Legal and Ethical Issues in Health Care
Assigmt 1
Start by reading and following these instructions:
1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.
2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
3. Consider the course discussions so far and any insights gained from it.
4. Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.
Assignment:
For this assignment, create a PowerPoint presentation based on the following case studies.
Read the case studies and answer the following questions:
Apply Guido’s MORAL model to resolve the dilemma presented in the case study described in Ethical Scenario 4-3 on p. 48 which is titled, “When Care Appears Medically Inappropriate,” (Guido textbook 7th edition).
• How might the nurses in this scenario respond to the physician’s request?
• How would this scenario begin to cause moral distress among the nursing staff, and what are the positive actions that the nurses might begin to take to prevent moral distress?
Read the following case study and answer the following questions: “You be the Ethicist”, presented at the end of Chapter 3, p. 41, which starts, “Helga Wanglie…” (Guido textbook).
• What are the compelling ethical rights that this case addresses?
• Whose rights should take precedence?
• How might the institutions’ organizational ethics policies have impacted the outcome of this case?
• Leaving any legal issues aside, how would you have used ethical principles to decide the outcome of this case, if Helga Wanglie had continued to survive relying on life-sustaining measures?
Now, examine the same Helga Wanglie scenario from the perspective of health care policy.
• How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy?
• Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook, p. 50) assist in this process?
• Create a proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified.
Your presentation should be at least 10 slides (not including title, objectives, and references slides) with detailed notes for each slide that addresses each of the points/questions, including audio for each slide. Be sure to handle all the points thoroughly. Use clear headings that allow your professor to know which section you are addressing on the slides in your presentation. Support your content with citations throughout your presentation. Make sure to reference the citations using the APA writing style for the presentation. Include a slide for your references at the end.
Assignment Expectations
Length: 10 slides minimum; answers must thoroughly address the questions in a clear, concise manner.
Structure:
Title: 1 slide
Objectives: 1 slide
Guido’s MORAL model: at least 2 slides
You be the Ethicist: at least 2 slides
The perspective of health care policy: at least 2 slides
Conclusion: 1 slide
References: 1 slide
Additionally, because a good presentation has few words on the slides include a script with the verbiage you would say when presenting; the script should be a minimum of 50 words per slide.
References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least two (2) scholarly sources to support your claims.
Format: Save your assignment as a Microsoft PowerPoint document and a Word document (.pptx) and (.doc or .docx) or Open Office Impress.
READING MATTERIALS
PAGE 48
moral distress may begin to make individuals more aware of their own beliefs and strive to handle ethical issues more effectively in future encounters.
Ethical Scenario 4–3 When Care Appears Medically Inappropriate Mrs. R., an 87-year-old patient, has a history that includes coronary artery disease, a previous stroke, and advanced Alzheimer’s dis-ease. Ten days ago, Mrs. R. was hospitalized for aspiration pneu-monia and has been ventilator dependent since being admitted to the intensive care unit in a small rural hospital. Family mem-bers visit daily and have repeatedly voiced their concern to the nursing staff about the continued ventilator support that Mrs. R. is receiving, most notably the fact that Mrs. R. would never have wanted such care. They also note that Mrs. R. has not recognized them in past months and that they plan to visit less in future days, but can be contacted should any change in Mrs. R.’s condition occur. Her primary physician has practiced in this community for mul-tiple years; he is well-known for his reluctance to discontinue any type of life-support for any patient. When questioned, Dr. G.’s consistent response is that, if this were his frail 92-year-old mother, he would prescribe the very same treatment for her. Dr. G. has now requested that the nurses talk to the family about moving Mrs. R. to a major-medical center, where she can receive more advanced care, including vigorous rehabilita-tion and physical therapy, so that she may eventually return to a long-term nursing care facility. How might the nurses in this scenario respond to the physi-cian’s request? How would this scenario begin to cause moral distress among the nursing staff and what are the positive ac-tions that