ask description
|
This task will require you to reflect upon and analyse a healthcare scenario from an ethico-legal perspective, using Driscoll's reflective model as a guide. You should choose ONE of the case studies below to use as the basis of your reflection.You are required to draw upon the unit content, personal experiences, relevant literature and learning resources to inform your reflection and analysis.
|
Task length
|
1500 words
|
Links to unit’s intended learning outcomes
|
1, 2
|
Assessment criteria
|
1. Demonstrates familiarity with key concepts of ethical practice (covered in the unit) pertaining to the chosen situation;
2. Demonstrates an understanding of the ethico-legal complexities inherent in the situation, and considers the implications of different courses of action;
3. Shows evidence of developing ethical awareness and how self-reflection may inform your practice and relationships with others;
4. Writes clearly and succinctly using Driscoll's model (written in the first-person), with correct grammar, ethico-legal terminology and referencing (Harvard style);
5. Integrates relevant literature and resources to support and justify key ideas and observations.
|
Contribution to final assessment
|
40%
|
1 Ruth is a 7-month-old baby who was born with Tetralogy of Fallot, a serious heart defect that can be corrected with surgery. Ruth had her first surgery - a shunt between the aorta and pulmonary artery to provide adequate blood flow to her lungs-when she was 2 months old. The complete repair of her heart will be performed when she is strong enough and her condition is stable enough to tolerate the stress of a more complicated operation. Her local physician and the paediatric cardiovascular surgeon at the medical centre estimate that Ruth will not be ready for surgery for several months, perhaps a year. Despite the earlier surgery, Ruth's heart functions inefficiently. As a result, her lungs frequently fill with fluid and she turns blue and becomes extremely short of breath. When this happens, her parents must rush her from their farm to the nearest hospital in a small town about 15 minutes away. In the Accident and Emergency Ward (A & E) she is usually given oxygen and medicines to help her breathe more easily and remove the extra fluid from her lungs. Ruth’s parents, Sam and Maddi Phillips, have had to rush her to the A & E ward approximately once a week since she was born. Sam is 18 years old; Maddi is 17 years old. Neither has finished high school. They live with Sam’s father on his farm. In addition to helping his father on the farm, Sam works from midnight to 6 am. at a local grocery store, in order to make a little extra money. He is chronically sleep-deprived and exhausted. Maddi is also chronically tired, as Ruth's care makes demands on her day and night. Both parents are terribly frightened by Ruth's crises and fear they may not make it to the A & E ward in time. They have become very close to the health workers and depend on them for psychological as well as medical support. One night Ruth arrives to A & E in more distress than usual. The staff are working as fast as they can to give the drugs needed to save her life. One of the nurses caring for Ruth is inexperienced; she rarely works in A & E and has never worked with critically ill children. In the stress of the crisis, she grabs the adult rather than the paediatric vial of morphine (the narcotic given to help ease Ruth's breathing) and inadvertently gives Ruth an adult dose rather than the paediatric dose. As a result, Ruth receives ten times the recommended dosage. Because morphine is a powerful respiratory suppressant, Ruth suffers a respiratory arrest and stops breathing completely. The staff are present when Ruth experiences her respiratory arrest and immediately begin resuscitation. Within a few minutes they discover the cause of the arrest and promptly give Ruth a narcotic antagonist - a drug to reverse the effects of the morphine. The narcotic antagonist works quickly, and in less than a minute Ruth is breathing again. Meanwhile, the oxygen and medicines have had a positive effect, and her breathing, heart function, and general condition are much improved. The A & E registrar, Dr. Koh, approaches Maddi and Sam. Maddi begins to cry and through her tears she sobs, "This is just what we were scared would happen. She's getting worse, isn't she? That's why she stopped breathing, isn't it? I don't know what we would do if we couldn't count on you." Dr. Koh had intended to tell Sam and Maddi the true cause of Ruth’s respiratory arrest, but now she hesitates. Dr. Koh knows these parents well; she has personally resuscitated Ruth several times and has seen firsthand the parents' stress and the difficulty they usually experience coping with the all- too-frequent crises her illness generates. Dr Koh wonders if it might be better not to tell Sam and Maddi about the medication error, as they may lose faith in the hospital. She is worried that the next time Ruth has an episode, they may decide to take her to another hospital half an hour further away. Any delay in resuscitating Ruth could cause death or irreversible brain damage. CNA153 – Foundations of professional practice 15/07/2019 1 CNA153 – FOUNDATIONS OF PROFESSIONAL PRACTICE What is Ethics? 1 ETHICS – WHAT IS IT? Philosophers… …tend to start with a ‘What is it?’ question Not a matter of dictionary definitions, but rather trying to delve into the nature of the phenomenon the word refers to. 2 ETHICS VERSUS MORALITY? A distinction is sometimes drawn by people in other disciplines: ▪ Personal beliefs versus social standards ▪ Or, social standards versus personal beliefs! ▪ Objective or absolute versus subjective and relative ▪ Cross-cultural and abstract versus socially-specific rules We are not studying the way other people behave in this unit – we want to ask how we, ourselves, as future professionals, should behave. ▪ We will not distinguish between ethics and morality! 