Cairns Base Hospital: Legal and Ethical Issues in Nursing Practice

This report examines the ethical and legal issues that affect the performance of the hospital environment, focusing on consent, patient rights, and bioethics. It is divided into two parts: the first part discusses legal issues such as elements of consent, refusal, and factors of life-sustaining decisions. The second part tackles ethical issues, including principles of Bioethics and Human Rights, stakeholder values, and the application of a model to solve conflicts. The report analyzes the legal consequences for health professionals, the importance of informed consent, and the factors considered when making decisions about withdrawing life-sustaining measures. It highlights the values of stakeholders like Chandler and Cairns Base Hospital, and how these values can lead to conflicts that are addressed using ethical models. The conclusion emphasizes the importance of upholding patient rights and the legal responsibilities of medical professionals.

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Nursing
Name
Institution

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NURSING
Introduction
This paper discusses the ethical and legal issues that affect the performance of the
hospital environment. The legal issue is a legal question that acts as the base of a case. It needs
the decision of the court (Hardicre, 2014). The outcome of the legal issue depends on the
interpretation of the Law by the court. Ethical issues are a situation or problem that requires
organization or a person to have a selection of alternatives which must be assessed as wrong
(unethical) or right (ethical). The main purpose of the ethical issues is to ensure that the
treatment of the patients is directed according to the desire of the patients. The paper is divided
into two parts (Furyk, Lawton, Ting & Taylor, 2017). The first part discusses the legal issues in
which it covers the following areas: elements of consent, the legal consequences of the health
professions, refusal, Rationale for consent, Legal choices for consent, and factors of a life-
sustaining decision. Consent is the ability of any person of sound mind to decide what should
happen to their body (Williams, Carter & Rychetnik, 2017). The second part discusses the ethical
issue in which the paper tackled the following issues; principles of the Bioethics and Human
Rights, values of the stakeholders and the application of the model to solve the conflict.
There are many legal issues that affect the activities of the hospital. Among the legal
issues is the consent. It is the ability of any person especially the patients to decide what should
happen to their body. A valid consent is made up of different elements. The first element is the
Capacity, this element state that an adult person is assumed to possess the capacity to refuse or
consent to medical treatment until and unless that presumption is refuted. Rose needs to be made
to understand the effect and nature of the decision, as well as demonstrating his understanding

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through communication in some way, such as by way of orally or writing (Brosnan & Flynn,
2017). The second element is the Voluntariness, this element state that the decision must be
made without restrictions by those who are sick in reply to an understanding of options that are
available for treatment. Treating family members and health professionals may help the patient
like I this case Ross to developed required decision (Grady, 2015). The third element is Informed
consent; the patient who is Ross must be informed of any decision that is being made by the
health professionals. Rose should be advised of recommended treatment, and the diagnosis
before the performance of surgery or any treatment (Mahmood, 2016). Lastly, the consent covers
the act in question to be performed; the treatment being provided must be within the specific
consent needed by the patient. In particular situations, the consent can also cover future
unforeseen treatment, for example, emergency (Gainotti et.al, 2016). When the health
professional fails to follow the consent then they will have to suffer civil liability. Health
professional who applies any kind of force to Patients, either indirectly or directly, without the
consent of the patient will be said to have assaulted the patient and the act is termed as an assault.
Paramedics have the authority of treating Ross after the Refusal. This is because a person
who voluntarily admitted to the hospital and shows no strange risk of danger to his/her life, have
the right to refuse any form of treatment by leaving the hospital. But an individual, who enters
involuntarily, because of injury to others or self, has no right of leaving the hospital. However,
the professional Doctors have no right of attending to the patient against her or his will, unless
allowed by the court order. The case of Rose is an exception because he has a severe mental
illness caused by traumatic brain damage with bruising and bleeding. The injury may make him
lacks the ability to consent to hospital treatment of his mental health. The exception can also

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occur when there is the emergency, where medication will only be given by mouth or injection,
for the purpose of controlling the emergency.
Where an individual is not capable of making the decision, those close to the Patients
should be incorporated in decision making, except when the Patient stated earlier that he doesn’t
need such involvement. Though, legally, the health professional in charge of an individual’s care
can also make the decision on whether to proceed with the treatment, if the decision is in the best
interest of the Patient. In most cases, the decision which is being used is that of the agreement
between the close relatives of the patient and professional cares. The Views of the patient will
also be used if the Patient conveyed clear views long ago on how to be treated in case they lose
capacity.
The Possible options available for the healthcare doctors to acquire consent: The
healthcare practitioners who are providing treatment have the responsibility of discussing the
consent with the Patient. The treating Doctor should have understood the treatment or procedure,
how it is being performed and the risk associated with it. If it is not possible for the health
practitioners to perform the task then they should delegate it to another person with the relevant
knowledge of the treatment. The health practitioners have the responsibility of ensuring that the
patient has sufficient information and time of making informed consented and decision to the
investigation or procedure (Olson, 2018).
Disagreement can occur between the family members, the family of the patient may have
different expectations about the care of the patient and the likelihood of the patient’s recovery.
Disagreement can also take place in a situation where there exists more than one individual who
is responsible for decision making (Berry et.al, 2018).

