‘Professional Practice and Ethics’

Case AYou are a school dental therapist working at a low decile primary school in Northland. Many pupils at the school have high levels of caries however it is often difficult to obtain consent for each treatment as parents or guardians do not always return signed consent forms, English is not necessarily their first language or they are difficult to contact during the day. Many children experience pain and discomfort due to multiple abscesses and often teeth must be extracted to avoid further oral health issues.
It is proposed that when registering children at primary school parents or guardians should provide consent for any future school dental care.
• Case B
You are a health promoter working within a large district health board (DHB). You’ve been asked to prepare a report to the board outlining the various arguments for and against introducing a new policy that would make it a requirement that health providers, employed by the DHB, be non-smokers. You are aware that at the conclusion of the presentation the Board will be asking you for your concluding position.
It is proposed that a condition of employment as a health provider is that you do not smoke.
• Case C
John is 82 and a patient in hospital. He has had a stroke and is confined to a wheelchair. He also has other health issues including high blood pressure, chronic heart failure and a recent hip fracture. John wishes to be discharged so that he can return home. He has a very supportive partner, almost 30 years younger than him who feels she will be able to cope with looking after him at home. The doctors disagree. They have concerns for his safety and doubt whether his partner would manage his 24-hour care needs. Claiming that there wouldn’t be funding for the level of home care required, hospital staff want to transfer John to a private hospital, despite his desire to go home. Based on: http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10775124
It is proposed that John’s wishes be respected, allowing him to go home.
• Case D
You are on duty in the hospital’s emergency ward. Suzi, the top shooter for the regional netball team in the national professional league, has shoulder pain and is seeking medical advice to rule out a serious injury. At the team’s next game they will be competing in the national final. The team has never reached this level before so everyone is feeling the pressure. Whilst examining Suzi, you enquire whether she has taken any painkillers for her injury. She discloses to you that she hasn’t and she wouldn’t be happy to do this, as she is actually 14 weeks pregnant. She isn’t noticeably pregnant but the team has a strict regulation that players must not continue playing past 12 weeks of pregnancy. As part of her professional contract, should any medical treatment be sought, a medical professional must declare players fit to play. You ask about her general health and she tells you she is very fit but did have a scare about three weeks previously when she experienced some unexpected bleeding but this stopped after self-imposed bed rest. Now she’s determined to play in the finals. Suzi tells you how important next week’s game is to her and the team. It is a rare opportunity and without her, the team will be at a disadvantage. She asks that you keep her pregnancy confidential and that after the game she’ll tell the coach and take leave from the team.
It is proposed that you keep Suzi’s pregnancy confidential
• Case E
You have been caring for a patient in a palliative care (end of life) setting for several weeks. An end of life care plan created by the patient states that they wants to pass away ‘with their family around them’. Doctors have now said that the patient is close to death, and that while they are still conscious, the patient is likely to pass-away within the next few hours. You make a phone call to the patient’s spouse to recommend to them that they visit the patient promptly, to say goodbye. However the spouse states that they have formed a new romantic relationship and are out-of-town with their new partner.
It is proposed that you tell the patient that their spouse is on their way.

Case F
Mrs. Panachetta is a 69-year-old Italian woman who has lived in Auckland for the past 2 months with her only son and daughter-in-law who settled in Auckland 8 years ago. Her husband died in Italy 6 months ago. Mrs. Panachetta understands some English, but is not at all fluent. You are a paramedic who receives an emergency call to their house where you find Mrs. Panachetta with severe back pain, and a dropping blood pressure. You suspect a ruptured aortic aneurysm, which carries a high chance of death without immediate surgical treatment. You have attended many patients with ruptured aneurysms and are confident of your diagnosis and prognosis. Mrs. Panachetta’s son approaches you, and asks to speak to you in private. You explain your suspicions about her diagnosis, and the urgency to get her to hospital for immediate treatment. Mr. Panachetta begs you not to tell his mother your suspected diagnosis and poor prognosis. In Italian culture, serious matters belong to the knowledge and decision of the family, and patients are not told since they might be harmed by the information through emotional fright and worries. On returning to Mrs. Panachetta, she is extremely pale and asks you; “What is wrong with me? Am I going to be alright?”
It is proposed that you should tell the patient her diagnosis and prognosis.

