Ethics in Health Care: Dementia - Essay Example

Ethics in Health Care: Dementia Ethics in Health Care: Dementia The essay shall talk about the ethic and legal issues involved in sending patients to healthcare centers while they are suffering from dementia. The question, which the essay tries to answer, is whether a patient should be sent to a hospital when he is suffering from dementia or should he be allowed to stay home. The point of view, which is crucial here, is to understand the relation between the disease and the right of the individual to make a choice as to his existence and choice of stay. The essay shall look at the perspective from the Public Health Ethics point of view and will try to bring the ethical and legal theory forwards to club it with the pros and cons of dementia patients, and then shall prepare an argument, which will take a side depending upon the research and findings of the author. The author will then conclude his theory based on ethics and legality of the topic. In order to move forwards with the argument, let us first understand the meaning and definition of Dementia. The definition is as follows: “Dementia is a term used to describe various symptoms of cognitive decline such as forgetfulness, but is not a clinical diagnosis itself until an underlying disease or disorder has been identified.”(Beauchamp T.L and Childress, 2001) Dementia in itself is not a disease, but a doorway to various cognitive related diseases, the most popular of them being Alzheimer’s disease. Dementia patients tend to lose their memory and are not able to remember key events, which have occurred in life. The patients who fall prey to dementia suffer from one or the other forms of memory loss related diseases. Dementia is impairment to memory, communication and thinking. Old age is one of the key significant factors to falling prey to this disease. The likelihood of Dementia increases with age. However, old age by itself is not the main cause of the disease. The question, which we have to now answer, is as follows: “Should people with Dementia be forced to stay at residential care homes?” There is an ethical issue concerned here which the essay shall now address. The subject of ethics, which shall be studied here, is Public Health Ethics. In order to move forward with the argument, it is imperative to understand the definition of ethics, broadly and then specifically to public health ethics. (Brazier M., 2003) Public health ethics deals with ethics in the public health community. This branch studies the questions of ethics related to patients and their right to be treated and cared by the hospitals. Following is the definition of public health: “Public health ethics involves a systematic process to clarify, prioritize and justify possible courses of public health action based on ethical principles, values and beliefs of stakeholders, and scientific and other information.”(Per Nortvedt, Marit Helene Hem and Helge Skirbekk, 2011) Let us look at public health from the perspective of law. The Public Health Code of Ethics affirms Article 25 of the Universal Declaration of Human Rights, which states in part “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family.”(United Nations Charter, 1948) The essay shall now look at the four principles of principalism and will apply the idea to the case at hand in order to ascertain the ethics and legality of the question, which has been posed before us. Following are the four principles of principalism: Autonomy: Free-will or agency Beneficence: To do good No maleficence: Not to harm, and Justice: Social distribution of benefits and burdens Let us now apply all these principles to our issue and try to come to a conclusion. The first code of ethical conduct is autonomy or free will. It states that each and every individual should have a free will and a power to decide for himself and what kind of treatment he wants to undergo. The patient must be given a right to chose and decide what he wants to do with his treatment. He must be given a right of first refusal and the right to say no to the authorities, which includes the hospitals and the doctors. The patient must be provided the comfort to chose his destiny and he should be given the power to decide whether he wants to stay at his home or go to a residential place. The patient, when provided the right of first refusal, which enjoy the autonomous right of choosing his destiny and the place of stay and he will be the last and the final person to take a call on where he wants to get treated. All in all, he will be the main person taking the decision and the decision of the place of the treatment will depend upon his choice only. The second principle of principalism is beneficence, which means to do well. The hospital and the doctors are duty bound to perform to their level best while treating the patient. It is imperative that the public health system looks after the patient in the best possible manner, and such issues are also put down in health law. Health law states that the doctors are liable for any negligence, which is a topic, which shall be covered later by the writer. The point, which the author is trying to make here, is that the hospital must ensure sound treatment, which includes a clean environment to start with, the best doctors who can take control of any situation which arises, on the spot nurses who are always there with the patient even when he doesn’t need them. The third point in the theory consists of no maleficence. This