Legal and Ethical Aspects of Health and Social Care Delivery - Essay Example

Legal and Ethical Aspects of Health and Social Care Delivery Legal and Ethical Aspects of Health and Social Care Delivery Introduction It is important for me as a nurse to give critical attention to legal and ethical aspects associated with the delivery of health and social care. Worth noting is the fact that my priority as a nurse is to ensure the delivery of quality care to patients with different illnesses. However, the nursing practice may place one in an ethical dilemma. When handling some patients, I may face difficulties in determining the right options that I should take in order to help the patient and maximize the quality of care. In such cases, I rely on my knowledge concerning both the legal and ethical aspects defining the nursing profession. When handling patients suffering from terminal illnesses, it is my role to ensure that a patient can successfully manage the condition, experience reduced pain, and approach the end of life stages with a positive outlook. Although my intention is to help such patients, complications may occur because of the choices made by the patients. The case of Brian, who is 55 years old and declined to adopt the advice and the equipment presented by me presents an ethical dilemma for any nurse. In this paper, I will discuss Brian’s case study in detail, evaluating, and analysing the case study and presenting my final ethical decision. In addition, the paper will examine the utilitarian ethical principle and weigh it against the respect for autonomy in an effort to help Brian experience quality life despite his condition. Description of the Case Study Brian, aged 55 years suffers from multiple sclerosis. Multiple sclerosis is a condition that presents adverse effects on an individual’s immune system. Specifically, the disease affects the protective sheath surrounding nerves. As a result, individuals suffering from the disease do not have a normal communication between the brain and the body. As the disease progresses, an individual’s nervous system may deteriorate badly. Usually, there is no cure for multiple sclerosis and patients with the disease have no other choice but to manage their condition. In the case of Brian, the disease has progressed to the level whereby he needs a wheelchair because he cannot walk (Dimond, 2011). Therefore, the disease has served to debilitate him compelling him to rely on my help and other social workers who help him to feed, wash, and get him out of bed occasionally. Worth noting is the fact that Brian does not have any carer at home because his wife suffers from Parkinson’s disease. Since Brian’s condition compels him to stay in bed or the wheelchair for many hours, he is subject to developing pressure ulcers. Therefore, I have ensured that his wheelchair has a cushion for minimizing pressure on his behind. In addition, the I have advised him to accept a special bed with a pressure-relieving mattress in an effort to minimize the occurrence of pressure ulcers (Banks & Gallagher, 2009). Unfortunately, Brian turned down my offer of the special bed, preferring to continue sharing his double bed with his wife. He explains that the special bed only has the single option, a factor that will compromise the relationship with his wife if he accepts. Brian has not considered the option of having an inflatable pressure mattress on his double bed as a viable alternative for preventing pressure ulcers. It is unfortunate that Brian is experiencing skin failure characterized by grade 4 pressure ulcers on his sacrum. Worth noting is the fact that grade 4 pressure ulcers present a serious case of skin failure that may eventually trigger tissue decay in areas adjacent to the ulcers (Barber, Martin, Brown, & Great, 2009). Therefore, I have a new role of dressing the pressure ulcers, although the schedule compels Brian to spend more hours in bed. For Brian, it is a disadvantage as spending more time in bed compels him to be separated from his wife. The worst part is that he is yet to accept any form of pressure relieving equipment. Failure to accept such equipment only means that his condition will worsen. The worsening of his condition will present adverse effects not only to himself, but also to his wife (Bartlett & Sandland, 2014). I believe that nurses face the compulsion of strictly following the ethical and legal regulations defining the nursing practice. Notably, as a nurse, I am not in a position to force a patient to accept advice or equipment. Patients have a right to self-determination as long as they are in a position to state what they want. Many patients may require proper training on why they need to accept certain equipment that serves to improve their conditions. It is sad that Brian has rejected the pressure relieving equipment I offered him (Beauchamp & Childress, 2013). For this reason, I have a difficult decision to make regarding Brian’s case. Because he is experiencing a serious skin failure, I face the compulsion of preventing pressure ulcers. Over time, Brian’s pressure ulcers have advanced to grade 4 levels. In many cases, the grade 4 level is the most advanced with patients living for only a few days after it becomes evident. Therefore, Brian’s choice of not accepting the equipment places his life at