CASE STUDIES FOR HLSC220 – HEALTH CARE ETHICS / ISSUES – Nursing Assignment

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.

Assignment: Practicing as a Physiotherapist

Assignment: Practicing as a Physiotherapist

Assignment: Practicing as a Physiotherapist

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”.

Assignment: Practicing as a Physiotherapist

Assignment: Practicing as a Physiotherapist

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 ante-natal 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 hours following 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 that she 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.

Case Study 7

Ibrahim works in a laboratory on a major cancer research project. The findings of the research are showing great promise; a breakthrough has been reached which will, most likely, produce both reduced mortality rates and improved quality of life for people with prostate cancer. The research project has advanced to the point where trials can commence on human participants. In the course of Ibrahim’ s work, however, he discovers that some results have been manipulated. While he hasfull confidence in the effectiveness of the treatment, he suspects that the manipulation has been done in order to ensure that funding continues for the project. Specifically, Ibrahim is aware that the financial and time constraints are placing undue stress on the Principal Researcher to produce positive results. At the same time, he is sure that, with more time, positive.

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

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.