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Ethical and Legal Dilemma: Case Study

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Summary

A very complex legal and ethical situation happened once with the physician. During his turn of duty, he faced the problem when the drunken patient refused the care and wanted to leave the health care institution without a proper treatment. He had remained unconscious for some time and did not remember what happened with him earlier. Eventually, the doctor managed to establish that this person had the large laceration on his forehead caused by falling down the concrete stairs. The patient did not want to be treated and claimed that, if the doctor forced him to stay in the hospital, he would sue him for assault, bodily blows, and unlawful confinement. The complexity of this issue is in the fact that the physician had to decide, whether it was possible to leave the patient with dangerous trauma without treatment or provide a proper medical assistance forcibly.

 

Choice #1

Choice #2

Benefit

Patient exercises his desire to leave the medical institution

Patient's health is not threatened

Burden

The patient leaves without treatment, and the nurse can be held liable for the failure to perform her duties

The person does not agree with the decision of the physician and can sue her for the violation of his inalienable rights.

Risk

Lack of treatment can lead to medical complications or death

The nurse can stand trial for failure to respect the patient's wishes

The decision is to force the patient to stay in hospital and provide him with appropriate treatment. The refusal to fulfill the patient’s requirements should be based on the fact that a person is drunk and cannot control his actions properly.

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The decision is validated by the Deontological theory.

There are several professional practice issues, which are applicable in this situation. First, the client restraints issues can be used. This question is regulated by the Patient Restraint Minimization Act of 2002, which prescribes, “Only a physician or a person specified by regulation is authorized to write an order to restrain or confine a patient in a hospital.” Thus, the physician should have enough authority to restraint the person. In addition, these actions can be carried out only after drawing up a written order. In comparison, when the patient refuses the treatment, he/she is obliged to prepare a written refusal. This action eliminates any uncertainties and serves as proof that a person declined the treatment voluntarily. Second, the best interests of client issues can be applied. Despite the reluctance of the patient to be treated, the nurse should analyze the condition of the person and decide that, due to the fact that the patient is not able to evaluate the situation and can make the wrong decision, it is wise to ignore his requirements and act in accordance with the patient’s interests (Fry, 2011).Identification of Dilemma

When the patient refused the treatment and expressed his wish to leave the hospital, the nurse faced the dilemma whether to allow him stay without treatment or ignore his requirements and provide medication without the consent of the injured person. There is an additional fact that the patient was drunk, and his ability to appraise the reality properly was in doubt. In addition, he mentioned that, in case his requirements were not fulfilled, the nurse would be sued.

Both two mentioned choices were available for the nurse, and she was obliged to consider and analyze all existing facts. In this case, there were several facts, on which special attention should be paid. The patient got serious injury, which was caused by the fall on a solid object. The laceration had to be treated and sewed up. The person did not remember under what circumstances he had received the injury. Moreover, he admitted that he drank alcohol in large amounts. Consequently, he could not be fully aware of sustained significance of his trauma and analyze his actions properly. In addition, the patient threatened to bring the physician to responsibility.

The nurse had to choose whether it was possible to leave the patient without treatment, or it would be wise to ignore his demands and provide a sufficient medication. The first choice corresponds to a patient's wish. Nevertheless, there is the risk that this person does not take care of himself, and will faces big problems associated with blood loss or infection. In this case, only the written and signed refusal can prove that the person did not allow treating him. However, the analyzed case has an additional fact, the alcohol intoxication of the patient. Under such circumstances, the physician does not have to meet the client’s requirements due to the fact that a drunken person cannot act adequately and understand the situation properly. Thereby, the physician should make an ethical decision and force the injured person to be treated in the hospital. These nurse’s actions are not violation of the Canadian Charter of Rights and Freedoms and the Patient Restraint Minimization Act (Fry, 2011).

In this case, the Deontological theory serves as a validation of physician’s actions. The duty of the doctor is to treat people. Despite the fact that medical staff are not obliged to prevent patients from wrongful action outside the hospital, when the person is in an infirmary, the physician takes responsibility for his/her recovery (Gastmans, 2010). This position is supported by the appropriate judicial practice. Thus, in the case McCarthy v. Englewood Neighborhood Health Clinic Chicago, the state court of Illinois had to decide whether the restraint of the person was fully consistent with the pending provisions of the health care legislation of Canada. The judge found a verdict that, according to the fact that the incapability of the patient had been proved by the defendant, there was no violation of the law and the physicians acted in accordance with the interests of the person.

The drunken injured could not act the best way; thus, the medic would act in accordance with both ethical and legal issues when forcing incapable person to be treated. The evaluation of the patient’s capability should be carried out in any particular situation. 

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