Paramedics often face difficult decisions that need a consideration of the models of ethics to make the most correct and ethical decision available at the time. Ethics in today’s paramedic field of work will often shape the way we complete some jobs, therefore becoming a professional has to involve the inclusion of ethical framework to support the decisions we make in the stressful premedical environment. One of the most accepted bioethical frameworks involves autonomy, beneficence, non-maleficence, and justice, known as the 4 principles.
It is understood that all 4 principles work together and not without one or another, but can outweigh each other in some cases (Beauchamp & Childress, 2013, p. xx). I will be using this framework to introduce
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a case that was investigated for medical malpractice and provide a balanced, reflective, and analytical discussion to explore these ethical issues, however will not attempt to solve the case. This particular case was addressed by the Australian Inquiry council and found to have mistreated a young girl whom suffered a head injury after being hit in the head with a golf ball in 2005 (Clare A Skinner Jeffrey Braithwaite Brad Frankum, Ross K Kerridge and Kerry J Goulston, & Hospital Reform Group, 2009). This event occurred on the morning of Sunday 6th November 2005, Vanessa was struck by a golf ball on the right side of her head and behind her ear and suffered a depressed fracture of her skull behind her right ear. Vanessa was conscious, but disoriented when she was first attended to by Ambulance officers on the golf course. Vanessa was conveyed to Hornsby Hospital where a scan was conducted. Vanessa had vomited several times on route and at the hospital. Vanessa was subsequently transferred to Royal North Shore Hospital where she was admitted and remained at that Hospital until her death sometime in the early hours of Tuesday 8th November 2005 (Magistrate Milovanovich, NSW Deputy State Coroner, 2008). Autonomy, one of the topics found in the ethical framework of choice, is the understanding that people have the right to have their choice in health care treatment plans. This area involves confidentiality of patient details, telling people the truth, respecting their confidentiality and obtaining informed consent (Townsend & Luck, 2013, p. xx). This is if they are able to make a choice, understand the consequences, and not under the control of drugs or alcohol. (Richardson, 2000, p. xx). It was found that she was disorientated and not fully able to comprehend the consequences of prolonging the procedure (Magistrate Milovanovich, NSW Deputy State Coroner, 2008). The responsibility for choosing a treatment pathway should have been up to the father due to the inability for Vanessa to do so. It was documented that he even raised the awareness that she should have already had the operation and was very unhappy and confused that she was in a monitored bed. (Clare A, 2009) Awareness, knowledge and attitudes about clinical treatments, along with skills pertaining to clinical ethics are highly variable among practicing physicians and trainees, and are often significantly lacking (Carrese & Sugarman, 2006, p. xx). This was evident in the case of Vanessa, whereby a doctor who was new to neurological treatments was placed head of the ward, and incorrect treatments proceeded due to this lack of experience. If the autonomic ethics were applied by the hospital, and there was clear involvement of the Vanessa’s family at the hospital, may have seen an earlier operation and ultimately her survival. (Clare A, 2009). In addition to this, it was found that no one knew she had been transferred to royal north shore hospital clinic, where she was left unmonitored and over drugged to a point where the depressive aspects of the endone put her into a seizure and passed away in the early hours of the morning. Within the inquiry of this unnecessary death, known as the garling report, brought on a major reform of the public health care system (Clare A, 2009) Another Aspect of Autonomy is the expectation that you will accurately document the facts of the case, so that the patient can make decisions when necessary, and choose their treatment pathway if able to do so (Townsend & Luck, 2013, p. xx). This was not adhered to at royal north shore hospital, with the transfer from Hornsby Hospital where a brain scan was taken, but was “lost” during transport and treatment was again put back because of not knowing the extent of the damage (Magistrate Milovanovich, NSW Deputy State Coroner, 2008). It was found during the inquest that loosing these scans was a common practice with around 50% of scans not being available for some time after transfer. As well as not being documented, the treatments that the doctors gave Vanessa, while written down, where never followed up, despite knowing they were wrong, and found this due to a level of respect for the doctor knowing what they were doing (Magistrate Milovanovich, NSW Deputy State Coroner, 2008). Vanessa’s avoidable death goes against the idea of beneficence, the key principle into most health care professionals. It refers to as far as possible, you should help your patients, even if it can cause temporary pain, and the overall benefit should outweigh the short term pain (Donchin, 2001, p. xx). This unfortunately cannot be said for Vanessa’s inquest, the doctors through a systemic root cause only caused harm to Vanessa. The lack of professional communication, training, monitoring and incorrect treatments, was not in the best interest of Vanessa’s healthy recovery. It is understood that beneficence is not always achievable and the relationship between autonomy and cannot always be achieved due to some obstacles, or what is not bio medially available. Some include isolation, lack of resources, polices and laws, poor co-operation and knowledge, but none of these were stopping the correct treatment from being available to Vanessa in this instance (Clare A, 2009) Beneficence can also be referred to as an understanding of the positive steps to helping people, for the benefit