Introduction

The purpose of this paper is to discuss the do not resuscitate order as a medical order that instructs health care providers not to perform cardiopulmonary resuscitation even if the patient is in a critical condition, as well as the legal, ethical, and professional issues that must be addressed and the course of action to be taken to resolve this situation.

Quality of care and health outcomes have not always incorporated the patient-centered perspective, which is defined as «a moral concept and philosophy that considers it to be the right thing to do when designing and delivering respectful, humane, and ethical care.

This paper will look at a case study to show how the 6-step framing model can be used to better understand the underlying ethical, legal, consent, and professional complexities that arise from critical decisions in the acute care setting. Medically, Kevin has cholelithiasis, a previous myocardial infarction, and prostate cancer.

He worked as a builder for 45 years and is now officially retired. His wife died last year, and his only son took over the family business, which Kevin still helps out with on the side. His son is the only next of kin, and the medical team has not yet been able to contact him.

Beneficence is defined as the act of doing good and the actions are taken to alleviate the harm. Even though there is no evidence of AHD or NFR, the medical team and nurses perform resuscitation to save Kevin’s life.

In this case, the ethical issues that have been identified are autonomy, which recognizes an individual’s right to make decisions about themselves that are unrestricted by factors such as controls imposed by others or a lack of information that would limit their freedom of choice (Beauchamp & Childress, 2012). This principle requires doctors to protect a patient’s right to choose whether or not to continue treatment.

Beneficence is defined as the act of doing good and the actions are taken to alleviate the harm. Even though there is no evidence of AHD or NFR, the medical team and nurses perform resuscitation to save Kevin’s life. Nonmaleficence is defined as causing no harm and refraining from providing ineffective treatment with no chance of benefit. In this case, Kevin was kept alive by a ventilator and medications while waiting for his next of kin to be located.

Consent

Consent must be given voluntarily. It may not be a valid legal defense if, for example, the patient felt obligated or was persuaded to accept treatment by others. Some patients may be particularly vulnerable to peer pressure, so nurses must be aware of the possibility of coercion and make every effort to support patients in making their own decisions (General Medical Council, 2008).

Consent isan agreement or understanding reached between two or more parties based on the principle that all people have the right to choose which diagnostic tests or treatments they will receive, unless there is a statutory provision that allows treatment without consent. An adult patient who is competent and is treated without their consent has the right to sue for assault.

Consent can be implied, verbally expressed, or in writing.Elements of valid consent are that it is given freely and voluntarily, that it is informed, that the risks and potential side effects are discussed, that the consent covers the procedure to be undertaken, and that the person giving the consent has the legal authority to do so.The legal issue of consent in this case study is Kevin’s capacity to give consent because he is over the age of 18.

Legal capacity or competence, as well as a rational mind, are required to understand the situation and capable of comprehending the nature and consequences of choices. A person is aware of the consequences of his decisions and capable of making an informed, voluntary, and non-coerced choice.

Kevin is of sound mind in this case to consent to his treatment because he can still respond to verbal commands and pain.Another legal issue concerning consent is incapacity to consent. When Kevin suffered a myocardial infarction, the healthcare team’s overriding duty of care in emergency situations (to do good) was to save his life by resuscitating him.

All adults have the right to refuse medical treatments and to choose which treatments they want. In Kevin’s case, the healthcare team should have obtained his permission prior to the operation and anesthesia.Nurses have a legal obligation to obtain informed consent from their patients before performing any intervention or treatment, which is one of the requirements, which establishes a mandatory framework of practice standards. (Nursing and Midwifery Council, 2015).

The battery is defined as the intentional touching or application of force to another person’s body in a harmful or offensive manner, without the victim’s consent. Battery poses a legal risk in three scenarios. If the patient has been misled about the treatment or there is other fraud in the informed consent, the entire consent is null and void. The second scenario occurs when the patient is unable to consent and receives substandard care.

The third scenario is the most likely: the patient refuses care and it is forced upon him or her, typically in an involuntary setting.  In this case study, Kevin was unable to provide consent due to his medical condition, so the anesthetist administered anesthesia without obtaining a proper medical history.

In an emergency where a person is incapable of giving consent, treatment may be provided without consent where treatment is required to save a person’s life which is reasonably required to meet the emergency in the patient’s best interests and is the least restrictive of the patient’s future options. In these cases, a consent form is not required; however, the circumstances surrounding the medical emergency and the patient’s inability to consent must be clearly documented in the patient’s medical record.

In this case study, Kevin does have mental capacity, but it is limited as a result of his recent resuscitation. According to WA Health (WA Department of Health, 2016) when a patient lacks capacity, there is no advanced healthcare directive or common law directive indicating that treatment should not take place, and a treatment decision cannot be obtained from a substitute decision-maker, treatment should be withheld. Under common law, a health professional may administer treatment and transport necessary to save the patient’s life, prevent serious harm to the patient’s health, or prevent the patient from suffering or continuing to suffer significant pain or distress.

Legal Issues

Medical malpractice is defined as any act or omission by a physician during the treatment of a patient that deviates from accepted medical practice norms and causes harm to the patient. These elements include the existence of a legal duty on the part of the doctor to provide care or treatment to the patient, a breach of this duty due to the treating doctor’s failure to adhere to professional standards, a causal relationship between such breach of duty and injury to the patient, and the existence of damages that flow from the injury such that the legal system can provide redress.

