Applied Health Care Ethics and Law - Essay Example

Applied Health Care Ethics and Law Total Number of Words: 4,998 Table of Contents I. Introduction ………………………………………………………… 4 II. Aim Purpose ofthe Study ………………………………………… 5 III. Ethical Principles and its Application within the Health and Social Care Setting …………………………………………………. 6 a. Autonomy and Consent to Treatment …………………….. 6 b. Confidentiality ……………………………………………... 7 c. Beneficence ………………………………………………… 8 IV. Legal Dimensions of Contemporary Health and Social Care ……… 9 a. Informed Consent …………………………………………. 9 b. Common Law of Informed Consent ……………………… 10 c. Legality of Advance Statement Pertaining the Patients’ Preferred Care and Treatment …………………. 11 V. Contribution of Ethical and Legal principles to Standards in Clinical Practice ……….…………………………………………… 11 VI. Issues on Equality and Diversity in the Practice of Health Care …. 12 VII. Nurses’ Responsibility in the Application of Tube-Feeding among Dementia Patients ………………………………………… 13 VIII. Debate on the Application of Ethical and Legal principles on Tube-Feeding Application among the Patients with Advanced Dementia in Acute Medical Ward ……………………... 14 a. Dementia Patients’ Preferences in the Use of Tube-Feeding ……………………………………………... 14 a.1 Debate on Dementia Patients’ Preferences in the Use of Tube Feeding in Acute Medical Ward …….. 14 b. Decision-Making Rights of Health and Social Care Professionals on Tube Feeding Application on Dementia Patients within the Acute Medical Ward ………………… 16 b.1 Debate on the Decision-Making Rights of Health and Social Care Professionals on Tube Feeding Application on Dementia Patients within the Acute Medical Ward ………………………………. 17 b.1.1 Argument on the fact that 84% of American internist do not agree to use tube feeding on patients with irreversible dementia after losing interest on eating ………………….. 17 b.1.2 Argument on the fact that 98% agree to use tube feeding on acutely ill 75 years old woman with aspiration pneumonia and delirium …………………………………… 18 b.1.3 Argument on the fact that around 57% of nurses agree to use tube feeding on patients with dementia after the patient rejects the food provided to them …………………….. 19 IX. Debate on the Impact of Personal and Professional Values on Clinical Decision-Making ………………………………………… 20 IX. Conclusion ………………………………………………………… 21 References ………………………………………………………………… 22 - 27 Introduction Health care ethics and law is vital in the regular practice of health care services particularly in the field of nursing. Basically, the study of nursing ethics focuses on the evaluation of merits, risks, and other social concerns with regards to the activities provided by nurses to the patients. In line with the practice of nursing, the codes of ethics, nurse practice act, standards of care, and the legal implications of the nursing standards of care has to be followed carefully to ensure that the best nursing practices will be rendered to the patients. (Aiken, 2004) The history of nursing ethics is rooted from the medical ethics. Since nursing theory gives emphasis on the collaborative relationship between nurses and the patients, there is a need to establish a separate code of ethics for nurses. For many years, the study of ethics has laid the foundation of the modern practice of nursing particularly in respect for Human Rights. In the twentieth Century, the nursing ethics has shifted from the virtues of the nurses towards the promotion of the human rightsi and duties of the nurses. (McHale and Gallagher, 2003) The modern nursing ethical theory supports the unique role of the nurses in giving respect for the patients’ autonomy in decision-making for their own treatment as well as being informed with the general facts concerning the process of their treatment. However, there are unavoidable situations wherein the patients are incapable of making their own choices for their treatment. In most cases, these patients are unable to make their own personal decisions are commonly due to mental illness caused by accidents, genetic disorders, or diseases associated with old age. In line with this matter, nurses are responsible in balance their duty of care with regards to the autonomyii or the practice of informed consent; including the practice of non-maleficenceiii, beneficenceiv, and justicev in the case of the mentally affected patients. (Bailey, 2007) In line with patients with mental illness, the study will specifically explore the ethical principles and its application within the health and social care setting; the legal dimensions of contemporary health and social care on the part of the patient and the health care professionals particularly the nurses; the contribution of ethical and legal principles to standards of clinical practice; and the issues pertaining to the equality and diversity in the practice of health care services particularly with the application