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Common Law Assignment Based On The Ethics And Health Care

Question

Task: Valentina Dawson is a 35 year old woman living in Brisbane. Her husband passed away six months ago. Ms Dawson is a devout Jehovah’s Witness and has practised her faith for over fifteen years. She was recently admitted to a Brisbane public hospital for delivery of her first child and, on admission, Ms Dawson signed a consent form which documented her consent to operative treatments and the use of anaesthetic. RN Kamal Singh was working on the ward when Ms Dawson was admitted. Ms Dawson explained to RN Singh that she was a practising Jehovah’s Witness and that she was opposed to the use of all blood products for medical purposes.

Ms Dawson’s brother, Carlos, accompanied her to the hospital. In the discussion with RN Singh, Ms Dawson indicated that she and her brother were very close but that she was not in contact with her sister Marina anymore after they had a disagreement about her religious beliefs a number of years earlier, and that she no longer shares any information with “that side of the family”. RN Singh documented these discussions in the patient’s clinical file.

After some complications, Ms Dawson’s baby was delivered safely but an emergency hysterectomy needed to be performed. Ms Dawson is now unconscious and has suffered blood loss. Dr Grace Petrova has advised Carlos that blood products will need to be administered urgently otherwise Ms Dawson will die. Carlos is distraught but has told Dr Petrova that their beliefs do not permit transfusions and that his sister Valentina is opposed to the use of blood products “under all circumstances”.

Valentina’s sister, Marina, has been informed by a mutual friend that Valentina has been hospitalised and is in a serious condition, and Marina has just phoned the hospital seeking an update on her sister’s condition.

Answer

1. Identify issues & collect information
Identify the problem:

Issue 1: Consent: Should RN Kamal Singh administers blood products to Ms. Dawson?
Issue 2: Confidentiality: Should the RN give information about Ms. Dawson’s condition to her sister Marina, without having consent from the patient or his brother Carol?

Gather relevant facts
In the case scenario of common law assignment, it has been revealed that 35 years old patient Ms. Valentine Dawson has been admitted to the Brisbane public hospital for delivery of her first child. She is a devout Jehovah’s Witness. On admission she has given the consent for operatic treatment and anesthetic usage. However, the patient has opposed to take blood products, while discussing with the RN Kamal Singh. After her delivery of a healthy baby, an emergency hysterectomy was performed, when she suffered blood loss. Ms. Dawson’s brother, who also possesses the same religious belief, has been advised by the physician that to save her life, blood transfusion is must. As the patient is unconscious, opinion from her brother was taken, which also indicated that “under any circumstances”, she should not be transfused with blood products. This is creating an ethical conflict.

Who is involved?
Ms. Valentine Dowsan, his borther Carol, registered nurse Kamal Singh and her sister Marina, the physician Dr. Grace Petrova and the hospital staffs are involved in the case.

2. Evaluate the issues
2.1 Ethical principles: Autonomy: It indicates that the patient’s and their family’s opinion needs to be promoted in care planning. In case of Ms. Dawson, if blood transfusion is done, her opinion would not be respected. Beneficence: It indicates that the RN should provide care service, which is beneficial to the patient. In case of Ms. Dawson, it has been revealed that if blood transfusion is conducted, it will save her life, thereby meeting this ethical principle (Deneyer et al., 2011).

Non-maleficence: This principle indicates that RN should provide care service, which will not harm the patient. If blood transfusion is not done, it would harm the patient, leading to fatal consequences, indicating that this principle will not be met.

Justice: Justice indicates that RN ensures adequate fair treatment to all patients, promoting their rights. However, if blood transfusion is done, it would interfere with human rights of Ms. Dawson.

2.2 Code of ethics: In order to ensure the position statement of the RN, the RN needs to consider the Ethical principles and ICN Codes of Ethics for nurses. According to the elements of the code, it is highlighted that the nurses should promote human rights, values, customers and spiritual beliefs of the patient, family and community, while providing care, while being responsible for making informed consent and sharing the right information with the patient and / or patient family (Nursing and Midwifery Board of Australia, 2008b). The following “Code of Ethics for Nurses in Australia” and “ICN Codes of Ethics for nurses” could be applied to the current case.