3 15/07/2019 2 SO FAR… ▪ In Semester 1 you were offered reasons as to why you should learn about ethics: 1. There are always going to be issues about which reasonable, compassionate and intelligent people will disagree. A knowledge of theoretical ethics helps you to better explain and justify your actions. 2. Ethics is NOT simply a matter of personal opinion! There is a lot of agreement when it comes to questions of how we should treat patients and why it is important we treat them well. Professional Codes, such as the Code of Conduct, do set out values and behaviours that you must comply with. The Codes, however, cannot tell you what to do in a situation that is ethically complex (i.e., when it is not clear what the right thing to do is, or there are pressures that are working against doing the right thing). 4 NORMATIVE ETHICS ▪ In CNA149 we looked at the four principles of bioethics: 1. Autonomy 2. Beneficence 3. Non-maleficence 4. Justice ▪ This week, you’ll be introduced to two ethical theories that are normative – that is, they purport to tell us what we should do when faced with a difficult ethical situation. ▪ Utilitarianism ▪ Deontology They will be the subject of the next two lectures (Part B &C). 5 BUT…ETHICS IS MORE THAN SIMPLY NORMS OR RULES THAT GUIDE BEHAVIOR! It is important to emphasise that ethical issues are in play all the time in everyday practice: ▪ Very often, there are tensions between competing values and expectations that you will have to navigate: ▪Part of learning about ethics requires you to transform yourself into a moral agent – to see ethics as something that you are, rather than something that you follow… 6 An example: Julie, a newly-graduated nurse, worries that if she were to exercise her values and spend extra time with her patients, she would be seen in a negative light by her colleagues because she didn’t have her patients ‘tucked into bed by ten’. 15/07/2019 3 AGENT-CENTRED APPROACHES ▪ Ethics, therefore, is more than just ‘making the right decision’. ▪ The lectures for Week 2 will look at some ‘agent-centred approaches’ that focus on the character traits and/or ways of comporting oneself. These relate not only to patients and their families, but colleagues, organisations and society more broadly. ▪ Virtue ethics and ‘emotional intelligence’ ▪ Narrative ethics 7 Cna153 foundations for professional practice 1 Cna153 foundations for professional practice 1 Week 1 Lecture B Normative Ethical Theories: Utilitarianism 1 Introduction - Triage What is triage? Triage is used in situations where existing needs cannot be met by the available resources (e.g., in the Emergency Departments of hospitals, wars and disasters). The aim of triage is to prioritise certain cases based on various factors: E.g., the need for immediate intervention to save life; severity of pain; acuteness of presentation etc. But not only these – survival probability is factored in and weighed against other factors, such as the resources required to maintain life, co-morbidities etc. Often based on an algorithm or a set of criteria to determine a specific treatment or treatment priority for each patient. 2 Triage and utilitarianism Triage systems are designed to assist scarce resource allocation. Based on utilitarian principles: ‘bring about the greatest amount of happiness for the greatest number of people’. Utilitarianism: The most ethical course of action is one that maximises happiness (the ‘good’) for the greatest number. But: an ethical conflict between ‘bringing about the best for the greatest number’ and other ethical principles in healthcare: The principle of equal respect for all The principle of non-maleficence The principle of non-abandonment 3 Hallmarks of utilitarian thought Everyone matters and matters equally (moral equivalence) – in this way, utilitarianism is impartial. Every action must be rationally related to the goal of promoting happiness (i.e., ‘the good’). Focuses on the consequences of an action (a form of Consequentialism). No action is inherently wrong: Killing an innocent person could be justified in order to bring about the ‘greater good’. 4 Utilitarian Reasoning Utilitarianism essentially requires a cost/benefit analysis of each of the alternatives For each option: What good outcomes is it expected to produce? How likely are these? What bad outcomes is it expected to produce? How likely are these? Think about alternative ways to act - what are the possible good and bad outcomes of these and how likely are they to occur? Which option produces the best overall balance of good versus bad outcomes? 5 Everyday ethics in practice A newly-graduated nurse, Mia, is caring for Mrs. Cheng, an elderly lady with multiple medical problems, including acute urinary retention. Mrs. Cheng is a regular in the small, private hospital where Mia works, and is known to prefer the older, more experienced nurses. The senior RN, Jen, tells Mia that Mrs. Cheng will need an indwelling urinary catheter inserted. Together, they go and talk to Mrs. Cheng. Jen explains the need for the urinary catheter to Mrs. Cheng and tells Mrs. Cheng that Mia will insert the catheter under her supervision. However, Jen does not tell Mrs. Cheng that Mia has never placed a catheter before. Mrs. Cheng consents to Mia performing the procedure. 6 What does utilitarianism say about our example? Possible good outcomes Mrs Cheng gets the catheter as needed. Mia gets vital experience (good for her and good for society overall –