basically talks about the fact that there should not be any harm committed to the patient while he is undergoing treatment by the hospitals and the doctors. The medical intuition should not cause any harm on purpose and should make sure that no harm is caused by mistake also. It is crucial on the part of the doctors and the nurses to avoid unnecessary treatment and to do medication as required and prescribed by the general health guidelines. Strict adherence must be followed of the general health guidelines and there lies no room for any mistakes whatsoever. The fourth point consists of justice and social benefits. This point does not apply directly to the patient however, must not assume that the hospital and the doctors are not supposed to do justice to their patient. When a doctor takes an oath he is duty bound to perform the medication of the individual to the best of his abilities. Now, it is equally important to make sure that the hospital adhere to the medical guidelines and do justice to the task they have taken at hand. The crucial aspect underlines the fact that the medical institution must be able to make sure that they do their best to the patient and do justice to the medical treatment they have been empowered to provide to the individual patient they are addressing. (Rumbold G., 2005) Informed Consent Informed consent is a very important concept, which focuses on the right of first refusal of the patient and his family. It is important that the hospital has the informed consent of the patient who is going to be treated. The patient has to be provided all the papers by the doctors and must be informed of the way the treatment is going to take place. The very crucial aspect here is that that doctors and the hospitals keep everything transparent and open with the patient and do not disappoint him with regards to the way the treatment is going to take place. The value of informed consent is tremendous here and the patient has to be informed and provided all the information for his perusal by the doctors and the hospital. (Tony Hope) (Stuart M White, 2009) Mental Capacity Act (Mathew Hotopf, 2006) The Mental Capacity Act is the main act, which talks about consent and other dimensions of public health law. The primary purpose of the Act is to make decisions on behalf of people who are unable to make decisions for themselves. The Act makes decisions for people who are suffering from dementia. The main reasoning of the act says that no decision should be made on behalf of the person unless and until it is established that the person lacks the capacity to make the decision. It has to be an established fact that the person is not able to make the decision for himself. Moving on, the act says that a person should not be regarded as someone who cannot make a decision for himself just because he is unable to make a wise decision. A man should also be given full chance to show the fact that he can make a wise decision. This act applies to people who cannot make a decision for themselves. In situations where it is a known fact that the person wont be able to make the decision for himself, it is the prerogative of the family and the doctors to make the decision for him and in his best interests. The decision made must not jeopardize his best interests and the freedom. Also, the decision should be made in the best interests and just in the same way as it would have been if the patient could have made a decision for himself. In the present case, the hospital shall take the responsibility along with the family and friends of the patient if the patient is unable to make a decision for himself. (Kai Sammet, 2007) Aspect of Negligence: The doctor and the hospital should make sure that there exists no negligence on the part of the doctor or the hospital. It is imperative on the part of the hospital to make sure that there is no negligence. The treatment of the people must be done properly to assure the patient that no lapse will happen. The crucial element here is the fact that no negligence can take place. Negligence means any mistake on the part of the hospital or the doctor, which jeopardizes the condition and the treatment of the patient. There is no scope of negligence and the doctors can be sued for any mistake or callousness on the part of the hospital. (Robin Jacoby, 2004) Following are the key elements of the code of conduct: Humans are interdependent Collaboration is a key to human development People and their physical environment are interdependent Identifying and promoting the fundamental requirements for health in a community are of primary concern to public health The most important code of ethics is the last one. The society is bound to provide each and every man the requirements of public health in the best manner. The hospitals and the doctors are duty bound to look after the patient and advise him in the best way possible. Having dealt with the ethical side of public health, let us now look at the legal issues concerning public health and then we shall analyze the issue given to us with regard to Dementia. Case Study of the Issue The case at hand for us is regarding the Dementia patients. The question, which has to be posed here, is whether dementia patients should be forced to stay at residential care homes. We shall now study the ethical questions regarding the issue. Public health code says that a society must integrate together and people should be provided to thrive in the best environment possible. The environment