Applying Ethics in Practice - Essay Example

Applying Ethics in Practice Introduction to the case MM is an 80 year old woman who resides in a nursing home that provides care at a range of levels. She has a history of transient ischaemic attacks (TIAs) and is now aphasic (unable to speak) due to a stroke which has left her paralysed down one side. Staff caring for MM are unclear how much she understands. She now spends most of her time either in bed or sitting in a chair. Her family visits irregularly, since they are located a considerable distance away. MM develops a urinary infection, but when oral antibiotics are commenced, MM begins to spit these out and declines to drink. A naso-gastric tube is inserted when she becomes dehydrated, but MM removes this, and becomes very agitated when attempts are made to reinsert the tube. The team responsible for MM’s care ask if she should be restrained in order to receive hydration and antibiotics, or, should therapy be ceased, knowing that this will result in MM’s death from dehydration, infection and malnutrition. The aim of the essay is to identify the key issues in the scenario. The santicity of life beliefs, death with dignity beliefs and perceived right to key stake holders will be discussed. The physicians may be practicing ethics daily in their practice without them being aware of it. The study and resolving conflicts will be also placed under ethics. Autonomy Every adult having a sound mind has the right to decide what may be done the body. This is a universal right that has been recognized in ethics, medical practice and law. It has been said in the Bartling court in California that a adult person who has been diagnosed by serious illness that may not be curable and not diagnosed as terminal, have the right to object physicians and to have the life support equipment disconnected even if that means death of the person.1 There has been instance of many patients refusing the offered procedure, treatment and advice of the doctors or physicians die to autonomy. The physician may consider this act as irrational but this act cannot be considered as immoral or not related to social due to the right that the patient has to determine the outcome.( John Davenport) Competence and Capacity The patient must be having a capacity to make decision to qualify or to use autonomy. Technically only a court of law can say who is competent though physicians has been seen of speaking of competent patients. The physician will be referring to the patient’s capacity in taking a decision. If the patient is sound enough to take or make medical decision, then the patient is deemed to have the capacity to go for autonomy. If the patient is not deemed to have the mental or psychological make up for taking decision, then the patient is deemed to not have the capacity for taking decisions. The three areas that the patient will be put under test to understand the capacity is to make sure that the patient should be able to understand the diagnosis and the information provided by the physician. The patient also should understand the significance of the disease diagnosed and the consequences that may arise of not taking a treatment. The patient can be tested by means of rephrasing by the physician. The patient can be tested on their moral values and the patient can be tested on what is important for them when making decisions. The patient can be tested for consistency in making decisions. There has been a reference by the court that it is the doctor who has the competence to take a decision whether the patient is competent or not. This can be described in following points(Descriptions of Ethical Theories and Principles) 1. The patient has the ability to understand all the issues that is with diagnosis 2. The patient has the ability to differentiate between moral and immoral issues. 3. The patient is to understand the correct information from morally relevant information 4. The patient has the ability to research articles and reflect on them 5. The patient is willing to seek advice when needed. 6. The patient has the ability to form unbiased conclusion in any given situation. 7. The patient has the justification to act on it. 8. The patient has the right to challenge the moral framework of one in light of unruly behavior. 9. The patient has been having consistency in moral framework. It is better to have the instruction appear in documentation in patient record, as it is a valid document. There has been instances in which the community health workers in their urge to help has made a situation by which the empowering people to do or help themselves out may be stifled. All does not follow this. An example is that Peace Corps who have given freedom for the community to seek new ways to help themselves out. The nurses and physicians should avoid situations of treating patients without their consent. Treating patients without giving them all the information is also wrong on the part of nurses and physicians ( Susan) .Information that is being forced on the patient when they are not interested in receiving it is also wrong on the part of nurses and physicians. Forcing the nurses or physicians to act against their moral values is also wrong. Beneficence The principle behind this is that it is the duty of the physician to help the patient. This has been the foundation principle under which the medical practice has found roots under Hippocrates.The practice is like that the patient will enquire about the disease and will follow the advice given by the physician. This has been bought into conflict with autonomy in recent times. The example can be said of carrying toxic waste from one community to another community. It can bring good to one community but it can also bring equal damage to the other community. The introduction of Western or modern health techniques to a community that has been following traditional methods also will be debated under this. There will be another conflict in the form of health professionals trying to take immunization program and the persons are against it on basis of religion and that can create conflict. Non-maleficence The term means to do no harm like the term beneficence. There has been found to be conflict between beneficence and non-maleficence ( Megan ). The reason for this is the risk/benefit analysis that has been used for that. Assume that a patient got injured while using a sharp weapon and the patient should be given an injection of tetanus to make sure that patient is protected. For this a needle has to be inserted and that can cause pain that can be said as violation of non-maleficence. There can be side effects of this injection also. Here it can be safely inferred that beneficence is ranked above Non-maleficence. This can be said through another example as an industry to an area can bring lot of employment opportunities but can also increase the health risks like decreased appetite, increased eye problems and so on. Justice This states that the ethical theories should describe the actions for those who are involved and ethical decisions should be consistent with ethical theory and it should be supporting the decision logically ( Four principles to bio medical ethics) .This can be said of an ambulance driver breaking the speed rules to make sure that the patient reaches the hospital faster so that the life is saved. This act can be justified even though it is breaking the law. The other example that can be said is of distributive justice that can be said of comparative treatment of the individual. There has to be a criteria developed on what will be given prominence like funding a treatment for HIV or preventing swine fever that has been in circles recently. Compensatory justice will be provided as a compensation for past wrong doings and procedural justice may go for first come first serve basis. There are lots of examples that can be said of poor mismanagement of terms like sending peanut butter to war ravaged Afghanistan. The people did not have nay clue on how to use the butter and mainly animals ate that. There have been instance of Middle Eastern wheat being transported to European countries and that has been also left unused. It is like sending used blankets and torn blankets to help the people suffering from severe cold. The norm would be to send fresh blankets. There will be lot of potential conflicts that the medical team will have to face like a community having abundant water but containing toxic materials .The community may be well aware of the toxic material that is present in the water and will be willing to use the water on the context that it was the only area for long areas that had water. The people had weighed the risks and benefits and came to conclusion that using water is more safe than dying without water. The health care cost has been increasing and there by the increase in the uninsured has been also increasing and this has to be taken into account. From the case study Autonomy Serious doubts can be raised about the patient’s ability to understand the situation on basis of age but as said in the article age is not the only criteria. There has been doubt about whether the patient is having full knowledge about the disease. There is doubt about the knowledge about the family members knowledge about the case, as they are not visiting regularly on context of distance. Beneficence and Non-maleficence If the idea is to follow that the patient need not be subjected to any harm, then it is better not to undergo the treatment that has been followed so far as that can cause considerable pain. Death with dignity beliefs It is a potential difficult subject as wether the patient can be allowed to die by not administering the medicine that is required to prevent dehydration. The autonomy of the patient will be put to test against the religious beliefs and this has to be understood more before a decision is taken. Sanctity of life beliefs This can be said of a situation by which the patient may be ending life on the basis of not getting treatment because the patient has been unwilling to cooperate. It has to be a case of euthanasia and the doctor may be correct in taking the patient to death without giving treatment. There are cases like the above instance when the patient has been diagnosis of suffering from terminal illness and giving death sentence can stop the suffering of the patient. The case is will the condition improve if the cure is taken forward and will the pain be bought down if the treatment is taken forward? Conclusion It is better to take the confidence of the patient and the family members before a final decision can be taken. Reference “Descriptions of Ethical Theories and Principles” ,viewed on may 25,2009,retrieved from http://www.bio.davidson.edu/people/kabernd/Indep/carainbow/Theories.htm “Four principles to bio medical ethics”,viewed on May 25,2009,retrieved from http://www.uq.edu.au/oppe/PDFS/Ethics_primer.pdf John Davenport,” Ethical principles in Clinical Practice”, viewed on May 25,2009,retrieved from http://xnet.kp.org/permanentejournal/sum97pj/principles.html Megan,2008, "Right of patient",Bio ethics,pp.131-135, Susan,2002,Autonomy,Nurse as Educator,pp.25-29 Read More

