Case Summary
Williams syndrome is a rare disease, and the case centers on a woman struggling to handle the situation. The pregnant Joan is only 20 years old. Joan keeps living with her parents. At 20 weeks gestation, she learned that her unborn child would have Williams syndrome. Due to family duress, Joan has consulted with her physician about obtaining an abortion. In the end, Joan chooses to have the baby. Katrina is born with congenital cardiovascular problems, notably aortic constriction due to supra-valvular aortic stenosis (SVAS). Due to its severity, the medical staff has determined that surgical treatment of the SVAS is necessary. Joan’s parents take a keen interest in Katrina’s well-being and frequently accompany her to medical appointments at the hospital. They recently visited the facility without Joan and addressed a medical staff member to request Katrina’s medical records. Joan understands that people with William’s Syndrome often have cognitive impairments of varying degrees. She worries that Joan will have to make all of Katrina’s decisions for her when she gets older. She seeks legal guidance in light of the Assisted Decision-Making Capacity Act of 2015. A legal officer’s input on the different legal and ethical considerations involved in this case is essential for making the right choice.
Ethical and legal issues in Joan’s case
It is commonly acknowledged that choosing the best course of therapy for a patient requires considering ethical and legal issues (Johnstone, 2022). Healthcare professionals and doctors are more prone than ever to encounter challenging ethical conundrums due to the intricate nature of the current legal framework, the increasing recognition of human rights, and the tremendous breakthroughs in medical understanding. Several circumstances cause these ethical difficulties experienced by healthcare professionals. Laws have been enacted throughout human history to regulate health care delivery. The primary drive of medical oversight is to protect the public from quacks that are not correctly licensed or do not have their Patient’s best interests at heart. Healthcare professionals are at risk from personal and external factors. As healthcare becomes more sophisticated, medical professionals face more challenging moral and legal issues while determining the best treatment for their patients. The biggest worry is doctors’ mental strength to handle such situations.
Autonomy
Doctors and other medical professionals should respect patients’ autonomy and the importance of their moral judgments and values when providing care (Clark, 2019, p. 44). It is an invasion of personal freedom when someone is exploited for the benefit of others at the expense of their own needs and desires. A self-determined, rational individual can take the initiative and make decisions independently of other influences. Due to the autonomy principle, the nurses are ethically obligated to honor Joan’s request that her parents not be involved in Katrina’s treatment.
Instead of considering how the antipsychotics would affect their daughter Katrina’s health, Joan thinks her parents are only concerned with how they might be affected by living with her.
Trust in the healthcare providers making decisions on the Patient’s behalf is crucial for improving adherence. In this case, Joan’s parents blessed her to keep the pregnancy (Clark, 2019, p. 44). This problem and the accompanying stress have had devastating consequences for her. Since Joan believes her parents are forcing her to take the medications to kill the kid, her medical team must consider her input when making treatment decisions. Joan can decide who will provide care for Katrina, or she can make those decisions for herself. In addition to being the target of unplanned hospitalizations, Joan may already feel a loss of autonomy or disempowered since she believes no one knows the difficulties child care is causing her. Therapists must determine if Joan’s parents’ resistance to treatment stems from a sense of helplessness. She might be inclined to participate in therapy if she has more control over the process. Mental health doctors must discover less harmful psychotropic substitutes or other ways to lessen the side impacts of the drugs they recommended for Katrina.
Beneficence
People are more likely to take responsibility for their actions and the actions of those within them when they have a sense of morality (Butts et al., 2022). Every person has a moral duty to act in a way that helps others. Being kind means that you do things that are meant to make the lives of those around you better. If a doctor or other health care worker acts in the Patient’s best interest, this is seen as good behavior. A nurse’s main job is to keep and improve the health of their patients. When caring for individuals with suicidal thoughts, nurses and doctors who concentrate on mental health face similar challenges (O’Neill et al., 2022). As an application of the beneficence principle, Joan’s psychiatrist considered alternative options that would less impact Joan and Katrina. Katrina’s (who has SVAS) care should similarly be based on this principle. If it is in a patient’s best interests, they can be committed to treatment under the Mental Capacity Act. The only thing stopping Joan from getting therapy is his parents’ decision-making on his care. Removing Joan’s parents and incorporating Joan in decision-making over Katrina’s care, especially highlighting the need for his taking her meds, will likely improve the success of the therapy.
Non-maleficence
The non-maleficence principle includes a commitment to minimizing patient harm (Thom et al., 2022). Nurses working in mental health must protect their patients from harm. Medical personnel owes it to their patients to provide care that restores health and alleviates suffering as much as possible. The nurses and mental health professionals caring for Joan should consider allowing him to select a trusted third party to make decisions about his care. Mental health nurses must administer treatment under the Mental Capacity Act to prevent further harm to Joan because she has been confused and does not know the treatment.
