Introduction to Professional Practice Assignment-

The following short case study has a number of questions to respond to for each component. The questions are 'prompts' for you to consider - you will need to demonstrate your understanding of legal and ethical principles in your answer to each of the four scenarios.  Hence, a detailed response that addresses legal and ethical concepts of the issue is required. For example, in the second scenario a question is "Is Jessica's consent valid?"  To answer this as Yes or No does not demonstrate your understanding of legal and ethical principles so you would need to expand your answer using these principles.

As a nurse you are a part of the health care team that is looking after the following four patients. 

1) Marion is a 38 year old woman who is unconscious when she arrives in the Accident and Emergency Department following a motor vehicle accident.  She is also 30 weeks pregnant.  The MO advises her partner Darren that due to the nature of her injuries she is unlikely to make a full recovery.  In fact, there is a high chance that she will remain in a persistent vegetative state and not regain consciousness.  Alternatively if she does regain consciousness she will be a quadriplegic.  John and Marge are Marion's parents, they insist that Marion would not want treatment in these circumstances and that she has an Advance Care Directive that clearly states this.   Darren insists that she be kept alive for as long as possible so that the foetus has a good chance of being born alive regardless of the outcome for Marion.

How should the treating team respond? Whose directions should they follow? What other options are available to them?

2) At 14 years of age Jess was diagnosed with an aggressive malignancy. Now at 15 years of age she presents to the hospital in need of chemotherapy, the side effects of this will mean that she will need multiple blood transfusions.  Both Jess and her parents refuse to have the chemotherapy as they will not agree to the blood transfusion as they are all practicing Jehovah's witnesses.  They are advised that there is an alternative chemotherapy regime but this is unlikely to lead to remission.  The parents agree to this form of treatment.  After the parents leave, Jess tells her MO that she has secretly completed an Advance Care Directive, and in that has appointed Tom her 19 year old cousin to be her substitute decision maker.  She is adamant that it is Tom and not her parents who should be making decisions about her treatment should she lose capacity and be unable to make these herself.  She explains that the reason for this is, that she wants to live as long a life as possible and that she is concerned that her parents would make decisions that honour their religious beliefs over her well-being. Jess then asks what she needs to do to increase her chances of full remission from the disease.

How should the MO respond to Jess? Has she made a valid refusal of treatment? Can Tom act on her behalf?  Could Tom order that the blood transfusion goes ahead?

3) Kerry Catel is a 64 year old woman who has a terminal illness.  Kerry's health has been deteriorating over the last few months and she has now made a decision that should she lose the capacity to make a decision about her health care she does not want any treatment. She is tired and has no purpose in life since her husband died last year. Kerry tells her MO that this decision has been made without any discussion with her adult children as she believes they would not support this.

Is this a valid refusal of treatment?  What else might Kerry do to make sure her wishes are upheld?

4) Dr Ron Practice is an orthopaedic surgeon performing a delicate knee reconstruction on Tony a well-known sporting hero.  During the procedure he tells Jane the scout nurse to get his mobile phone and take a video of the procedure for him as he wants it as a souvenir.  He then asks her to send this via email to a colleague who barracks for the patient's team.  Reluctantly Jane does this.  The nightly television news broadcasts a story about Tony's admission to hospital for surgery.  Jess is working at the hospital and believes she might be allocated to look after Tony during his admission.  She is also a devoted fan and hopes she can help him during his recovery.  On these grounds she decides to access his notes through the electronic system to see what is going on, just in case she will be looking after him.

Is this a reasonable request from Ron?  How should Jane respond? Has Jess acted appropriately?

1000 words

7 references.