In every career, ethical issues are to be adhered to so as to concur with the legal standards of the profession. In the nursing career, many individuals are faced with ethical and legal dilemmas. A nurse’s professional competence statement should integrate the theoretical knowledge dealing with ethical aspects in relation to the legal viewpoints of health care values. These are the vital elements that should be integrated into the nursing profession (GLANNON 2005, P. 22). Therefore, acknowledging the ethical dilemmas in the nursing profession highlights the ways in which these have been dealt with in the past. This brings into account the malpractices present in the profession and strategies in which the nurses can prevent themselves into getting trapped (ESPEJO 2002, P. 57).
In ethical laws, it is significant to become aware of the differences between the two. In ethics, actions and values of people are examined in that; when one is faced with a dilemma, a problem occurs in determining the right way to deal with it. However, when faced with such dilemmas, the guiding principle is the meaning that laws are binding and when breached, one is liable to punishment according to Webster’s Online Dictionary.
In highlighting current circumstances as pertains to law and ethics, various examples would help in understanding the issue at hand (GLANNON 2005, P. 42). Therefore, we look at action that pertains to ethical and the legal case. In this situation, a nurse who follows orders from a doctor may be faced with a decision that is ethical but not legal in that the nurse allows a patient suffering from cancer to continue inhaling herbs for the purpose of medicinal value. This in the medical world may not be allowed by most professionals, but on the other side, the action may be legally punished due to the laws of the land warranting the individual and the nurse to imprisonment. In the other case of an action being legal but not ethical, this can be looked at in the dimension of a certain state allowing abortion. According to moral standards, abortion is seen to be unethical. In making such contradictory errors, the nursing code of ethics becomes a guide to which action should be taken. This reduces risks taken by many nurses especially when it comes to dealing with such cases (GLANNON 2005, P. 55).
These points out a bigger problem on the decisions made as many nurses take appropriate action so as to save lives. For instance, when a mother is giving birth and a complication arises, there is a tough decision to either save the mother and let the child die or save the child and let the mother live. With such incidences, the ethical aspects engage in a tug of war with the legal aspects of the medical profession. In looking at the case studies below, certain ethical principles are to be followed in attending to such cases.
Sara Baines is a forty two year old woman who has been diagnosed with multiple sclerosis. She is on a neurological ward for tests as her condition has worsened over the last 12 months, and she now uses a wheelchair and requires considerable nursing input from her partner, Louise. Sara is a well respected lawyer with an impressive record in disability rights, and is intractably opposed to euthanasia. While you are reading her notes, you discover that the doctors have decided to assign a ‘Do Not Resuscitate’ (DNR) note in her file. You are certain that neither Sara nor Louise is aware of this. In discussing the professional, ethical and legal aspects of this case, the following are highlighted:
Ethical principles related to cultural norms are usually considered whenever an attempt to resuscitate at the beginning and the ending of the treatment process. As in the case above, the physician commonly has a role to play especially when resuscitation decisions are to be made. However, this should be influenced by scientifically verified information and done according to the patient’s freedom of choice. In explaining this in depth, the following highlights the patient’s independence in decision making (HEALEY 2002, P.58).
Patient Autonomy Principle
This is mostly to be accepted in the ethical and legal aspects in that the assumption derives the notion that the patient has an understanding of what the treatment might involve. This informs on the agreement of the intervention or denial of the procedure. Among the adults, the norms for decision making are that they are legally capable to undertake such measures unless they are deemed to be deprived of efficiency or not competent by the Court of Law. Therefore, a consented decision is vital in enhancing that ethical and legal mechanisms are followed with all patients.(HEALEY 2008, P.5) says, “Adult patients make their own decisions unless they are incapacitated or declared incompetent by a Court of Law”. An authentic decision that is made in awareness is one that the patient comes to the knowledge that his condition is to be intervened in the suggested manner and the risks involved are to be highlighted in relation to the alternatives and benefits. The choices are to be given so that the patient has the freedom to decide on matters that involve his or her life and thus come to the understanding of the values attached to the decision. But incase the treatment is not clarified; the patient is to be assisted in any way until such a time that they can be fully aware of the choices available.
The four main principles
These principles give provisions that use an approach that is simple and accessible. In this sense, it becomes lenient to the cultural norms thereby integrating ethical issues that are considered in health issues. This approach was adopted and acquired in the United States with the fundamental principle of apparent moral responsibility of respect, justice, malfeasance and beneficence in relation to their applied nature. However the principles are not prescriptions that offer rules and legalities but are useful to health workers in making decisions which reflect their ethical and moral competence at work (HEALEY 2002, P.58)
In using the word “prima facie”, Ross states that it means the principle is valid or binding in the sense of legality therefore in the case of a misunderstanding with other moral principles, then, it is befitting to choose between the two. However, this does not mean that the approach of the four principles is a preference method but they have to be perceived as commitments which are moral factors that initiate an action or process that inform the relevant individuals in question. Thus in considering each case in question, the principles are to provide an approach that highlights the way forward according to one’s own judgment and conscience thereby analyzing each case (HEALEY 2008, P.58). To understand further, the following paragraphs will delve into saying more about the four principles.
