Mr R had a better day on Tuesday, but his pain persisted. No agitation or suicidal ideas. Mr R obsessivelyadjusted his postoperative gadget. Rita noticed mood improvement despite some issues:location.mood swings & uncertainity about his dischargeagitation mood swings and uncertainty about his discharge location the prefers living in Sydney withouthis brother).Rita examined Mr R eight days after surgery and found his mood improved and no suicidal ideation,indicating mood stability. Two days earlier his mood deteriorated briefly. This did not cause suicidalthoughts. Rita addressed Mr R's discharge plan with his brother, who said it was too soon to release himfrom the hospital despite Mr R's good attitude. Rita reported to Prof. S. Mr R was released that day.at the hospital and wittnessed him enter theTwo days later Mr R's brother dropped him off at the Hospital's entrance and witnessed him enter theadministration area. Mr R stayed in the Summit Apartments, a nearby hotel, instead of the Hospital. 10:20am. Mr R texted his brother at 11h30. This text implied:believed he was imporperly reintroduced to TRO's medicine.His Pain worried Mr R. Mr Relieved he was improperly reintroduced to TRD's medicine supervisionand pain management; The treatment team didn't believe or listen to him; He may not have had theoperation if he had been warned of such anguish. Medical advice and therapy could have saved him.saw MIR fall aff balcony at 11:30am (8th floor)MrRAn eyewitness fall off his halcony at 11:00 am (9th floor)What are the ethical and legal issues? explain competing claims or interests and analyse ethical tensionsusing ethical principles Rita, a psychiatric nurse, treats Treatment-Resistant Depression with a multidisciplinary team (TRD). Ritadismisses patients. Her team leader, Prof S, uses her reports to discharge patients. Mr R jumped from the8th floor of a nearby hotel after being discharged.Mr R's family has expressed concerns regarding his Coroners Court treatment. Included:Appropriateness of the treating nursing team's qualifications, assessments, and role in Mr R's hospitalrelease;A lack of an effective permission process for the installation of a Deep Brain Stimulator] (DBS) and afailure to inform Mr R that suicide and irreversible mood/personality alterations were dangers of DBSsurgery;Clinicians not communicating with Mr R's family; DBS complications; Hospitalization for physical andmental issues; His medical advice and treatment could have saved him.Case MrR-21 was diagnosed with depression at 15. MrR Self-reported over 30 ineffective / PoorlyMER self reported over 20 ineffective and/or noodlytolerated drug attempts and an ineffective course of electroconvulsive therapy when Rita met him. He triedexperimental treatments after these failed. Rita offered to Mr R that enrol in a new experimental TDR DBStrial during their first encounter. She co-researches this experiment with Prof. S.Mr R sought Prof S to engage in the experimental DBS trial to target his TRD one week after Rita's firstencounter with him. Mr R's brother attended the consultation. Prof S informed Mr R that DBS may treatTDR symptoms experimentally. Prof S told Mr R that a DBS operation could cause death, permanentdisability, brain or IPG infection. seizure disorder, and irreversible mood/personality abnormalities. Mr Rwas informed DBS therapy may not relieve his symptoms. Mr K's brother now denies that he was warnedof irreparable mood and personality changes.The informed consent Mr R signed stated: "The doctor may [...] withdraw you from the trial at anymoment it he/she thinks this to be in your best interest. Une month later, Mr K's surgery went smoothlyand his wounds healed. Mr R implanted bilateral subcallosal cingulate cortex stimulators.On Thursday, one day after surgery. Mr R complained to Rita of headaches and said. "I feel like I am whoI am today, but it's not me that went into the surgery. Mr K had suicidal thoughts and felt self-estranged.He said his only reason for not acting was wanting to make it permanent. Rita listed several causes ofconcern in her records:Brain surgery caused Mr R great agony. His DBS device, which just restarted, wasn't working well.Rita thought Mr R was dysphoric/depressed and hypomanic. She thought DBS stimulation causedhypomaniaMr R complained of a "twisting" head discomfort to Rita on Monday. Mr R attributed the pain tostimulation and morning drugs. Over the weekend, he informed Rita he felt self-estranged, irritated, andsuicidal. Rita reported that Mr R's discomfort caused suicidal thoughts.The next morning, Prof S upped Mr R's DBS voltages. Rita stated Mr R was "extremely dissatisfied andirritated" that afternoon. He regretted his voltages weren't "tweaked earlier". Rita stated he may notimprove every day. Mr R wanted further TDR improvement after implantation. DBS or stress? unsure.weekends. "I don't recognise my brother since the surgery " Rita's brother said in a work voicemail. He'simpulsive and constantly changing his opinion".The treating team recommended device removal due to severe side effects, believing that additionaltherany would not be beneficial Mr R resisted device removal despite the trial's ineffectiveness and severesuicidality.

