Law Ethics

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Law Ethics in the Australian paramedic field
07.08.2019
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Introduction

Ethical considerations in the medical field in Australia are an inherent part due to the various obligations to patients and other stakeholders in the field. The law society in Australia is usually responsible for ensuring that it has assisted all medical practitioners in order to deliver services according to the stipulations of the profession. There are various ways in which the law can apply to the medical field, and this can be done through consideration of the Acts and laws that have been passed. This paper aims at creating a case scenario that involves ethics and legal provisions that exist in the Australian paramedic field.

Case Scenario

John is an elderly person who has been diagnosed with terminal cancer and has already exhausted all medical options. He is under palliative care at a home where he has raised his family. He is under the care of Mary, a nurse who has practiced for more than ten years. Mary has been applying the doctor’s instructions to ensure that John’s pain has gone away. In this home where John is undergoing care, there is no advanced health directive. Paul is the director of the home, and he says that there is no such directive that can be applied there. The management of the home includes Joan, who is a matron, as well as Veronica, a nurse who works part-time in the wards.

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John continues deteriorating, and his children, Michael, and Jill are concerned that the people at the home are not taking sufficient care of him. They feel that he has been neglected and has thoughts of moving him into another care home. John meets the criteria that have been set for treatment and transport according to ambulance guidelines. Though he is weak, he is alert and seems aware that his death is imminent. He has talked to his children and told them not to worry about his condition, as his age has caught up with him and there is nothing much to be done.

One day, the nurse, Mary, finds John on the floor of his room with difficulty in breathing as well as bleeding from various parts of his face. Mary tries to resuscitate him, but Paul prevents her from doing so saying that the man is almost dead. Mary has seen that John has a wound on his forehead, and he is losing a lot of blood, in addition to his cancerous state. Later, she realized that Paul was the cause of John’s fall, they argued about a business they undertook together and a fight broke up. Mary informs John’s children and the police, whereby John was taken to an advanced hospital under police supervision, while Paul was locked up in custody.

After two days at the hospital, John becomes stable and it has been found out that he had tried to attack Paul with a knife that he had concealed in his garments. He is taken back to the hospital under police supervision before he has been taken to court for his offense. He then undergoes a heart attack; consequently, an ambulance is called to take him to hospital. After the ambulance has come, the crew finds out that there is a conflict between relatives on whether he should remain at home or he should be taken to hospital. The crew then transports him to the hospital where he dies before he can undergo treatment. His children blame the relatives for delaying his transportation to the hospital.

2. Carefully identify all the people involved by name or role

In this scenario, there are various players, who are actively involved in the development of the case. Firstly, there is John, an elderly man who is suffering from cancer and also instances of a heart attack. John has two children, Michael and Jill, who pay for his upkeep in the home, where he is held for care and observation. Another character is Paul, who is the director of the care home. There are also Mary and Joan, who are nurses responsible for taking care of patients held in this care home. This is a responsibility that they have carried out for several years, for example, Mary has worked as a nurse for ten years. There is also a matron called Veronica. Her role includes ensuring that the elderly people treated there are comfortable and also assisting nurses in taking good care of the elderly patients. The other characters include the ambulance crew who took John to and from the hospital. Additionally, there are other unnamed relatives who have been mentioned in the case, but they have been instrumental in developing the plot.

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3. Then specify the legally significant relationships that connect professionals to clients and non-professionals to each other. This is not essential, but if there is a good supporting case then cites it.

In this case scenario, there is a distinction that should be made regarding the rights of a patient that are enforceable by law. For instance confidentiality, an example of those that are not enforceable includes the right to a second opinion (Badzek, Henaghan, Turner, & Monsen, 2013). John’s relatives have no right to determine the medical attention that he should be subjected to. They should not go against his wishes and that of his children. In this case, it is the wishes of the patient that count, assuming that all provisions for informed consent have been met (Iedema et al., 2011). Considering the context of John’s condition, there is no duty to provide futile treatment, but there is a duty to improve treatable as well as reversible conditions.

According to the Medical Treatment Act of 1986, there is a need to speak in such a context and provide chronically and terminally ill people with a possibility to decline treatment if they wish so (Forrester & Griffiths, 2014). Interpersonal resolutions of values and conflicts are not in the domain of the paramedicine but neutrality is impossible (Levett-Jones & Bourgeois, 2014). Regarding the ambulance crew, they should have explored more options to serve John and should not have listened to their relatives. It is the ambulance crew that should have considered their rights to determine whether to listen to or ignore the calls of the patient and the third party (Badzek et al., 2013). Their primary duty is supposed to be focused on the patient.

