ASSESSMENT TASK 2:
1. select ONE case study from the list below;
2. identify the ethical issues that are raised by the events described in the chosen case study
3. analyse the ethical issues in relation to the notions of human dignity, human rights, your professional codes of ethics/conduct, relevant professional policies/legislation, and the principles of health care ethics studied in this unit; and
4. make recommendations for professional practice
(Please note: with the exception of case study 1, these cases are not based in fact/ actual events. They have been fabricated for the purposes of the assessment)
CASE STUDY 1
Amos was a high school student living away from home at a residential property near his school in Malawi. There were other students in the same year level of studying with him; however, they were living in the boarding facilities provided by the school.
One day, during the school term, the nearby hospital reported that many students were presenting to the facility with an array of severe symptoms, including abdominal pain, profuse watery diarrhoea, vomiting, thirst, muscle cramps, restlessness and irritability. Some students were admitted to the hospital for treatment. Staff at the hospital soon realised that they were dealing with a cholera outbreak. Amos was not spared from this illness and, like most students who were unwell, presented himself at the hospital.
The triage nurse and doctor on duty realised that they did not have enough medical supplies for everyone; so, they decided to limit treatment to only those students who were boarders at the school, excluding all other students. Amos argued that while he was residing outside of the school premises, he still remained a student at this particular school. However, his efforts to seek help were futile, and he was sent away without treatment.
Amos decided to return to his home so that he could be looked after by his family. By the time Amos arrived home, he was severely dehydrated, went into shock, and died within hours of his arrival.
CASE STUDY 2
Justin and Daisy were doctoral students conducting research into the effectiveness of pilates in maintaining mobility and balance in men who had Parkinsons Disease (PD). The participants were over the age of seventy. Their research was conducted over a three year period. Justin and Daisy also worked part-time in private physiotherapy practice.
The task of recruiting sufficient numbers of participants was difficult but, ultimately, they managed to recruit just enough for their research findings to be meaningful. However, 18 months into the trial, 60% of the research participants had withdrawn from the pilates program, reporting lack of interest or enjoyment in the classes. Justin and Daisy, in an effort to continue their research, (secretly) offered to pay the participants $200 each time they attended a pilates class. To fund this promise, they made fraudulent claims to private health insurance companies and, as well, provided additional (and unnecessary) services to their existing clients in private practice.
The promise of a financial reward was effective in inducing research participants to return to pilates sessions. Ultimately, Justin and Daisy’s research project was completed and the findings, which demonstrated that pilates is effective in improving mobility and balance in older men with PD, was published in international journals. Consequently, physiotherapists now recommend pilates classes to their patients who have been diagnosed with PD. As well, private health insurance companies have agreed to cover the cost of pilates classes for older patients with PD. Notably, few claims are made to them overall as the majority of older men with PD do not attend pilates classes for long.
CASE STUDY 3
Jack and Sophie are paramedics. They are called out to a home at 2200 hours. On arrival, they hear shouting from inside the house. A woman (Sandra) opens the door to them and states that her 2 year-old child, Milly, has had a fall. Jack and Sophie examine Milly who is crying and clutching her arm. They suspect a likely fracture of the humerus, and inform Sandra that they will need to transport Milly to a nearby hospital for treatment. Sandra’s partner emerges from the kitchen, visibly intoxicated. He verbally abuses Sandra and the paramedics, and attempts to prevent them from removing Milly from the house. Jack and Sophie warn Sandra’s partner that they will need to call the police if they are unable to proceed with the transfer. On the way to hospital, Sophie notices small, round-shaped burns on Milly’s legs and abdomen. On arrival at the hospital, they are greeted by Beth, the triage nurse. They report their concerns to her regarding possible physical abuse. Beth states that she will report the matter to the doctors.
After receiving a handover from the paramedics, Beth is called to check a dose of Morphine with an agency nurse on duty. Beth checks the order and removes a 10mg ampoule from the locked cupboard. The agency nurse draws up the prescribed dose of 2.5mgs. She then draws up the remainder of the ampoule in a separate syringe and states: “do you want to go halves on this”?
CASE STUDY 4
Archie Simpson was born with encephalomyopathic mitochondrial DNA depletion syndrome (MDDS). The doctors informed Archie’s parents that the disease was progressive and that Archie could not be expected to live for more than a few months. They referred Archie to the palliative care team for symptom control. The midwife (Mandy) who delivered Archie advised his parents to seek a second opinion. She told them that there was some early-stage research being conducted into this condition in the United States, and that they should not ‘give up’ on pursuing a cure.
Archie’s parents took him home, but returned to hospital six weeks later, as Archie was experiencing difficulty with breathing and had been fitting. On examination, he also exhibited severe muscle weakness and was non-responsive to any stimuli. Archie was admitted to the neo-natal intensive care unit (NICU), intubated and ventilated. Following an array of tests, the doctors explained to Archie’s parents that there was no possibility that Archie would now recover. They explained that any further treatment would be therapeutically futile and, for this reason, it would be in Archie’s best interests to withdraw all curative measures.
Mandy visited Archie’s parents in the NICU. She reminded them of the research being done in the United States and urged them to ‘keep fighting’. Archie’s parents took hope from Mandy’s visit; they spoke to staff in the NICU and insisted that they continue treatment while they sought further advice from the United States researchers. Hospital administrators were urging the doctors to withdraw treatment, given the urgent need for beds in the NICU.