structure by enhancing the capacity of QLD Health to react
to unsatisfactory and unsafe practices in infection control. Chapter 4 of the act involves
individuals performing declared health services as described in the act to take appropriate
precautions and care to minimize other people’s risk of infection. In the case of Nursing and
Midwifery Board of Australia v Laughlan (2017) QCAT 388, proceedings were initiated
against Ms Jodi Laughlan under s 193(1)(a)(i) of the Health Practitioner Regulation National
Law (QLD). Ms Jodi was a registered nurse and was found liable for professional
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misbehaviour. In this case, the evidence was put forwarded by the other staff members and
nurses who were present and worked in same shift.
In some conditions, for example, when an individual has been infected while at work and
others may have been exposed, it is suggested that the workplace provide such individuals
with data as well as others such as relatives or caregivers.
Principles of Ethics
Followings are the main ethical principles of hand hygiene (North and Hughes, 2012):
Non-Maleficence:
Healthcare professionals have an obligation to prevent patient harm, which can be prevented
by adequate hand hygiene procedures in the event of Healthcare Associated infections
(HCAI). This may clash with the amount of time it takes to finish hand hygiene, thereby
decreasing the amount of time available for patient to participate. Constant use of cleansing
products can lead to dry skin and pain (Atkins, Sheryl and Bonnie, 2017).
Professional Autonomy Respect:
Like most health care activities, hand hygiene involves certain aspects of professional
judgement. Under certain conditions, it may be sensible not to carry but hand out hand
hygiene. To ensure that justification continue to prioritize patient safety, care must be taken.
They do not creep or originate to be applied in conditions where hygiene of hand is necessary
and essential (Masters, 2015).
Beneficence:
It is expected from healthcare professional to concentrate on the patient’s well-being. Every
time a health care professional fails to adhere to adequate hand hygiene procedures, he or she
puts the health of the patient at danger.
I have not experienced hand washing or sanitizing issues with any co-health worker yet.
However, I can relate this situation with a colleague nurse, wherein the other nurse was not
following the hand washing procedure after patient check-up. In this situation, colleague
nurse of other department asked the nurse to follow the hand-washing procedure as per ethics
and to prevent the patients from infections. The other nurse replied that hand rubs dispensers
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and sinks are not always in convenient places in hospitals. In this context, the colleague nurse
replied that hand hygiene should be maintained as it can affect the health of patients and other
co-workers in the hospital. The other nurse agreed to the colleague nurse and after that,
conversation followed hand-washing procedure.
Conclusion
From the above it can be said that hand washing should become a concern for education. The
most significant instrument for preventing the spread of patient-associated healthcare disease
is hand hygiene. The RN and RM should strictly adhere to laws and guidelines laid down by
various government agencies in order to make sure to prevent the spread of infection in
patients. Washing hands appears to be as simple alternative to avoid bacteria from spreading
among patients.
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Case Study 3
Introduction
The registered nurse (RN) or midwifery (RM) is essential to providing the healthcare system
with secure, great eminence nursing care and spine of healthcare structure. They account for
more than 50% of clinical positions in the government health industry in QLD. Having regard
to the prominent position of the registered nurse, the achievement of any health project will
be directly affected by the extent to which the nursing population is able to practice
continuously to its complete extent. This paper will deal with the legislation relating
professional conduct of nurses and midwifery and ethical principles dealing with use of drugs
by the medical professionals.
Legislation dealing with professional misconduct
The Nursing and Midwifery Board (NMBA) is accountable for professional regulation and
sets Australia’s nursing and midwifery professions requirements, codes and guidelines. These
rules clarify the criteria for registered health professionals, practitioner’s employers and
educational providers to create compulsory notifications under national law to avoid damage
to the public. Making a compulsory notification is a severe move to avoid damage to the
public and should only be taken on adequate basis (Scanlon et al., 2014). The National Law
needs that professionals, owners and educational providers report to AHPRA 'notifiable
behaviour’ as described in sec 140 of the National Law, in order to avoid damage to the
public. An individual or the staff member is protected from civil or criminal liability by the
virtue of sec237 of National Law, who gives information of such conduct in good faith. Sec
140 of the act defines what a notifiable conduct is. As per this section, a notifiable conduct
means when a practitioner has (Daly, Speedy and Jackson, 2017):
 Proficient the profession of him while being drunk by drugs or alcohol.
 Put the public at danger of damage because the physician practiced the profession in
such a manner that the accepted specialised norms were significantly different.
As per sec 140(a) of the National Law practitioner who practices his profession while
intoxicated by alcohol or drugs triggers the necessity to create a compulsory report. The term
intoxicated is although not defined in the National Law; therefore, the term has its common
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significance under the impact of alcohol or drugs. A practitioner shall be considered as
intoxicated by board if, because of being under the impact of drugs or alcohol, their ability to
exercise rational caution and skill in health profession practice is impaired or adversely
impacted. The main problem is that the physician practiced while being intoxicated,
irrespective of when the drugs or alcohol was consumed (Scanlon et al., 2016). However, the
national Law does not mandate the notification of a practitioner who is on drugs if they do
not practice their health profession unless the intoxication triggers another reason for
compulsory notification.
Ethical Principle
Professional behaviour relates to how an individual acts in a professional ability (Hegney,
Eley and Francis, 2013). The Australian Code of Professional Conduct supports the
Australian Professional Conduct Code for nurses for nurses Establishes the minimum norms
for exercise that a professional individual is supposed to maintain both within and outside the
competent fields to guarantee the nursing profession’s good standing (Hooper, 2011). The
registered nurses and midwifery are required to follow prescribed standard of ethics (Chang
and Daly, 2012). Some of the professional ethics, which are required to be followed by them,
are (Koutoukidis, Stainton and Hughson, 2016):
 RN and RM should practice in safe and competent manner.
 RN should practice according to professional norms and the wider health system.
 RN and RM should exercise and conduct themselves in accordance with the
legislation, appropriate to nursing profession and practice.
 Nurses should respect the dignity, culture, ethnicity, values and views of caregivers
and peers.
 Nurses should practice their profession reflectively and ethically.
Thus, abovementioned were some of the ethical standard, which should be followed by RN
and RM.
During my training phase, one of colleague came in the hospital in drunken condition. Our
head identified that the student was not in a normal condition. The head took the student
aside and asked him to leave the hospital for the day and take rest as he can harm patient
unintentionally due to the side effects of alcohol. As per ethics, the healthcare workers are
ideally positioned for the promotion and improvement of the health and fitness of people,
relatives and communities. However, communication with patients and the level of
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HEALTH LAWS AND ETHICS
interference and maintenance distributed to patients might be determined by a diversity of
influences, comprising the health professional’s particular and specialized insolences,
principles and involvements of alcohol, as well as their own private liquor use.
Conclusion
It can be concluded that consuming drugs before coming to duty in medical field is very
dangerous. As the RN and RM plays important role in the treatment of patient, they cannot
treat patient effectively as well as working with a hangover may affect decision-making
eventually, which will result in putting patient at risk. Various guidelines and professional
conduct are introduced by the NMBA. Those who do not adhere to these guidelines, have to
face legal and ethical implications. Thus, it is duty of every RN, RM and medical students to
follow these guidelines.
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