of others, and as health care professionals expected to understand the professional duty of care, and their codes of conduct (Joffe, 2003, p. xx). However still lacked in communicating with each other for professional analysis of treatment, not treating to guidelines of drug dosages, not monitoring her and not getting the operation on track in time to save her life. This idea of is often coupled with the aspect of non-maleficence, in short means “do no harm”, therefore beneficence and non-maleficence can be considered as a conjoined moral obligation (Tsai, 2005, p. xx) Dr little, and Dr Williams formed the view that Vanessa most likely had Dural lacerations with bone fragments within the brain itself. He diagnosed Vanessa as having a mild head injury. The evidence supports that negligence of the hospital systemically caused harm and directly opposing what is meant by the idea. The doctors did not order the operation due to not having the correct information at hand, which was not filled out because the lack of communication between the doctors. In hindsight they were “withholding and/or withdrawing treatment” (Carrese & Sugarman, 2006, p. xx) “Early in the afternoon of 7th November 2005, in response to Vanessa’s ongoing or increasing pain, Dr Williams prescribed Panadeine Forte (2 tablets four times a day), and Endone (5 mg six times a day, PRN).” This is an unacceptable dose of the drugs and was never mentioned to any of the senior staff, as this is what was done on previous rotations. In addition to this Dr Ismail increased the dose by double, and did not take note of the maximum dose, or discuss this with any other doctors in rotation either. Associate Professor Besser gave evidence during the inquest into the death of Vanessa, and confirmed that narcotics in head injuries does no benefit to the patient in high doses, in fact does the opposite, It leads to respiratory centre depression (Magistrate Milovanovich, NSW Deputy State Coroner, 2008). With this information it is confirmed that all professional doctors during the time of Vanessa’s treatment that they were in fact doing harm and never helping the patient, the exact opposite to the ethical principles outlined by Luck and Townsend (Luck and Townsend, 2013) Justice is the ethical idea that you will treat all patients equally in regards to their needs, disregarding all prejudices, sex, age, race or any other predisposing factors, for this reason it is often referred to as the blind principle. It is furthermore paramount that you would treat every patient “fairly”, for example allocating resources to those who have substantial capacity to benefit (Townsend & Luck, 2013, p. xx). For example it is considered fair to be giving priority to those with severe symptoms and dysfunctions, as outlined in the Fairness “egalitarianism” model – those who are disadvantaged should not be denied social benefits to overcome the effects of life’s lotteries (Donchin, 2001, p. xx). This is similar to the Comparative Justice Triage system which is based on the needs, take into account limited resources. (Luck and Townsend, 2013) Considering that the needs of a patient was not considered in a justified manner, Vanessa was not treated fairly in terms of allocation of resources. Within the coroner’s report she was not even considered a patient until (doctor’s name) came around and noticed her in an unmonitored. She was not given the treatment that was appropriate for her condition of mild head trauma to provide the best possible outcome, because the doctors claimed they were “too tired” to consider any other treatments (Magistrate Milovanovich, NSW Deputy State Coroner, 2008). This close analysis of the framework and how the framework applies to Vanessa’s unnecessary death, has allowed for an in-depth examination of non-maleficence, beneficence, autonomy and justice and outline some key points that were misaligned with the ethical ideas outlined in the framework. Throughout Vanessa’s time with the hospital she was let down by professionals that did not provide the level of care that should have been available at royal north shore hospital at the time. Overall it can be said that the principles of the framework were not exercised and may have led to an unfavourable outcome for Vanessa. References Beauchamp, T. L., & Childress, J. F. (2013). Respect for autonomy, Nonmaleficence, Beneficence, Justice. In Principles of biomedical ethics (7th ed.). New York: Oxford University Press. Carrese, J. A., & Sugarman, J. (2006). The Inescapable Relevance of Bioethics for the Practicing Clinician. Chest, 130(6), 1864-1872. doi:10.1378/chest.130.6.1864 Clare A Skinner, Jeffrey Braithwaite, Brad Frankum, Ross K Kerridge and Kerry J Goulston, & Hospital Reform Group. (2009, January 19). Reforming New South Wales public hospitals: an assessment of the Garling inquiry. 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doi:http://dx.doi.org/10.1057/hs.2014.1
Autonomy is a concept found in moral, political, and bioethical reasoning. Inside these connections, it is the limit of a sound individual to make an educated, unpressured decision. Patient autonomy can conflict with clinician autonomy and, in such a clash of values, it is not obvious which should prevail. (Lantos, Matlock & Wendler, 2011). In order to gain informed consent, a patient
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
In studying Plato’s Law’s, Levin was able to find themes in the work to create a doctor-patient model which successfully moved away from that of the paternalistic model and include autonomy without leaving the patient. By recognizing and accounting for the fallibility that is innate in all humans, Levin is able to eliminate the problem of assumed moral knowledge. In shifting the possible power imbalance between doctor and patient by adopting a balanced asymmetry, the model avoids an unwarranted power divide that caused the downfall of the two models proposed by the Emmanuels’ and Pellegrino and Thomasma. Also, moral education is implemented to prevent doctors from having too much power and control, which aids in keeping clear of the paternalistic model.