of tube feeding among the patients diagnosed with advanced dementia. In line with assessing two journals: ‘Tube Feeding Patients with Advanced Dementia: An Ethical Dilemma’ (McNamara, 2001) and ‘Tube Feeding in Advanced Dementia: the Metabolic Perspective’ (Hoffer, 2006); the study will debate on the application of ethical and legal principles in acute medical ward concerning the case of advanced dementia patients and the impact of personal and professional values on clinical decision-making. Aim / Purpose of the Study To purpose of this study is to enable the researcher to develop a broader knowledge and determine the differences between the nursing ethics and its legal system by assessing two journals related to the ethical and legal concerns of applying tube feeding in dementia patients with in the clinical setting. Ethical Principles and its Application within the Health and Social Care Setting Autonomy and consent to treatment With regards to autonomy particularly the informed consent issue, considering that the mentally incapacitated patients could not decide about his/her preferred care and treatment, the health and social care professionals should follow the guidelines developed by the Department of Health called ‘Reference Guide to Consent for Examination or Treatment (2001)’; ‘Seeking Consent: Working with Older People (2001)’; ‘Seeking Consent: Working with People with Learning Disabilities (2001)’; and/or the ‘Mental Capacity Act (2005)’. (NHS, 2006; p. 6, 8) According to the Mental Capacity Act (2005), concerning the patients with dementia, the health practitioners should prove that the patients do not have the capacity to make decisions for themselves; by all means, the health practitioners must provide all the available and necessary support to the patient prior to the conclusion that the patient is not capable of making decisions for themselves; health care practitioners should avoid making unwise decisions; any decisions made on behalf of the patient should be for the benefit or best interests of the patient; and any decisions made on behalf of the incapacitated patients should restrict their rights and basic freedoms as little as possible. As part of a legal and ethical health care practice, ‘informed consent’ is a standard operating procedure of the health care service prior to the start of any treatment, physical investigation, or providing personal care for the patient. (NHS, 2006; p. 8; DOH, 2001a, p. 2; DOH, 2001b; p. 1) In the case of patients with severe dementia, it is important for health care professionals not to automatically assume that these patients could no longer communicate or make any decisions for themselves. (DOH, 2001b; p. 9) The capability of these patients to give consent on a particular care or treatment should be considered unless it is clinically proven otherwise. Decision-making for patients with advanced dementia is a critical situation wherein the health care professionals or carers, and relatives should have the opportunity to participate in the process of deciding what is the best care and treatment to be given to the patient. (NHS, 2006; p. 6) Along the process, health care professionals / carers and relatives should be guided with the necessary information and support they need. Confidentiality The practice of confidentially is also important. Health care professionals should always discuss with the patient the need to share their personal information with other health care agencies. It is highly unethical to disclose the patients’ confidential records without getting their consent under any circumstances. In case the patient is mentally incapable of making a decision, the context of the Mental Capacity Act (2005) with regards to disclosing the patient’s information should be applied. Considering that patient with dementia is still capable of making a decision, the health care professionals should encourage the patient to use the advance statement with regards to the preferred care (such as washing or bathing) and treatment or refusal to a specific treatment particularly on the use of tube feeding (DOH, 2001a; p. 10; DOH, 2001b; p. 5, 10); a preferred place of health care providers (i.e. a specific hospital); and a lasting power of attorney in case the patient loses his capacity to decide and communicate. (NHS, 2006a; p. 8) Advance statement pertaining the refusal of a particular treatment should be acknowledged as a legal binding contract between the patient and the health care professionals. (NHS, 2006b; p. 8) On the other hand, advanced statement regarding how they would like to be cared for in case of future incapacity to communicate is never a legal binding contract between the two parties. (NHS, 2006b; p. 8) However, these concerns should weigh more in the final decision-making of the health care professionals. Beneficence Beneficence demands nurses to