Ethical Issues and Health - Essay Example

Ethical Issue Ethical Issue Admittedly, health care profession poses a large number of ethical issues that are rather quite explicit. However, unlike other fields, ethical issues in health care profession are not easily resolved. The first complicating factor is that moral ideals sometimes conflict with one another and the second factor is that people tend to differ from each other in the application of even those ideals they agree about. The issue being addressed here is the use of physical and chemical restraints in order to prevent patients from moving freely. In some cases, sedatives are used to restrict the patient’s physical and mental functioning. For example, a patient with chronic arthritis of the hip will not be able to do all those physical activities the patient did in the past. In another case, an elderly patient who is in the habit of wandering may be stopped using a physical restraint. I have a friend who works as a nurse in a mental health care setting. He has, many a times, told me how violent, distressing, and troublesome mental patients can be in such settings. One day, I found him rather upset after work, and when I asked as to what the reason was, he told me the violence created by a patient and the way the patient was handled. The patient was a middle aged man. As he was extremely violent and inflicted harm on other patients and himself, the shift supervisor was called, and the supervisor directed the patient to submit but the patient did not given in. So, the force team caught hold of the patient and in the effort, my friend was bitten by the patient on his arm. The patient was handcuffed, and placed in supine position. Soon, the doctor came and a chemical restraint was used to pacify the patient before moving the patient to a safe cell. My friend really seemed confused about the ethics in using such restraints in mental health care settings as the first glance impression is that restraints are against the concept of autonomy. Here, a puzzling question is the ethics involved in the use of physical and chemical restraints in a mental health care setting. Admittedly, this use is in stark contradiction with the concept of allowing autonomy of the patient. In such cases, the main complicating factor is that the nurses and health care aides are in no way able to discuss with the patient and allow the patient to make rational choices. Firstly, the patient may not be able to understand the importance of the procedures adopted by the health care setting, and secondly, the patient may not be able to take wise decisions because of the mental illness. As Barker (2011) states, the tendency in medical profession is to resort to physical and chemical restraints that totally restrict the patient’s freedom; both physical and mental. Admittedly, the issue of autonomy becomes a matter of dispute when it is considered as ‘the freedom to act’. However, in order to solve the issue surrounding autonomy and the use of physical and chemical restraints, Yeo, Moorhouse, Khan and Rodney (2010) give the term ‘autonomy’ a different meaning, that is, ‘effective deliberation’. In this case, I think autonomy gives a totally different picture. Admittedly, the term effective deliberation means the quality of reasoning one uses to support ones opinion should be sound. Thus, certain prerequisites of effective deliberation are a proper understanding of ones situation, the knowledge about the risks, determents, and benefits and drawbacks of various options at a juncture, and the ability to weigh one option against another in order to take a rational decision. If these are the basic tenets of effective deliberation, evidently, a patient in a mental health setting is the least reliable deliberator because mental illness is the dysfunction of mind. Admittedly, rational deliberation does not mean that the patient should fully agree with the demands of the clinical team, but it means the ability to negotiate and cooperate in a rational way, and an understanding of ones situation. One has to agree to the fact that many a times, mental patients tend to possess quite less or wrong information about their own conditions and treatment options. This has a serious impact on their decision making ability. Thus, it becomes evident that mental patients generally do not possess the ability to engage in effective deliberation, and they do not have autonomy themselves. Now, it seems that the best way to approach this issue of autonomy and restraints through the tenets of Deontology. According to Deontology as propounded by Immanuel Kant, when faced with an ethical dilemma, one should develop such a rule that is universally applicable. In other words, ones morality lies in following ones duty. According to Kant, it is possible for us to understand what our moral duty is, and hence, it is not necessarily yielding to the will of another. Instead, one is supposed to comprehend what ones duty is and act accordingly. Thus, deontology points out that autonomy means submitting oneself to a law that is supported by rationality and that is universally applicable. According to the tenets of deontology, autonomy is not only about allowing a patient to make his or her decision, but also about the duty to make decisions in accordance with the demands of reason. Thus, it becomes evident that the concept of autonomy has totally altered at this juncture. The new insight is that autonomy is not doing what one loves or making ones will prevail. This is so because if autonomy is submitting oneself to a universal law, a desire to the contrary is not autonomy. Hence, just desire without rational reasoning is not an expression of autonomy. Thus, according to deontology, it is common if one finds ones interests in sharp contradiction with what is ethical. Even if it is so, duty should be given the first preference. Now, a look back into the use of restraints proves that allowing autonomy in medical setting does not mean allowing the patient to wander away and cause harm to oneself and others. As far as the patient is not able to take such decisions that are universally applicable, there is no autonomy to be allowed. However, this does not mean that the medical team can use any restraint without utilizing their best efforts to provide the best acceptable forms of restraints. Now, in order to understand if it is right to use physical constraints, the best way is to use the principles of utilitarianism. In the opinion of Husted and Husted (2008), principles of utilitarianism claim that ethics lies in producing the greatest good to the greatest number of people. According to the tenets of utilitarianism, the value of an action is decided by its result, and good results mean those results that provide maximum good to the maximum number of people. If this is the case, the medical team possesses the right to use both physical and chemical restraints. The use of restraints means the medical team gets what is best for it as the intended constraint is put into effect, society gets what is good for it as it is protected from the possible harm that can be inflicted by the insane, and the patient gets the best as he is protected from the possible harm caused by wandering. If someone is not getting what is perceived as good by them, it is the patient. According to Tingle and Cribb (2002), it becomes evident that ethical theories cannot be used to restrain the use of restraints in the case of mental illnesses. As it becomes evident from various principles of ethics, constraints are not against autonomy. Firstly, autonomy is not allowing total freedom, but is dependent on the ability to base ones claims on rational thinking. References Barker, P. (2011). Mental Health Ethics: The Human Context.USA: Routledge. Husted, J. H & Husted, G. L. (2008). Ethical Decision in Nursing and Health Care: The Symphonological Approach. New York: Springer Publishing Company. Tingle, J & Cribb, A. (2002). Nursing Law and Ethics. UK: Blackwell Publishing. Yeo, M., Moorhouse, A., Khan, P & Rodney, P. (2010). Concepts and Causes in Nursing Ethics. Canada: Broadview Press. Read More