NUR222 Task 2: Ethical and Legal Dilemmas in Peter Smith's Case

This case study examines the ethical and legal complexities surrounding the care of Peter Smith, an 82-year-old man with early-onset dementia who has an Advanced Health Directive (AHD) stating he does not want active treatment. The scenario presents dilemmas involving Mary, his daughter and power of attorney, who is conflicted between her father's AHD and his current state of confusion, agitation, and aggression. The analysis delves into the legal requirements of AHDs, informed consent, and the ethical principles of beneficence and autonomy. It highlights the conflict between respecting patient wishes (AHD) and the need for potential medical intervention. The case study explores the nurse's professional responsibilities, including consulting with family members, explaining treatment options, and upholding ethical codes of conduct to balance patient rights and welfare. The study references relevant legal and ethical theories, professional codes, standards, and guidelines to support decision-making in this complex situation.

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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The case study is about Peter Smith, an 82 year old man who has been diagnosed with
early onset dementia. Since the death of his wife Betty, he has moved to Sunny Hill Aged Care.
Recently, he has completed an Advanced Health Directive (AHD) 18 months ago and he has
stated in his AHD that he does want active treatment if brought to the hospital. The case present
several legal and ethical issues in decision making about Peter’s treatment because he has been
brought into emergency department with confusion, agitation and aggression. Mary is aware
about his father AHD, but he is very upset with his state of confusion and aggression. The
decision making for Peter will be difficult because of conflict between legal requirement of AHD
and violation of patient consent if Mary goes against her father’s AHD.
The key legal requirement in decision making for Peter is to comply by the procedure of
AHD and fulfil patients living will regarding future care to be provided to him. Advanced care
planning legislation exists for all states and territories of Australia. According to the legal
procedure for obtained AHD, it is necessary to discuss about AHD with physician and family
members. All involved members should have the copy of the directive too (Government of
Western Australia, 2019). Peter followed similar procedure as he discussed about this with
daughter and Mary, his lawyer doctor and nursing home had the copy of AHD. However, the
dilemma in the scenario is whether the AHD can be changed or ignored now following
deteriorating of patient condition. The legislations related to AHD in Australia include the
Medical Treatment Planning and Decisions Act 2016, which recognizes AHD as a legal
document (publicadvocate.vic.gov.au 2018). However, Mary cannot go against AHD despite
being the power of attorney because under the common law, the condition of advanced care
directive must be respected. Hence, Mary is at risk of legal actions if Peter’s AHD is not
respected.

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However, the case scenario presents several ethical conflicts too. For example, the issue
is related to conflict between informed consent and ethical code of beneficence. For Mary,
withholding active treatment is important as per Peter’s AHD. This is relevant with the ethical
principle of informed consent and autonomy which supports respecting patient’s wishes and
preferences related to care plan and treatment and providing full autonomy to patient during
decision making. AHD is an important way to safeguard the autonomy of incompetent medical
patient (Judkins-Cohn et al. 2013). However, the moral authority of such patient autonomy is
questioned when a patient suffers from acute deterioration of health and family member’s fail to
endure sufferings for their loved ones. Similar ethical conflict is seen in the scenario too as Mary
saw her father is aggressive towards the staffs and he is trying to take off his clothes. Currently,
his condition is uncontrollable unless active treatment is initiated. If he is left like this, it may
harm him as well as other staffs in the ward. In addition, it will increase stress for family
members too. Evidence by Johnson et al. (2018) shows that although health care professionals
are in favour of respecting patient autonomy. However, respecting the same in real clinical
situations become very difficult.
The professional responsibility of a nurse in such situation according to the ethical code
of conduct is to consult patient’s family members regarding the best decision and inform them
about real situation related to pros and cons of going ahead with each treatment options (NMBA,
2018)). I would explain Mary that going ahead with AHD can be detrimental for Peter and it may
lead to disrespect of patient too as he will be left on his own. Explaining the risk and benefits of
treatment is important for me according to the ethical code of conduct for nurses in Australia
which states the need to recognize the rights of people to engage in shared decision making and
value the contribution of family members in case of patients whose decision making is restricted

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because of incapacity (NMBA 2010). In addition, as Mary is the person with the power of
attorney, I would have taken final confirmation from her regarding the treatment to be initiated
for Peter. Mary need to take difficult decision for Peter regarding the option to either respect
patient autonomy or respect physician’s view about treatment. Following ACD will respect
Peter’s right and personal values. However, denying the same will violate patients right to self-
determination (Yu et al. 2015). Due to the responsibility of health care professionals to promote
welfare of patient and preserve the ethical value of ‘maximizing greatest good for the greatest
number of people’, treatment for aggression will be started after taking Mary’s concern regarding
the same. The above decision will lead to fulfilment of ethical principle of beneficence which
emphasizes on taking all actions to ensure no harm to patient.

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References:
Government of Western Australia. 2019. Advance Health Directives. Retrieved from:
https://ww2.health.wa.gov.au/Articles/A_E/Advance-Health-Directives
Johnson, S. B., Butow, P. N., Kerridge, I., and Tattersall, M. H. 2018. Patient autonomy and
advance care planning: a qualitative study of oncologist and palliative care physicians’
perspectives. Supportive Care in Cancer, 26(2), 565-574.
Judkins-Cohn, T. M., Kielwasser-Withrow, K., Owen, M., and Ward, J. 2013. Ethical principles
of informed consent: Exploring nurses’ dual role of care provider and researcher. The Journal of
Continuing Education in Nursing, 45(1), 35-42.
NMBA 2018. Code of conduct for nurses. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx
NMBA (Nursing and Midwifery Board of Australia) 2010. Code of Ethics for Nurses in
Australia. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-
Statements/Professional-standards.aspx
publicadvocate.vic.gov.au 2018. About us. Retrieved from:
https://www.publicadvocate.vic.gov.au/about-us/index.php?
option=com_content&view=article&id=261:advance-care-directive&catid=20:medical-
consent&Itemid=468

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Yu, J., Brown, D., Kodner, I. J., and Ray, S. 2015. Looking beyond the crystal ball: An ethical
dilemma in advance directive implementation in multidisciplinary patient care. Surgery, 158(5),
1389.