the nurses might begin to take to prevent moral dis-tress? Therapeutic Jurisprudence Though not often discussed in relation to ethical perspec-tives, the concept of therapeutic jurisprudence serves to ensure that the rights of patients are met in a humane and just manner. Therapeutic jurisprudence, which has as its premise that the law and legal processes have physical and psychological effects on the people who are involved, focuses on the positive aspects that legal outcomes may have. Therapeutic jurisprudence is the interdisciplinary study of law as a social force, understanding law’s impact on an individual’s emotional life and psychological well-being. First coined as a phrase in the early 1990s by law professors Bruce Winick and David Wexler (Wexler & Winick, 1991), therapeutic jurisprudence begins to describe the extent to which law and ethics affect the way in which health care is delivered. Primarily, therapeutic jurisprudence acknowl-edges the fact that “well-being” is one of the many goals of the legal system and begins to ensure that this goal is inte-grated when applying legal remedies and processes. Therapeutic jurisprudence, similar to applying ethi-cal behavior in clinical settings, challenges nurses to always consider the outcome of one’s actions. Perhaps the one case study that best depicts the effect that therapeutic jurispru-dence might have involves the case of Theresa (Terri) M. Schiavo. Mrs. Schiavo suffered a cardiac arrest in February, 1990. She was without oxygen for approximately 11 minutes, or 5 to 7 minutes longer than most medical experts believe is possible to sustain without suffering severe and permanent brain damage. She was resuscitated and, at the insistence of her husband, was intubated, placed on a ventilator, and eventually received a tracheotomy. The cause of her cardiac arrest was later determined to be a severe electrolyte imbal-ance caused by an eating disorder as Ms. Schiavo had lost approximately 140 pounds, going from 250 to 110 pounds, in the months prior to her cardiac arrest. Mrs. Schiavo was in a coma for the first two months after her cardiac arrest. She then regained some wakefulness and was eventually diagnosed as being in persistent vegetative state (PVS). She was successfully weaned from the ventilator and was able to swallow her saliva, both reflexive behaviors. Characteristic of PVS, Mrs. Schiavo was not able to eat food or drink liquids, and a permanent feeding tube was placed so that she could receive nutrition and hydration. For the next few years, there was no challenge to the PVS diagnosis or to the appointment of her husband as her legal guardian. In 1995, a successful lawsuit was filed by her husband, Michael Schiavo, against the fertil-ity physician who failed to detect her electrolyte imbal-ance. A judgment of $300,000 was awarded to Mr. Schiavo for loss of companionship, and $700,000 was placed in a court-managed trust fund to maintain and provide for the future care of Mrs. Schiavo. Also during this time frame, Mrs. Shiavo continued with extensive rehabilitation, including aggressive physical, occupational, and speech therapies. She also underwent multiple medical tests, pri-marily to determine the extent of her brain damage. The tests and the specialists who were consulted determined that she had no recognition of those around her and that there was no hope for improvement in her overall condi-tion, though she could be sustained on artificial nutrition and hydration for multiple years. Sometime after this successful lawsuit, the close family relationship between Michael Schiavo and Terri’s parents had begun to erode, and the public first became aware of Mrs. Schiavo’s plight. Challenges to the husband’s appoint-ment as guardian and her future care were at the heart of their dispute. As her court-appointed guardian noted: Thereafter, what is for millions of Americans a pro-foundly private matter catapulted a close, loving family into an internationally watched blood feud. The end product was a most public death for a very private individual. . . . Theresa was by all accounts a very shy, fun loving, and sweet woman who loved her husband and her parents very much. The family breach and public circus would have been anathema to her. (Wolfson, 2005, p. 17)
PAGE 41- You be the Ethicist -Helga Wanglie, an active and well-educated 85-year-old woman, tripped on a rug and was hospitalized for a bro-ken hip in 1989. During her hospitalization, she sustained several cardiac arrests, was placed on life-sustaining mea-sures, and was eventually diagnosed as being in a persis-tent vegetative state. The health care staff caring for Mrs. Wanglie sought to withdraw her life-sustaining support measures. Her case became nationally known when her Questions 1. What are the compelling ethical rights that this case ad-dresses? 2. Whose rights should take precedence? 3. Would the institution’s organizational ethics policies impact the outcome of this case?
