Ethical Legal Dilemma Advanced Practice Nursing Case Study II Norman Ginn
Ethical and Legal Perspectives
Ethical Legal Dilemma Advanced Practice Nursing Case Study II Health insurance policies have set limits on what services will be paid for with a terminally ill person in the home and these limitations may conflict with the nurse’s obligation to provide care for the terminally ill patient (Fry, Veatch & Taylor, 2011). Speaking with the family of a 59 year old male with his only history being terminal lung cancer that has metastasized to the brain, they express concern that they are beginning to have increase difficulty managing this condition. The patient is receiving hospice currently in the home, but the insurance company will not cover both hospice and respite services to assist the family. Community nurses working in the homes of dying patients often encounter many forms of ethical dilemma and they need support in this demanding situation that arises during the end of a patient’s life in the home (Karlsson et al., 2010). The community nurse is a professional to whom the patient and family turn when they have questions or want to discuss plan of care and treatment options at a critical time in the patient’s life when personal assistance is required (Erlen, 2005). Speaking with the family (son and daughter), it is now found that the patient is now incontinent of both stool and urine and they are now limiting his intake of food and fluid in the afternoon and evening, so that their father doesn’t “lay in his own wastes throughout the night”. The patient has now developed an excoriated perineum and it appears that further skin breakdown is imminent. The patient has become increasingly weak, and has fallen several times over the last few days. He requires total care with all ADL’s and IADL’s and the family verbalizes being overwhelmed with what their father requires. The patient is receiving hospice for medication administration for agitation and pain as well. Both son and daughter are at risk of losing their jobs related to missing work in order to take care of their father. The son works day shift and the sister works afternoon shift. They have each decided to return to work and this will cause their father to be left alone for almost two hours each day. This could be a case of negligence, where there is a failure to exercise a standard of care and it can be alleged when a person fails to act when a duty exists. There are five elements required to establish a case of negligence: the existence of a legal duty to exercise reasonable care; a failure to exercise reasonable care; cause in fact of physical harm by the negligent conduct; physical harm in the form of actual damages; and proximate cause, a showing that the harm is within the scope of liability (Cornell University Law School, n.d). Negligence falls under tort law and could be criminal. According to Collins English Dictionary (2009) negligence or mal-practice is defined as any immoral, unethical misconduct or neglect of a health care professional. The patient is receiving care at home from Hospice for pain and agitation medication management, which is not sufficient. There is no absolute method to avoid lawsuits; however, prevention of this case could have occurred prior to discharge with proper education of the family of their options for care regarding their father. Detailed explanation of what care their father may need as the end of life is near, may have steered the family to make alternative arrangements for their father. Hospice will have a duty to educate the family of the possible act of negligence and it will be the duty of the hospice workers to report this act made by the family, by following their policies and procedures, which will be their best defense (Grant & Ballard, 2011). Further discussion has shed light on the possibility of Human Rights being violated, under the...
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