In your role as a registered nurse, you will be faced with complex and challenging situations. There will at times be a legal solution that can be applied to the situation. It is important that you are aware of what this might be so that you can confidently practice within these legal boundaries. Almost always there will be differing ethical positions that need to be considered. The purpose of this case study is to enable you to practice identifying a legal issue and possible outcomes and consider why an ethical conflict arises.

 

Instructions:

 

You are required to write a 1500 word essay. In your essay, you must identify and discuss the legal and ethical issues presented in the case study that follows. In your discussion, you must address the questions posed at the end of the case study.

 

You are expected to submit your essay with appropriate grammar, spelling, sentences, paragraphs and references. It should be structured using the following ‘APA Level 2’ headings:

 

Introduction Legal Issues Ethical Issues Conclusion

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Case Study Scenario

 

Joseph and Sofie have been happily married for more than 50 years and have one adult daughter, Cindy. Before they retired Joseph worked as an accountant, and Sofie was a cosmetics consultant. Although Joseph is relatively well for his age he has very poor eyesight. Sofie suffers from chronic gastro-oesophageal reflux, recurrent urinary tract infections and diabetes. To help manage her unstable diabetes, Sofie is visited three times each week by the community nurse, RN Kiki.

 

Sofie has always been quite particular about her looks; over the past few years has undertaken several cosmetic surgical procedures, including liposuction a facelift and rhinoplasty. Sofie has always had the same surgeon, Dr Lin, perform these procedures and has been very happy with the result on each occasion.

 

During her routine visit, RN Kiki notices that Sofie appears pale, lethargic and slightly confused. Sofie cannot recall Kiki’s name or the reason for her visit. RN Kiki observes Sofie test her blood sugar levels and notes that the reading is normal. She then records Sofie’s vital signs, noting a slightly elevated temperature, before assisting Sofie to administer her regular dose of insulin. Concerned that Sofie may be developing another urinary tract infection, RN Kiki suggests that Sofie may need to see her usual General Practitioner (GP). Before leaving for the day, RN Kiki discusses her concerns with Joseph who says that he has also noticed that Sofie has recently become quite forgetful. Recalling that Sofie had a doctor’s appointment scheduled the next day, Joseph assures RN Kiki that he will mention these symptoms to the doctor during the consultation.

 

The appointment that Sofie had scheduled, however, was not with her usual GP but with Dr Lin. Sofie was keen to have some further cosmetic surgery and had booked an appointment to discuss the possibility of an abdominoplasty. Joseph and Sofie both attend the consultation with Dr Lin. While Sofie is very keen to proceed with the surgery, Joseph is a little hesitant. He raises his concerns regarding Sofie’s forgetfulness and her elevated temperature with Dr Lin. Having known Sofie for several years, Dr Lin assures Joseph that Sofie’s current symptoms are probably due another urinary tract infection and prescribes her a course of antibiotics. Dr Lin then proceeds to arrange Sofie’s admission to hospital for the abdominoplasty.

 

On the morning of her planned admission, Sofie is taken to the hospital by Joseph, and their daughter Cindy. By this time her temperature had resolved, but she was still a little confused. Both Joseph and Cindy commented to Dr Lin that Sofie didn’t really seem to be herself. Dr Lin assesses Sofie, and asks her whether she still wants the surgery. Sofie indicates that she is still keen to proceed. Just as Dr Lin is about to leave the room, Sofie asks Cindy and Joseph why she is in hospital. Cindy reminds Sofie that she is having surgery to ‘fix her tummy’, to which Sofie responds, ‘oh that’s good’. Joseph looks at Dr Lin, and asks whether it would be best to postpone Sofie’s surgery until she is less confused. Dr Lin reassures Joseph that everything will be okay, and as Sofie has indicated that she is keen to proceed, the operation should go ahead. Joseph looks at Dr Lin and nods his head.

 

 

 

Shortly after, Sofie is administered a pre-operative medication and drifts off to sleep. As the ward RN begins to work through the pre-operative paperwork, she sees that the consent form in the medical record has not been signed. Observing that Sofie is sleeping, she asks Joseph if he would sign the consent form that Dr Lin had filled in. Joseph signs the form.

 

Sofie’s surgery proceeds as expected and after an overnight stay in hospital, she is discharged home. Several days later, during her regular visit, RN Kiki notices that Sofie has not recovered at all well from her surgery. She has an elevated temperature, is tachycardic and much more disorientated than she was before the surgery. RN Kiki arranges for Sofie to be transferred back to hospital. Unfortunately, Sofie had developed a post-operative infection and sepsis. Despite optimum care, her condition rapidly deteriorated and Sofie passed away. Joseph and Cindy are devastated. They believe that, given Sofie’s confusion and possible urinary tract infection Sofie should not have been operated on, and wish to sue Dr Lin.

 

 

 

Full Details of the Task

 

Your essay is to be written in an academic style with appropriate grammar, sentences and paragraphs. You are not required to number each of the paragraphs, and you should not use dot points. You should structure your essay as follows and answer the legal and ethical questions included below.

 

Introduction

 

A short introductory paragraph that outlines what you will be presenting in your case report.

 

You do not need to include a detailed account of the facts in the scenario; the markers are aware of the facts and this is an unnecessary use of words.

 

 

Legal Issues

 

Using structured sentences and paragraphs, answer the following questions in relation to the legal issues around consent, raised by the case.

 

  1. If Joseph and Cindy decided to sue Dr Lin, what type of legal action would that be?

 

What are the elements of the offence that Joseph and Cindy need to prove for the action to be successful? What is the standard of proof required in this case?

 

  1. Describe the defence that Dr Lin could raise. This includes describing the elements of a valid consent (with supporting case law and legislation), and the process for obtaining consent in those circumstances when an adult cannot provide it themselves.

 

  1. What are the possible outcomes of this case?

 

 

 

 

Ethical Issues

 

With reference to Beauchamp and Childress’ (2009) four principles of bioethics:

 

  1. Identify two principles that are relevant in this scenario and describe how they apply to the facts in the scenario.

 

  1. Describe where a conflict between these principles may arise by considering the different values of stakeholders in the scenario.

 

  1. Apply the Kerridge et al. (2013) model for ethical problem solving to address the conflict.

 

 

Conclusion

 

Write a short concluding paragraph that brings it all together.

 

NB* you are not required to decide the outcome of this case – in relation to the legal issues this would be a role for the courts. In relation to the ethical issues, there will not be one “right” answer, so the focus for this task is the process that you are being asked to apply.

 

 

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