NUR304: Law and Ethics - A Case Study on Patient Autonomy Issues

This case study delves into the ethical and legal complexities surrounding a 20-year-old college student's refusal of treatment for bacterial meningitis. It examines the conflicts between patient autonomy and the healthcare provider's duty of care, considering relevant legal frameworks such as the Mental Capacity Act and GDPR. The analysis covers ethical principles like justice, fairness, utilitarianism, and deontology, highlighting the dilemmas faced by healthcare professionals in balancing patient rights with the need to provide life-saving treatment. The study emphasizes the importance of informed consent, confidentiality, and adherence to professional codes of conduct, ultimately aiming to navigate the challenging intersection of law, ethics, and patient care.

NUR304 Law and Ethics

Table of Content
INTRODUCTION...........................................................................................................................1
MAIN BODY..................................................................................................................................1
Overview of the case scenario 1..................................................................................................3
Conflicts and Dilemma issues.....................................................................................................4
Justice and Fairness.....................................................................................................................5
Utilitarianism and Deontological principles................................................................................6
Conflict and Dilemma Issues.......................................................................................................7
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................9

INTRODUCTION
The law and ethics unit encompasses development, implementation and evaluation of legal
and other ethical frameworks (Bruce and et. al., 2019). Law and ethics are efficiently designed to
protect and prevent people from any sort of harm. In addition, the rights of fundamental rights of
the health and the social care is being protected (Aborode and et. al., 2021). The health care
professionals are accountable for providing effective health care to protect and maintain the law
and ethics of their patients (Adewusiand Olugasa, 2021). If they breach their duties and any
patient gets injured as a outcome of breach while the patient care, they are implied to penalties
and they have to pay the compensation which the process to safeguard the laws and ethics within
the health care settings (Chima, 2022). Laws and ethic are the set off rules that are majorly
enforced by the national government and other associated authorities to protect the rights of the
patients (Cognat and et. al., 2021). Ethics are the morals and the ethical principles that is adapted
to foster the efficient goals of the society (Costerus and et. al., 2018). These are governed by the
systematic bodies within the nation to protect the rights of the people in a nation. The healthcare
segment is majorly ruled over by sets of efficient rules, regulations and other associated ethical
standards (Costeru and et. al., 2018). These legal standards are mainly set by the government
laws. Other associated ethical standards which mandatorily have legal basis and this is so crucial
for the healthcare sector to foster the laws and ethics that is vital for the patient care (Droby and
et. al., 2020). Legal standards promote efficient healthcare information’s that is vital for the
healthcare and gives the patient and the healthcare professionals an ideology of what is their
basic right when some unethical issues arise there within the medical premise (Goold and
Herring, 2018). The use of laws ad ethics within the medical practices is vital as ethical standards
which are primarily based on the human rights of the principles of the right and the wrong
(Boylan, 2022). With laws and ethics in the medical practices the legal standards are in place and
authorities are allowed to enforce the rules and laws and when an individual does something
illegal (Hall and et. al., 2018). Healthcare ethics is a detailed set of morals and ethical principles,
beliefs and other associated values that guides in the process of the decision making about
medical and patient care (Ljubisavljevic, 2020). This is the core of healthcare ethics which
defines the right and wrong and other associated beliefs about the rights that an individual
possesses during the medical care (Nersessian, 2018). In addition, duties and associated other
responsibilities that an individual owes with medical and patient care. The law and ethics
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efficiently promote the whole of government and society essential approaches that is required in
the legal and the ethical reforms by stimulating with other healthcare professionals
(Nowaczewska and et. al., 2019).
MAIN BODY
In addition to this, the discussion is carried about law, moral, ethical and ethical principle
and ethical framework. Moreover, law is about rule that used by nurses and other medical staff in
healthcare setting to maintain the progress of patient treatment in positive way. Whereas, moral
is also referring as the custom law and value which is made by professional and body itself to
keep their mind and working positive and foster value (Shawand et. al., 2018). The ethical
principle applied within workplace to maintain patient compliance in term of safety and
precaution from breach of data and information. Moreover, respect and dignity should properly
have regulated.
