Case Study :  The Case  of Muna

Muna was admitted via the Emergency Department to the ward following a fall at home.   She was treated for a fractured neck of femur and had a total hip replacement from which she is recovering well.  She is 66 years old, recently widowed and, two years ago, she was diagnosed with Alzheimer’s disease.
Muna displays certain behaviours that are annoying other patients on the ward and some of the nursing staff.  The main issue is that she refuses to remain either in bed or in her chair and attempts to mobilise without assistance.  She continually appears agitated and can be aggressive to other patients who try to approach her. The nursing staff are concerned for her safety and the safety of other patients.
To aIDress Muna’s behaviour, a nurse has contacted the doctor to discuss prescribing sedative medication and the doctor has consequently prescribed diazepam to see if it would help.
Muna’s family visit her in the afternoon and find her lying in a wet bed.  She is non responsive and very sleepy.  They are concerned that she no longer seems able to recognise them or respond to their questions.
They complain to the nursing staff that they were not consulted about their mother’s treatment and insist on the sedative being discontinued.
€¢    Use the ethical decision making framework to determine your recommendations  for the ongoing care of Muna
€¢    Consider the legal and ethical implications surrounding the chemical restraint of Muna.
Can chemical restraint be justified to be in the best interests of Muna
Consider interests of all stakeholders and resource availability
Consider Safety and hazards
Consider mental health legislation.

Model for Ethical Decision-Making.

1. Clearly state the problem
Consider the problem within its context and attempt to distinguish between ethical problems and other medical, social and legal problems

2. Get the facts:
Find out as much as you can about the problem through history, examination and relevant investigations.
Are there necessary facts that you do not have? If not search for them.

3. Consider the four ethical principles:
€¢    Autonomy: what are the patient’s preferences?
€¢    Beneficence: What benefits can be obtained for the patient?
€¢    Non-maleficence: what are the risks and how can they be avoided?
€¢    Justice: how are the interests of different parties to be balanced?

4. Identify ethical conflicts:
Explain why the conflicts occur and how they may be resolved.

5. Consider the Law:
Identify relevant legal concepts and laws and how they might guide management,
Examine relationships between the clinical-ethical decision and the law.

6. Making the ethical decision: Clearly state the clinical ethical decision and justify it eg:
Specify how guiding principles were balanced and why( i.e. justify the decision)
Take responsibility for the decision & provide alternative management;
Evaluate the decision;
Document the decision
Reference:
Kerridge, I., Lowe, M., & McPhee, J. (1998). Ethics and law for the health professions (p. 84) Tuggerah, NSW: Social Science Press