Ethics and Law in Nursing Care - Essay Example

?Reflection: Ethics and Law Introduction In the clinical practice of health professionals, the legal and ethical standards of the practice are a significant part of their lives and their overall activity processes. These standards are there in order to provide a clear and detailed process which would legitimize their actions, as well as protect their decisions in the practice. These standards however, primarily protect the patients, making sure that their legal and ethical rights are protected and safeguarded. This paper shall be a reflection carried out using Gibbs’ Reflection model, evaluating a case and the actions related thereto in terms of confidentiality of patients, consent, and other ethical principles. It shall consider ethical and legal support for this nurse’s actions, reflecting on the possible future actions which can also be applied. Body Gibbs Reflective Cycle Description A 70-year old patient was admitted to the casualty department after a road traffic accident. He sustained severe injuries which required blood transfusion, but has refused to give his consent to such treatment due to his religious beliefs. He is fully aware that his life is at risk and he needs the blood transfusion if he were to survive. He drifted in and out of consciousness several times during his confinement. His family arrived and agreed that he needs the blood transfusion; however, he still refused such intervention. The nurses have tried to convince him, but he still could not be refused. Another nurse commented to the patient’s relatives that he did not see why they were making a big fuss about his refusal when the patient was old and would probably not have much longer to live anyway. Feelings I felt helpless in this case because I wanted very much to assist the patient in recovering and I felt helpless about our inability to perform a simple and routine procedure which would make a significant impact on the patient’s outcomes. However, I felt that as a health professional, I was bound by my ethical oath to respect the patient’s autonomy and right to self-determination. I also felt annoyed with my colleague who made the remark about the patient not having much to live anyway. It was a callous and insensitive remark, one which was not in keeping with the code of our professional and ethical conduct. Evaluation I believe that we made the right decision about respecting the patient’s autonomy and not administering the blood transfusion. I believe that we also made the right decision in terms of not allowing the patient’s relatives to overall the patient’s personal choice. However, what was bad about the experience was the nurse making a comment about the family not needing to make a fuss about the patient’s decision because the patient was old and would not have much longer to live anyway. Analysis First and foremost, informed consent is one of the most important elements of the health care practice. The Nursing and Midwifery Code (NMC, 2004, p. 5) specifies that a nurse must first obtain the informed consent of the patient before any treatment of intervention is administered. By informed consent, the need to properly inform the patient about his condition is important and the nurse must reveal to the patient all the necessary information, risks, implications, and processes involved in the intervention or procedure. The nurse is also required to respect the patient’s needs and wishes, especially the wishes of those who refuse or who are unable to receive data about their condition (NMC, 2004, p. 5). The information transmitted must also be accurate and truthful and presented in a manner which the patient can fully understand. The patient’s autonomy must be respected, even if their refusal for treatment would result in their death or even when their decisions would seem unreasonable or even illogical (NMC, 2004, p. 6). In gaining an informed consent, the nurse must ensure that such consent is given by a legally competent individual, is given voluntarily, and such consent is fully informed. All patients are assumed to be legally competent unless proven otherwise. A legally competent individual is able to understand and retain information, and can use such information to make a fully informed decision (Jones, et.al., 2002, p. 4). Legally competent individuals can then express their consent in writing or orally or by cooperating with the health professionals administering care. They may also refuse to give their consent orally or in writing. The nurse’s job in this case is to fully ensure that the documents which pertain to the patient’s case are fully integrated into her chart. In this case, the patient is well within his rights to refuse treatment on religious, cultural, or any other personal grounds (Leino-Kilpi, 2000, p. 48). It is part of his legal and ethical right to refuse such treatment and this must be respected else be subjected to legal sanctions. The patient is also fully competent and has understood the full implications of his refusal to be treated. Therefore, his decision is very much a fully informed one, and must therefore be respected. The right to autonomy and self-determination is one of the four basic ethical principles being applied and practiced in health care. This right to self-determination is based on the concept of respecting patient choices in terms of the control they can have over their care (Jones, et.al., 2002, p. 18). It also refers to the concept of patient empowerment, allowing the patient to have more power or control over his decisions and over the medical procedures being carried out in his behalf (Murray and Evans, 2003, p. 577). For the most part, patient autonomy and the right to self-determination is another means for the patient to feel more comfortable about the decisions which relate to his care. Some patients often feel powerless about being subjected to various medical procedures and their right to self-determination gives them some form of control over their body and their care (Leino-Kilpi, 2000, p. 40). Patients also have the right to be respected for their religious beliefs. In this case, the patient refused a blood transfusion because it was against his religion (Viney, 1996, p. 321). Religious beliefs and other cultural beliefs and traditions are considered to be an essential part of patient’s lives. Many of their life decisions are often dictated by their culture and religion. It is therefore not surprising for individuals to use the teachings of their religion to help them decide their health care (Viney, 1996, p. 321). Effa-Heap discusses (2009, p. 174) discusses that Jehovah’s Witnesses have a firm belief that a person’s life is contained in his blood, and therefore, accepting blood transfusion and blood products are considered sinful practices. Administering blood to a Jehovah’s Witness who has already refused a blood transfusion makes a health care professional liable for criminal and civil