4. Analyze the professional and non-professional behavior regarding the legislation you have studied, making sure that all references to Acts and Regulations are in terms of sections and sub-sections. An example would be to use the Civil Liability Act 1936 (SA) when discussing the duty of care and standards of care.

The professional behavior that is evident in this case involves the nurses at the care home. They seem to strictly follow the Health Practitioner Regulation Law Act of 2010 (Santonocito, Ristagno, Gullo, & Weil, 2013). This Act states that all paramedics and health practitioners have the responsibility of taking care of all patients equally and competitively on all occasions. John receives proper care from the nurses, and this shows how professionally they carry out their duties. Another instance of professionalism is seen when the ambulance crew managed to take John to the hospital. They did not listen to the relatives and made sure that they fully cooperated according to the Health Practitioner Regulation National Law Number 86 of 2015. This is yet another example of professional behavior.

Cases of lack of professionalism include the director of the care home. It was completely wrong of him to conduct business with a patient, which lead to a confrontation when the deal went sour. This is unethical, and Paul must be subjected to disciplinary action. The behavior of the director is against the Medical Treatment Act of 1986 that states that all patients should be allowed to undergo medication with no interference in order to ensure that they have recovered fully (Badzek et al., 2013). The Access to Medical Reports Act of 1988 has also been violated in this case, as Paul fails to handle medical documents and reports relating to John (De Cruz, 2013). This conduct means that services such as insurance coverage regarding insurance contracts have been ignored.

John has also acted in an unethical manner when he sometimes refused treatment, arguing that his time for a living was over. This means that he has violated the Medical Treatment Act of 1988. He has not yet obtained a certificate of the refusal of treatment. As a result, according to the medical law, he is wrong.

5. Note any legal cases that support legal relationships between individuals (cite case name and date), e.g., the duty of care, parent and child, etc.

There is evidence that warrants investigation of competence as well as education of paramedics in legal and ethical domains. One legal example that can support the legal relationships between individuals is the case of the NSW vs. an unnamed defendant, which involved patient refusal of medical treatment due to religious beliefs (Bismark, Spittal, Gurrin, Ward, & Studdert, 2012). In this case, he was unconscious and had been admitted to the emergency department of the hospital. He suffered from a condition of septic shock and respiratory failure as well as showed a decreased level of consciousness (Bismark et al., 2012). The patient was then transferred to the hospital’s intensive care unit where he stayed for several days. He had been given the required medical care, but his state deteriorated because of the development of renal failure (Schneider & Whitehead, 2013). The patient was kept alive by mechanical ventilation and kidney dialysis. The medical team then realized that there was a document that the patient had signed earlier, stating that he would never consent to dialysis. The document was valid, and this meant that it had to be followed to the letter (Coumarelos, Pleasence, & Wei, 2013). The failure to honor the document would have allowed the patient to sue the hospital once he was discharged, and this was the point where the dilemma arouses.

In John’s situation, an act of strengthening the entire health care system and an effort to work on improving services for the elderly would play a paramount role in reducing his personal expenses. It is important to take into account that seniors often incur hospital treatment costs. An increasingly large number of much older people are very dependent on a quite proportionately shrinking resource, which is supported by younger people. In many developed and developing countries, children are commonly seen as a source of livelihood for older people, and the expectations of filial support at old age are widely shared by the current generation of adults.

6. Comment on how the SAAS conduct codes apply to the professional behavior (references to codes should be precise: title, date, page, and section if there is one.

One conduct code that has been affected in this case is the Medical Treatment Act of 1988 (Bismark et al., 2012). The Act makes a provision for a competent adult to refuse medical treatment, regardless of the refusal that might put their lives at risk. It also makes a provision for an agent, who has been properly appointed, to withhold consent on behalf of a patient if the surrogate believes there would be an occurrence of unreasonable distress when the treatment is given. A refusal must be related to a current situation, thus guaranteeing that the refusal is resolute and specific. It has to be signed by a medical practitioner as well as one other witness as a safeguard to guarantee that the matters have been established in a formal way, and with enough information.

Another conduct code that has been involved in this scenario is the Cancer Act of 1958 (Brierley et al., 2012). This act states that all people who are suffering from this condition have the right to undertake various systems of treatment in order to alleviate the effects of the disease. This means that John has been receiving care that has been defined in this Act, and there is nothing that he should be denied that has been provided for in this situation. Nursing practitioners’ role is to ensure that they have developed and implemented policies, programs as well as initiatives that will support prevention, diagnosis, and treatment of cancer (Brierley et al., 2012). These specialists have to ensure that they complete the process of cancer treatment and provide ongoing care for the patients until they regain better health.

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