Both law and ethics in medicine rests on the principles that is associated with self-determination
of efficient individualist, maleficence on the part of medical practitioners. In addition, a concept
of justice as fairness to be afforded to the patients by both medical practitioners and the
associated society(Siems, 2019). Medical ethics are very essential at this present time as these
aids in guidance of clinicians and the other healthcare professionals not to cause any harm while
providing patient care and out their duties. Ethics provides privacy and confidentiality and the
very truthfulness in the doctor-patient kinship (Wasson, 2022). Medical ethics and law promote
in the well-being, health, regards towards their patient, making effective decisions on the
principles of patient care, their dignified justice. Every individual hopes their health care
providers are aware of the current laws and ethical care in the healthcare settings. After all,
without these guidelines and medical malpractices would be unnoticed and this will affect the
major health care settings and those individuals would unpunished and more importantly lives
would be affected and lost. Confidentiality is a fundamental part of any healthcare profession
and should be strictly followed by them effectively (Yiangou and et. al., 2019). The Nursing and
Midwifery Council (NMC) is a revised code that efficiently places the public expectations at the
heart of the sound nursing services and midwifery practices in the patient care. Midwifery is the
term that details the skilled, knowledgeable and compassionate care for women who are
childbearing, new born infants and families across the time from pregnancies, birth and the very
early weeks of the life. This NMC code is accountable to all the nurses and the midwives
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practising in a health care setting. The code contains a significant series of statements that wholly
implies the significant good practices that is comes with effect from nurses, midwives and the
other nursing associates. Being able and proficient to follow the guidelines that are associated
with the standards and ethics to the healthcare setting is a fundamental aspect that is considered
in the nursing and midwifery council. The midwives are privileged with entering the lives of
women who trust them enough to share they’re the most private information’s and details and
other related precious moments. So, this is their vital responsibility to take their efficient care
(Wallerstedt and et. al., 2019).
The rules and regulations are pre-set out by the NMC that is very clear and give strict
boundaries to ensure fairness within the practice and equality throughout the service processes.
NMC looks forward in the legal aspects and the rights of the women. The GDPR (General Data
Protection and Regulation, 2018) significantly outlines the six data protection of the principles
that implies its many essential requirements. The confidentiality maintains the accuracy, other
storage limitation and integrity and confidentiality of the respective patients. The healthcare
professional is responsible for utilising personal data and they have to follow strict rules which
denotes the data protection principles. They make sure that the information is fairly used,
lawfully and transparently obeyed. The principle of wholeness and confidentiality requires you
to handle personal data which efficiently ensures the security and safety of patients. In addition,
this provides protection against the unlawful practices, accidental losses, or any other destruction
or damage to the patient care. GDPR mainly signifies and provides Member States scope to
balance the right to privacy and also the right to freedom of expression and information of an
individual. This report will mainly comprise the law and ethics that are required to maintain and
ensure patient's confidentiality and privacy. Healthcare ethics is a set of moral principles, beliefs
and values which efficiently guides in the decision making of choices about the medical and
healthcare to patients. At the core of healthcare ethics and morals, it is the role and responsibility
of healthcare providers to provide the sense of right and wrong and associated beliefs that are
about rights and duties which they owe to the patient care. This is efficient within the health care
practices as this provides healthcare professional to recognise the healthcare dilemmas and
making efficient decisions that is required to keep values while practising. In addition, this keeps
them within the laws and legalities that govern their actions (Saleh and et. al., 2022).
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Overview of the case scenario 1
In this case study, there is a 20-year-old college student who's living in the hostel. The
student has been brought up by a friend to the Emergency Department (ED) as the boy was
suffering with unforgiving headache and fever. The student then seemed to appear drowsy but
was also responsive and still had fever with 40 degrees which was diagnosed on examination. In
addition, neck rigidity was also found on examination. Lumbar puncture was executed and there
was cloudiness in the spinal fluid was appeared and there also was elevated white cells. Gram
stain efficiently showed gram positive diplococci (which is a bacterium that mainly exists as
pairs of cocci, such as pneumococcus). Later based on diagnosis of bacterial meningitis, the boy
was prescribing with antibiotics and was also admitted to the hospital for further patient care by
efficient patient care support. This can be a significant reason for life threatening difficulties in
the patient. The former consent for further diagnosis was implicit and on the contrary the lumbar
puncture was explicit. The boy later refuses to get treated without providing any relevant reason
and insisted the medical professional to return to his hostel back. Even after detailed explanation
about the needs of the treatment that body requires the boy refused to get treated to the
seriousness of his diagnosis eve after the boy was explained about the needs of the treatment by
his healthcare physician. In addition, the boy needed the absolute immediate treatment. This
could further foster the dangers and health related risks which he was refusing to. The boy's life
would be at risk if he does not take words of the physician. The boy was still adamant in his
refusal to treatment and going back to his hostel. This could worsen the boy's health with greater
risks and that would harm his very health and trouble his difficulties (Shawahna, 2019).