In this case study, the anesthesiologist did not obtain the patient’s medical history prior to administering anesthesia.Negligence is defined as a medical professional’s act or omission (failure to act) that deviates from the accepted medical standard of care. Medical professionals have a duty of care to their patients as well, to provide treatment that meets the “medical standard of care.”The healthcare team in this case study failed to educate the patient about the risks of surgery and treatment options. Professional misconduct in healthcare is defined as a long-term situation in which patients are endangered or actually harmed. In this case, Kevin was already determined to be unsuitable for resuscitation, but the healthcare team proceeded with resuscitation without informing him of the risk.

An Advance Medical Directive (AMD) is a legal document signed in advance to inform a doctor that if a person becomes terminally ill and unconscious, they do not want any extraordinary life-sustaining treatment used to prolong their life. In this scenario, treatment should be provided in accordance with the decisions expressed in AMD, and substitute decision makers should not be allowed to override these decisions.

If an AMD does not cover the treatment decision to be made, a substitute decision maker should be identified, as outlined in the decision-making hierarchy under Substitute Decision Makers(WA Department of Health, 2016).When a patient of 18 years or older is unable to make reasonable decisions about proposed treatment, the Guardianship and Administration Act 1990 (GA Act) applies.

Ethical Issues

The four fundamentals of ethical issues are beneficence, nonmaleficence, autonomy and justice. Beneficence is a physician’s obligation to act for the benefit of the patient and supports a number of moral rules to protect and defend the rights of others, prevent harm, remove conditions that will cause harm, assist people with disabilities, and rescue people in danger.

In Kevin’s case, the medical team acted quickly to detect cardiac changes. Nonmaleficence is a physician’s responsibility to avoid causing harm to the patient. This simply stated principle supports several moral rules: do not kill, do not cause pain or suffering, do not injure, do not offend, and do not deprive others of the goods of life such as Kevin’s care was not neglected, and he is still being monitored by the healthcare team.

Autonomy means that people have the right to self-determination, or the ability to make their own decisions about their lives without interference from others. In this case, requires the physician to disclose medical information and treatment options that are required for the patient to exercise self-determination and encourages informed consent, truth-telling, and confidentiality.

Justice is where people are generally treated in a fair, equitable, and appropriate manner.In Kevin’s case, the doctors responded quickly and impartially to his need for emergency medical care.The principle of autonomy frequently clashes with the principle of beneficence.

In this situation, healthcare professionals, whether intentionally or unintentionally, use a paternalistic approach when caring for their patients because they believe that approach is beneficial to their patients. Though the intervention appears to be beneficial to the patient, it violates the patient’s autonomy by disregarding her right to make treatment decisions.

Professional Issues

The professional issues that have been raised is informed consent means that a patient freely agrees to a treatment or procedure with full knowledge of the risks, benefits and possible consequences. Unless a patient provides informed consent for a procedure, that procedure can considered an assault or even a homicide if the patient were to die as a result of treatment.

Deciding on DNR on behalf of patients, may serve equity rather than equality, and appears to violate the principle of autonomy. The most important ethical values when dealing with the DNR status, according to nurses and physicians, are autonomy and non-maleficence.Good documentation contributes to better patient outcomes by allowing all members of the healthcare team to exchange information and provide continuity of care.

Healthcare records are one of the most important information sources available to clinicians, given the complexity of healthcare and the fluidity of clinical teams in the modern day.Person-centered care is a concept that influences medical staff and caregivers’ thought processes.

As patients’ needs continue to evolve, the term is constantly changing and evolving. The Health Foundation defines the term using four principles: it is personalized, coordinated, enabling, and supportive.Professional framework includes comprehensive care which aims to ensure that patients receive health care that is tailored to their specific needs and takes into account the impact of their health issues on their life.

Recognizing and Responding to Acute Deterioration is a step towards improving patient care. Code of conducts includes people’s autonomy and the right to self-determination must be respected and promoted. Practicing in a responsible and accountable manner is essential. Keep clear and accurate records. Respecting people’s values, needs, and rights is part of the code of conduct for public sector workers.

The four elements of the ICN Code of Ethics for Nurses: nurses and people, nurses and practice, nurses and the profession, and nurses and coworkers, provide a framework for ethical standards.Thinks critically and analyzes nursing practice is one of the Registered Nurse practice standards. Participates in both therapeutic and professional relationships. Preserves the ability to practice. Assessments are carried out thoroughly. Creates a nursing practice plan. Quality nursing practice that is safe, appropriate, and responsive.

Conclusion

Healthcare workers have a legal and ethical obligation to protect the patients they care for, and codes of ethics must be followed by practitioners. The solution for these case studies is to respect patient autonomy by not performing CPR and to obtain informed consent from the patient’s next of kin before beginning any lifesaving treatments.

To avoid negligence in care, obtain the patient’s history before nursing the patient.As patient advocates, it is our responsibility to ensure that our patients have all of the information they need to make informed decisions, such as potential risks, benefits, and complications. The healthcare team can then tailor care to the patient’s preferences. We employ nonmaleficence by choosing interventions that cause the least amount of harm while achieving a beneficial outcome.

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