Case G
Nearing the end of a long tiring shift, Judy, a nurse, is trying to give Mr. Jamieson, a 25-year-old accident patient, an intravenous injection. As happens on occasion in this environment, she sticks herself with the needle. Judy is worried. She is unsure what real risk this poses. Perhaps she will catch HIV or hepatitis? With trepidation she asks a colleague for advice. He reassures Judy, advising her that the regular post-exposure medication will be dispensed. He also reminds Judy that bloods were taken earlier that evening and maybe those could be tested for any blood-borne infections. He advises Judy to contact the hospital lab immediately. It is late, but he tells Judy that someone will be on duty. Judy feels uncomfortable with this advice as patient consent wasn’t given for this specific test but at the same time is worried for her health. As the medical laboratory scientist on shift that evening you receive the call from Judy and must make a decision.
It is proposed that you agree to test an existing sample of the patient’s blood for additional infections not consented for by the patient.

Case H
Kei is a 23 year-old single mother of three who receives a Solo Parent Support benefit. For this case, imagine that you’re a physiotherapist working at a local practice, although the case is applicable to other clinical professions. Kei presents to you one day with severe thoracic and lumbar spine discomfort, which she cannot pinpoint to any event or accident. You suspect that her back pain is due to inactivity and obesity which would mean she will not be covered by ACC and will have to pay the full cost for each physiotherapy visit. Accident Compensation Corporation (ACC) provides comprehensive, no-fault personal injury cover including a set number of funded treatments for services such as physiotherapy. To qualify for ACC funded treatments the injury must be caused by an accident. Kei indicates to you that she cannot afford to continue with physiotherapy as she is currently just scraping by on the benefit but that her pain is preventing her from gaining employment. You are confident that Kei’s back pain will resolve with increased physical activity and some physiotherapy sessions in the gym. If you can attribute Kei’s back pain to a specific event (such as lifting her 6 year-old daughter), ACC will cover her claim and will contribute to a series of treatments for Kei. You discuss the case with a colleague. She suggests you complete the ACC Injury Claim form and attribute the back injury to a lifting event.
It is proposed that you complete the ACC form, attributing the back injury to a lifting event.

Question 1:

Choose one of the case scenarios A-H, on pages 14-16. While it is often beneficial to choose a case from your own discipline (Dentistry) feel free to choose the scenario that appeals to you the most.

Define and apply two of the following ethical theories to your chosen case. This requires you to apply each theory as an academic exercise which may be different to your own views on the case.

Choose two theories from:

Utilitariansim
Deontology
Cultural Relativism
Virtue Ethics
My response:
Question 2:

(Assesses LO2; 500 words)

My response:
Question 3:

Choose a further theory from the list in Q1 above and one not already used in previous questions.

Select a short segment (around 30 seconds: Please write down the start and end time of your selected audio segment) from the following radio interview, from Week 2, that reflects your chosen theory. Further instructions will be given.

http://www.radionz.co.nz/national/programmes/saturday/audio/201832073/dr-lester-levy-health’s-most-powerful-appointee

In 400 words, explain your choice of interview segment and how it reflects values relevant to the chosen theory.
Then reflect on the relevance of these values for the patients/clients/communities you will one day work to help.

(Assesses LO3; 400 words)

My Response:
Question 4:

Identify one or more examples of an ethical issue from your own professional practice (dentistry) that you have experienced or can anticipate occurring. Examine what makes this situation an ethical issue and the implications of this issue on those involved.

(Assesses LO4; 500 words)

My response:

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