Conflicts and Dilemma issues
The ethical dilemma in nursing is refer as situation where a nurse must decide to make
distinguish values and known that no matter what choice that they made and there is various
consequence are arising that render the ethical work that is based on role and responsibilities of
nurses within healthcare setting. In addition to this, the boy is facing the issue of bacterial
meningitis and later on it is also analysing that he refuses to take treatment. In other hand, there
are some ethical dilemma is analysing that is the patient have right to take their decision for their
treatment, where, patient have issue with bacterial meningitis where the law Mental capacity act
is driven that allow the professional to take their decision and provide them basic treatment until
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patient family member configure statement for consent to continue the treatment. Moreover, the
mental capacity act allows healthcare professional to take the aspect where that can treat
functionally at the beginning level to maintain the condition normal until approval for further
continuation will arrive.
In the healthcare sector, autonomy generally expressed as the right of the competent
individuals in order to make an informed decisions about their own clinical care. Its principle
generally underlies the need to effectively seek the informed or consent agreement of the
vulnerable patient (as in the case scenario of 20-year-old college student) prior investigating or
the care treatment take place. A patient autonomy is generally essential within healthcare as it is
the right of vulnerable patient to make effective care decisions about their clinical care without
their well-being care giver and trying to impact the care decisions as well. In addition to this, a
patient’s autonomy generally does enable for the well-being care givers to effectively educate the
vulnerable patient but it does not enable the well-being care giver to make specific decisions for
the patient about their care treatment. Within healthcare, exercising the patient’s autonomy can
encourages the vulnerable patients to feel more in the control as well as confident in their
capability to make effective care and educated well-being decisions and can choose the right
healthcare professionals as well. Having an autonomy can significantly leads to a positive well-
being result as well. While talking about the case scenario of 20-year-old college student,
autonomy is not appropriately being followed as the healthcare professionals and care nurses
should have signed the consent form. They must consider his opinion about his care treatment
whether the patient wants to avail the care treatment or not. If an appropriate regulations and
rules are followed within the healthcare organization then patients such as college student must
not have refused the care treatment. In addition to this, the healthcare professionals and care
nurses must have asked and provide a consent form to the patient and must have involved him in
the care plan so that he also gets some understanding what he actually is going through (Leslie,
2019).
While talking about the ethical principles, Fidelity and Veracity are the two most essential
ethical principles while providing the care to a vulnerable patient. In context with Veracity, it
generally denotes the respect of a patient. It is generally one of the basic ethical as well as a
moral societal principle. It is the duty of a healthcare professional and care nurses that they must
have practice the veracity, as they should exhibit some respect for their patient as well as his
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right that is effectively treated equally and fairly as well. In context with fidelity, it is a final
ethical principle while making decisions. It can address individuals’ responsibility to be loyal as
well as truthful within their relationship with others as well. It can involve promise keeping,
trustworthiness and many more. While linking with the chosen case scenario, the two ethical
principles were lack as the healthcare professionals and care nurses did not make trustful bond
and does not maintain a loyal relationship with 20-year-old college student. In addition to this,
when the care nurses or healthcare team does not support the autonomy among patient, then they
will not feel empowered to make ethical and beneficial decisions regarding their well-being as
well as does not have confidence in knowing their care decisions as well (Avant and Swetz,
2020). So, it is quite essential for professionals and nurses to encourage the concept of autonomy
among vulnerable patient, as it can make them (20-year-old college student) to feel empowered
while making positive decisions regarding their well-being. In context with beneficence, it can
be defined as an act of mercy, as well as kindness with involving a strong connotation of doing
good to other patients consisting moral obligations as well. In context with case scenario,
professionals and nurses must have followed the care principle like beneficence to improve his
well-being more appropriately. On the other hand, the ethical principle non-maleficence
generally holds that there is an obligation that include not to harm the other people. The care
nurses have given an appropriate care standard to him which can involve the potential to reduce
the possible harm but he has refused to take care treatment or further care services and wanted to
leave the healthcare (Schembri and Jahić Jašić, 2022).
Sometime, the duty of care is also an aspect which is undertaken within the workplace to
make the impact positive within the healthcare setting and in front of patient. The duty of care
state provision for nurses and other medical staff to engage with patient and provide them every
possible treatment and care that they require to stable their function that render and cause the
physiological alteration. As per the case scenario, sometime, nursing call is reliable to make call
that allow to start an initial treatment to prevent the spread or condition worsens.
Justice and Fairness
The healthcare industry is follows the principle of equality, justice and fairness in
providing treatment to patients (Henderson, Horne, Hills and Kendall, 2018). This means that
every patient has the right to receive same treatment from the healthcare staff from the beginning
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of their treatment to the end of their treatment and not face any kind of discrimination on the
basis of their age, disability, nationality, ethnicity, culture, religion and race. In addition to this
the equality act is also followed by workplace to maintain justice and fairness in the
organization. According to the Equality Act, the rights of individuals are protected from
discrimination advancing equal opportunities and treatment of all through this legal framework.