do only good actions which may contribute to the welfare of the patients. Concerning the principle of beneficence, it is important that any decisions made by the health and social care professionals on behalf of the patient should be for the greater benefit or best interests of the patient. (Mental Capacity Act, 2005; DOH, 2001b; p. 9) For instance, the patient with advanced dementia has lost his/her ability to communicate his preferred care and treatment, health and social care professionals should always ensure that any decisions made with regards to the care of the patient is for the best interest of the patient such that spoon feeding is better than the application of tube feeding on patients that is gradually losing his/her appetite and/or weight due to old age because of the other clinically proven side-effects of using tube feeding devices in the overall health and wellness of the patient. Legal Dimensions of Contemporary Health and Social Care Informed Consent For consent to be considered as legal, the consent must be given voluntarily by informed individual ages 18 and above. (DOH, 2001a; p. 4; DOH, 2001b; p. 7) A parental guidance is always needed for patients under the age of 18. In general, the practice of informed consent is a part of the general legal process in providing a major intervention on the health care service provided to the patients. (DOH, 2001a; p. 8) Based on the principle of informed consent, patients have the right to be informed about the health care treatment or physical inspection that will be provided to them regardless of their physical and mental condition. In case this principle is violated for any reason, the patient(s), patient’s family and relatives, and/or the rest of the health care professional body may subject the particular health and social care provider(s) to a legal action. (DOH, 2001a; p. 2) In some cases, the entire group of health care providers may also be held liable for the particular violation of their staff. (DOH, 2001a; p. 2) In case the patient with advanced dementia is no longer able to decide for himself/herself, the patient, family or relatives, the health and social care professionals should be present or be involved in the decision-making process for the patient. (DOH, 2001b; p. 9) In line with this matter, it is necessary for the health care professionals to provide the family or close relatives with concrete regarding the application procedure, purposes, consequences, and danger of using the tube-feeding devices including the proposed alternative solution for the care and treatment before allowing these people to think and make an important decision for the care and treatment of the patient(s) with advanced dementia. (DOH, 2001a; p. 6; DOH, 2001b; p. 3, 6) In the absent of providing the patient, family or relatives the nature and purpose of the procedures, etc. could make the health and social care professionals be liable for an act of negligence in case the patient suffers from harm due to the care and treatment the patient has received. (DOH, 2001a; p. 5) To avoid some future miscommunication about the patients’, the family or relatives’ decision on the care and treatment of the patients, all information regarding the informed consent including the decline on certain care or treatment should be recorded. (DOH, 2001a; p. 6; DOH, 2001b; p. 3) As the rule of thumb, each patient has the legal right to either agree or disagree on certain care or treatment based on their religious belief or value system regardless of whether the health and social care practitioners view the patients’ decision to be irrational. (DOH, 2001b; p. 3) Patients’ decision on his/her desired care and treatment should always be treated with respect by their health care provider(s). Common Law of Informed Consent The common law or case law has considered ‘touching a patient’ in the absent of a legal consent, to result with a civil or criminal offence of battery. Without a securing a legal consent from the patient, in case the patient has been harmed from a care or treatment provided to them; it is possible for the patient to sue the health or social care practitioner for ‘negligence’. (DOH, 2001a; p. 2) This includes physical interventions such as administration of drugs, providing assistance on dressing or other activities of daily living, the use of feeding tubes on patients with dementia, etc. For this reason, it is advisable to health and social care professionals to keep themselves informed of any legal developments related to their profession. In case of any doubt with regards to a certain action pertaining their profession, it is highly recommended to seek legal advices to avoid any legal problems that may occur in performing care and treatment for the patients. Common law in nursing is more or less based on the Human Rights Act 1998. Therefore, it is vital for all health care