Step 1

Yes, the case involves an ethical dilemma. The patient’s family and the healthcare providers are at crossroads as regards making a choice because decision making has become difficult and needs a well thought out solution that adheres to the ethical guidelines. The healthcare providers feel that they should let the patient know the condition that the patient is suffering from, but the grandmother who also adds up as the guardian has directed that the child should not be told about the diagnosis with HIV/AIDS.

One of the ethical values in the CNO Ethics standard that relates to the case is truthfulness and acting with integrity and honesty. The healthcare team is being compelled to lie to the patient hence breaching professional ethical values. Healthcare practitioners are expected to be truthful in their practice but they are compelled to lie by the guardian of the patient, and this is in conflict with the case. The privacy and confidentiality ethical value also relates to the case because the guardian wants the confidentiality of the diagnosis maintained so that the patient is not informed about the two conditions. The healthcare providers feel that the patient should know about all the diagnosis results but the guardian advises otherwise.

The ethical principles from LHO that relate to the case include the nonmaleficence and veracity ethical principles. The nonmaleficence ethical principle dictates that the patients should be protected from harm and any actions that may cause harm. The principle is applied when healthcare practitioners identify a patient risk and work to prevent the patient from any harm as a result of the risk. While the healthcare providers have not seen any harm of telling the patient about the diagnosis with HV/AIDS, the Guardian thinks that telling the patient about the condition could be a risk and asks the team not to tell the patient about it.

The veracity ethical principle also comes in when the healthcare team is asked to protect the patient from the truth intentionally. The healthcare team is not comfortable with the request from the guarding to protect the patient from the truth because this is contrary to the ethical principles.

Step 2

Step 2a: Gather all relevant information.  Identify known and unknown facts and evidence. Consider medical indications, client capacity, and preferences, quality of life and client safety, social, legal and economic factors.

The child has a long history of sickness which seems to be well documented and the healthcare team knows that she has a few days to live. The guardian doesn’t want the healthcare team to reveal to the child about the diagnosis of HIV/AIDS. Such a shocking revelation can cause stigma and may also end the life of the patient before the right time comes because of stress. Knowledge of the diagnosis can contribute to further deterioration of the patient’s condition. The patient may not be in a position to make a decision concerning confidentiality and privacy because they are young and may not understand most of the ethical guidelines. The patient may not benefit from the autonomy ethical principle because they are still young to make choices and decisions on their own. The Guardian is therefore justified to make some of these decisions on behalf of the patient because it is clear from the case study that there are growth problems and the long medical history indicated that they are critically ill to make any decisions on their treatment and diagnosis. The long medical history of the patient at their age makes it difficult to save their life because the immune system is not well developed at that age. The patient does not have the capacity to make decisions because they are facing death as the case points out. Critically ill patients have no capacity to make decisions and give their preferences and can only depend on their families, relatives, guardians, lawyers of medical practitioners to make certain decisions. The quality of life of the client has deteriorated and has to rely on medical support to survive. The fact that the medical team has indicated that the patient has a few days to live, it is a sign of a critical condition and poor quality of life. The patient is in the hospital with a guardian who is their grandparent. It shows that the parents are not are not around or alive because they would be in the company of their child at such a critical moment. The social setting that the child may be living could have contributed to the poor health reported by the medical team. The cases of pneumonia attack might be a result of cold and lack of proper clothing or housing to protect the patient from such conditions. The child may have been born with HIV/AIDS or infected. Most children born with HIV/AIDS or infected and not diagnosed at an early stage are likely to suffer such infections and other life-threatening conditions which weaken their immune system and could result in death. The child may not be coming from a background that is well off economically could be the reason that she has not been treated to manage the condition. Most children who are born or diagnosed with HIV/AIDS at an early stage are able to get treatment to manage the condition well and lead a normal life. The economic factors may have played a significant role in the deterioration of the child’s health.

While the healthcare team is in a dilemma whether to tell the child about the diagnosis, there may be no legal implications for the same because the guardian makes the decision for the child since they have not attained the legal age for making decisions independently.

Step 2b: Consider policies, guidelines, professional standards, code of ethics and relevant legislation which relate to this case study(support with evidence of research).

