Multiple Perspectives- Ethical dimensions
Clinical scenario one (Four Ethical Principles)
A young man living in a remote community receives burns to his lower leg. He is flown by air ambulance to the city and is treated in the burns unit. Following a period of rehabilitation, he returns to the community with two pressure garments, the standard allocation per client, to be worn for scar management. The visiting health team conducted a follow up assessment four weeks after his return. He had stopped wearing the pressure garments after two weeks as the elasticity had deteriorated because he does not wear shoes. The pressure garments are not wearable.
In the given scenario, firstly healthcare professional has to identify the appropriate intervention for the patients and identify weather that intervention is good for thepatients outcome or not in order to prevent from harm.
QUESTION ONE: Identify and discuss the ethical issues in this case using the four principles approach:
·acting for the good of individuals and society (beneficence)
·refraining from harming others (non-maleficence)
·being fair (justice)
·allowing others to make decisions and act according to their own wishes (autonomy).
Give reasons for your answers.
Clinical scenario two (Moral theory and Ethical Practice)
A health professional is approached by a 13-year-old girl for information about having a human papilloma virus (HPV) vaccination she has learned through social media that HPV vaccination is a safe and effective vaccine administered to prevent HPV infections – in particular cervical cancer. She discloses that her grandmother had cervical cancer and that she is afraid of getting the disease ‘when I am older’.She tells the health professional that she has accessed information on the internet recommending the HPV vaccination to be administered to girls between 9 years and 13 years, and that this will provide protection for between 5 and 10 years. She tells the health professional that ‘her friends have had the vaccination with no dramas’, and she wants to have the vaccination too. She reveals she has tried to discuss the matter with her parents and to obtain their permission for her to go to their GP and have the vaccination. They refused to discuss the matter, however and would not consent for her to go to the family GP. She tells the health professional her parents are ‘very religious’ and ‘don’t believe in vaccinations’. She further states that they are ‘disgusted’ with her wanting ‘this particular vaccine’, as only girls who are ‘promiscuous’ needed to have it.
QUESTION TWO (2):What are the ethical principles raised in this case?Give reasons for your answers.
Clinical Scenario three (Vulnerable Populations)
The manager of the midwifery-led Continuity of Care Program (Continuity) at the local public hospital has capacity for one more woman in the current case load. Continuity supports women throughout their pregnancy and birth journey with a focus on achieving normal birth. Each woman in Continuity is supported by one dedicated midwife to provide a continuity of service and support. Research suggests continuity midwifery is the preferable model of care resulting in better outcomes for women and babies when compared to other models (Sandall, Soltani, Gates, Shennan & Devane, XXXXXXXXXXThe manager has one position in the Continuity of Care Program to offer and three eligible women (all 14 weeks pregnant) on the waiting list, the other two women will be referred to the public antenatal program.
Ashley is 19 years old and has a two-year-old son, her first pregnancy and birth were ‘uneventful’. She currently does not have a partner, but her elderly grandparents are very supportive. She often stays with her grandparents as she does not have stable housing or employment. Ashley is moderately overweight, otherwise she is physically well, she is a social smoker and suffers from anxiety and depression for which she takes regular medications. Ashley takes casual hospitality shifts when she is able to get her grandparents to care for her toddler, she also receives government financial support.
Mirka is 28, she immigrated to Australia eight years ago with her family. Mirka is multilingual, with English being her third language, her English is still developing. She and her partner Catherine are expecting their first baby after successful artificial insemination using anonymous donor sperm. Both expectant parents work full time, with Catherine in an executive role; Catherine plans to be a stay at home parent while Mirka returns to work after her maternity leave. Mirka’s family are not supportive of her ‘lifestyle’ choice i.e. being in a lesbian relationship, and they are certainly not planning to have any involvement with the baby; the couple have no local family support. Mirka has been experiencing significant morning sickness, but she is otherwise well.
Deb is 39, she had one pregnancy terminated in her early 20’s, and since being married has had multiple miscarriages, this is the first pregnancy to reach the second trimester. Deb has a supportive husband, and three older stepchildren. Deb is nervous about her pregnancy given her obstetric history, but she is hopeful this pregnancy will progress to full term. Deb is following all the recommendations regarding prenatal preparation, supplements, diet restrictions and prenatal yoga. Deb has had a knee reconstruction from a sporting injury and has a history of endometriosis but otherwise is fit and well. Deb works full time in public administration, her husband is a small business owner.
QUESTION THREE: Which of the women should the manager invite onto the CMP? Consider your answer with regard to doing the ‘greatest good’ using ethical theory (not just principles) to craft your response.
Clinical scenario four (End of life)
In 2005, in the aftermath of Hurricane Katrina, allegations were made that a number of ‘mercy killings’ had occurred at Memorial Medical Centre in the city of New Orleans. As inquiries progressed, it was revealed that four non-ambulatory patients had been euthanised apparently to prevent their needless suffering in the face of having ‘no realistic chances of surviving in a stranded, incapacitated hospital (Curiel, 2006, p 2067) an evacuated hospital without power or services. In July of the following year, a New Orleans physician and two nurses were arrested and charged with murder in relation to the patients’ deaths, sparking public debate on whether the killings were ‘murder or mercy’. It was eventually revealed that none of the four patients in question were expected to die immediately from natural causes, were in pain or had consented to the lethal doses of drugs given. They did; however, have several characteristics in common: they were poor, black, old (61–90 years of age) and dependent on their professional caregivers. Another commonality was they were all the subject of a consented DNR (Do Not Resuscitate) directive – although one observer noted, no one had warned them in the case of natural disaster the hospital staff would interpret DNR to mean ‘Do Not (Johnstone, 2019) Rescue’ (Note: DNR is used interchangeably with NFR - Not For Resuscitation as part of Advanced Care Directives in Australian health facilities).
QUESTION FOUR: Were the nurses ‘right’ or ‘wrong’ to assist with euthanising the patients? Use an ethical theory or the ‘four principles approach’ to develop your answer.
Reference List
Curiel, T. J XXXXXXXXXXMurder or mercy? Hurricane Katrina and the need for disaster training.New England Journal of Medicine,355(20), XXXXXXXXXX, doi: XXXXXXXXXX/NEJMp068196
Johnstone, M. J. (2019).Bioethics: a nursing perspective. Chatswood, NSW: Elsevier.
Sandall, J., Soltani , H., Gates, S., Shennan, A. & Devane, D XXXXXXXXXXMidwife‐led continuity models versus other models of care for childbearing women.Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD XXXXXXXXXXdoi: XXXXXXXXXX/ XXXXXXXXXXCD004667.pub5.
Wintrup, J., Biggs, H., Brannelly, T., Fenwick, A. & Ingham, R. (2018).Ethics from the ground up emerging debates, changing practices and new voices in healthcare.McMillan International Higher Education.