Question

Mr R had a better day on Tuesday, but his pain persisted. No agitation or suicidal ideas. Mr R obsessivelyadjusted his postoperative gadget. Rita noticed mood improvement despite some issues:location.mood swings & uncertainity about his dischargeagitation mood swings and uncertainty about his discharge location the prefers living in Sydney withouthis brother).Rita examined Mr R eight days after surgery and found his mood improved and no suicidal ideation,indicating mood stability. Two days earlier his mood deteriorated briefly. This did not cause suicidalthoughts. Rita addressed Mr R's discharge plan with his brother, who said it was too soon to release himfrom the hospital despite Mr R's good attitude. Rita reported to Prof. S. Mr R was released that day.at the hospital and wittnessed him enter theTwo days later Mr R's brother dropped him off at the Hospital's entrance and witnessed him enter theadministration area. Mr R stayed in the Summit Apartments, a nearby hotel, instead of the Hospital. 10:20am. Mr R texted his brother at 11h30. This text implied:believed he was imporperly reintroduced to TRO's medicine.His Pain worried Mr R. Mr Relieved he was improperly reintroduced to TRD's medicine supervisionand pain management; The treatment team didn't believe or listen to him; He may not have had theoperation if he had been warned of such anguish. Medical advice and therapy could have saved him.saw MIR fall aff balcony at 11:30am (8th floor)MrRAn eyewitness fall off his halcony at 11:00 am (9th floor)What are the ethical and legal issues? explain competing claims or interests and analyse ethical tensionsusing ethical principles Rita, a psychiatric nurse, treats Treatment-Resistant Depression with a multidisciplinary team (TRD). Ritadismisses patients. Her team leader, Prof S, uses her reports to discharge patients. Mr R jumped from the8th floor of a nearby hotel after being discharged.Mr R's family has expressed concerns regarding his Coroners Court treatment. Included:Appropriateness of the treating nursing team's qualifications, assessments, and role in Mr R's hospitalrelease;A lack of an effective permission process for the installation of a Deep Brain Stimulator] (DBS) and afailure to inform Mr R that suicide and irreversible mood/personality alterations were dangers of DBSsurgery;Clinicians not communicating with Mr R's family; DBS complications; Hospitalization for physical andmental issues; His medical advice and treatment could have saved him.Case MrR-21 was diagnosed with depression at 15. MrR Self-reported over 30 ineffective / PoorlyMER self reported over 20 ineffective and/or noodlytolerated drug attempts and an ineffective course of electroconvulsive therapy when Rita met him. He triedexperimental treatments after these failed. Rita offered to Mr R that enrol in a new experimental TDR DBStrial during their first encounter. She co-researches this experiment with Prof. S.Mr R sought Prof S to engage in the experimental DBS trial to target his TRD one week after Rita's firstencounter with him. Mr R's brother attended the consultation. Prof S informed Mr R that DBS may treatTDR symptoms experimentally. Prof S told Mr R that a DBS operation could cause death, permanentdisability, brain or IPG infection. seizure disorder, and irreversible mood/personality abnormalities. Mr Rwas informed DBS therapy may not relieve his symptoms. Mr K's brother now denies that he was warnedof irreparable mood and personality changes.The informed consent Mr R signed stated: &#34;The doctor may [...] withdraw you from the trial at anymoment it he/she thinks this to be in your best interest. Une month later, Mr K's surgery went smoothlyand his wounds healed. Mr R implanted bilateral subcallosal cingulate cortex stimulators.On Thursday, one day after surgery. Mr R complained to Rita of headaches and said. &#34;I feel like I am whoI am today, but it's not me that went into the surgery. Mr K had suicidal thoughts and felt self-estranged.He said his only reason for not acting was wanting to make it permanent. Rita listed several causes ofconcern in her records:Brain surgery caused Mr R great agony. His DBS device, which just restarted, wasn't working well.Rita thought Mr R was dysphoric/depressed and hypomanic. She thought DBS stimulation causedhypomaniaMr R complained of a &#34;twisting&#34; head discomfort to Rita on Monday. Mr R attributed the pain tostimulation and morning drugs. Over the weekend, he informed Rita he felt self-estranged, irritated, andsuicidal. Rita reported that Mr R's discomfort caused suicidal thoughts.The next morning, Prof S upped Mr R's DBS voltages. Rita stated Mr R was &#34;extremely dissatisfied andirritated&#34; that afternoon. He regretted his voltages weren't &#34;tweaked earlier&#34;. Rita stated he may notimprove every day. Mr R wanted further TDR improvement after implantation. DBS or stress? unsure.weekends. &#34;I don't recognise my brother since the surgery &#34; Rita's brother said in a work voicemail. He'simpulsive and constantly changing his opinion&#34;.The treating team recommended device removal due to severe side effects, believing that additionaltherany would not be beneficial Mr R resisted device removal despite the trial's ineffectiveness and severesuicidality.

Accepted Answer

Mr R was a patient diagnosed with Treatment-Resistant Depression (TRD) who was treated by a…