practitioners to be familiar with the said regulations especially with regards to ‘protection of rights to life’; ‘prohibition of torture, inhuman or degrading treatment or punishment’; and the ‘freedom of thought, conscience and religion’ among others. (DOH, 2001a; p. 3) Legality of Advance Statement Pertaining the Patients’ Preferred Care and Treatment Patients that has legally and voluntarily provided a written statement pertaining his/her preferred care and treatment in case the patients is no longer capable of deciding for himself/herself should be respected. (DOH, 2001b; p. 4) In case any of the health and social care professionals fail to acknowledge the advanced statement of the patient(s), the health and social care practitioner(s) could end up facing a legal action from the patient’s side. (DOH, 2001a; p. 10 – 11) In case of doubt with regards to sensitive matters like withdrawal of nutrition and hydration from patients with advanced dementia, the health and social care practitioners should get a legal approval from the court. (DOH, 2001a; p. 13, 20; DOH, 2001b; p. 15, 17) Contribution of Ethical and Legal principles to Standards of Clinical Practice The principles of nursing ethics and its legality serve as the standards for the clinical practice of nurses. The nursing code of ethics such as: beneficence, justice, non-maleficence, understanding or tolerance, publicity, respect for the person, veracity, autonomy, confidentiality, equality, and finality (Bailey, 2007) together with the legal practice concerning the nursing profession guides all nurses to render the best nursing practice equally to all patients regardless of their physical condition, mental capacity, race, age, sex, or beliefs. As the standards of clinical practice for nurses, all nurses are obliged to follow the guidelines regarding the accepted values, ethical principles and its legality in making a universally accepted ethical decision-making practices within the nursing profession. Issues on Equality and Diversity in the Practice of Health Care As part of the equality and diversity in the practice of health care concerning dementia, it is vital that patients with dementia including the health and social care professionals responsible for their care to receive equal respect regardless of their sex, ethnicity, age, and/or religion. (NHS, 2006; p. 7) There should be non-discrimination in the provision of health care services to people with dementia. Language should never be a barrier to the care and treatment provided to these patients. In case a different language is spoken between the health and social care provider and the patient, it may be necessary for the health care provider to seek help from other people specifically on translating the patients’ needs and wishes concerning his care and treatment. (DOH, 2001b; p. 6) Health and social care professionals must ensure that patients with cognitive and functional impairment are not denied to access good health care services. (NHS, 2006; p. 7) In line with this matter, health care professionals are expected to identify the patient’s specific needs and record it in the patient’s care plan especially issues concerning the patient’s nutritional needs or diet. In order to acknowledge the diversity in the needs of patients with dementia, it is necessary for the health and social care staff to get proper training or skill development concerning dementia awareness and their roles and responsibilities as health and social care service providers. (NHS, 2006; p. 24) Generally speaking, the dementia-care training should include educational programmes on the early signs and symptoms of dementia; the impact of dementia on the patients including their family and relatives; palliative care approach; and the nutritional requirements of people with dementia including the application and consequences of tube feeding, etc. The health care professionals should continuously search for broader knowledge concerning the proper care and treatment for patients with dementia. Nurses’ Responsibility in the Application of Tube Feeding among Dementia Patients Part of the nurses’ responsibility is to ensure that each patient receives the best health care service with respect to the patients’ human right regardless of the patients’ general health condition as long as all the principles of health care ethics such as respect for individuals, autonomy, non-maleficence, beneficence, justice, confidentiality, fidelity, and veracity are legally met. Considering the fact that patients suffering from an advanced stage of dementia are no longer in the position to decide for himself, the parents, relatives, nurse(s) and other health care professionals or even the spouse should not take full responsibility in making a major decisions on behalf of the patient who could no longer decide on care and treatment for himself/herself. (DOH, 