Justice
According to this theory, everyone should be treated equally, and all accessible resources should be used equitably (Butts et al., 2022). How Joan applied this moral principle was appropriate. Since Joan is only 20, the psychiatrists recommending therapy for her child have given her free reign to make that decision. Experts in mental health care should also create treatments with minimal risk of adverse patient effects.
Confidentiality
A healthcare professional cannot discuss a patient’s care with anybody else without the Patient’s consent. If a patient is not a danger to themselves or others, information regarding their treatment plan should be kept private. In this instance, Joan’s medical data access will be restricted to the person entrusted with raising Joan’s kid. To disclose Katrina’s illness to Katrina’s parents or anybody else, Joan must provide her consent.
Mental Health Law and Consent
For Youngsters, Patients at mental health facilities typically agree to be treated there or voluntarily check themselves in. Nevertheless, numerous reports of people being detained or forced to undergo mental health therapy are against their choice (Morris et al., 2020). People with psychological disorders must follow two different rules to get treatment and therapy. The Act of 2007 changed the Mental Capacity Act of 2005 and the Mental Health Act of 1983 (Butts et al., 2022). The Mental Health Act of 1983 (MHA) was passed to ensure that people with mental illness can be identified, treated, and protected by the law. This law provides a resource for individuals with mental health issues to learn more about their evaluation and treatment options, both in and out of institutional settings. The MHA ensures that procedures are in place to preserve the rights of patients even when they are detained or receiving medical care against their will at a hospital. The Mental Capacity Act (MCA) stipulates that to make choices for another individual, and they must demonstrate their age (16 or older) and incapacity. These choices can entail situations that would severely curtail or even take away a person’s freedom.
According to the MHA, a patient can only be locked up if a doctor thinks her mental state makes her a danger to herself or others (Twite et al., 2019, p. 483). Medical staff may treat a held patient even if the patient does not consent. Legally and in reality, the person being held has the right to know why. The ethical dilemma that healthcare workers have to solve can be looked at through the lens of mental health laws. Joan initially refused medical assistance out of fear of adverse outcomes. She was counseled to undergo an abortion but persisted in her strenuous routine. It is possible that her father’s psychiatric medication influenced Joan’s decision to forego an abortion or because her parents disregarded her wishes to care for her unborn child. The MHA also allows therapy to be administered without a patient’s permission if doing so is in the Patient’s best interests. Nevertheless, Joan’s condition has changed due to her therapies.
The Assisted Decision-Making Capacity Act 2015
The President signed the Assisted Decision-Making (Capacity) (Amendment) Act 2022 into law on December 17 of that year (Johnstone, 2022). For the 2015 Act to go into effect in its entirety, it required this amending legislation, the Assisted Decision-Making (Capacity) (Amendment) Bill 2022 (the Amendment Bill). The Amendment Bill was necessary to simplify procedures mandated by the 2015 Act and strengthen protections.
This Act has established a new legal framework for assisted decision-making. It creates new laws and provides valuable aid for those who may have trouble making decisions due to dementia, advanced age, mental illness, intellectual disability, or traumatic brain injury (Pesut et al., 2022, p. 152). Since it would provide more robust safeguards for vulnerable people regarding their decision-making capacity, this Act is a welcome replacement for the expiring Wardship System. The assumption of capacity is a crucial concept in the Act. Without proof, the Act treats every adult as having capacity. This safeguards against the blanket determination of incapacity among entire groups of people.
The Circuit Court is where the ADMC applications are filed. Supporting individuals and families through the assisted decision-making process is a novel approach. The decision-making person can ask someone to help collect, analyze, and use the data. One person making a choice can choose a co-decision maker (Johnstone, 2022). If an individual lacks the psychological capacity to make choices, the legal system will choose someone else to act on their behalf.
If the individual requires medical assistance but cannot express their wishes at the time, their advance medical order specifies the type of care they prefer. Once customers have completed the procedure, the Decision Support Service will provide more details, such as monitoring and assistance with drafting and filing these forms. The Act further states that any attempt to interfere with an individual’s liberties and freedoms should be made if required, to the extent necessary, and with as little interference as possible. A practical exam can assess a person’s capacity to take in information, process it, and appropriately present their conclusion. As a result, someone may be considered able to make a particular choice but not another. We commend the shift from the basic Wards of Court approach to more nuanced decision-making considering individual circumstances.