References American College of Healthcare Executives. (2015). Creating an ethical culture within the healthcare organization. Retrieved December 10, 2016 from https://www.ache.org/policy/environ. cfm American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. Barrocas, A., Yarbrough, G., Becnel, P., & Nelson, J. E. (2003). Ethical and Legal Issues in Nutrition Support of the Geriatric Patient: The Can, Should, and Must of Nutrition Support. Nutrition in Clinical Practice, 18(1), 37–47. Beauchamp, T. L., & Childress, J. E. (2013). Principles of biomedical eth-ics. (7th ed.). New York: Oxford University Press. Bergum, V., & Dossetor, J. (2005). Relational ethics: The full meaning of respect. Hagerstown, MD: University Publishing Group. Clark, M. M. (2003). Corporate Ethics Programs Make a Difference, But Not the Only Difference. Human Resources Magazine, 47(7), 36. Cooper, J. M., ed. (1997). Plato: Complete works. Indianapolis, ID: Hackett Publishing Company. Ellis, C. (2007). Telling Secrets, Revealing Lives: Relational Ethics in Research with Intimate Others. Qualitative Inquiry, 13, 3–29. Frankena, W. K., & Granrose, J. T., eds. (1974). Introductory reading in ethics. Englewood Cliffs, NJ: Prentice Hall. Gastmans, C. (2013). Dignity-Enhancing Nursing Care: A Founda-tional Ethical Framework. Nursing Ethics, 20(2),142–149. Harkness, M., & Wanklyn, P. (2006). Cardiopulmonary Resuscitation: Capacity, Discussion, and Documentation. QJM: An International Journal of Medicine, 99(10), 683–690. Joint Commission for Accreditation of Healthcare Organizations. (1992). Accreditation manual for hospitals. Oakbrook Terrace, IL: Author. Jonsen, A., Siegler, M., & Winslade, W. (2015). Clinical ethics: A practi-cal approach to ethical decisions in clinical medicine. (8th ed.). New York: McGraw-Hill Education. Levine, M. (1977). Ethics: Nursing Ethics and the Ethical Nurse. American Journal of Nursing, 77, 845–849. McCarthy, J. (2006). A Pluralist View of Nursing Ethics. Nursing Philosophy, 7, 157–164. Naylor, M., & Berlinger, N. (2016). Transitional Care: A Priority for Health Care Organizational Ethics. Hastings Center Report, 46(5), S39–S42. Phillips, S. (2006). Ethical Decision-Making When Caring for the Noncompliant Patient. Journal of Infusion Nursing, 29(5), 266–271. Post, L. F., Blustein, J., & Dubler, N. N. (2015). Handbook for healthcare ethics committees. (2nd ed.). Baltimore, MD: John Hopkins Univer-sity Press. Ross, W. D. (1930/2002). The right and the good. Oxford: Oxford Uni-versity Press. The Joint Commission. (2017). Comprehensive accreditation manual for hospitals. Oak Brook IL: Author. Videbeck, S. L. (2004). Psychiatric mental health nursing. (2nd ed.). Philadelphia: Lippincott, Williams and Wilkins. Zomorodi, M., & Folwy, B. J. (2009). The Nature of Advocacy vs. Paternalism in Nursing: Clarifying the “Thin Line.” Journal of Advanced Nursing, 65(8), 1746–1752. 4. What additional facts would assist in deciding this case? 5. Leaving the legal issues aside, how would you have decided the outcome if Mrs. Wanglie had continued to survive relying upon life-sustaining measures? 87-year-old husband refused to consent to the withdrawal of life-sustaining treatments and her attending physicians requested that a judge name an alternate guardian based on the belief that her continued life-sustaining treatments were futile. The judge declined to name an alternate guard-ian, resulting in her continued use of life-sustaining equip-ment and care. Despite these continued measures, Mrs. Wanglie died when further resuscitative efforts failed.