2001a; p. 12) The best option is to gather the patient’s spouse, family and/or relatives together with the health and social care professionals to be present and be involved in the decision-making process for the patient. (DOH, 2001b; p. 9) In this case, autonomy can be practiced in accordance to the informed consent guidelines of Mental Capacity Act (2005). In situation where there is doubt such as in the case of withdrawal of nutrition and hydration such as tube-feeding devices from patients with advanced dementia, the health and social care practitioners should get a legal approval from the High Court to provide them with ruling in the case of the mentally incompetent patient. (DOH, 2001a; p. 12, 13, 20) Debate on the Application of Ethical and Legal principles on Tube Feeding Application among the Patients with Advanced Dementia in Acute Medical Ward Dementia Patients’ Preferences in the Use of Tube Feeding Based on a surveyed research study, roughly eighty-four percent male and female patients over 65 years of age prefers not to use any life-sustaining treatment such as tube feeding in case they suffer from any degree of dementia. (Gjerdingen et al., 1999) Only four percent has shown their desire to use tube feeding in case they are placed in a situation wherein they could no longer care for themselves. On the other hand, based on an interview conducted with 379 individuals in nursing home residents were asked the same question about tube feeding in case they suffer from a permanent brain damage. (O’Brien et al., 1995) As much as one-third of the participants stated that they prefer to use tube feeding in such scenario. Debate on Dementia Patients’ Preferences in the Use of Tube Feeding in Acute Medical Ward The past surveyed studies on dementia patients’ preferences in the use of tube feeding reflects a great difference between the number of individuals who would prefer or chose not to use tube feeding regardless of the situation. It is possible that the participants for the survey do not have any concrete knowledge with regards to the benefits and consequences of using tube feeding among patients with an advanced stage of dementia. For this reason, nurses or other health and social care providers should not presume that all patients suffering from dementia in the acute medical ward would all want to use tube feeding to sustain their nutritional needs. Doing so would be a great violation on the patients’ autonomy. (NHS, 2006; p. 8; DOH, 2001a, p. 2) It is a general knowledge that violation of the patients’ autonomy could eventually result to a legal punishment. (DOH, 2001a; p. 2) Health and social care practitioners should teach and explain the benefits and consequences of using tube feeding on patients with advanced dementia to enable the patients and/or the patients’ family and relatives in making a wise decision for the incapacitated patients. Health and social care practitioners should avoid making a personal decision as much as possible on the care and treatment of the patients particularly on the use of tube feeding devices. When deciding upon the patients’ autonomy in the case of those suffering from advanced dementia, the metabolic perspective of the patient has to be considered in order to give justice and respect to the patients’ body. (Hoffer, 2006) In line with the guidance of Mental Capacity Act 2005 specifically noting that the health care practitioners should avoid making unwise decisions and that any decisions made on behalf of the patient should be for the benefit or best interests of the patient; it is advisable for the health and social care providers to check on the possible cause of the reduction in food intake among the patients with advanced dementia. Among the possible causes includes: depression, ill-fitting dentures, poor quality or poor presentation of food among others should first be acted upon. Decision-Making Rights of Health and Social Care Professionals on Tube Feeding Application on Dementia Patients within the Acute Medical Ward Health and Social Care Professionals are the primary decision-makers on matters related to the use of feeding-tube on elderly patients with dementia. (McNamara and Kennedy, 2001) The personal opinions of the physicians as well as the other health care professionals contributes a lot on the use of tube feeding in these patients. Decision-making process on the part of the physicians and other surrogate decision-makers normally face difficulties in coming with a right judgment since critical decisions for the health of the patients with advanced dementia should respect the ethical principles particularly the autonomy, non-maleficence, and beneficence. Deciding on whether to use tube feeding devices on patients with advanced dementia that has gradually stopped eating but is not dying is a difficult challenge on the part of the health and social