Respect for autonomy
In the dictionary, autonomy is defined as a self rule attributed to moral causative substance. In using the definition we can then say that when an individual has autonomy, decision making is on the basis of deliberated actions which influence the events that lead to the action taken (MCMILLAN ET AL 1987, P.84). Therefore, people act in regard to implementing their actions out of their will or intended action. However, as we make our own decisions, respect for autonomy has an obligation that makes us aware of those who are around us. With this in mind, we can then come to respect the autonomy of those who are to be affected by the actions taken as a result of the decisions made. In emphasis, respect for autonomy in Kantian terms can be described as seeing others in the light of them being ends rather than means to an end a formulation known as “Categorical imperative.” This is treating others as ends in themselves and never merely as means.
In relation to the health sector, respect for autonomy has various implicit understandings as it directs people to deliberate with the aim of coming to an agreement before jumping into conclusions. Thus in looking at the above case study, many implications arise. In the case of Sara, she is suffering and her condition worsens day by day. In contrary, her file contains information that is supposed to be given to her by the authority involved. Thus, when the doctors make a decision, they need to consult so that she can be free to decide on what should be done. In addition, she should have the capability to free Louise who has been assigned to her for the length she continues to live.
In the medical world, respecting their autonomy requires confidentiality. This does not mean keeping secrets of their situation, but rather having the standards of releasing that information with the consent of the patient. Therefore, holding information from the rightful owner denies their rights to access material and information regarding her life (BACH, J, S, BURSELL, S, & SZUMSKI, 1987 P.18).
This requires the patients not to be deceived in any manner but reorganize their lives in ways that respect their rights to personal information unless they choose not to be informed. In enforcing these rights, the health workers should be good communicators to really finding out what the patient wants in regard to their personal diagnosed information.
Beneficence and non-malfeasance
In the sector of care, there is a possibility of hurting patients either through negligence or incompetence on the side of the care giver. This is where the principles of beneficence and non- malfeasance are important. However, the two should be given considerations since beneficence is generosity or charity while non-malfeasance is being nasty or vicious. Both of them play a major role in making sure that patients get benefits with minimal harm as required by health professionals (YOUNG 2007, P.46). In health profession requirements, there needs to be effectiveness in training health workers to benefit patients. This leads the workers to respect the autonomy of patients thus allowing freedom of choice in ways that befits them. In the case study above, Sara needs to be respected in being able to come to the agreement of what is best for her as regards her treatment. In addition, the health care obligation requires clarity to risks and anticipations whenever evaluations are made in relation to what is best for the patient.
Recently, the approach taken by professionals has been empowerment which has mainly focused in helping patients to have more power in determining their health and how they would want to be taken care of. Thus in retrospect, empowerment integrates beneficence and respect for autonomy thereby assisting patients to strategize their control.
This means fairness and is a moral duty to act in relation to objective mediation between two contentions. In viewing justice, three categories are to be discussed which are distributive justice, legal and rights based justice. In justice, equality is the main aim since controversies have merged that people can be treated equally in unjust systems. In health care relations, resources distribution clashes with moral concerns and to meet the needs of all people is difficult if the resources are not evenly distributed. Therefore distributive justice serves to bring equilibrium so that health care needs are met. In meeting peoples’ needs, justice is needed to allow people with choices to take care of their own health (O’NEILL 1994, P. 25).
The health sector is dependent on the informal health careers especially in areas where medical facilities are scarce in helping relatives and those lacking the mental know how to take care of themselves. The motto among the health care givers should be to say that there will be no decisions made without the patient’s authority. Therefore, this promotes the view that the government has to mediate in cases where the patient and the doctor have a misunderstanding (O’NEILL 1994, P. 25). To resolve this, one focuses on always consulting the patients and updating them on their progress in conjunction with their treatment and come to some agreement on how they would like to approach the treatment. Clauses that fight for the medical spokes person to introduce a bill that will cater in having disagreements looked at in a more objective manner should be introduced.
NMC Code of Conduct (2008)
The NMC code is about standards of conduct. Performance and ethics for nurses and health care workers comes from having the people as one’s priority and acknowledging every individual by respecting his or her dignity (O’NEILL 1994, P. 38). Networking to promote the health of people should be done. There should be high standards of health practice and care by being honest and upholding the name and dignity of the health profession. This goes a long way in ensuring that as professionals, one is accountable for the actions arising from the decisions made especially on their patients.
