Legal and Ethical Issues in Nursing (Case Study Sample)

Law and Ethics: Scenario 2
Legal, Ethical and Professional Issues
Topic: Consent and Mental Capacity
Word count with in-text reference: 3978
Word count without in-text reference: 4864
Introduction
Professional, ethical, and legal issues are critical in nursing. In the case, Shanaz, a 23-year-old female, is brought into the emergency department following a late-night assault in a nightclub. The patient is intoxicated and has signs of a head injury and a possible fractured ankle. Due to her intoxication, she refuses examination or cannulation for IV medications. She insists that she wants to be left alone and taken home to her boyfriend’s flat. As a result, one junior nurse mutters, "just send the silly cow home." Shanaz case sets forth the legal, ethical, and professional implications surrounding the nursing practice. Nurses have three primary duties, among many others, which are the duty of confidentiality, autonomy, and duty to care for their patients. These duties are supplemented by other duties including the principle of beneficence, which means to act the patients’ best interests. Nurses and emergency physicians (EPs) have a mandate to act professionally, ethically, and with total adherence to laws that guide their practice. Professionalism demands that EPs not only follow the set the ethical codes of practice but also act in the best interest of the patients. As such, EPs must always find ways to foresee potential events that might occur as a result of their omissions or actions. Laws are designed to hold EPs liable for any harm that arises as a consequence of their actions, even when they are not the direct causers of harm.
Legal Issues
Legal issues have a set of rules on which they are based and are punishable by law if those rules are not adhered to conclusively. One key issue in the medical practice is the concept of “duty of care” which argues that medical practitioners in general should always make patients care and safety their number one goal, and ensure that their needs are recognized, assessed and attended to accordingly (Biros, 2018, p. 72). The perspective regarding duty of care gained relevance with the case Donoghue v. Stevenson, where the civil law tort of negligence and obliged businesses to observe a duty of care towards their customer was established. In the ruling, judge Lord Atkin stated that: ‘one must always take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour’ (Dowie, 2017, p. 48). With reference to this case, EPs have a mandate to foresee potential events that may occur as a result of their actions or omissions. Physicians face many dilemmas when an intoxicated patient like Shanaz is brought into an emergency room. First, whether to undertake treatment despite the lack of informed consent or withdraw from the medical intervention and possibly face the consequences surrounding malpractice and omission (Pozgar, 2019). Questions surrounding medical interventions are much more complicated when a patient requiring medical care is alcohol intoxicated.
Alcohol intoxication, which refers to the excessive consumption of alcohol either voluntarily or involuntarily, impacts judgment of patients making it almost impossible to give informed consent, which is the basis of medical treatment (Gostin, Friedman, and Wetter, 2020). In the above scenario, Shanaz, is intoxicated and showing signs of head injury and possibly has a fractured ankle. Historically, treating or offering care to mentally challenged or mentally disturbed patients raises several legal problems due to the patients’ inability to provide formal consent (Gostin and Wiley, 2016). However, arguments, including one by The House of Lords in Re F (Mental Patient: Sterilisation), agree that treatment involving mentally challenged patients is approached regarding the principle of necessity. Determining what is best for the patient rests solely on the emergency practitioners (EPs). The Mental Capacity Act (MCA) 2005 has been introduced to protect a patient's right to autonomy while also protecting the interests of patients without the capacity to make decisions for themselves. MCA's guiding principle is that an individual should have the capacity unless proven to lack capacity. In the healthcare sector, EPs are responsible for ensuring that a patient in ED can consent to advised medical treatment. If the patient lacks the capacity, treatment should proceed guided by the principles given in section 5 of MCA (Walton, 2020, p. 131). Shanaz cannot make informed consent, and her case could potentially call for the application of section 5 of MCA.
MCA 2005 sets forth several factors to determine whether a patient can grasp information and offer accurate consent. In section 2 of MCA 2005, one is considered to lack capacity if, at the material time and date, they were unable to make an informed decision for themselves in relation to the medical issue facing them because of mental impairment or disturbance (Walton, 2020, p. 132). Section 3, part 1 argues that a person is considered mentally impaired or disturbed if they cannot understand the information warranting an immediate decision. If they cannot retain the information to guide their decision making or if they cannot communicate the decision to the practitioner, whether through signs, written speech, or any other understandable way (Herring, J., 2020, p. 158) if they can’t then what – incomplete sentence. with reference to Shanaz’s case, MCA 2005 offers sufficient grounds for EPs to proceed with a decision that serves the patients best interests (Grady, 2015). As such, EPs shall respect the rights and strive to protect the best interests of their patients, particularly the most vulnerable and those with impaired decision-making capacity like Shanaz.
Medical practitioners are often faced with difficulties when making decisions surrounding intoxicated patients refusing medical care or forcing their way out of the ED against medical advice (AMA) (Dowie, 2017, pp. 12). With reference to the legal Case, Gregory Cole vs. Doe Hospital and Roe Emergency Room Physicians, it was found that an emergency physician was responsible for damages caused to the patient because he treated the emergency case with little detail to the legal underpinnings guiding medical practice (Taylor, 2016, p. 176). In the case, a patient in his 20s was brought to an emergency room by the police with a head injury. Intoxicated, the patient was not in a position to accept treatment. However, after thorough convincing, a head scan was conducted, and the X-ray results as read by the doctor indicated that there was no head injury. According to the physician in charge, although the patient was intoxicated at the time, he was in a position to make an AMA decision. He was released as requested, but after the radiologist re-examined the x-ray results later that day, it was discovered that the client had a left parietal skull fracture and was recalled, where an operation was advised and conducted immediately. Through the operation, the skull fractures elevated, and as a result, the patient suffered significant cognitive impairments that impacted his ability to gain meaningful employment. As presented in the court of law by the patient (plaintiff), the physician was responsible for his cognitive impairment because he failed to recognize his problem on time, which caused a delay in treatment which later caused a significant neurological deficit. The physical was heavily fined. This means therefore that, EPs without the right expertise would find it easy to discharge troublesome patients like Shanaz only to have the issue culminate into a complex medical and social problem.
In another case Kowalski vs. St Francis Hosp. & Health Center, a highly intoxicated patient was brought into an emergency after he was found by a friend abandoned in a parking lot. The patient was unresponsive except to painful stimuli. He was intoxicated and exhibited poor communication skills, and was placed in an emergency room as the physicians monitored his case while they waited for his intoxication level to drop. However, a few hours later, the patient health deteriorated. The patient was transferred to another health facility but died en-route, with the cause of death being internal bleeding. In court, the plaintiff argued for a case of negligence and demanded to know why the patient was not transferred to a better facility with the right equipment, such as a CT scan on time. The defendant won the case. Close look at this case, indicates that there was a delay in the deceased client’s diagnostic evaluation. The patient lacked the capacity to communicate as expected but the patient’s responsiveness to pain stimuli was enough reason to speed up the evaluation (Brazier and Cave, 2016). which the emergency physicians failed. Even though intoxicated, the physicians could dismiss alcohol as a cause of the client’s aggression and instead pursue more urgent diagnostic evaluations (Taylor, 2016, p. 179). In the case of Shanaz, the EPs have significant decisions to make. While granting her AMA is an option, there is a possibility that Shanaz has internal injuries which could culminate in omission and negligence, as seen in the above legal cases.
In most cases, alcohol-impaired patients refuse emergency treatment because they are fully able to understand the benefits of treatment, risks surrounding their medical state, and treatment alternatives, at the time thus undermining informed consent (Fields and Calvert, 2015). However, set and existing case law strongly recommend that emergency physicians operate strongly along the lines of caution and restrain and only trea...