Essay Writing: An Ethical Dilemma

Internal Code: MAS3541

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CASE STUDY 1 : Harry Nelson has end-stage cancer and has exhausted all treatment options. He is currently receiving palliative care at the home where he has raised a family. He has not as yet prepared an Advanced Care Directive. Harry’s condition deteriorates: he is increasingly breathless and is having difficulty swallowing both food and fluids. However, though very weak, Harry is alert and fully aware that his death is imminent. He has always said that he wished to die in his own home. Harry’s daughter Stacey becomes distressed and calls for an ambulance because she believes that her father could live longer if he received further treatment. She is especially worried about him choking when he drinks. A crew arrives to find considerable conflict. Despite phone calls to the palliative care team, there seems no way to resolve the conflict between Harry’s desire to stay at home and the insistence with some force by Stacey to transport her father to hospital. According to ambulance guidelines, Harry meets the criteria for medical treatment and transport. The crew transports Harry despite his objections.

CASE STUDY 2: Kamil Samra is a sports physiotherapist who is employed by an AFL club. Kamil enjoys friendly relations with the players and the club managers and has become a close friend of two of the players. One evening, at a bar, Kamil is made aware that the coach and exercise scientist are supplying performance-enhancing drugs to the players. He later verifies this information for himself when he discovers a package containing the banned peptide Thymosin beta-4 at the club headquarters. Kamil discusses this issue with both the coach and the club management who, in turn, offer him an even higher salary in exchange for his silence on this matter. If he accepts this offer, Kamil could ensure care for his poor, aging parents in Lebanon. However, he is aware that Thymosin beta-4 not only enhances athletic performance (and is in breach of the anti-doping rules in sport), but it may also be detrimental to the long-term health of the players. Further, Kamil also knows that, in being contractually bound to follow instructions by the coaching team, the players are not really free to refuse to use this banned peptide.

CASE STUDY 3: Patrick Le is an 18-month-old infant who is brought in by ambulance to the emergency department of a small community hospital. On admission, he is diagnosed with gastroenteritis and dehydration and subsequently transferred to a ward for ongoing treatment and care. On admission to the ward, the nurse discovers an extensive medical history that was not communicated prior to arranging the ward transfer. While conducting a nursing assessment, the nurse witnesses Patrick having a seizure and calls for help. The nurse insists that Patrick be transferred to the tertiary hospital where he has been receiving ongoing care; however, the emergency physician and paediatric registrar insist that Patrick remain on the current ward. Patrick’s mother, Sally, tells the nurse that she had asked the paramedics to take Patrick straight to the tertiary hospital; however, they explained that they were instructed to take patients to the closest hospital. As Patrick’s condition deteriorates, the medical team continue to perform ongoing investigations on the ward. The nurse continues to insist that Patrick be transferred. Sally hears the nurse’s objections and, eventually, decides to take Patrick to the tertiary hospital herself.

CASE STUDY 4: You are working in a laboratory on a major cancer research project. The findings of the research are showing great promise; a breakthrough has been reached which will, most likely, produce both reduced mortality rates and improved quality of life for people with prostate cancer. The research project has advanced to the point where trials can commence on human participants. In the course of your work, however, you discover that some results have been manipulated. While you have full confidence in the effectiveness of the treatment, you suspect that the manipulation has been done in order to ensure that funding continues for the project. Specifically, you are aware that the financial and time constraints are placing undue stress on the Principal Researcher to produce positive results. At the same time, you are sure that, with more time, positive results will eventuate anyway.

CASE STUDY 5: Megan is an uncomplicated primigravid woman at term; she has been in established labour for 10 hours. On vaginal examination, Megan is found to be four centimetres dilated, and fully effaced with the baby in Right Occiput Posterior (ROP). Her observations are within normal limits and the foetal heart rate is also normal (140bpm with no decelerations auscultated). The midwife caring for Megan is committed to respecting a woman’s right to make informed decisions regarding her delivery. Out of concern for Megan, the midwife suggests that labour is slow and that Megan would benefit from an epidural. Megan is happy with this suggestion but reminds the midwife that she wants a ‘natural delivery’. An obstetrician reviews Megan and agrees that the labour is slow and, therefore, decides to perform a caesarian section (LUSC) procedure. The obstetrician convinces Megan that she and her baby would be increasing their risk of birth complications if she did not consent to this procedure.

CASE STUDY 6: You are part of a multi-disciplinary team at a primary care centre providing assistance to people from marginalised backgrounds who suffer from renal disease, neurological and musculoskeletal disabilities, and chronic acquired injuries. The centre also offers health promotion activities to the local population, and provides important epidemiological data to researchers. Recent changes in government funding have meant a cut in your centre’s budget and, potentially, a complete closure of the venue. If the closure was to go ahead, it would mean that the nearest access to similar services for people in your population would be at least 70 Km away. The state government does not believe there is a need for your services in the area as the documentation that justifies the budget for the centre has not been accurately reported by the centre manager. On closer investigation, you discover that the centre manager, who is also your best friend, has been manipulating the funding for his own financial gain. You also know that he is the most senior member of the team, and his knowledge and experience are invaluable.

CASE STUDY 7: Amelia has taken up a position as a speech pathologist in a medical centre where a number of other allied health workers are also employed. The centre itself is situated in an inner city suburb where the local residents belong to a broad range of socio-economic backgrounds, including professional ‘elites’ and unemployed people living in public housing. The majority of Amelia’s clients are children with communication impairments who, she is pleased to discover, really do benefit from her interventions. Some of her clients, however, require longer terms of therapy in order to achieve sufficient progress in correcting such impairments as stutter. However, given restrictions on Medicare reimbursement for speech pathology services, the centre’s administration requires Amelia to discharge her patients when the funding stops, and not when the client’s communication impairment has been resolved. Amelia believes that any progress made by such clients will be lost under these conditions; indeed, she knows that they will regress altogether. When she discusses these concerns with her manager, she is told that clients can continue to receive speech therapy providing they pay for it out-of-pocket. Amelia knows that only her wealthier clients could afford her services.

Questions: 1. Identify at least one ethical conflict in your chosen scenario 2. Propose and discuss a legally and ethically defensible approach to addressing the identified ethical conflict(s). In doing so, consider the conflict(s) in relation to a. the relevant principles of health care ethics; b. the relevant professional code of ethics (if available) c. the relevant code of professional conduct d. other national and international charters; and e. one ethical theory that informs professional health care practice