Ethics Surrounding The Wayne Case Study Essay

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Ethics is a grey area in many instances within the medical community. Ethical codes help by providing guidance that allow for professional judgment or discretion and the idiosyncratic nature surrounding ethical dilemmas. As mentioned in the first lecture concerning ethics, ethics is mostly observed as being a serious reflective activity essentially concerned with a methodical inspection of the ethical life (Callaghan & Ryan, 2012). It is intended to illuminate what should be done by asking to consider and reconsider ordinary justification, actions, and judgments. In the case study, Wayne became afraid to tell anyone anything. Nurses did not know his condition and he was acting in a way that was violent. Medical staff that tended to him saw him as either mentally ill or anti-social. It seemed he was both. In the end, he was able to talk to a psychiatrist, one that he talked to before. He felt confident to reveal to her what happened because she talked to him prior.

However, this is an important and tricky situation to cover. During the court proceedings, the psychiatrist he had trusted revealed his violent and criminal history. This not only increased his already high level of paranoia, but also made it appear like the patient confidentiality aspect of medical care cannot be trusted. In lecture 6, the topic of common law duty to warn was covered. It describes the confidential and open nature of psychotherapy; how it encourages disclosure among patients.

If patients like Wayne feel apprehensive about discussing their issues to doctors, they may never get the treatment they need. Some medical staff, as mentioned prior, were unaware of how sick Wayne was. If he simply would have told them what happened to him before and his medical history he would have been dealt with in a better manner. However, now that he sees he cannot trust doctors because of that negative experience, it may lead to potential problems in the future.

Wayne had prior treatment. He still kept disregarding his medication and making it possible for his schizophrenia to come back. Nevertheless, if one takes it from the perspective of a criminal case, the psychiatrist had some right to reveal some of Wayne's history. Revealing his criminal history and his mental illness makes the case against him less criminal and more about getting him assistance with mental health problems. Sometimes doctors have to waive the patient confidentiality in certain situations.

Going back to lecture 6, It describes false positives- how prediction may have its limitations. No one knows how something will turn out, let alone how scenarios will play out. Therefore, thanks to the U.S. 1976 Tarasoff Decision, it became duty to safeguard third parties from a client's foreseeable violence. In this case, Wayne was known to be violent before. It was considered ethical to reveal his prior behavior so he may be treated appropriately and hopefully prevent future problems.

Regarding Wayne's interaction with medical staff during his six months of treatment, there were very unethically grey areas in the scenarios. First are the horse racing bets. Wayne providing betting tips to the staff can see that seen as unethical since medical staff are not supposed to engage with patients in that manner. Another odd occurrence was Wayne performing allocated tasks for the staff. He is a patient; he should be focused on recovering, not performing tasks for anyone in the hospital.

Medical staff have responsibilities and tasks that they must perform. Those that work in sanitation in the hospital should perform the tasks allotted to them not patients. Lecture 2 discusses Aristotle and the concept of virtue or a life lived through virtue. If someone (In Aristotle's perspective) lives a virtuous life, that person will be happy. The hospital staff are not being virtuous by gambling and letting patients provide them with "betting tips." Aristotle states that without justice, benevolence, and courage, people cannot achieve happiness, because these are fundamental virtues.

A virtue has several components and one of them is exercising of judgment in order to make choices. The medical staff were not exercising strong judgment. They, unlike Wayne, are of sound mind and body. They should not be teaching Wayne to behave in a certain way and should not engage in unlawful or frowned upon behavior. Mentally ill people are generally not regarded as capable in some regard and sometimes are treated as second-class citizens. If one desires to rehabilitate a mentally ill person, showing unethical behavior like as described in...

...

He could not drink or take drugs. If virtuous people would have influenced him, he may have had an easier time after he left the hospital. Evidence of hardship in regards to morality is the urine test that tested positive of cannabis as well as fluctuating medication levels. Wayne has to take his medication continually or else he risks another violent episode. Seeing that he disregards rules by smoking cannabis and not taking the recommended amount of medications provides evidence that he may stop taking his medication altogether like he in previous times.
When Wayne began being treated by the community team, another ethical grey area came from the team's awareness of his occasional drug use. Staff are supposed to alert doctors and psychiatrists if someone like Wayne uses drugs. This could be a potential red flag and could prevent someone like Wayne (a violent schizophrenic), from reacting again in a violent manner. Lecture 3 discusses Kantian ethics. What are Kantian ethics?

