Case study of Oswald v. Le Grand in 1990.
Assignment must be ORIGINAL – Plagiarism free, make a proper APA reference to the article, format with peer-reviewed references only!.
1. Please clearly write a summary of the case study.
2. Answer the following questions
How does this case impact you as a nurse about to practice?
Which ethical term did the case violate? (Use the proper legal and ethical terminology)
Plaintiffs Susan and Larry Oswald have been married for ten years and are the parents of two healthy sons. During Susan’s third pregnancy, she began experiencing bleeding and painful cramping just prior to her five-month checkup. At that time, she was under the care of a family practice physician, defendant Barry Smith. He ordered an ultrasound test and Susan was then examined in his office by one of his colleagues, defendant Larry LeGrand, an obstetrician. Neither the test nor the examination revealed an explanation for the bleeding and Susan was instructed to go home and stay off her feet. Later that day, however, Susan began to bleed heavily. She was taken by ambulance to defendant Mercy Health Center. The bleeding eventually stopped, Dr. Smith’s further examination failed to yield a cause of the problem, and Susan was discharged the following day with directions to take it easy.
The following day, Susan’s cramping and bleeding worsened. Susan thought she was in labor and feared a miscarriage. She was unable to reach Dr. Smith by telephone and so Larry drove her to the emergency room at Mercy. There Dr. Christopher Clark, another physician in association with Smith and LeGrand, examined her. He advised her there was nothing to be done and she should go home. Larry was angered by this response and insisted Susan be admitted to the hospital. Dr. Clark honored this request and Susan was transferred to the labor and delivery ward.
In considerable pain and anxious about her pregnancy, Susan’s first contact on the ward was with a nurse who said, “What are you doing here? The doctor told you to stay home and rest.” Susan felt like “a real pest.” A short while later, while attached to a fetal monitor, Susan was told by another nurse that if she miscarried it would not be a baby, it would be a “big blob of blood.” Susan was scared.
The next morning, an argument apparently ensued over which physician was responsible for Susan’s care. Standing outside Susan’s room, Dr. Clark yelled, “I don’t want to take that patient. She’s not my patient and I am sick and tired of Dr. Smith dumping his case load on me.” At the urging of Larry and a nurse, Dr. Clark apologized to Susan for this outburst. He assured her that he would care for her until he left for vacation at noon that day when he was scheduled to go “off call” and Dr. LeGrand would take over.
Around 9:00 a.m. Susan began experiencing a great deal of pain that she believed to be labor contractions. Dr. Clark prescribed Tylenol and scheduled her for an ultrasound and amniocentesis at 11:00 a.m. By that time, Susan was screaming in pain and yelling that she was in labor. Dr. Clark arrived in the x-ray department halfway through the ultrasound procedure and determined from viewing the sonogram that there was insufficient fluid in the amniotic sac to perform an amniocentesis. He told the Oswalds that the situation was unusual but did not reveal to them
- Basic and obvious moral truths that guide deliberation and action
- Presuppose a basic respect for persons
- Included in moral theories, although sometimes in different ways
Respect for Autonomy
- Definition: self-governing
- Freedom to make decisions about issues that affect one’s life free from lies, restraint, or coercion.
The autonomous person
- Is respected
- Is able to determine personal goals
- Has the capacity to decide upon a plan of action
- Is free to act on choices
Think About It
- A homeless psychotic man stops his anti-psychotic medication because it makes him sleepy.
- How do you view this man’s autonomy?
- Are there subtleties of autonomy in this case?
Think About It
- Is autonomy good?
- Should patients be autonomous?
- How far should autonomy go?
- Can you reconcile the concepts of personal autonomy and noncompliance?
- Value of autonomy is culturally dependent.
- Some cultures don’t regard all people as of equal value.
- Some cultures value social structure over individual rights.
- Respect for autonomy does not require respect for all autonomous decisions.
- Must uphold respect for self and others who might be harmed by another’s choices.
- Respect the principle rather than each action or choice.
- Practical application of the principles of respect for autonomy.
- Demonstrates legal protection of personal autonomy in regard to specific medical treatments and procedures
- Contemporary informed consent is a direct outcome of past research atrocities.
Paternalism and Advocacy
- Paternalism: places power in the hands of the person who is making the decision for the patient. Implies that the decision maker knows what is best.
- Advocacy: ensures the patient’s welfare and respects the patient’s autonomy because it aims to act according to the patient’s values.
- May unwittingly cross from advocacy to paternalism
- Lack of participation in a regimen that has been planned by the health care professional but must be carried out by the
ETHICS AND NURSING
- It is through the intimacy and trust of the nurse-patient relationship that nurses become critical participants in the process of ethical decision making.
- By developing a working knowledge of ethical theory, nurses can make clear and consistent decisions.
- The intense and critical examination of beliefs and assumptions.
- It gives coherence to the whole realm of thought and experience and offers principles for deciding what actions and qualities are most worthwhile.
- It gives shape to what would otherwise be a chaos of thoughts, beliefs, assumptions, values, contradictions, and superstitions.
- Provides a framework for cohesive and consistent ethical reasoning and decision making.
- The best moral theories are part of larger integrated philosophies.
- Two moral theories having the greatest influence on contemporary bioethics and nursing: utilitarianism and deontology.
MORALS AND ETHICS
- Moral philosophy is the philosophical discussion of what is considered good or bad, right or wrong, in terms of moral issues.
- Moral issues are those which are essential, basic, or important and deal with important moral issues.
- Ethics is a formal process making logical and consistent decisions, based upon moral philosophy.
- Ethical theories explain values and behavior related to cultural and moral norms.
- As a morally central health care profession, nursing requires astuteness concerning moral and ethical issues.
- Professional codes of ethics provide a formal process for applying moral philosophy and ethics.
- Regards ethics as dependent upon nature and psychology.
- Proposes that nearly all people have a tendency to make similar ethical decisions despite differences in culture.
- Sympathy is a motivating factor in moral decision making.
- Rationalists believe feelings or perceptions, though they may seem similar in many people, may not actually be similar in all people.
- Believe there exist universal truths, independent from humans, that can be known through the process of reasoning.