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50 Chapter 4 Childress (2013) noted, slippery slope problems compel an analysis of what harm could result from a seemingly attrac-tive and benign argument. Examples of slippery slope argu-ments in bioethics include the debate over research using stem cells, the continued study and initiation of the human genome project, the appropriateness of embryo cloning and in vitro fertilization, and legally allowing voluntary eutha-nasia. Using a decision-making model to arrive at acceptable ethical solutions assists the nurse in avoiding being caught in a slippery slope argument. Health Policy Policy concerns courses of action to guide and determine present and future decisions. Inherent in these deci-sions is how allocations of resources are used to achieve desired goals and priorities (O’Grady, Mason, Outlaw, & Gardner, 2016). Policy is shaped by politics and is defined as the principles that govern actions directed toward spe-cific aims and outcomes, reflecting the values of those who set the policy. Health policy refers to decisions, plan, and actions that are undertaken to achieve specific health care goals within a society. Developing and implement-ing health policy defines a vision for the future, helping to establish targets and points of reference for short-and medium-term goals. Health policy outlines priorities and the expected roles of individuals within a society, build-ing consensus and informing the citizens of that society. Policy, including health policy, is a process that views issues and possible solutions to those issues. Consistent in all policies are a number of aspects. Policy has generality in that it addresses more than one person and more than one set of circumstances. Policy has normativity in that it formal-izes judgments about what course of action is better among alternatives and the rules under which those alternatives will be determined. Policy has scale in that policies apply at different levels of an organization or society and policies at one level can supersede policies at lesser levels. Policy is always decided by someone, though it is sometimes difficult to determine by whom a policy was made. Policy may be generated in a number of ways. Often, policy is generated by the workplace and revolves around relevant issues in the workplace, such as the des-ignation of no-smoking areas, need for family leave, or patient-to-nurse ratios. Policy may also be generated by governmental agencies on a local, regional, state, or federal level and may also include the designation of no-smoking areas or family leave. Community groups, whether neighborhood groups or more regional groups, may generate policy that is critical to the welfare of the given community. Finally, policy may be generated through the efforts of professional organizations at local or national levels. Nurses have been and continue to be an integral part of policy development and implementa-tion in all of these spheres. A framework for addressing policy and the need for new or additional policy in a clinical setting begins by addressing a series of questions, including the following: • What is the problem? • Where is the process? • How many are affected? • What possible solutions could be proposed? • What are the ethical arguments involved? • At what level is the problem most effectively addressed? • Who is in a position to make policy decisions? • What are the obstacles to policy interventions? • What resources are available? • How can I get involved? (Malone, 2005, p. 138) Nurses are patient advocates, and extending one’s advocacy skills to the policy arena is the beginning of mak-ing a greater impact on patient outcomes (Priest, 2012). The framework proposed by Malone (2005) in the above text assists nurses individually and collectively to better educate and empower their patients and themselves, and to address health care issues in a more effective manner. Ethical Scenario 4–4 Assisting Emergency Department Patients More Effectively You are one of the staff registered nurses in a busy emer-gency department in a large metropolitan area. Several of the patients have existing chronic health care problems and frequently return to the emergency center for re-evaluation and follow-up treatment. As a means of working with these patients, you and some of your co-workers have increased the amount of time spent in discussing discharge orders and the need for compliancy with discharge orders, prescriptions, and treatment plans. This has resulted in longer “wait times” for incoming patients, and the nurse manager has dictated that nurses are to limit their discharge instructions to essential facts, informing patients that they need to read the written materials and call their family health care providers if further problems arise. Examine the above scenario from the perspective of health care policy. How would you begin to evaluate the need for the policy and the possible support or lack of sup-port for the policy from your peers, nursing management, and others who might be affected by the policy? Do the 10 questions outlined by Malone (2005) assist in this pro-cess? Draft a proposed policy to address the issue you have identified.
