Case Scenario: Amos and the Outbreak of Cholera

Discuss about the Charter of Ethics and Nursing Practice.

Healthcare ethics guide decision making in practice that is based on moral principles. It is noted to be the philosophy dealing with personal principles, beliefs and morals. The present paper critically points out the ethical issues arising in the given case study revolving around Amos. The paper aims to demonstrate the application of ethical values, principles, codes and historical commitments which inform professional healthcare practice. The ethical disagreements are explained in a morally plurastic and diverse society. The analysis would be based on the ethical standards guiding professional practice, the professional codes, and policies governing practice. Further, the four health care ethics principles are reflected upon in this paper. Recommendations are provided regarding how professional practice could have been demonstrated in an appropriate manner. A conclusion provides a summary to the paper at the end.

The present case scenario revolves around Amos, a high school student staying at the residential property near the school he studies in Malawi. His peers reside in boarding facilities that the school has provided to them. During a school term, the hospital at the nearby place had reported that many students presented at the unit upon suffering severe symptoms of abdominal pain, profuse watery diarrhoea, vomiting, thirst, muscle cramps, restlessness and irritability. It was also reported that some students had to be hospitalized for receiving treatment. The staff eventually acknowledged that an outbreak of cholera had occurred. Amos also became a victim of the outbreak and became ill, thereby presenting to the facility. The doctor and the triage nurse realized the hospital lacked adequate resources for addressing the concerns of all the students. Thus, they provided care to only those who were residing at the boarding facility of the school. Though Amos put up the argument that he was also a student of the same school, he was sent away with no treatment being given. When Amos returned home, he suffered severe dehydration due to his condition and he eventually succumbed to his condition.

Analysis of the case scenario on ethical ground pinpoints that the approach of the triage nurse and the doctor was unethical at its core. This is said so since the approach to enabling heath care access for the patients presenting to the facility was marked by bias and injustice. The children who presented at the facility were subjected to discrimination and prejudice. Instead of delivering care on the basis of the care needs of the patient, the healthcare professionals considered delivering care based on the boarding status of the children. Amos was a victim of such discrimination and inequity. There lies another significant ethical concern in the case scenario. Amos was not delivered any primary care for addressing his presenting symptoms.

Ethical Analysis of the Case Scenario

After pointing out the key ethical issue arising from the study, it would be justified to analyze the same against fundamental principles of healthcare ethics. Right of healthcare services is one of the fundamental rights of human beings across the country (Coughlin et al., 2018). The right to health is an element of the internationally agreed human rights standards, and is indivisible from other rights. The right to health includes entitlements and freedoms. Entitlements include the right to health protection giving everyone the equal opportunity to access proper healthcare. Freedom includes the right to control one’s health condition and be free from any form of interference. The Australian Charter of Healthcare Rights points out that every individual has the right to receive treatment as per the need. In addition, every individual has the right to comment on the form of care being given to him (safetyandquality.gov.au, 2012). Reflecting on the present scenario, the right to get proper treatment was not adhered to as Amos was denied care by the triage nurse and the doctor at the facility. Amos had to raise his voice for bringing forward his concerns and justifying his position in the situation.

At this juncture it is to be mentioned that nurses, who are an important part of the healthcare workforce, are to work as per the outlined codes of practice. The two codes that they are to adhere to under all circumstances are the Code of Ethics and the Code of Professional Conduct. The Code of Professional Conduct for Nurses in Australia governs nursing practice within a professional capacity. The Value Statement 4 of this Code states that ‘nurses value access to quality nursing and healthcare for all people’ (nursingmidwiferyboard.gov.au, 2018). This implies that nurses are supposed to consider the principles of the right to healthcare determined by the availability, accessibility, safety and quality of services. Access refers to provision of healthcare irrespective of factors such as geography and social gradient. In the present scenario, the nurse did not value the importance of providing unbiased and non-discriminatory care. the nurse had a prejudicial attitude as care was not given on the basis of need.

The Code of Ethics for Nurses in Australia governs a nurse to demonstrate skills of showing respect to the patients and fostering best patient outcomes. The Conduct Statement 4 states “nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues’ (nursingmidwiferyboard.gov.au, 2018). Nurses are obliged to stay away from discriminatory behavior towards the patients. However, in relation to Amos, this obligation was breached as reflected from the discriminatory behavior of the nurse.

