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Assignment Task:
2805NRS: Legal and Ethical Principles in Healthcare Assignment Help

 

Case Scenario

Ross is a 52 year-old-man who lives in Bundaberg and is employed as a marine engineer. He recently separated from his wife, Rachel, after 16 years of marriage. Ross and Rachel have two daughters who they co-parent. Ross’ elderly father, Joey, lives with Ross. The ship Ross works on operates between Bundaberg and Asia. Having worked together on the ship for years, Ross had developed a close friendship with the ship’s captain, Chandler. The ship set off from Bundaberg, planning to stop at Rockhampton and Cairns before sailing to its final Asian destination. During a period of particularly rough seas Ross slipped on the deck, bumped his head on a storage container and landed heavily on his back. After a couple of minutes, he eventually managed to stand up and continue working.

Two days later the ship berthed at the Port of Rockhampton. At that time Ross complained of a severe headache, neck pain and feeling generally unwell. He attended the local medical centre where he was diagnosed as having a musculoskeletal injury and advised to rest. He was provided with a prescription for oxycodone, a narcotic, and a non-steroidal anti-inflammatory medication for his symptoms. The ship then departed for Cairns, arriving three days later. During this time, Ross’ pain head and neck pain worsened, and Chandler decided that he should be reviewed again before they set off on the longest leg of their journey. Ross did not want to be a burden, and despite the ongoing pain, said he would stay on the ship while in port.

Unconvinced, Chandler radioed the Cairns Port Communication Tower requesting an ambulance to transport Ross to the Cairns Base Hospital for further assessment. When Chandler told Ross the ambulance was on its way, Ross was annoyed. Keen to show that he did not require any additional medical treatment Ross took four oxycodone tablets, and four of the anti-n inflammatory tablets. He thought this would help the pain and convince Chandler and the paramedics that no further treatment was required. However, when the paramedics arrived, Chandler ordered Ross to go to the hospital for further investigation. On visual inspection, it was apparent to the paramedics that Ross needed further assessment and possible treatment as he was pale, sweaty, and unsteady. Ross disembarked the ship slowly, and clumsily, made his way to the waiting ambulance. Once there, he refused to let the paramedics examine him, aggressively asking that they transport

him as quickly as possible to get this ‘whole thing over with’. Chandler apologised to the paramedics stating that this behaviour was quite out of character. En route to the hospital, the paramedics asked several times whether Ross would allow them to take a set of observations, but he refused.

Arriving at the Emergency Department, the paramedics provided the triage nurse with a summary of Ross’ condition. Ross remained uncooperative, refusing to allow the nursing staff to assess him. Ross did see a doctor clear that he was only there under the orders of his Captain and wished to return to the ship. Given his lack of cooperation, there was little any of the healthcare practitioners at the hospital could do to assist Ross and he walked out of the department without being properly examined.

Ross returned to the ship and reported to Chandler that he had seen the doctor, and that there was nothing more they could do but ‘give it some time’. Chandler’s understood this to mean that Ross would eventually improve with the medication he had been prescribed. He was not concerned when Ross retired to his cabin.
In the cabin Ross he began to feel nauseous and the pain escalated. In an effort to relieve it, he took more oxycodone tablets. While having a mild effect on the pain, the oxycodone exacerbated the nausea and began to make Ross feel disorientated. Feeling as though he needed to vomit, he made his way up onto the deck. In his disorientated state, he did not notice that he had stepped beneath a crane that was unloading cargo onto the ship’s deck. As he lurched to vomit over the edge, the crane released its cargo, which landed directly on top of him. One of the crew saw the cargo fall on Ross and immediately called the ambulance. In the meantime, all efforts were made to move the cargo that was crushing Ross.

Upon arrival, the paramedics assessed Ross as having facial and skull fractures with bleeding and bruising, a suspected traumatic brain injury, fractured ribs and a possibly a pneumothorax. As Ross was minimally responsive and bleeding profusely, they immediately intubated him, attempted to arrest the bleeding, and transported him back to Cairns Base Hospital. CT scans confirmed multiple skull and facial fractures, a large subarachnoid haemorrhage and a left pneumothorax; Ross was admitted to the intensive care unit (ICU). In the meantime, Chandler contacted Rachel and Joey who made urgent plans to fly from Bundaberg to Cairns with the children. However, as there were no direct flights, the family were not there when Ross was wheeled to surgery.

Ethical Issues
Kerridge et al. (2013) note that solving an ethical problem requires gathering the facts, and this includes ascertaining the beliefs and values of those caring for the patient. In structured sentences and paragraphs address the following criteria that are aligned with the Kerridge et al., (2013) model of ethical problem solving. You are required to:

1. Identify one belief or value that Rachel may have and, referring to appropriate academic literature, describe this belief or value.

2. Identify one belief or value that Chandler may have and, referring to appropriate academic literature, describe this belief or value.

3. Discuss how the different beliefs or values held by Rachel and Chandler may contribute to their different points of view on Ross’ ongoing care.

Kerridge et al. (2013) also recommend that we consider broader principles when seeking to solve an ethical problem.

4. Select two of the principles in the Universal Declaration on Bioethics and Human Rights and describe how they conflict when applied to the facts in the scenario.

Legal Issues
Using structured sentences and paragraphs, answer the following questions in relation to legal issues raised by the case.

5. What elements must be present for Ross’ consent to treatment for his musculo-skeletal pain to be valid? What legal authority can you rely upon to support your answer? What potential legal consequences may flow if healthcare practitioners provide treatment without first obtaining consent?

6. As Ross had previously refused treatment for the pain he experienced after he slipped on the deck, do the paramedics have any legal authority to institute treatment for his head injury? What legal authority can you rely upon to support your answer?

7. After sustaining the head injury, Ross will not have decision-making capacity. Unless it is an emergency, it is a legal requirement that healthcare practitioners obtain
consent for all medical treatment. Provide a rationale for the legal obligation to obtain consent for Ross’ tracheostomy in these circumstances.

8. List the legal options available for the healthcare practitioners to obtain consent for Ross’ ongoing care in these circumstances. Support your answer with Queensland
legal authority.

9. In circumstances where there are two or more substitute decision-makers who could potentially provide consent, and they disagree, describe the legal options available to provide a definitive answer as to what course of action the healthcare practitioners should take.

10. What factors will be considered when deciding whether Ross’ life-sustaining measures can be withdrawn?


 


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