A two-stage functional model is outlined in the Mental Capacity Act of 2005 (MCA) to determine whether Joan has the mental capacity to make decisions on Katrina’s care. Mental health professionals must first examine the Patient’s mental state to determine if they are suffering from psychological conditions and, if so, how much these illnesses may affect the Patient’s ability to make decisions. The Patient is deemed to have the necessary MCA mental capability if the medical practitioner concludes that they do not have a disease that prohibits them from using sound judgment (Twite et al., 2019, p. 483). The right of Joan and her parents to determine Katarina’s course of treatment should be evaluated against the fact that, in the U.K., teens aged 16 and 17 can do so without parental permission. Joan thinks her parents only care about her removing Katrina because they fear for their safety. The MCA states that one’s capability is decision and time-bound. Joan’s decision to reject her parents’ decisions affecting her badly demonstrates her autonomy, as does her adherence to the Act’s restrictions. Therefore, the mental health specialists should listen carefully as Joan explains why she thinks her parents should not be involved in the treatment and instead select a third party to help make such decisions. According to the Mental Capacity Act, a third party can make medical decisions on behalf of a patient.
Everyone should be able to decline any potentially harmful medical procedure or examination. In both the U.K. and the U.S., a person is assumed to have the mental capacity to make choices about their care at 16 or 17, and this assumption can only be changed by solid evidence (Morris et al., 2020). Before the age of 16, a child should only agree to treatment if they are intelligent, mature, and aware enough to understand what is happening. If not, the child’s parents or guardians must give their permission if the child is younger than 16. Before helping a child, medical staff must get permission from at least one legal guardian (Diez-Itza et al., 2022). If a court decides that a parent’s decision to let their child get medical care is not in the child’s best interest, the choice can be taken away.
The Health Insurance Portability and Accountability Act (HIPAA) outlines how and when hospitals may release patient information. The HIPAA and related rules specify what kinds of patient information hospitals may share with other parties and what kinds of data must be kept confidential (Griffith et al., 2023). In this circumstance, even a tiny exaggeration can have unintended consequences. Court proceedings and civil suits involving the loss or theft of social security cards and the exposing of personal health information are shared with medical executives.
The fundamental moral law underlying the behavior is more relevant than duty-oriented thinking about the consequences of the deed. To offer an example: even if the truth has negative consequences, one must still tell it since it is the ethically proper thing to do. No one should ever utter a lie, not even to save a life, because it is their moral obligation always. Intentional reasoning grounded on universal principles is at the heart of duty-oriented thinking. Consequentialists employ a cost-benefit analysis to maximize the number of people who profit. This is the portion about the significance going beyond the deeds discussed there. Or, to put it another way, the results indicate that the means were appropriate (Twite et al., 2019, p. 483). Therefore, in this case, the troop’s lives would be more important than that of the scout leader. It is morally required to help as many people as possible. It would be immoral not to save as many lives as possible while allowing as few people as possible to perish in this situation.
Professional negligence, breach of duty of care, disregard for patient autonomy as evidenced by inadequate documentation of care, and inability to take matters to the Nurse in Charge and the Doctor Responsible for the Patient are all within the bounds of the Nurse’s Scope of Practice (Pesut et al., 2022, p. 152). However, the case study also exemplifies best nursing practices, such as carefully recording all care given and always adhering to ethical standards.
Following the popularity of the “respect for individuals” idea, there has recently been a renewed interest in patients’ rights as “autonomous agents” to make their own healthcare decisions (Miezah et al., 2020). Patients’ legal rights are safeguarded when they lack the mental capacity to make decisions about their health treatment. Fundamental freedoms are vigorously defended by both the federal government and local governments. The President signed the Patient Self-Care Determination Act into law in 1990. Hospitals and other healthcare providers are now lawfully required to discuss advance directives with their adult patients. The law’s purpose is to protect Patient’s rights to make healthcare decisions, including whether or not to agree to treatment and how to convey future healthcare preferences if they cannot do so. MOLSTs and POLSTs, which are medical instructions for life-sustaining therapy, have recently been supported by state rules. A patient and their healthcare team can use each tool to document the person’s medical treatment decisions.
Conclusion
There are constantly emerging cancer medical concerns that present new ethical dilemmas for clinicians to solve. Genetically driven treatment plans for many illnesses are now possible thanks to the virtual boom of technology and discoveries in molecular biology, which are quickly improving our knowledge of individual and family treatment. The power of computers to analyze vast amounts of patient data has led to a blurring of the lines between research and clinical treatment, leading to a greater emphasis on learning healthcare systems. Respect for the needs, values, and choices of the Patient and family will always be at the center of patient care, no matter how challenging the situation, how advanced the healthcare delivery system is, or how diverse our community. To relieve their pain, particularly in the later stages of life, our ongoing responsibility as nurses is to gain the trust of our patients and those who care for them.
References
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