Case study: Mr Wang is 62 years old. He is an alcoholic gentleman who has been diagnosed with cirrhosis of the liver some 3 years ago.
Mr Wang attends the clinic regularly for check -ups however recently his condition has worsened and he has presented with nausea, ascites, and slothfulness. Mr Wang was informed that the disease process was advancing. Mr Wang’s family were informed that he was now terminal and that care would be largely palliative from this point on. The family asked that the terminal nature of the disease be retained from their father and the consultant agreed.

The clinic proposed that he be admitted to hospital for drainage of the ascites and the insertion of a urinary catheter. Mr Wang agrees to go to the hospital for the interim care and tells his family he will be home soon and ready to spend the Christmas holidays with them all.

Mr Wang dies in hospital prior to the holiday seasons arrival.

-Use the ethical decision making framework to determine your analysis of the care provided to Mr Wang

-Consider the legal and ethical implications surrounding the withholding of the truth from Mr Wang as his disease status becomes terminal.

-Can it be justified to withhold information?

-Consider professional and regulatory responsibilities as well for the Nurses involved together with other members of the multidisciplinary team.

Model for Ethical Decision-Making.

• Please use these headings when writing your case study

1. Clearly state the problem:
Consider the problem within its context and attempt to distinguish between ethical problems and other medical, social and legal problems

2. Get the facts:
Find out as much as you can about the problem through history, examination and relevant investigations.
Are there necessary facts that you do not have? If not search for them.

3. Consider the four ethical principles:
• Autonomy: what are the patient’s preferences?
• Beneficence: What benefits can be obtained for the patient?
• Non-maleficence: what are the risks and how can they be avoided?
• Justice: how are the interests of different parties to be balanced?

4. Identify ethical conflicts:
Explain why the conflicts occur and how they may be resolved.

5. Consider the Law:
Identify relevant legal concepts and laws and how they might guide management,
Examine relationships between the clinical-ethical decision and the law.

6. Making the ethical decision: Clearly state the clinical ethical decision and justify it eg:
Specify how guiding principles were balanced and why( i.e. justify the decision)
Take responsibility for the decision & provide alternative management;
Evaluate the decision;
Document the decision
Use the Model for Ethical Decision Making provided below to determine your recommendations for the ongoing care of your chosen client.

You MUST include in your referencing two (2) or more of the following: (please see useful resources link at the top of your Assessments tab in Blackboard for links to documents required).

Health Practitioner Regulation National Law Act 2010 (WA)
ANMC Code of Conduct for the Registered Nurse
Singapore Code of Ethics and Professional Conduct
ANMC National Competency Standards for the Registered Nurse 2012
Singapore Nursing Board Standards of Practice
ANMC Code of Ethics for Registered Nurses 2008 or Singapore Code of Ethics
ANMC National Framework for the Development of Decision Making Framework:
2007 Scope of Nursing Practice
ANMC Professional Boundaries 2010

Guideline:

There should be attention to spelling grammar and punctuation. Citations within text and reference list should conform to APA 6th ed format. There should be evidence of critical thinking.

Introduction:
To include a rationale as to why they are using a Model for Ethical Decision Making and to correctly. Reference the particular model in the text and the reference list the introduction should include the ethical problem statement, the medical problem statement, the legal problem statement and the social problem statement. This should look like:
Ethical: Is it ethical that Mr Wang does not know his condition? Has Mr Wang’s Family been fair in withholding information?
Medical There should be referenced material about cirrhosis. Some reference should be made to terminal and palliative. Consideration should be made around the possible psychological effects of being having this condition and not knowing about it and the impact of being given the information about his condition.
Describe social issues such as family support.
Legal Describe legal issues such as potential for harm to be caused to Mr Wang because he has not had information about his disease or treatment.

Get the Facts
What further questions would you ask from the history, what further investigations are needed?Are there any other necessary facts that you don’t have and would want to know?

Consider the Four Ethical Principles
Referenced definition of each principle
Statement of how each principle applies to the case.

Autonomy
Mr Wang’s right to have information about his condition and treatment and to actively participate in decision making.
Beneficence
Is it in Mr Wang’s best interest that his family had stopped him from knowing about his condition and treatment? Does the doctor have a role in changing this situation?

Non Maleficence
Is the fact that Mr Wang doesn’t have knowledge about his treatment causing him harm? Does the doctor have a role in changing this situation?

Justice
Is it fair that Mr Wang is being treated differently to other patients because of his family asking that he not be told about the nature of his condition?

Ethical Conflicts
Discuss conflicts that may occur between autonomy and justice or beneficence and nonmaleficence.

Consider The Law
Explain with regard to Mr Wang Consent, relevant ANMC codes and standards. Potential for harm to Mr Wang not understanding treatment.

Ethical Decision
As per marking guide
Decision is clearly stated
Referenced justification for decision
Considers how decision would be evaluated
Evidence of clear understanding of the documentation process required
Uses appropriate in text citations

Marking Criteria:
Consideration of practice standards, law and legislation. (15 marks)

Identification and application of ethical principles
Identification of potential ethical conflicts (15 marks)

Resolution to problem reached and conclusion(10 marks)

Conventions:
• grammar
• spelling
• punctuation
• APA style
• in-text referencing
end-text referencing (10 marks)