where a person lives and eats is the most crucial aspect to his recovery. In cases of dementia, it becomes even more important as the environment form the very basis of his memories and his survival depends on his well he is able to communicate and interact with is community. Since a person is very vulnerable emotionally and psychologically, it is very important that he breathes and eats in front of familiar people. Looking at the perspective of living inside a care home, the idea is not bad. However, there are a lot of things, which are missing. First of all is the lack of family and friends. This is even more important when the patient is suffering from memory loss. If a person is not provided space with his family with whom he spent all his life then he will not be able to take the full advantage of the medication provided to him at the care home. This is not to say that everything is bad if he is sent to the care home. Of course, the attention and the medical care provided will be of the best quality and beautiful nurses shall attend him personally too. However, nobody can replace the importance of family and friends and it is imperative that family should be around the person. Let us now look at the second alternative, which is that the patient is staying at home with his family and loved ones. The ethical issue here is the comfort and care of the patient. Along with that, the universal declaration of human rights states that the person has the right to the best environment and health care. Health care is a comprehensive treatment, which includes doctors, nurses, medicines and the environment. If one of the elements is missing then the person is not being provided the best treatment possible, which is against the ethics of public health. So the patient is moved to his home. The question, which arises now, is whether he will be able to receive the best medical treatment possible for his survival. It is not enough to live with family in a condition where you have lost your memory. Consider a patient of dementia living in the house who needs the best treatment and attention all the time. In the night when the family is sleeping he might have an attack, and the lack of doctors and nurse might lead to a situation where the quality medical treatment maybe compromised. It is crucial and imperative for the patient to be around doctors and constant attention so that he can be attended whenever needed and especially in cases of emergency. (Mason JK, McCall Smith R A & Laurie, 2005) Conclusion The essay has proven that both examples of a care home and residential treatment will not be enough to satisfy the public health ethical code of conduct as well as the legal principle laid out in the universal declaration of human rights. An ideal situation for the patient would be to stay at his home along with the medical care and attention provided. It is crucial to live by the greatest ethical principles and the most productive manner is to provide the best medical health care to the patient. Putting a dementia patient in his home so that he is living in familiar territory, as this is one of the best medicines, can do this. The environment makes a huge difference and therefore the dementia patient must be kept in his home and should not be taken to a residential home. However, since it is not enough to live with the family and friends and it is crucial that the patient receives the required medical attention, so we suggest that along with keeping the patient in his home, he should be provided a separate room where a mini hospital must be set up. Here a nurse must stay with her at all times and in case of any emergency, she must be capable to be able to deal with it. (T. Hope, 2005) References Beauchamp T.L and Childress J.F.. 2001/ 2008 Principles of Biomedical Ethics (6th Edition) or 5th Edition Oxford University Press Brazier M. 2003 Medicine, Patients and Law Penguin Books 0199282390 Mason JK, McCall Smith R A & Laurie G T 2005 Law and medical Ethics (7th ed) Oxford University Press 0 7020 2312 4 Rumbold G. 2005 Ethics in Nursing Practice Bailliere Tindall 0192802828 Hope, T 2004 Medical Ethics a Short Introduction Open University Press 9780230314436 Illingworth P 2012 Us Before Me: Ethics and Social Capital for Global Well-Being Palgrave Macmillan 9780470018132 Seedhouse D 2007 Ethics: The Heart of Health Care (3rd ed Wiley) Good Decision Making in real time: Public Health ethics training for local departments The ethics of care: Role obligations and moderate partiality in health care, Per Nortvedt, Marit Helene Hem and Helge Skirbekk BUTTS, J. B., & RICH, K. (2013). Nursing ethics: across the curriculum and into practice. 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: Robin Jacoby Decision making in terminal care: a survey of Finnish doctors treatment decisions in end-of-life scenarios involving a terminal cancer and a terminal dementia patient:
H Hinkka, E Kosunen, U-K Lammi, R Metsänoja, A Puustelli and P Kellokumpu-Lehtinen Practical Decision Making in Health Care Ethics:
Cases and Concepts (3ed): By Raymond J. Devettere, Published by Georgetown University Press, Washington DC Best interests, dementia and the Mental Capacity Act (2005); T Hope The autonomy of demented patients: interviews with care givers S-LEkman, ANorberg University of Umea, Sweden Some ethical issues in dementia research: B. Mahendra Autonomy or protection from harm? Judgements of German courts on care for the elderly in nursing homes: Kai Sammet Read More