There are a number of policy guidelines, professional guidelines and relevant legislation that are related to the case. One such legislation is the right to information where the patient has the right to get information about their health and the diagnosis (Edozien, 2015). While mature people have the right to make decisions on their medical care, the children rights are limited because they cannot think around complex issues and the parents have to make most of the healthcare decisions. However, the children are entitled with the right to information on their health as long as such information does not interfere with their emotional well being, health and growth (Bolton, 2015). The healthcare providers are required to give children information on their health on consultation with their parents and experts to understand whether there are possible negative implications of giving the children such information. Sometimes the decisions made by the parents or guardians may not be the right ones (Parent, 2017). The decisions may also affect the children or result in legal liability on the side of the healthcare practitioners and it’s necessary for the healthcare providers to seek the support of ethics experts to avoid legal implications.

Step 3

Step 3a: Identify and Evaluate Stakeholders Responsibilities & Perspectives

Complete the chart below by considering the following for each identified stakeholder:

• What are their responsibilities (roles, duties or obligations) in this situation?
• Which of their values, beliefs, goals or assumptions will affect this decision?

Step 3b: Identify where conflicts exist by reflecting on the following questions:

• Do the responsibilities of one stakeholder conflict with others’ responsibilities or perspectives?

Yes, there are a number of conflicts that emerge in the case where the guardian is supposed to make the healthcare decisions of the patient but the healthcare team is concerned that the decision to conceal the diagnosis information from the patient is not right and is a breach of the ethical values and principles. On the other hand, the guardian believes the decision will be in the best interest of the patient.

• Do the values, beliefs or goals of one stakeholder conflict with other’s responsibilities or perspectives?

Yes, the patient has the right to information but the guardian believes that certain information about diagnosis should be withheld from the patient for some reasons. This conflicts the right to information that the patient has which is limited by age and capacity. The healthcare providers are bound and guided by the ethical values that require truthfulness and sharing of all the information with the patient. However, this value and goal are in conflict with the guardian’s request to conceal the HIV/AIDS diagnosis from the patient. The reverse is also true since the guardian has the goal of ensuring that any healthcare decision made does not affect the patient and that is the reason they are asking that the information on HIV/AIDS diagnosis is withheld from the patient. As a result, the healthcare team thought of giving the patient this information contradicts the goal and values guiding the guardian.

• Do any stakeholders’ perspectives hold greater weight/priority? Why?

Yes, the position of the guarding requesting that the diagnosis of HIV/AIDS should not be revealed to the patient holds greater weight because it is the guardian who has the responsibility of giving consent about anything on the patient since the patient does not have the capacity to give consent because of their young age and health condition.

Step 4

Examine and determine your own values on the issues presented in the case, and how that might impact your ethical perspective?

One of my values on the issue present is client wellbeing. The wellbeing of the client is very important and if concealing the diagnosis information will make the client feel better, my perspective would support the guardian decision considering that the patient is a child and the guardian understands better what is good for child psychologically.

Step 5

Write out the issue/problem – a clear, simple statement. Ensure that you identify the problem in terms of ethical values/principles

The issue is veracity where care providers are expected to be truthful. In the case, the health care team is being requested to protect the patient from the truth which is against the veracity ethical principle for healthcare workers.

Step 6

Brainstorm all possible options or courses of action. For each identify the Pros/Benefits and the Negatives/Consequences. Consider the stakeholders when considering all of the options.

Step 7

Make or recommend a decision and provide the justification/rationale. Based on the full analysis of the options, determine which option best addresses the situation.

The healthcare team should make the guardian sign a consent form directing that the patient should not be made to know of the HIV/AIDS diagnosis. Informed consent protects both the guardian and the healthcare team (Cohen, Wright, Cooney & Fried, 2015). Such consent will protect the healthcare team from any legal liability and disciplinary action. The healthcare team will have a binding document protecting their actions because guardians in the absence of parent are legally allowed to make healthcare decisions on behalf of minors (Committee on Bioethics, 2016)

References

Bolton, H. (2015). The Montgomery ruling extends patient autonomy. BJOG: An International Journal of Obstetrics & Gynaecology,                 122(9), 1273-1273.

Cohen, A. B., Wright, M. S., Cooney, L., & Fried, T. (2015). Guardianship and end-of-life decision making. JAMA internal medicine,                    175(10), 1687-1691.

Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), e20161484.

Edozien, L. C. (2015). UK law on consent finally embraces the prudent patient standard. BMJ: British Medical Journal (Online), 350.

Parent, W. A. (2017). Privacy, morality, and the law. In Privacy (pp. 105-124). Routledge.