Fundamental Principles of Healthcare Ethics

Further analysis of the case scenario would highlight that the Registered Nurse Standards for Practice was also not adhered to by the triage nurse. The Standard 6 states that, ‘nurses are to provide safe, appropriate and responsiveness quality nursing practice’ (nursingmidwiferyboard.gov.au, 2018). The meaning of this statement is that nurses are to be responsible for delegating goal-directed actions set of ethical principles. Accountability is to be upheld by the nurse regarding how patient’s needs are addressed. Unsafe outcomes are to be avoided at all costs through effective measures. In case of Amos this was not adhered to as the nurse did not provide primary care to him, leading to drastic deterioration in his health and subsequent death.

Ellis (2014) outlined the four fundamental principles of healthcare ethics that guide professionals in due course of their decision making process. These four principles are autonomy, justice, beneficence, and non-maleficence. The principle of beneficence reflects on the obligation to bring good in actions. The principle of non-maleficence entails professionals to not to harm the healthcare consumers. The principle of justice entails that professionals provide care in a non-discriminatory manner. The principle of autonomy entails that professionals uphold the right of the patients to select their treatment and fight for it. Analysis of the case scenario on the basis of the above description enables readers to understand that the principles of beneficence, and non-maleficence and justice were breached. Injustice was done as only those staying at the boarding facilities were given care. The principle of non-maleficence was not adhered to as Amos suffered harm and eventually died. The principle of beneficence was not adhered to as no good was done to Amos on the whole.

Recommendations for better professional practice point out that since there was scarcity of healthcare resources at the facility, the triage nurse and the doctor should have provided the primary form of care to prevent deterioration in the symptoms presented by Amos. On the first place, the professionals must not have undertaken discriminatory approach. It would have been advisable if they decided upon resource allocation based on the severity of the symptoms presented by the patients (Potter et al., 2016).  They should have referred Amos to any other care facility where his needs could be addressed. Such a step would have prevented decline in Amos’s condition and prevented the severe dehydration that he suffered (Chadwick & Gallagher, 2016). The eventual outcome would have been prevention of death.

Coming to the end of the paper, it can be concluded that the case scenario presented significant breaches to ethical principles and obligations. The case is an example of breaches to the principles of justice, beneficence, and non-maleficence. Further, the codes of professional conduct and code of ethics were also not adhered to. Better outcomes would have been achieved if the professionals considered the fundamental principles of healthcare ethics.

References

Australian charter of healthcare rights. (2012). [ebook] Available at: https://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Charter-PDf.pdf [Accessed 27 Apr. 2018].

Chadwick, R., & Gallagher, A. (2016). Ethics and nursing practice. Palgrave Macmillan. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=vG6CDAAAQBAJ&oi=fnd&pg=PP1&dq=nursing+ethics+book&ots=_Jb9yXB_ed&sig=bC17TR4pb4cxUUsMnbxojyZW-yg#v=onepage&q=nursing%20ethics%20book&f=false

Code of Ethics for Nurses in Australia. (2018). Nursing and Midwifery Board of Australia. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 27 Apr. 2018].

Code of Professional Conduct for Nurses (2018). Nursing and Midwifery Board of Australia. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 27 Apr. 2018].

Coughlin, S., Roberts, D., O’neill, K., & Brooks, P. (2018). Looking to tomorrow’s healthcare today: a participatory health perspective. Internal medicine journal, 48(1), 92-96. DOI: https://doi.org/10.1111/imj.13661

Ellis, P. (2017). Understanding Ethics for Nursing Students. Learning Matters. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=SiElDwAAQBAJ&oi=fnd&pg=PP1&dq=Ellis,+P.+(2017).+Understanding+Ethics+for+Nursing+Students.+Learning+Matters.&ots=tGglXBxCUl&sig=nd2oKrpdThITsl3M6fugu9sfS70#v=onepage&q=Ellis%2C%20P.%20(2017).%20Understanding%20Ethics%20for%20Nursing%20Students.%20Learning%20Matters.&f=false

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing-E-Book. Elsevier Health Sciences. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=eCKKCwAAQBAJ&oi=fnd&pg=PP1&dq=nursing+ethics+book&ots=oSOgDC2unz&sig=aCvNf3E9wKIXqvDHK0vKwHqS0cE#v=onepage&q=nursing%20ethics%20book&f=false

Registered Nurse Standards for Practice (2018). Nursing and Midwifery Board of Australia. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx [Accessed 27 Apr. 2018].