Wilson , James G. S., “Rights”, Principles of Health Care Ethics, Second Edition, eds. R.E. Ashcroft, A. Dawson, H. Draper and J.R. McMillan. John Wiley & Sons, Ltd. 2007. pp. 239.
Veatch, Robert M.,"The Normative Principles of Medical Ethics." In Medical ethics. 1997. Reprint, Boston, MA: Jones and Bartlett, 1989 29-56.
Within public health, the issue of paternalism has become a controversial topic. Questions about the ethics of public health are being asked. The role of ethics in medical practice is now receiving close scrutiny, so it is timely that ethical concepts, such as autonomy and paternalism, be re-examined in their applied context (Med J Aust. 1994). Clinically, patients are treated on a one on one basis, but public health’s obligation is toward the protection and promotion of an entire population’s health. So, based on this difference, the gaping questions targeting public health now becomes, under what conditions is it right to intervene and override an individuals’ autonomy?
The four major ethical principles in health care are: Autonomy – to honor the patient’s right to make their own decision (the opposite is paternalism - the health care provider knows best for the patient), Beneficence – to help the patient advance his/her own good, Nonmaleficence – to do no harm (many bioethical controversies involves this principle), and Justice – to be fair and treat like cases alike. All 4 principles are considered to be in effect at all times. In theory, each is of equal weight or importance. Ethical responsibilities in a given situation depend in part on the nature of the decision and in part on the roles everyone involved play.
Alan Goldman argues that medical paternalism is unjustified except in very rare cases. He states that disregarding patient autonomy, forcing patients to undergo procedures, and withholding important information regarding diagnoses and medical procedures is morally wrong. Goldman argues that it is more important to allow patients to have the ability to make autonomous decisions with their health and what treatment options if any they want to pursue. He argues that medical professionals must respect patient autonomy regardless of the results that may or may not be beneficial to a patient’s health. I will both offer an objection and support Goldman’s argument. I will
Munson, Ronald. Intervention and Reflection: Basic Issues in Bioethics. 9th ed. Boston, MA: Wadsworth, Cengage Learning, 2012. Print.
Jecker, N. (1990). Integrating medical ethics with normative theory: Patient advocacy and social responsibility. 11(2), 125-139.
In this diverse society we are confronted everyday with so many ethical choices in provision of healthcare for individuals. It becomes very difficult to find a guideline that would include a border perspective which might include individual’s beliefs and preference across the world. Due to these controversies, the four principles in biomedical ethic which includes autonomy, beneficence, non-maleficence and justice help us understand and explain which medical practices are ethical and acceptable. These principles are not only used to protect the rights of a patient but also the physician from being violated.
Steinbock, Bonnie, Alex J. London, and John D. Arras. "’Rights- Based’ Approaches." Ethical Issues in Modern Medicine. Contemporary Readings in Bioethics. 8th ed. New York: McGraw-Hill, 2013. 23. Print.
The American Nurses Association Code of Ethics for Nurses has five elements that pertain to the Principle of Autonomy. Each individual element applies to “respect individual persons” (Baillie, McGeehan, Garrett T, M., Garrett R. M., 2013, p.33). In Chapter 2 of the Health Care ethics: Principles and problems text, it discusses thouroghly the consent of an individual to make their own decisions regarding their health and future requests of care. As a nurse or within all heath care professions, we must treat each individual patient with care, respect, and to remain mindful to the patient regarding any aspect of their lives. In the ANA Code of Ethics for Nurses, it explains ways of maintaining the empathy required in the health field. It further discusses that the respect for human dignity must be a priority, relationships to patients must remain neutral, the severity of the situation, the right to self-rule, and the professionalism that must be upheld by the nurse and their associates.
McGee, Glenn and Arthur L. Caplan. "Medical Ethics." Microsoft® Encarta® 98 Encyclopedia. © 1993-1997: Microsoft Corporation. CD-ROM.
Medical ethics refers to the relationship between health professionals and patients. The trust of patients in physicians has been vanishing. Today a lot of health care providers primary concerns seem to be in profit rather than in providing the proper healthcare to the public. Medical ethics consist of several different principles. Nonmaleficence, beneficence, justice, and autonomy are just a few of the many principals. Nonmaleficence enacts that a health care providers, can never use treatment to injure or wrong their patients. Beneficence claims that health care providers are obligated to help others further their interest. Justice requires health providers treat every patient as equal and provide equal treatment for everyone with the same