The lecture much like the case study, discusses an example of a young male schizophrenic like Wayne, who behaved violently towards someone else. The scenario asks what should be done. Either prevent him from hurting someone else, or seek to help him rehabilitate. Kantian ethics cover how a person behaves ethically when decisions are consistent with her or his genuine rational nature and are done free from force by others as well as cultural and social conventions. It also states morality is not negotiable and moral law must apply to everyone that possesses a free will.

Some like Wayne or Jason, who can be a serious threat to society may be viewed from the perspective of Kantian Ethics. They should not be allowed to deviate from the treatment plan, even in the slightest. With Wayne taking cannabis, this is immoral and unethical under the Kantian ethics lens. If Wayne were with a community team that believed in this way, he would have faced serious consequences for failing a drug test. In Kantian ethics, the motive of duty is always present and should be regarded with importance and finality.

This analysis is meant to focus on the hospitalization and leave stage of the case study from the perspective of the doctor and the patient. The last section focused on the perspective of the doctor. This next section will focus on the perspective of the patient. Perspective changes and skews ethics. It may seem like it would be more or less the same if approaching a scenario objectively, but subjective interpretation creates a lens that makes a situation either more negative or more positive than what it really is.

Lecture 4 explains the concept of Utilitarianism. In it, they also provide information for a distint scenario that applies in the Wayne case study. If someone for example Wayne, is on a forensic order and does not comply, i.e., does not take his medication, he under the 2000 Mental Health Act, can face returning to a mental health facility. There are several instances where Wayne shows non-compliance with the conditions of his LCT and because of that, amount and conditions of his leave during his six-month hospital change was changed.

It also came into play when he was trying to get a job and was regressing with continued and more frequent drug use. If anyone during his treatment thought his minor regressions were harmless, the last part of the doctor perspective showed that was not the case. He ended up reverting almost entirely by cursing on the phone and mentioning he heard the female voice again. People like Wayne cannot be taken lightly when addressing his issues. Revealing criminal history like was done in the court proceedings would have been helpful when he was attempting to get a job around girls and women.

Moving into the client perspective, just as mentioned in the doctor perspective, Wayne explained he felt very anxious and worried about trusting people. Utilitarianism is about doing what is right based on the consequences. " ... an act is right if its consequences are at least as good as those of any alternative" (Ward, 2011, p. 36). Although Wayne was violent towards another person, the courts saw him as a mentally ill person so instead decided to rehabilitate him. It was clear reading his perspective; he has serious mental health issues. When regarding Bentham's utilitarianism, only…

Sources Used in Documents:

References

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Callaghan, S., & Ryan, C. (2012). Rising to the human rights challenge in compulsory treatment - new approaches to mental health law in Australia.Australian And New Zealand Journal Of Psychiatry, 46(7), 611-620. http://dx.doi.org/10.1177/0004867412438872

EMANUEL, L. (2000). Ethics and the Structures of Healthcare. Cambridge Q. Healthcare Ethics, 9(02). http://dx.doi.org/10.1017/s0963180100902032

Fins, J., Miller, F., & Bacchetta, M. (1997). Clinical Pragmatism: A Method of Moral Problem Solving. Kennedy Institute Of Ethics Journal, 7(2), 129-143. http://dx.doi.org/10.1353/ken.1997.0013
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Lazzaretto-Green, D., Austin, W., Goble, E., Buys, L., Gorman, T., & Rankel, M. (2011). Walking a fine line: Forensic mental health practitioners' experience of working with correctional officers. Journal Of Forensic Nursing, 7(3), 109-119. http://dx.doi.org/10.1111/j.1939-3938.2011.01107.x
McSherry, B. (2001). Confidentiality of psychiatric and psychological communications: The public interest exception. Psychiatry, Psychology And Law, 8(1), 12-22. http://dx.doi.org/10.1080/13218710109525000
Moulden, H., & Firestone, P. (2010). Therapist Awareness and Responsibility in Working With Sexual Offenders. Sexual Abuse: A Journal Of Research And Treatment, 22(4), 374-386. http://dx.doi.org/10.1177/1079063210382047
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The concept of boundaries in clinical practice: theoretical and risk- management dimensions. (1993). American Journal Of Psychiatry, 150(2), 188-196. http://dx.doi.org/10.1176/ajp.150.2.188
Ward, T. (2013). Addressing the dual relationship problem in forensic and correctional practice. Aggression And Violent Behavior, 18(1), 92-100. http://dx.doi.org/10.1016/j.avb.2012.10.006
Winick, B. (2008). A Therapeutic Jurisprudence Approach to Dealing with Coercion in the Mental Health System. Psychiatry, Psychology And Law,15(1), 25-39. http://dx.doi.org/10.1080/13218710801979084


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