charges (Effa-Heap, 2009, p. 174). Moreover, based on an ethical understanding, a rational adult who has been fully informed of his condition and his need for a blood transfusion, but still refuses such procedure, must be fully respected. In this case, the nurses and other health professionals must consider alternatives to blood transfusion, alternatives which can help the patient achieve similar results as the blood transfusion (Effa-Heap, 2009, p. 174). These alternatives may include cell salvage, volume expanders, antifibrolytics, and the administration of erythropoietin. The fact that the patient may be in and out of consciousness does not impact or negate his competence in making sound medical decisions. During the times when he was conscious, the patient could fully understand the gravity of his condition and the fact that the blood transfusion would likely save his life (Foex, 2001, p. 198). The fact that he was drifting in and out of consciousness must not therefore negate his ability to make an informed decision regarding his care. He is assumed to be competent, and without any signs which would indicate mental illness or which would negate his competence, such competence shall not be invalidated (Foex, 2001, p. 198). Moreover, the fact that he is drifting in and out of consciousness does not also negate the fact that the patient is a Jehovah’s Witness and that it is already common knowledge within the medical community that Jehovah’s Witnesses are against blood transfusions. Therefore, the fact that the patient was in and out of consciousness is not sufficient reason for the family to take over and to serve as proxy decision makers (Rowland and Rowland, 1997, p. 199). Proxy or surrogate decision-making can be carried out in behalf of the patient in instances when he is deemed incompetent to carry out sound medical decisions (Singer and Viens, 2008, p. 62). These proxy decisions must however still be based on sound medical advice and on the patient’s preferred choices had he been competent to make the decisions. In instances where there are advanced directives on the decisions regarding the patient’s care, such advance directives must be followed and must guide the proxy’s decisions regarding the patient’s care (Singer and Viens, 2008, p. 62). Since the patient is fully competent to make the decisions regarding his care, proxy decisions which are apparently made in his behalf, especially those which negate his wishes (religious or personal) are legally actionable and ethically objectionable. The nurse’s words to the family are also ethically and legally objectionable because they represent discriminatory practices against the patient based on his age. It is considered ageism and labelling. Ageism is considered an attitude of mind which may lead to age discrimination (Centre for Policy on Ageing, 2009, p. 9). This is a concept which involves the act of denying resources and opportunities which all people would have enjoyed had it not been for their age. The nurse’s comments imply a denigration of the patient’s right to medical care and his right to be treated with dignity and respect. The fact that he is elderly must not be considered a determinant or a qualification in the allocation of his essential needs and care requirements (Centre for Policy on Ageing, 2009, p. 9). Conclusion Based on the above discussion, I believe that our actions in respecting the patient’s decision regarding his refusal to have the blood transfusion are ethically and legally viable. First and foremost, the patient has the right to self-autonomy and self-determination and must therefore be respected in the exercise of these rights. Secondly, I also believe that it was appropriate for us not to allow the wishes of the family to overrule the patient’s decision. Since the patient is competent to make the decisions regarding his care, he must be allowed to make such independent determination in his care. Lastly, I believe that the nurse who made the insensitive comments about the patient has discriminated against the patient in relation to the latter’s age. The nurse also made a comment which did not respect the patient’s dignity and right to appropriate medical care. I do not think there would be anything I would have done differently in this case. I did my best to explain to the patient about his illness and to make sure he understood the implications of his refusal to treat. I believe that we were able to comply with the requirements of informed consent. In this regard therefore, I believe that there would not have been anything I would have done differently. Action Plan When faced with a similar occurrence in the future, I believe that I would not act differently. However, I would also try to talk to the family and make sure that they also understand the patient’s decision. The patient made a decision which was not favoured by the family. The fact that they want what is also best for their family member and want to insist on the blood transfusion, much stress may be caused to the patient. This stress may cause the patient further anxiety and may set back his recovery. It is important to talk to the family and to discuss with them that the patient is making the decision soundly and with the full understanding of his condition. By discussing the patient’s decisions with the family, they may take on a more supportive attitude towards the patient – an attitude which would not cause the patient much stress and anxiety. Works Cited Centre for Policy on Ageing, 2009, Ageism and age discrimination in secondary health care in the United Kingdom: A review from the literature, Department of Health, viewed 05 November 2011 from http://www.cpa.org.uk/information/reviews/CPA-ageism_and_age_discrimination_in_secondary_health_care-report.pdf Effa-Heap, 2009, Blood transfusion: implications of treating a Jehovah’s Witness patient, British Journal of Nursing, vol. 18, no. 3, pp 174 – 177. Foex, B. 2001, The problem of informed consent in emergency medicine research, Emerg Med J., vol. 18, pp. 198–204 Jones, G., Endacott, R., & Crouch, R. 2002, Emergency nursing care: principles and practice, London: Cambridge University Press. Leino-Kilpi, H. 2000, Patient's autonomy, privacy and informed consent, Oxford, IOS Press. Murray, C. & Evans, D. 2003, Health systems performance assessment: debates, methods and empiricism, Switzerland, World Health Organization. Nursing Midwifery Council 2004, The NMC code of professional conduct: standards for conduct, performance and ethics, viewed 07 November 2011 from http://www.positive-options.com/news/downloads/NMC_-_Code_of_Professional_Conduct_-_2004.pdf Rowland, H. & Rowland, B. 1997, Nursing administration handbook, London: Jones & Bartlett Learning Singer, P. & Viens, A. 2008, The Cambridge textbook of bioethics, Cambridge, Cambridge University Press Viney, C. 1996, Nursing the critically ill, London, Elsevier Health Sciences. 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