Ethics

 

 

Select a case study from the list below and addressthe following points:
1) Identify the ethical issues atstake in your chosen case study
2) Establish a clear ethical perspective on the issues
3) Recognise an alternative perspective to your own
4) Discuss the ethical issues from the perspectives of:
 The requirement to respect human dignity and human rights;
 your future profession’s codes of ethics/ professional conduct & professional
standards;
 one ethical theory you have studied in this unit; &
 the principles of health care ethics
5) Make recommendations for professional practice

 

 

Case Study 1
Henry has been practising as a physiotherapist for 8 years. He works in an inner-city medical centre
along with orthopaedic surgeons, a podiatrist, a rheumatologist, a radiologist, and a massage therapist.
Henry has been treating Jim, a 73 year old man, following bilateral knee replacements. After 3 months
of therapy, Jim has shown little improvement in mobility; his wife tells you that Jim is not following his
exercise program at home. Henry has a waiting list of patients who need his assistance; for this reason,
he decides to discontinue Jim’s treatment. Instead, he suggests that Jim see the massage therapist.
Later that week, the practice manager, Sally, calls a meeting with Henry to discuss his decision to
discontinue Jim’s treatment as she believes thatsuch measures could undermine the reputation of the
practice. She warns Henry that if he discontinues treating patients, they will go elsewhere. Later, Henry
raises his concerns with the practice manager over the well-being of one of the surgeons. He tells Sally
that the surgeon frequently arrives to work smelling of alcohol, including on those days on which he
performs surgery. Sally offers to speak with the surgeon, assuring Henry that he does not need to
intervene in this matter. Weeks go by and the surgeon continues to arrive at work in the same
condition.
Select a case study from the list below and addressthe following points:
1) Identify the ethical issues atstake in your chosen case study
2) Establish a clear ethical perspective on the issues
3) Recognise an alternative perspective to your own
4) Discuss the ethical issues from the perspectives of:
 The requirement to respect human dignity and human rights;
 your future profession’s codes of ethics/ professional conduct & professional
standards;
 one ethical theory you have studied in this unit; &
 the principles of health care ethics
5) Make recommendations for professional practice
Case Study 2
Camilla works on a surgical unit in a large, inner-city hospital. One morning shift,she is assigned to care
for Sam, a 21 year-old man who was admitted during the night for investigation of acute abdominal
pain. His medical history includes multiple admissions to the emergency department for treatment of
(among other things) drug-related psychosis. At the beginning of her shift, Camilla attempts to check
Sam’s vital signs but is unable to do so as he is very agitated, attempting to push her away. He is also
calling out and unable to answer her questions rationally. Camilla asks the medical team to review Sam
as she is concerned about not being able to monitor his condition effectively. She is also concerned for
her own safety and that of her colleagues. The medical team arrives to find Sam pulling out his IV
cannula and verbally abusing Camilla. They order that Sam be placed in physical restraints and
document as much in the notes.
Camilla is concerned that this approach will only exacerbate Sam’s agitation and that, ultimately, he will
injure himself and/or other patients and staff. She expresses her concerns to the nurse in charge of the
shift (Julia) who advises her to apply the restraints and focus on caring for the other patients she has
been assigned. Julia states: “patients like Sam are a waste of our time. Besides, we haven’t got enough
staff rostered on today to be worried about him”.
Case Study 3
Jane works as a midwife in an inner-city hospital where she runs an ante-natal clinic twice a week; on
other days,she works on the labour ward. Jane is aware that one of the women attending the antenatal
clinic (Tiffany) is alcohol dependent and lives with a physically abusive partner; Tiffany has been
admitted to the emergency department on several occasions with multiple injuries, including fractured
ribs, bruising to her face and, on one occasion, a fractured mandible. Jane refers Tiffany to the hospital
social worker who, in turn, refers her to the drug and alcohol services; she has attended the D&A clinic
only once and continues to abuse alcohol on most days. Eventually, Tiffany gave birth to a seemingly
healthy baby. Her partner visited a few hourslater and became verbally abusive. Jane became
concerned about discharging Tiffany home; in particular,she worried over the well-being of the baby.
However, Tiffany insisted that they would be ‘alright’ and discharged herself only a few hoursfollowing
delivery.
Case Study 4
Cindy is a social worker on an adolescent mental health unit. She has been working with a 15 year-old
client, Ben, who was admitted as an outpatient following a suicide attempt 3 months ago. On one
occasion, Ben tells Cindy that he is involved in a sexual relationship with a 30 year old man; he explains
that he is happy with this arrangement even though he worries that his parents will find out. Cindy
continues to see Ben each week but has not mentioned Ben’s situation to other team members;she
believes thatshe will be able to help Ben arrive at a decision, independently, to terminate the
relationship. Besides,she finds it rewarding to work with clients like Ben who,she believes, really need
her help.
Case Study 5
Luke is a speech pathologist who specialises in working with patients who have sustained a traumatic
brain injury (TBI). He works with a team of health care professionals attached to a neurology
department of a metropolitan teaching hospital. One of his clients, Tom, suffered a TBI in a motor
vehicle accident. He has shown no real progress over the last 9 months; his cognitive function, as well as
his speech and language impairments remain unchanged. Tom’s dysphagia persists such that he
continues to need artificial feeding via a PEG tube. Luke believes that weekly treatment visits should
stop; he believes that the sessions are exhausting and frustrating for Tom. He also knows that is difficult
for his wife to accept Tom’s condition and believes that continuing treatment is deceptive inasmuch as it
encourages a ‘false hope’ on her part. The other team members wish to continue treatment even
though they agree that Tom is unlikely to improve. While Luke cares about Tom’s well-being, he is also
aware that there is a waiting list for his services.
Case Study 6
Alex, an ‘early career’ epidemiologist, has been employed by the Australian Institute of Health and
Welfare (AIHW) to work on a cohortstudy; the project has involved comparing the morbidity rates of
the refugee population with the general non-indigenous population. Data was collected from public
hospitals and general medical practices where large numbers of refugees attended. The research
proposal was approved by the relevant ethics committee in accordance with the NH&MRC guidelines.
Towards the completion of the study, it became evident that the use of health services by the refugee
population was significantly higher than that of the general population. Moreover, refugees were
significantly more likely to consult health services in relation to mental health conditions, especially
post-traumatic stress disorder (PTSD) and psychoses. These findings were discussed on ‘talk back’ radio
and other media outlets in ways that alienated and offended refugees; for instance,some
commentators were angry that, as taxpayers, they had to pay for medical care of newly-arrived refugees
while, at the same time, “our own diggers” were neglected on return from active service. Department
heads within the AIHW were considering, in future, to censor research findings they thought likely to
undermine social cohesion. However, Alex disagreed; he believes that hiding such evidence is both
deceitful and undermining of public health objectives.

 

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