risk. In my opinion, my role as the carer is to ensure that he receives the best care in an effort to lengthen his life. Now, there are conflicting interests between Brian and me, who is unwilling to accept the pressure relieving equipment. Therefore, I have to make an ethical decision regarding Brian’s case. Although patients have the right to choose what they want, nurses should make them recognize the potential consequences of their decisions. If Brian does not accept the pressure relieving equipment, it is possible that he will lose his life in a few days (Bell, 2002). Analysis of the Case Study I have the conviction that Brian requires quality care if he is to live longer and experience a measure of comfort. The local authorities have made steps to ensuring that he receives healthcare at home in accordance with the care Act 2014 (Dimond, 2011). I, therefore, have a responsibility of ensuring that he receives the best kind of care so that he can be comfortable and experience less pain. I should have the capacity to discern emerging needs of the patient and define effective intervention strategies. Now, I take care of Brian four times in a day. Since he is unable to move, he relies on a wheelchair. He only gets out of bed with my help and needs me to help him with basic activities such as feeding and washing himself (Brammer, 2010). Worth noting is the fact that he lives with his wife who suffers from the Parkinson’s disease. Brian’s priority seems to be his relationship with his wife and not improving his health condition. He has rejected offers of pressure relieving equipment that can help him develop fewer pressure ulcers. In his condition, pressure ulcers are inevitable, but with the correct measures, they can be reduced effectively. I have tried my best to help Brian recognize the value of the pressure relieving equipment, but with no avail. In my opinion, I need to make decisions that will promote the well-being of the patient (Brayne & Carr, 2005). According to the Human Rights Act 1998, and the Equality Act of 2010, nurses have to ensure that their guiding principles in practice include dignity, diversity, humanity, and equality. Notably, the basic principle of delivering healthcare for both nurses and social workers is to preserve the dignity of individuals. The Equality Act of 2010 places emphasis on the fact that no patient should be subject to any form of discrimination, either based on his or her illness, age, gender, marriage, religion, race, and civil partnership. In the recent past, nurses have also been urged to deliver person-centred care, ensuring that it meets the needs of patients. In order to ensure that nurses and carers act in accordance with human rights legislations, there is a salient need for them to understand the existing laws in details. For this reason, if I am to promote dignity, equality, diversity, and humanity, I have to involve the patient in all the decision-making processes (Burnard, Chapman, & Smallman, 2004). I have a strong conviction that as long as a patient is in a position to contribute to decision-making positively, then I should be in a position to give attention to their opinion. Human dignity has a close association with autonomy, a factor that allows patients to make decisions that promote their personal interests. According to Dimond (2011), in the case of Brian, I have to respect his right to exercise autonomy. For this reason, I should treat him with respect and compassion despite the fact that he is not willing to implement the advice I presented to him. As highlighted above, Brian gives first attention to his relationship with his wife. Therefore, he makes decisions based on their potential consequences on his relationship with his wife. He realizes that both of them suffer from terminal illnesses and may have only a limited time left together. Therefore, he chooses to reject the pressure relieving equipment because he wants to continue sharing a bed with his wife. However, he is well aware that his decisions will affect the condition of his pressure ulcers (Clements, 2010). I am obliged to respect his decisions. In accordance with the human rights Act, Brian deserves to be treated with respect, accorded the right dignity, compassion, and provided with person-centred care. For this reason, it would be wrong for me to condemn Brian for the decisions that he has made (Alaszewski & Heyman, 2000). Therefore, my priority should be to continue persuading him to reconsider his decisions in order to accept one of the pressure relieving equipment so that his condition may improve (Dimond, 2011). In my opinion, Brian deserves a right to quality care that considers his unique needs based on his unique experience of his health condition. I am aware that I need to understand his reasons for not willing to accept the pressure reducing equipment. Respecting his decisions and treating him with the relevant compulsion will help him experience a measure of dignity, which is more important for any patient. Evidently, Brian needs to experience a positive feeling that he is worthy of human dignity and has a right to make autonomous decisions. Therefore, I am compelled to design other intervention strategies that can help Brian manage the pressure ulcers more effectively if he does not conform to the already suggested alternatives (Fulford, Dickenson, & Murray, 2002). I believe that the utilitarianism theory can be an effective, ethical theory in determining the best alternative in Brian’s case. Although my priority is to address the needs of the patient effectively, utilitarianism can apply in Brian’s case. Notably, every patient needs to experience a measure of comfort even when they have a terminal illness. Therefore, Brian needs to experience such comfort despite the debilitating effect of multiple sclerosis. On the other hand, Brian wants to continue experiencing memorable times close to his wife. Therefore, the views of his wife are important factors in determining the best alternative. The best decision, in this case, should promote Brian’s wellbeing reducing his discomfort and allowing him to enjoy a quality life before his death (Griffith & Tengnah, 2008). The quality of life is debatable in this case because the factors of assessing quality differ immensely. It seems that quality to Brian translates to being close to his wife. Therefore, I should make a decision that not only promotes his own good in terms of his health condition, but also one that allows him to be closer to his wife. Utilitarianism promotes the maximum good for all the parties involved. In this case, a utilitarian approach will ensure that Brian’s wellbeing is promoted and that he is closer to his wife. Such a decision will also ensure that Brian can live for much longer. I have the conviction that I should develop a maximized plan for delivering quality healthcare to Brian ensuring that I promote the best interests of all the parties (Harris, 2008). Brian’s wife suffers from Parkinson’s disease and requires the support from her husband. For this reason, persuading Brian to accept intervention measures that seek to address the pressure issue will promote the happiness of the couple. On the other hand, I will have an easier time focusing on meeting his other needs. Adopting a utilitarian approach will help Brian realize that grade 4 pressure ulcers may worsen his condition compelling him to leave his wife alone. For a person who treasures his wife that much, he will be able to rethink (Matthews & Fraser, 2008). I should, therefore, help him recognize that his individual needs, in this case, deserve a priority. The Decision-making Process The Decide model is the most effective in nursing decision-making. The first step involves the definition of the problem. In Brian’s case, the ethical problem is that he has rejected intervention strategies that can alleviate the pressure evident on his skin. His refusal of such type of care may result to the worsening of his condition. However, he has a right as an individual to express his autonomy regarding the kind of interventions he requires. On the other hand, I have an outstanding duty of addressing his health needs. The second step is the ethical review. In my opinion, I should carry out an ethical review in order to determine the ethical principles that deserve a priority. The patient’s autonomy, as well as my beneficence, is the most outstanding ethical principles. Whereas Brian has a right to choose what he wants, I have an obligation of promoting his wellbeing and allowing him to experience quality life despite his terminal illness (Parrott, 2010). According to the tort law, a nurse has the obligation of providing care to patients in accordance with the beneficence ethical principle. At the same time, it is only logical to respect the wishes of patients and discuss care options with them. Brian’s responsibility to his wife as a husband is also an important aspect of this ethical problem. The third step involves the identification of potential options for reducing the pressure ulcers and ensuring that Brian has a much comfortable life. Urging Brian to use the pressure relieving equipment such as the special bed and mattress is one of the viable options. However, as it is now, Brian has rejected any equipment offered to him. I have the conviction that relying on a healthy diet can also be a potential solution. Healthy diets that Brian needs to incorporate into his meals are beef, milk products, and beans that are rich in proteins have the capacity to help Brian minimize the occurrence of pressure ulcers. In addition, I have chosen to visit him more times in a day in order to change his position regularly (Rowson, 2006). It is possible for Brian to address the issue of pressure ulcers without having to rely on reducing equipment. The fourth step is to investigate the potential outcomes from each of the options highlighted above. If Brian reconsiders the option of using a special mattress, it will help in reducing the pressure, and his condition may improve immensely. In addition, he will not have to sleep in a separate bed with his wife and both of them to spend quality time. Notably, his wife suffers from Parkinson’s disease and will also benefit from the special mattress since she is also subject to developing pressure ulcers. In the case of a healthy diet, it may present positive outcomes, although it depends on whether Brian will like the recommended foods. In this case, I will have to decide the expected outcomes of a diet comprising of proteins in accordance with his condition (Seedhouse, 2005). The other option will require me and carers to allocate more