Element 1.4 of the ICN Codes of Ethics for nurses” indicate that the nurses should ensure the “professional values such as respectfulness, responsiveness, compassion, trustworthiness and integrity”. It is indicating that the RN has to show respect and integrity, while communicating and making decision for Ms. Dawson, respecting her cultural viewpoint about not administering blood products (International Council of Nurses, 2012).

Element 1.7 of the codes mentioned in this common law assignment indicate that the nurses should “value ethical management of information”. In order to follow this element of ethical codes, the RN has to consider the ethical aspects, while making decision for sharing Ms. Dawson’s information with her sister Marina, about whom the patient has expressed negative thoughts (Gupta et al., 2012).

In addition, Value statement 1(2) in the “Ethical codes for nurses in Australia” indicates that “Nurses should actively participate in minimization of risks for individuals”. Considering this, the RN should make decision of administering the blood products, in order to eliminate fatal consequences (Nursing and Midwifery Board of Australia, 2008b).

2.3 Legal principles: In Ms. Dawson’s case, two main issues are highlighted, the issue of consent related to the administration of blood products to Jehovah’s witness patient, against her will; and the issue of confidentiality related to inform her sister Marina, without her consent.

Regarding the consent issue, the “The Medical Treatment Planning and Decision Act 2016”, “The Medical Treatment Act 1988”, “The Human Tissues Act 1982”, “Guardianship and Administration Act 1986” and “National Health Act 1953” are applicable. According to the Guidelines on Informed Consent, under the “National Health Act 1953”, if the Jehovah’s Witness patient has given an “advance directive” that he or she is not willing to receive blood transfusion, in such case, refusal should be accepted and decision should be made accordingly. One thing is noteworthy here regarding the patient; that is she signed the informed consent document, agreeing for “operative and anesthetic procedures” (Garraud, 2014). Considering this it can be said that the act is being breached, if she is administered with blood products. Further, it is also noteworthy that in order to save a patient’s life or eliminating chronic suffering, the medical professional could administer treatment, encountering emergency situation, when the patient is not in a status to give consent (“The Medical Treatment Planning and Decision Act 2016”). However, it is opposed to offer treatment, if the practitioner is aware of the fact that the patient is unwilling to receive treatment (“The Medical Treatment Act 1988”). In that context of common law assignment, the RN is responsible for making “Refusal of Treatment Certificate”, considering ethical and legal consequences. RN Singh was aware about Ms. Dawson’s wish to refuse blood transfusion.

Regarding confidentiality issue, two main sources could be explored for understanding the “responsibility of protecting confidentiality”; i.e. “Common law (Trevorrow v South Australia)” and “Statute law (Hospital and Health Board Act)”. It has been revealed from HHBA that “patient’s confidential information is not disclosed, directly or indirectly to another person unless…required or permitted under the Act” (HHBA, s39). The confidentiality breach could have exception under this law, considering “patient consent” (s144) and “disclosure to a person with sufficient interest in…the patient” (s146). In the current case, the patient has not given “consent” for sharing information with Marina; although being sister, Marina has significant interest towards knowing Ms. Dawson’s condition (Chand, Subramanya & Rao, 2014).

2.4 Conclusions: According ethical and legal aspects, if the patient would be provided with blood products, it would be unethical. Thus, taking consent from Carol and other person with best interest for Ms. Dawson’s wellbeing needs to give consent.

2.5 Consequences: Consequences upon administering blood products would be improved health status of Ms. Dawson. On the other hand, consequence of sharing information with Marina would lead to breach of confidentiality, but taking consent from Carol could eliminate negative consequences.

3. Action – what to do in practice
Code of professional conduct:
The following “Code of Professional Conduct for Nurses in Australia” is applied here.
According to CS (1)/(2), “Nurses should provide safe and competent nursing care, within scope of practice”. In order to provide safe practice, RN Singh needs to administer blood products, to safeguard Ms. Dawson’s life (health.vic.gov.au, 2010). On the other hand, CS5(1)/(3) indicates that “Nurses should protect privacy of people seeking and receiving care of their representatives prior disclosing information”. Here, following this code in the study of common law assignment, the RN would not disclose information to Marina, without Ms. Dawson’s consent.

