ethical dilemma

ethical dilemma

Assessment Task 3: Essay – An Ethical Dilemma
Select a case study from the list below and address the following points.
1. Determine the stakeholders including two health care professionals in the case scenario;
2. Differentiate the ethical and legal conflicts and explain them from the following perspectives:
The dignity and rights of all stakeholders in this case
The principles and virtues of health care ethics that inform professional practice
The relevant codes of ethics and/or codes of professional conduct
3. Propose a legally and ethically defensible resolution to these conflicts
CASE STUDY ONE
Kamil Samra is a sports physiotherapist and specialist in treating musculoskeletal injuries who is employed
by an AFL club on the basis of his notable success. Kamil enjoys friendly relations with the players and the
club managers and has become a close friend of two of the players. One evening, at a bar, Kamil is made
aware that the coach and sports scientists are supplying performance-enhancing drugs to the players. He
later verifies this information for himself when he discovers a package containing the banned peptide
Thymosin beta-4 at the club headquarters. Kamil discusses this issue with both the coach and the club
management who, in turn, offer him an even higher salary in exchange for his silence on this matter. In
accepting the offer Kamil can ensure care for his poor, aging parents in Lebanon. However, he is aware
that Thymosin beta-4 not only enhances athletic performance (and is in breach of the anti-doping rules in
sport), but it may also cause long-term health issues, but the players, in being contractually bound to follow
instructions by the coaching team, are not really free to refuse to use this banned peptide.
CASE STUDY TWO
Alex Ng, a senior paramedic in a regional centre, is called out to attend a motor vehicle accident on the
main highway, involving two cars and a large transport truck. On arrival at the scene, Alex finds passengers
trapped in both cars; two children in a small car are not moving and show no other signs of consciousness
while the female driver is slumped over the steering wheel, bleeding from a head wound. The male driver of
the other car is conscious but trapped in the wreckage; he tells Alex’s partner that he cannot feel or move
his lower limbs. The male truck driver is walking around the wreckage and appears confused and
disorientated; at a glance, he does not appear to be physically injured. A woman who was driving past
stops her car and comes forward; she tells Alex that she is an emergency physician and can help. Alex is
grateful for the offer of help and asks her to attend to the children, however, he notices the smell of alcohol
on her breath when she walks past him. After opening the door of the other car, Alex notices that the
trapped driver is wearing earphones attached to his mobile phone and the phone screen indicates that he
was on a call when the accident occurred. The driver is alone and Alex recognizes him as the local
magistrate, and a good family friend. Just then, he hears the screech of brakes and turns to see that the
truck driver has walked up the highway and into oncoming traffic. He is lying on the road and does not
appear to be breathing.
CASE STUDY THREE
Baby Thomas was born at 24 weeks’ gestation and was at his parents’ request, immediately transferred to
the neonatal intensive care unit (NICU) where he is administered an array of invasive measures for
ensuring adequate cardio-respiratory function and cerebral perfusion, as well as preventing
hypoglycaemia, hypothermia, malnutrition, thromboses and sepsis. Over the subsequent days and weeks,
baby Thomas experiences recurrent episodes of apnoea requiring resuscitation. He has also required other
medical measures for treating bronchopulmonary dysplasia, repeated episodes of diminished cardiac
output, sepsis and pneumonia. Efforts to extubate the baby continue to be unsuccessful. Thomas has been
in NICU for 52 days; notwithstanding his poor response to treatment, his parents wish to continue with
NICU management. At the same time, the Head of the ICU and Anaesthesia Department is ordering the
medical staff to remove Thomas’ advanced life support measures, given the evident medical futility of
continuing treatment. The nurses and physiotherapists are very concerned that, in the most unlikely event
that baby Thomas survives, he would be living with profound neurological damage, and other serious
disabilities. The social worker is concerned that the parents were not properly prepared for the high
probability that their baby may not survive at all. The Head of the Finance Department is also requesting
that, in light of strict budgetary limits, NICU treatment be withdrawn for this baby, given its cost of $3,000
per day (approximately $156,000 to date). The parents are distressed by the suggestion to withdraw
treatment and contact the media in order to draw attention to their baby’s plight.
CASE STUDY FOUR
Elsie Lee, 88 years old had recently moved to a Residential Aged Care Facility (RAC). She had difficulty
mobilising due to severe rheumatoid arthritis as well as short-term memory and vision impairment. Elsie
also had a history of AMI, removal of bilateral cataracts, and a (L) hip replacement four years ago. On
admission to the RAC facility, on Tuesday afternoon, the Nurse Manager suggested that Elsie consider
making out an advanced care directive (ACD), indicating what she would want done in the event that her
health should deteriorate. Elsie agreed and awaited the help of her family when they visited on Sunday.
She was pleased to have this opportunity as, although she had discussed her wishes with her family, she
wanted to make it clear to staff caring for her that she did not want aggressive treatment of any kind and
did not want to be resuscitated. On Friday night, Elsie developed severe chest pain which radiated down
her (L) shoulder, an irregular pulse and a BP of 73/48 and the RN on duty called the ambulance. Elsie
pleaded with the paramedics to leave her ‘as she was’; the R.N. insisted that they transport Elsie to
hospital as she had not filled out an ACD indicating otherwise. In transit to the hospital, Elsie suffered a
cardiac arrest. The paramedics attempted resuscitation but were unsuccessful. On arrival to the ED, Elsie
was pronounced dead. Her family determined that Elsie’s death was brought on by the stress of being
moved to hospital. They decided to sue the R.N., the paramedics and the RAC facility for assault and
battery.

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