care providers including the patients’ family and relatives. (Hoffer, 2006; McNamara and Kennedy, 2001) Based on a study that was conducted among the American internists, 84% do not agree to use tube feeding on patients with irreversible dementia after losing interest on eating; and 98% agree to use tube feeding on acutely ill 75 years old woman with aspiration pneumonia and delirium. (Hodges et al., 1994) On the other hand, around 57% of nurses agree to use tube feeding on patients with dementia after the patient rejects the food provided to them. The number of nurses agreeing to use tube feeding on patients with dementia greatly varies depending on the country. Australian, Canadian, and Swedish nurses are the ones that strongly not agreeable with the use of tube feeding among these patients. (McNamara and Kennedy, 2001) Debate on the Decision-Making Rights of Health and Social Care Professionals on Tube Feeding Application on Dementia Patients within the Acute Medical Ward Argument on the fact that 84% of American internist do not agree to use tube feeding on patients with irreversible dementia after losing interest on eating It is good that the percentage of American internist that do not agree with the use of tube feeding on patients with irreversible dementia out numbered those that wishes to use tube feeding devices after the patient starts losing interest on food. (Hodges et al., 1994) Based on the current study of L John Hoffer (2006), reduced food intake and weight loss are some of the normal signs of old age. It is also possible that factors such as ill-fitting dentures, functional disability, depression, isolation, and poverty could affect the food intake of the elderly patients. Based on a series of observational data and the results of several tests on the use of tube feeding shows that tube feeding on patients with advanced dementia neither prolongs their life nor improves its quality life. (Fine, 2006; Chernoff, 2006; Casarett, Kapo, and Caplan, 2005; Monteleoni and Clark, 2004; Skelly, 2002; McNamara and Kennedy, 2001; Gillick, 2000) In fact, the use of tube feeding devices on patients could even shorten their life and has been proven to be inefficient in providing the required nutrients among patients with dementia. (Fine, 2006; Chernoff, 2006; Skelly, 2002; Gillick, 2000) Since people with advanced dementia have a low metabolic rate, the food intake requirement they need is much lesser than the nutritional requirements of people with normal metabolic rate. (Hoffer, 2006) For this reason, eating less does not mean that patients with dementia are starving. Therefore, avoiding the use of tube feeding devices on patients with advanced dementia supports the ethical principle of beneficence wherein the nurses are required to do only good actions which could contribute to the welfare of the patients; and non-maleficence in such a way that nurses avoids injuring the patients with the use of tube feeding devices. Thus, giving justice to patients suffering from an advanced stage of dementia. It is immoral or ethically wrong to deny the patients from the normal nutritional sustenance. (Fine, 2006; Chernoff, 2006; Jotkowitz, Clarfield, and Glick, 2005; Truog and Chochrane, 2005; McNamara and Kennedy, 2001) Therefore, alternative solutions such as skillful techniques in feeding, being patient while feeding the patients with advanced dementia, offering them their favorite foods or strong flavored energy- and protein-rich foods, and constantly reminding the patients to chew their food before swallowing rather than simply promoting the use of tube feeding devices on these patients. (McNamara and Kennedy, 2001) Studying and identifying the possible expected long-term and short-term effects of each alternative solutions must be compared with the pros and cons of using tube feeding on these patients. To avoid patients’ death from starvation, it is possible for health and social care professionals to determine whether patients with advanced dementia is starving by weighing them. (Hoffer, 2006) By using the weighing technique, the health and social care professionals could determine whether the patient needs to be fed orally with rich flavored good nutritious food. This method is an effective way of avoiding solely the use of tube feeding devices. It also gives justice to patients suffering from an advanced state of dementia from going through a lot of discomfort and health risks associated with the use of tube feeding devices. (Hoffer, 2006; Galanos et al., 1994) Argument on the fact that 98% agree to use tube feeding on acutely-ill 75 years old woman with aspiration pneumonia and delirium Allowing patients with advanced dementia to go through the use of tube feeding devices greatly violates the ethical principle of beneficence and non-maleficence because there is no study done to prove that the use of tube feeding