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In this situation, the healthcare practitioners will offer information and support so that the
individual (s) responsible for making decisions on the behalf of the patients will be given enough
support to act in the best interest of the patient. The healthcare practitioners will provide the
family of the patient enough time of solving their conflict. The healthcare practitioners may also
facilitate the appointment of the other suitable decision makers who have the power of reducing
the disagreement that exists between the other decision makers (Blum, Moazzez & Doyle, 2018).
The factors that must be considered when making the decision on whether to withdraw
life-sustaining measures include: Pain and mental capacity, patient Advance Directives,
premorbid cognitive function, and other less important factors were liability of care to the family
of the patient, alcohol abuse, Drug abuse, and socioeconomic status, individual’s age, financial
strain, the family decision/directives and hospital policy (Higgins & Wysong, 2018). The
withdrawal of life-sustaining measure can also take place when it is the hospital policy and if
there is the danger of legal implication. Withdrawal can also take place when the patient is not
willing to take the consent. It can also occur when the patient is not willing to take information
pertaining to their medical treatment. An example is a situation where Ross experience pain and
the health professional cannot control it. They will have to withdraw the measures on life-
sustaining in order to reduce the pain that the Patient experience (Orr & Baruah, 2018). The
patient’s employment status and ethnic background can also contribute to the effect but they
were the least essential consideration factors (Terry & Amudalat, 2018).
Ethical issues are situations or problems that need an organization or a person to select
between substitutes that must be assessed as unethical or ethical. The two principles of Universal
Declaration on Bioethics and Human Rights that is relevant in this scenario include: The first
principle is the Consent that state that any diagnostic, preventive as well as therapeutic medical

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intervention must be performed with the free, prior and informed consent of the patient
concerned, and the patient should be supplied with enough information. The consent must, where
suitable, may be withdrawn and be expressed by the individual concerned for any reason at any
time without prejudice or disadvantage. In this case, Rose at first refuse to attend to the services
of the hospital and according to the legal requirement, he has the capacity to do so.( Mancini
et.al, 2015). The second principle state that an individual has no capacity to consent- The
domestic law state that a person who has no capacity to consent must be given special protection.
Any research should be performed for the best interest of the patient and authorization for the
medical practice and research should be acquired in accordance with the interest of the patient. In
this case, Rose was given medical treatment because the medical profession had the surety that
the procedure will improve the life of his life (Lachman, 2015).
The two Stakeholders in the case are the Chandler who is the captain of the ship and
Cairns Base Hospital. The values of the Chandler as the stakeholders include: Responsibility-
this is a state of being responsible or it may represent a situation of being responsible.
Responsibility witnessed was in the form of Accountability, trustworthiness and
dependability/reliability (Ashton & Sullivan, 2018). This ethical value is revealed in Chandler in
that he attempts to feel responsible for the Patient who in this case is Ross. He stayed with the
patient during the time he needs medical assistance. He took and insists that Ross must attend
and seek the attention of the medical Doctors because his condition began to worsen. The second
value is Charity; this is in the form of Goodwill, Tolerance, caring, compassion and kindness.
Chandler also displays all these characteristics to Ross during his time in the hospital. He ensures
that Rose has the best treatment even after the Patient refuses to attend the help of the healthcare

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practitioners. He took the Patient to the hospital for the further treatment in the absence of his
Family.
The Cairns Base Hospital has the following values. The first value is the Integrity; this
includes the use of moral judgment in professional practice in the work environment. The
hospital uses the best practice because the health professionals ensure that the patients are well
treated. The second value is the Fidelity; the hospital tries to be faithful to the client by the
provision of medical treatment necessary for the healing process of the Patient. The hospital was
also loyal to both the family of the Patient and to the requirements of the Chandler.
The values mentioned above can create conflict in that Chandler being caring and
responsible will avoid the requirements of the consent. Even after Rose refused to attend to the
medical help of the Doctor, Chandler still insisted on the treatment neglecting the consent rule.
Kerridge et al. (2013) model proposed here attempts to solve the ethical problems in the
medical healthcare. The model tries to solve the problem by establishing a conceptual
understanding of the moral ethics that can be used in both the practical and theoretical problems
to help in solving a conflict. Practical applications are explained in 3 areas: hospital ethics
committees, individual ethical problem solving and provision of teaching programs on ethics.
The model can be used in the provision of medical advice to the family on the ethics for the
purpose of addressing the conflict that may arise between the family of Rose and the hospital.
Conclusion
The paper covers the legal responsibilities and obligations that all medical professionals
must follow to ensure that the rights of the patients are upheld. The paper discussed the various
elements of a valid consent such as Capacity, informed consent, and voluntariness. The consent

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can be written, verbal and implied. The consent must also satisfy the legal requirements in order
to be valid.
Among the determinant of the factor that affects the decision to continue life support or
to withdraw, patient advanced directives are the essential determinant factor of all the factors that
influence the decision. It is also true that in life support, medical professionals act as the main
decision makers. The outcome of any case that relates to the legal issues can only be determined
by the courts. In ethical issues, it will not provide one right answer, it is a continuing process that
one will be asked to apply.

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