Identify options within the common law assignment
The two options regarding consent:

1) Not administering blood products, respecting patient’s opinion, known that the patient would die further

2) Administering blood products, upon making her brother and sister understand the urgency and taking their consent

The two options mentioned in this common law assignment regarding confidentiality:

1) Not disclosing information, by respecting Ms. Dawson’s viewpoint and protecting her confidential data

2) Estimating Marina as the person with best interest for Ms. Dawson, consulting with Carol and taking consent for giving Marina information and involving her in the care procedure

Make decisions & take responsibility
For both issue, option 2 have been selected, taking responsibility of ensuring maximum wellbeing of the patient.

Justify decision
Administering blood products would save Ms. Dawson’s life. It is justified as “The Medical Treatment Planning and Decision Act 2016” indicated that at emergency situation, for saving life, medical practitioner can treat without consent (health.vic.gov.au, 2010). On the other hand, Marina would be informed, upon taking consent from Carol, as she could make the right decision for her sister, having best interest for her.

4. Implement
Act upon decision: Ms. Dawson needs blood transfusion, otherwise she will die, which has been highlighted by the physician. Considering the ethical principles of beneficence and non-maleficence, as well as the legal considerations for the dying patients, it has been decided to inform Marine the situation of her sister and bring her to the hospital, so that a thorough discussion could be conducted with Carol and Marine about their sister’s treatment (health.vic.gov.au, 2010).

Plan for consequences: If they agree for transfusion, the medical procedure would be performed; otherwise, respecting their consent, a “Refusal of Treatment Certificate” would be prepared and documented for the case.

5. Reflection and Assessment of outcomes
Evaluating the decision-making process within this common law assignment, I revealed that I have followed a systematic way, considered both legal and ethical principles, concepts and related aspects. Thus, I believe that the decision and its implementation would lead to improved outcomes of Ms. Dawson.

Reference List
Journals
Chand, N. K., Subramanya, H. B., & Rao, G. V. (2014). Management of patients who refuse blood transfusion. Indian journal of anaesthesia, 58(5), 658.

Deneyer, M., Matthys, D., Ramef, J., Michel, L., Holsters, D., & Vandenplas, Y. (2011). Legislation and refusal of blood transfusion by a minor Jehovah-witness in Belgium. Acta chirurgica Belgica, 111(6), 355-359.

Garraud, O. (2014). Jehovah’s witnesses and blood transfusion refusal: what next?. Blood Transfusion, 12(Suppl 1), s402.

Gupta, S., Onwude, J., Stasi, R., & Manyonda, I. (2012). Refusal of blood transfusion by Jehovah’s Witness women: a survey of current management in obstetric and gynaecological practice in the UK. Blood Transfusion, 10(4), 462.

Websites
health.vic.gov.au. (2010). Jehovah’s Witnesses and Blood Transfusions. Online. Available at: http://docs2.health.vic.gov.au/docs/doc/7EC20AD6B48DF5B2CA2578C3000333EA/$FILE/PG07_Jehovahs_Witnesses_and_Blood_Transfusions_09[1].pdf [Accessed on: 12th September 2019]

International Council of Nurses. common law assignment (2012). THE ICN CODE OF ETHICS FOR NURSES. Online. Available at: https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf [Accessed on: 12th September 2019]

Nursing and Midwifery Board of Australia (2008b). Code of Professional Conduct for Nurses in Australia, Melbourne, VIC; NMBA

Nursing and Midwifery Board of Australia (2008b). Code of Ethics for Nurses in Australia, Melbourne, VIC; NMBA

Legislation
The Medical Treatment Planning and Decision Act 2016 (Australia)
The Medical Treatment Act 1988 (Australia)
The Human Tissues Act 1982 (Qld)
Guardianship and Administration Act 1986 (Australia)
Common law (Trevorrow v South Australia)
Statute law (Hospital and Health Board Act, Qld)
National Health Act 1953

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