The three areas that the patient will be put under test to understand the capacity is to make sure that the patient should be able to understand the diagnosis and the information provided by the physician. The patient also should understand the significance of the disease diagnosed and the consequences that may arise of not taking a treatment. The patient can be tested by means of rephrasing by the physician. The patient can be tested on their moral values and the patient can be tested on what is important for them when making decisions.

The patient can be tested for consistency in making decisions. There has been a reference by the court that it is the doctor who has the competence to take a decision whether the patient is competent or not. This can be described in following points(Descriptions of Ethical Theories and Principles) 1. The patient has the ability to understand all the issues that is with diagnosis 2. The patient has the ability to differentiate between moral and immoral issues. 3. The patient is to understand the correct information from morally relevant information 4.

The patient has the ability to research articles and reflect on them 5. The patient is willing to seek advice when needed. 6. The patient has the ability to form unbiased conclusion in any given situation. 7. The patient has the justification to act on it. 8. The patient has the right to challenge the moral framework of one in light of unruly behavior. 9. The patient has been having consistency in moral framework. It is better to have the instruction appear in documentation in patient record, as it is a valid document.

There has been instances in which the community health workers in their urge to help has made a situation by which the empowering people to do or help themselves out may be stifled. All does not follow this. An example is that Peace Corps who have given freedom for the community to seek new ways to help themselves out. The nurses and physicians should avoid situations of treating patients without their consent. Treating patients without giving them all the information is also wrong on the part of nurses and physicians ( Susan) .

Information that is being forced on the patient when they are not interested in receiving it is also wrong on the part of nurses and physicians. Forcing the nurses or physicians to act against their moral values is also wrong. Beneficence The principle behind this is that it is the duty of the physician to help the patient. This has been the foundation principle under which the medical practice has found roots under Hippocrates.The practice is like that the patient will enquire about the disease and will follow the advice given by the physician.

This has been bought into conflict with autonomy in recent times. The example can be said of carrying toxic waste from one community to another community. It can bring good to one community but it can also bring equal damage to the other community. The introduction of Western or modern health techniques to a community that has been following traditional methods also will be debated under this. There will be another conflict in the form of health professionals trying to take immunization program and the persons are against it on basis of religion and that can create conflict.

Non-maleficence The term means to do no harm like the term beneficence. There has been found to be conflict between beneficence and non-maleficence ( Megan ). The reason for this is the risk/benefit analysis that has been used for that. Assume that a patient got injured while using a sharp weapon and the patient should be given an injection of tetanus to make sure that patient is protected. For this a needle has to be inserted and that can cause pain that can be said as violation of non-maleficence.

There can be side effects of this injection also. Here it can be safely inferred that beneficence is ranked above Non-maleficence. This can be said through another example as an industry to an area can bring lot of employment opportunities but can also increase the health risks like decreased appetite, increased eye problems and so on.

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