In the case study, the code points out that being open and honest brings integrity to the health profession. This is evident whenever doctors and nurses become trusted by their patients as in the case above. Therefore, the health workers are to approach this matter with all principles. In doing this, it takes their professional responsibility to become accountable for the decisions taken together with the patient. These decisions should be justified lawfully thus their professional practice becomes one that is to be admired.
One Statute (Act of Parliament – Mental Capacity Act (2005)
In considering the law, the Mental Capacity Act 2005 (MCA), addresses cases where individuals are lacking the legal capacity and their interest is taken into account to the fullest. In this case, deprivation of liberty safeguards is to be taken whenever the patient needs placement so as to access care and treatment. As in Sara’s case, the question of whether she needs a place is seen when the professionals keep a secret of her health and still continue to treat her even though she deteriorates. On the issue of confidentiality, Sara’s case was breached in that one of the workers got access to classified information without her consent. Therefore, the duty of care was neglected.
In using Gibbs’ model, the following was used to write the following paragraphs:
Description of what happened
In the case of Sara, she was denied her right to know about her health. The insights that emerged from her case ignited feelings of distress. The scenario brought a sense of surprise in that one’s information on personal health could be violated.
What were you thinking and feeling?
You need to demonstrate what you have learned from undertaking your assignment, what insights you have developed, how you believe you could apply these to practice, and what additional learning needs you have identified for your future development.
Evaluation of what was good and bad about the experience
The experience of watching a patient being taken advantage of brought a feeling of pity and I felt that justice had to be done. The good thing was that Sara was receiving treatment while the bad thing was that she was being kept there while the health workers knew that she was worsening (ESPEJO 2002, P. 57). This calls for the health sector to provide necessary needs of services that bring healing and property management.
In analyzing Sara’s situation, it warrants human rights advocacy so that the patient’s preference is to be considered but also the doctors should aim at improving her health. The laws of justice need to be applied in protecting patients who are under the mercy of health workers. The breach of confidentiality is one thing that those responsible should be sued for.
The case study points out that being open and honest brings integrity to the health profession. This will be evident whenever doctors and nurses become trusted by their patients as in the case above according to Beauchamp et al (1994). The information about Sara is crucial to her. Therefore, the health workers are to approach this matter with all principles. In doing this, they take their professional responsibility to become accountable for the decisions taken together with the patient. These decisions should be justified lawfully thus their professional practice becomes one that is to be admired. There is a need to change ways in which the workers act to inculcate honesty and professionalism. If it were to happen again, the source of the problem should be sought.
Considering the law, the Mental Capacity Act 2005 (MCA) is to be followed so as to address cases where the interests of individuals who lack the capacity are taken into full account. In this case, deprivation of liberty safeguards is to be considered whenever the patient needs placement so as to access care and treatment (O’NEILL 1994, P. 25). As in Sara’s case, the question of whether she needs a place is seen when the professionals keep a secret of her health and still continue to treat her even though she deteriorates. On the issue of confidentiality, Sara’s case was breached in that one of the workers got access to classified information without consent. Therefore, the duty of care was neglected as negligence crept in thereby putting at stake the issue of accountability. In conclusion, Sara Baines’ euthanasia case can be justified by the three principles that are contained in the prime rule that regulates the act. It is important that people are respected and given the liberty to make decisions and not forced to be experimented because they deserve self respect as the law puts it (MCMILLAN ET AL 1987, P.84). It is also important for patients to be treated as per their interests. They should be treated as they wish for their own benefits as any decision made by physicians without their consent is illegal. Justice should as well prevail in the mistreatment of human subjects for the common benefit of all the human beings. Euthanasia should therefore be ignored as a measure towards avoiding the offensive act on patients who are critically ill. It was therefore wrong for the doctors to put the “Do not resuscitate” note in Sara Baines’ file as it was a pure act of euthanasia, a situation which she did not advocate for. The doctors are therefore legally wrong and should know that it is illegal to deny a patient his or her medication rights.
BACH, J, S, BURSELL, S, & SZUMSKI, B 1987, Biomedical ethics: opposing viewpoints, Greenhaven Press, St. Paul, Minn.
BEAUCHAMP ET AL1994, Principles of biomedical ethics, Oxford University Press, New York.
ESPEJO, R 2002, Biomedical ethics, Greenhaven Press, San Diego, CA.
GLANNON, W 2005, Biomedical ethics, Oxford University Press, New York.
HEALEY, J 2002,The euthanasia debate, Spinney Press, Rozelle, N.S.W.
HEALEY, J 2008, Voluntary euthanasia, The Spinney Press, Thirroul, N.S.W.
MCMILLAN ET AL1987, Euthanasia and the newborn: conflicts regarding saving lives, Reidel Pub. Co, Dordrecht, D.
O’NEILL, T 1994, Biomedical ethics: opposing viewpoints, Greenhaven Press, San Diego, CA.
YOUNG, M 2007, Euthanasia, Greenhaven Press, Detroit.