analy se th e e th ic a l is su es in r e la tio n to t h e n otio ns o f h um an d ig nit y , h um an r ig hts , y o ur
pro fe ssio nal c o des o f e th ic s/c o n duct, r e le va nt p ro fe ssio nal p olic ie s/le gis la tio n, a nd th e
prin cip le s o f h ealt h c a re e th ic s s tu die d in th is u nit ; a nd 4 . m ake r e co m m endatio ns fo r
pro fe ssio nal p ra ctic e .

Ethics case study
In this case study a number of ethical issues arise as a high school student from
Malawi named Amos unfortunately contracts the cholera disease as well as other
schoolmates during their school term and he is denied treatment by the triage nurse and
doctor on the basis that the hospital does not have enough medical supplies to treat
everyone and there for treatment is saved for only those students that board at the
school. Amos’s explanation to the nurse and doctor that he is actually residing just
outside of the school and away from home is not considered and unfortunately he
returns home where he dies a few hours later. There are number of ethical issues that
have risen from this scenario in relation to the violation of Amos’s human rights and
human dignity. The case study looks at these ethical issues in relation to a nurse’s
professional code of ethics and conduct, the relevant professional policies and
legislation, the principles of healthcare ethics and make recommendations for
professional practice.

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The ethical issues raised from this case study are, firstly, allocation of limited
medical resources in hospitals, as healthcare professionals do we have the right to
choose who gets to benefit from the limited resources and is there a criteria. Secondly,
do healthcare professionals have the right to turn patients away from obtaining
treatment,was the nurse and doctor’s decision to turn some of students away from
receiving treatment appropriate or inappropriate as per ethical standards. Thirdly, is the
violation of the right to health. As stated in the World health Organisation (1948) that it
is a fundamental right of every human being to attain the highest standard of health(
World Health Organisation 1948) and who enforces this right. Lastly, the failure of
healthcare professionals to recognize and respect the virtue of human dignity. Amos is

denied treatment that could have been potentially life saving, an injustice carried out by
healthcare professionals who are supposed to have a duty of care to their patient no
matter the circumstances or background.
Human dignity as a virtue(Sulsmay, 2007). Thomas Aquinas argues that human
dignity as a virtue should be honoured ,respected or observed. It is important for health
professionals to observe the dignity of the client (Amos)when delivering care.
Acknowledging human dignity when delivering care helps health care givers to deal
with challenging situations that arise during care for example in the instance of Amos
when treatment was not enough for every student, if human dignity was observed he
would have been treated as he had presented himself to hospital as all the other
students and even though there was a shortage of medication, there was still enough
to treat him. Health care settings restrict patients to exercise their dignity and
self-respect due to ill health and the way care is provided. A system has to be followed
and human beings have to submit to it in order to receive care. For example if a patient
was sick they would have to present to hospital but if dignity was to be observed, a
patient may choose to be treated at home.

The notion of the human right to health care, it is a fundamental right of every
human being to enjoy the highest attainable standard of health as stated in the
constitution of the World health organisation 1948. Healthcare providers are bound by
this right to protect and promote health in all people despite their race, religion or
background. The Universal Declaration of Human Rights states ” all human beings are
born free and equal in dignity and right”. In Australia, the Charter of of health care
rights allows all people giving and receiving care to work together in observing the right
to health(ACHR 2008). A question that arises from this case study is, are human rights
of less recognition in developing countries and are healthcare professionals in
developing countries such as Malawi aware of these fundamental human rights.
According to the Ministry of Health in Malawi, one of the guiding principles in delivering
care is ” Human Rights based approach and equity”.It states that all Malawians shall

have access to healthcare services without distinction and that these rights are to be
respected and protected by care providers. If such rights exist as indicated by the
Ministry of Health,the triage nurse and doctor were in breach of these fundamental
rights.

Nurses in Australia are governed by professional standards. These standard
include the code of ethics(NMBA 2018), the code of professional conduct(NMBA
2008), the NMBA National framework from the development of decision making tools
for nurses and midwifery practices and so on . All these professional standards provide
a framework for nurses to practice responsibly and safely when delivering clinical care.
All healthcare professionals are bound by principles of health care ethics, these
principles are there to guide healthcare professionals in making ethical decisions when
they are faced with dilemmas and making sure care is given and distributed fairly
among society. Healthcare professionals have the power to help or or cause harm as
well as easily take advantage of patients (Pellegrino, 2012 p.22).

Beneficence as a principle in health care refers to a moral obligation to take
actions that will benefit the others(Pallegrino, 1994). It is the duty and obligation of
healthcare professionals to assist and care for those in need of treatment. But what
happens when the resources (treatment) are simply not available for instance in
developing countries, What solution do healthcare care professionals have. Luck of
essential resources like drugs can cause moral distress on healthcare professionals
who work in developing countries leaving them to fall short of making ethical decisions.

Non-maleficence as principle means to do no harm ( Beauchamp & Childress,
2013). Healthcare givers are professionally bound by this principle, the breach of
non-maleficence is considered moral negligence and is associated with civil law
(Hunter 2000). In this case study the triage nurse and doctor were in breach of the

principle of non- maleficence by denying Amos treatment and in the end resulted in
loss of a life.

Justice is to distribute resources equally and fairly among society especially when
resources are scarce( Beauchamp & Childress, 2013). But when care providers are
confronted with so many ill patients and so little resources (treatment), how can justice
be exercised as fair and equal for everyone. According to Malawi medical journal the
scarcity and inadequate supply of Intensive Care Beds leads to hard ethical decisions to
be made about critically ill patients, requiring healthcare professionals to choice
between patients about who will benefit more from critical care. This choice denies the
other patient potentially beneficial treatment on the basis of scarcity of resources. So is
this justice, who is to blame for this kind of injustice.
Autonomy is described as freedom from external constraints and the presences of
critical mental capacity (Childress, 1990). A patient is free to make decisions about their
care according to what they think is right for them and health care professionals are to
respect and promote patient autonomy. But how autonomous is a patient or society with
limited resources.

In conclusion Healthcare professionals will always be faced with ethical dilemmas
and limited resources in the community as seen in the case study, it is of moral value
that the healthcare professionals remain ethical,follow professional codes of
ethics/conduct,practice in accordance with professional standards.

References
http://www.health.gov.mw/index.php/explore/guiding-principles ?.

Beauchamp, T. & Childress, J. (2013). Principles of Biomedical Ethics (7th ed). New
York: Oxford
Fry, S. & Johnstone, M. (2008). Ethics in Nursing Practice: A guide to ethical
decision-making, 3rd revised edition, Blackwell Science/International Council of Nurses,
London/Geneva.

Manda-Taylor, Lucinda. (2017). Critical care in Malawi: The ethics of beneficence and
justice. Malawi medical journal, 30(1). Retrieved from ?http://www.mmj.mw/?p=6319

Nursing & Midwifery Board of Australia (2017). Professional Standards. Retrieved from
http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professionalst
andards.aspx
Ozolins, J. (2015). Ethical Principlism. In J. Ozolins & J. Grainger (eds). Foundations of
Healthcare Ethics: Theory to Practice. Port Melbourne: CUP.

World Health Organisation (2017). Constitution of WHO: Principles. Retrieved from
http://www.who.int/about/mission/en/ ?.