The equality act states that the protected characteristics included in this act are safeguarded from
discrimination in workplaces and wider society making discrimination on the basis of such
protected characteristic an illegal offence in Nigeria. The protected characteristics in the equality
act are gender, sex, religion, race, ethnicity, culture and nationality.
The constitution in Nigeria supports non-discrimination and promotes freedom and
equality of all in the country. This means that healthcare institutions also need to consider the
values of equality and non-discrimination while providing treatment for all of its patients. In this
way it is fair and egalitarian for the healthcare institutions to ensure that the patient which is
admitted in the emergency ward is given the same treatment, environment and rights as the other
patients (Liebler and McConnell, 2020). In context of the specific case study the concept of
fairness and justice was ignored and the patient was not given an equal environment. This is
because the procedure o gaining consent from the patient was not followed unlike other patients
where this procedure is implemented to ensure that the permission and consent of the patients is
gained. This is an important procedure in medical ethics and support fair treatment of patients so
that they are given the choice of selecting to continue their treatment of not. It promotes farness
and equality as each individual patient has to follow the same procedure when completing their
admission to the hospital or healthcare institution for treatment.
Utilitarianism and Deontological principles
Helsinkis declaration
This declaration provides a statement of ethical principles which needs to be followed by
medical research participants human subjects and patients including the search on individual
human material and data. The basic principles of this declaration include respect for individuals
right to make informed decisions recognition of vulnerable groups and well-being of individuals
over all other areas of interest. It also states that participation of the individual in the medical
research needs to be voluntary and after their permission only. The outlook of implementing the
declaration is compatible to deontological ethics as it states that the morality of an action is based
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on whether the action is itself right or wrong under the series of rule instead of measuring and
evaluating the morality of the results of the specific action. In context of the present case study
the action of going on with the treatment without taking permission of the patient is consider it
immoral and unethical when considering the rules and principles of the declaration which
specifically state that participation of individuals needs to be voluntary with informed consent
and permission.
Hippocratic oath
The Hippocratic Oath states the obligation of physicians and medical staff to their pupils and
patients. According to the oath physician pledges to only give patients the fictions and treatments
which are beneficial to them as per there are abilities and judgment and avoid causing harm or
hurt and maintain exemplary personal and professional decision making (Huda, 2018). This
Hippocratic Oath matches with the ethical philosophy of utilitarianism which states that actions
which result in maximum good of the people need to be adopted and followed by individuals. in
context of the present case study the Hippocratic Oath was not followed because the patient was
not given the opportunity to give their permission on going on with the treatment when they were
admitted in emergency care. On the other hand the concept of utilitarianism was implemented as
the patient was given the best treatment for their speedy recovery. In spite this the permission of
the patient needs to be taken to ensure that they're comfortable and have given consent to
completion of the treatment.
Conflict and Dilemma Issues
Informing and Communicating with the patient: It is important to ensure that the patient is
informed about their treatment and the impact of the treatment on their body at all times so
that their consent and autonomy is gained for the completion of the treatment (Teisberg,
Wallace and O’Hara, 2020). In the particular case study this was not followed as the patient
was admitted to emergency care and procedures relating to gaining consent and offering the
patient autonomy were not followed effectively.
Taking patient permission: It is important to ensure that the patient provides permission to
implementation of the treatment to the physicians and medical staff before starting the actual
treatment (Pope and Mays, eds., 2020). In the particular case study this was not followed
which created issues and developed.
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CONCLUSION
From the above discussion, it is being concluded that ethics is quite essential within the
healthcare organization it is because, the care professionals and nurses should effectively
recognise the healthcare dilemmas, can make effective and good judgements and the decisions
generally based over their values while keeping within the legal matter which can govern them.
It is analysed by the discussion that following the ethical norms is essential within healthcare
organization is crucial as it can promote the care nurses to provide their patient autonomy in
order to make an effective and essential care decisions regarding their well-being. In addition to
this, justice within healthcare settings can provide the specific right to patients to be treated fairly
and appropriate care as well. Furthermore, there are various ethical dilemmas possible that may
occur within healthcare settings such as lack of access to care, malpractice and negligence,
maintaining confidentiality among healthcare professionals and patient as well. These such
things have lack in care scenario of 20-year-old college student which must not be taken place.
To overcome such things within healthcare settings, the management and care professionals must
have taken into consideration that all the ethical standards should effectively being followed
within healthcare organization.
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