time to attend to him and ensure that we change his position more regularly. Evidently, this option may present challenges to me. In my view, therefore, the most ethical decision should address the individual needs of Brian, whose experience of his health condition is unique in his way. His priorities as an individual require proper consideration as well. Therefore, the best option is to urge Brian to consider using a special mattress on the double bed (Tingle & Cribb, 2007). The reason for this is because he will benefit immensely from the move as his health condition will improve, and he will spend time with his wife. The fifth step involves making a proper decision and setting the objectives. In this case, I will need to take a step of convincing Brian to use the special mattress highlighting its benefits to both him and his wife. I consider making an offer of the special mattress. After Brian has obtained the special mattress, it is possible that his condition will improve. I will monitor his condition closely in an effort to determine any improvement. The primary goal of the intervention should ensure that Brian’s condition improves and that he is not separated from his wife. Evaluation As highlighted above, both legal and ethical considerations are of critical importance when dealing with patients who require high levels of care. The case of Brian is a sensitive one because he is an elderly man suffering from a terminal illness. His wife has a terminal illness as well a factor that compels me to visit him regularly and present Brian with palliative care. A close analysis of his situation reveals that I should urge him to consider using a special mattress on their double bed. The special mattress will improve his condition, that of his wife, and give them an opportunity to be together. Worth noting is the fact that I should always respect the views of Brian while doing my best to deliver quality healthcare (Wood, 2010). Conclusion Evidently, I cannot afford to underestimate the value of legal and ethical aspects of nursing. As highlighted above, patients require to be treated as humans with the highest level of dignity in accordance with the human rights act of 1988. Therefore, I have to respect the right of patients to make autonomous decisions. Sometimes, patients make decisions that conflict with the priorities defined by the nurses. In the case study described above, Brian chose to reject any stress relieving equipment while I had identified, such equipment as important for addressing the resulting pressure. The utilitarian theory highlights that nurses should make decisions that provide the maximum good to a high number of people. In this case, the best option was to persuade Brian to accept the special mattress, which will reduce the pressure and allow him to be close to his wife. Bibliography Alaszewski, A, & Heyman, B. (2000). Managing Risk In Community Practice: Nursing, Risk And Decision Making. London, New York: Baillière Tindall. Banks, S, & Gallagher, A. (2009). Ethics In Professional Life: Virtues For Health And Social Care. Basingstoke [England]; New York: Palgrave Macmillan. Barber, P, Martin, D, Brown, R, & Great, B. (2009). Mental Health Law In England And Wales: A Guide For Mental Health Professionals Including The Text Of The Mental Health Act 1983 As Amended By The Mental Health Act 2007. Exeter: Sage Publications, Ltd. UK. Bartlett, P, & Sandland, R. (2014). Mental Health Law : Policy And Practice. Oxford, United Kingdom : Oxford University Press. Beauchamp, T, & Childress, J. (2013). Principles Of Biomedical Ethics. New York : Oxford University Press. Bell, M. (2002). Equality: The New Legal Framework. Social & Legal Studies, 21, 1, pp. 141-144. Brammer, A. (2010). Social work law. Harlow, England: Pearson Longman. Brayne, H, & Carr, H. (2005). Law For Social Workers. Oxford ; New York : Oxford University Press. Burnard, P., Chapman, C. M., & Smallman, S. (2004). Professional and ethical issues in nursing. Edinburgh: Baillière Tindall. Clements, L. (2010). Carers and their rights: The law relating to carers. London: Carers UK.. Dimond, B. (2011). Legal aspects of nursing. Harlow, Essex, England: Pearson. Fulford, K. W. M., Dickenson, D., & Murray, T. (2002). Healthcare ethics and human values: An introductory text with readings and case studies. A Malden, Mass: Blackwell Publishers. Griffith, R, & Tengnah, C. (2008). Law And Professional Issues In Nursing. Exeter: Sage Publications, Ltd. UK. Harris, D. (2008). Contemporary Issues In Healthcare Law And Ethics. Chicago: Health Administration Press. Matthews, S, & Fraser, S. (2008). The Critical Practitioner In Social Work And Health Care. Milton Keynes, SAGE Publications Ltd. Parrott, L. (2010). Values And Ethics In Social Work Practice. Exeter: Learning Matters. Rowson, R. (2006). Working Ethics. [Electronic Resource] : How To Be Fair In A Culturally Complex World. London ; Philadelphia : Jessica Kingsley Publishers. Seedhouse, D. (2005). Values-Based Decision-Making For The Caring Professions. Chichester ; Hoboken, NJ : Wiley. Tingle, J, & Cribb, A. (2007). Nursing Law And Ethics. Oxford ; Malden, MA : Blackwell Pub Wood, J. (2010). Nursing ethics: a principle-based approach, 2nd edition. Nursing Ethics, 17, 4, p. 532, Science Citation Index, EBSCOhost, viewed 26 April 2015. Read More