devices on patients could reduce the risk of aspiration and aspiration pneumonia among these patients; improves the physical functions; or even improves the survival rate of the patients. (Finucane et al., 1999) Since patients with advanced dementia are restricted in their physical movements in order not to dislocate the tube inserted in the body of the patient, there is a big risk that these patients could suffer from decubitus ulcer. Thus, resulting to a more serious implications such as a higher chance of death rate due to a worsening the formation of decubitus ulcer on certain parts of the patients’ body in the long run. (McNamara and Kennedy, 2001) The presence of decubitus ulcer alone is a clinical sign of neglect on the part of the health care providers. In this case, the health and social care providers should be legally accountable for the degradation in the quality of patients’ life. The use of tube feeding devices is heavily discouraged because of the negative clinical evidences it could bring to the life of patients with advanced dementia. Among the negative clinical evidences of using tube-feeding devices include: higher incidence of aspiration pneumonia and decubitus ulcer among the tube-fed patients (Peck et al., 1990); causes discomfort on patients due to restriction in their body movements (Quill, 1989); and no improvement in the nutritional status of patients being tube-fed (Kaw and Sekas, 1994). In fact, the use of tube-feeding devices has been proven to provide the patients with no survival benefits at all. (Mitchell et al., 1997) Argument on the fact that around 57% of nurses agree to use tube feeding on patients with dementia after the patient rejects the food provided to them With all the negative clinical evidences that may arise with the use of tube-feeding devices on patients with advanced dementia, I strongly do not agree with the use of such devices. There are only two possibilities wherein 57% of these nurses would agree with the use of tube feeding devices: (1) these nurses lack the knowledge on the danger and discomfort it could bring to the life of these patients; and (2) the use of tube feeding devices on patients with advanced dementia makes their job so much easier. Either way, it is not acceptable for these nurses not to know the general knowledge on the negative effects of using tube-feeding devices in the life of these patients since a part of the job of these nurses is to regularly update their knowledge concerning the proper care for their patients. In this case, I conclude that these nurses have not been doing their duty to update their general knowledge on the use of tube-feeding devices. Debate on the Impact of Personal and Professional Values on Clinical Decision-Making The personal and professional values of nurses result to a big impact on the clinical decision-making on the care and treatment being delivered to these patients. Nurses that are impatient would normally choose the easiest way out to keep their job lighter. Given the fact that patients with advanced dementia could no longer speak up for themselves, there is a higher chance that these patients are not getting the same or equal care and treatment that are given to patients who could speak up for themselves. In line with this serious matter, it is important to test and monitor the personal and professional values of the nurses since their clinical decision-making could greatly affect the care and treatment these valuable patients would be getting. Conclusion It is important to seek a legal consent from patients with dementia prior to assuming that these patients are no longer capable of giving consent. People with old age generally need lesser food intake because of their metabolic rate. For this reason, not all patients suffering from advanced dementia are candidate for the use of tube feeding devices. In general, it is always advisable for health care professionals to follow the nursing code of ethics and legal guidelines to avoid getting into trouble. In making a serious decision on the withdrawal of nutrition and hydration from patients with advanced dementia, the health and social care practitioners should get a legal approval from the high court in order to avoid facing a possible lawsuit. *** End *** References: 1 Aiken, T.D. (2004) ‘Legal, Ethical, and Political Issues in Nursing’ 2nd Edition. Philadelphia, Pa: F.A. Davisl 2004, part 1. in ‘Book Review’ Critical Care Nurse. October 2005. Vol. 25, No. 5, p. 72. 2 Bailey, G. (2007) ‘NASW Standards for Social Work Practice in Palliative and End of Life Care’ National Association of Social Workers. Retrieved: June 24, 2007 < http://www.naswdc.org/ > 3 Casarett, D.; Kapo, J.; and Caplan, A. (2005) ‘Appropriate Use of Artificial Nutrition and Hydration – Fundamental Principles and Recommendations’ N. 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