CASE STUDY FOUR Elsie Lee, 88 years old had recently moved to a Residential Aged Care Facility (RAC). She had difficulty mobilising due to severe rheumatoid arthritis as well as short-term memory and vision impairment. Elsie also had a history of AMI, removal of bilateral cataracts, and a (L) hip replacement four years ago. On admission to the RAC facility, on Tuesday afternoon, the Nurse Manager suggested that Elsie consider making out an advanced care directive (ACD), indicating what she would want done in the event that her health should deteriorate. Elsie agreed and awaited the help of her family when they visited on Sunday. She was pleased to have this opportunity as, although she had discussed her wishes with her family, she wanted to make it clear to staff caring for her that she did not want aggressive treatment of any kind and did not want to be resuscitated. On Friday night, Elsie developed severe chest pain which radiated down her (L) shoulder, an irregular pulse and a BP of 73/48 and the RN on duty called the ambulance. Elsie pleaded with the paramedics to leave her ‘as she was’; the R.N. insisted that they transport Elsie to hospital as she had not filled out an ACD indicating otherwise. In transit to the hospital, Elsie suffered a cardiac arrest. The paramedics attempted resuscitation but were unsuccessful. On arrival to the ED, Elsie was pronounced dead. Her family determined that Elsie’s death was brought on by the stress of being moved to hospital. They decided to sue the R.N., the paramedics and the RAC facility for assault and battery. Assessment task 3 Assistance The following is a guide to assist you in writing your essay. Selection of your Case Study Students are required to select the scenario representative of their own health professional discipline and compare and contrast their duties in the chosen scenario to the duties of different health care professionals. If students are studying in a course that is a dual degree, they can focus on their two professional specialties for this assessment task. As there are many disciplines undertaking the unit, you should pick the scenario that will represent a moral dilemma in your discipline. The scenarios are mainly generic and if you look at them holistically, they will demonstrate a multidisciplinary perspective. Think about how you would be involved in any given scenario. 1. Determine the stakeholders including two health care professionals in the case scenario; This refers to the people who are affected by the ethical dilemma in the chosen scenario, including you in your discipline area and a selected other health care professional that would be affected. 2. Differentiate the ethical and legal conflicts and explain them from the following perspectives: a. The dignity and rights of all stakeholders in this case This will be assessed on the content you have learned in the classroom with regards to ethical theories, and health care and human rights charters. b. The principles and virtues of health care ethics that inform professional practice This is self-explanatory. It is expected that you make references to specific ethical principles in health care ethics and discuss how they are relevant in your chosen scenario and possible how they conflict with each other. c. The relevant codes of ethics and/or codes of professional conduct This refers to your codes of professional conduct and what parts are particularly relevant in your chosen scenario and how they will guide your ethical practice. 3. Propose a legally and ethically defensible resolution to these conflicts This point will look at how you bring all the above to propose a resolution to the identified ethical dilemma. It is expected that each student will propose different solutions as the theories; principles and codes of professional conduct are so diverse. All of the above criteria must be supported through your research with peer reviewed sources. You can consider the essay in this way: Introduce your discussion. You can identify the stakeholders (those who have a stake/ interest in the actual scenario, including 2 health care professionals), in the actual introduction. Only consider those stakeholders who are mentioned in the case study You then start the body of the essay by identifying the ethical and legal conflicts in the scenario. What are they? You then consider how those conflicts affect the stakeholders; i.e. what responsibilities or goals or values do those stakeholders have that are being threatened in some way? You consider (analyse) them by asking what the following ethical concepts and principles require of you? The notion of human dignity (of the affected stakeholders) and human rights. This concept applies to all stakeholders you are considering. There is a chapter on human dignity in your prescribed text book (chapter 4). There is also a discussion on human dignity in Module 2 with a link to a book on the topic. You have studied some chapters on human rights in week 1 (and at various points in the unit) Beauchamp & Childress 4 principles of health care ethics. These principles apply to the health care professionals. Think about what those principles require of you as the hcp involved. That is, you need to consider what the principles require of you in dealing with the actual conflicts you have identified. Remember, these principles inform some of the important laws we have governing health care activity (e.g. nonmaleficence and the law of negligence, justice and the distributive standard in the Medicare legislation, respect for patient autonomy and laws governing privacy and confidentiality etc) The virtues that inform the health care professions: what would a virtuous (kind, compassionate, empathic, courageous, caring, honest, etc) health care professional do in this situation? See the first section of module 3, including the link to Pellegrino in Activity 1. See also Chapters 5 and 6 of your prescribed text book for discussions on the virtues. You should limit your analysis of the virtues to the health care professionals. The relevant codes of ethics & professional conduct. After having analysed the conflicts (by considering how the above ethical concepts and principles would guide your decision-making), you then draw on that analysis to: Propose a legally and ethically defensible resolution to these conflicts. Provide a brief conclusion (no new ideas here – just a brief summary of your discussion) Just think about it like this: You are a health care professional who has found themselves in an ethical and legal dilemma. You have to think critically about how you are going to proceed, taking into account all (or most) of the other stakeholders involved. You want to get to a stage where you can say: this is what is required if I am to resolve the conflicts and be able to defend my decisions against the objections/ disagreements of others. As a guide only I have provided the following general essay information. The assessment task is 2000 words. Paragraph and Essay Structure An essay includes an introduction, body and conclusion. 1. The introduction should provide the reader with a framework for the essay and what will be discussed. Sometimes it’s easier to write the introduction last or after you have completed outlining what you will be discussing. (Approximately 100 words) 2. The body of the essay is the crux of your discussion and will consume the bulk of your words. Your paragraph structure is important to note as follows: - Each paragraph should have an introductory and concluding statement. Each paragraph should have a direct connection with the one prior and one after it. This allows the essay to flow. 3. The conclusion should provide a summary of the key points presented in the essay. (Approximately 100 words) 4. The definitions used in your essay should only use academic references (not online dictionaries) 5. It is important to note that this is an academic essay and should be written in the third person. 6. There are no minimum requirements for the number of sources you use however as a general guideline an academic paper can have 1 source per hundred words. 7. In regards to the currency of the references, there is no pre-determined time limit on the publication dates of your philosophical sources. However, if the discussion concerns current practice in your profession it will be expected that current and relevant literature is used (Usually within 5 years published age). If you have sourced a reference that is older than this you must demonstrate how it is relevant in your writing. Finally from the rubric defining what we mean by the following: Content, evidence and examples – Everything you have included should be relevant to the scenario and to the unit – Health care ethics and health law. Examples to support you resolution will enhance your discussion. You can source these from real legal cases that are accessible through the library or online. Critical thinking, reasoning and evaluation of the evidence – What do the experts state regarding the topic? Here you present the research you have undertaken and looking at different perspectives. You should then synthesis the research by asking yourself “What connections can I make regarding the research into expert discussions” and finally evaluation means what conclusion do I come to after presenting the arguments based on my analysis and synthesis? Referencing – Must be APA 6th edition.