Nursing ETHICS, LAW AND PROFESSION
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Ethics are principles and value which works together with codes of conduct and law to regulate legal professions in the healthcare environment. They ensure that there are a right and proper conduct in daily life activities. Integrity, freedom, and honesty are the main areas covered by ethics. A profession in ethics and law includes the ethical codes which govern the conduct of the person involved in the legal sector as well as in the practice law. All the persons in the legal profession have a duty to uphold the court and management of justice. Within the legal profession, legal ethics is the minimum standard of conduct. These ethics in the profession have the following importance; useful in identifying the moral and working following the work strategies. (onescu, 2016) The scenario that I will cover in my assignment is Emily’s scenario who has been admitted to the Beeches unit at the regional NHS psychiatric hospital. The patient is diagnosed with anorexia and has had contact with mental and health disorders. she is currently at the amendment act 1983, she is losing weight because she refuses to take food, also refuses a nasogastric feeding tube.
As employees it is significant to know all the laws and legal ethics responsibilities. Nursing and midwifery council (NMC) is among the rules that nurses accept to follow, it offers qualified standards and moral behavior for the nurses. It is a director for NHS professionals to assist and save the patient’s safety. The moral dilemma in healthcare involves the need to choose from the two or more, acceptable moral option or unacceptable actions, and one choice prevent selection of others. Nurses face a moral dilemma in their everyday activities which can affect decision making thus it is significant that nurses keep up to date with the rule and training. In this paper the ethical principles will be linked to Emily’s scenario; autonomy principle (right to make a decision), beneficence (to do good), non-maleficence (do no harm), and finally justice.
Moral dilemmas associated with the case and explain how nurses and other health care make choices lawfully also, professionally to allow patients to choose the best interest. Emily is under section 3 of mental act 1983, which the main section of the legislation which governs the evaluation, treatment, and privileges of persons with a mental health disorder. (Chadwick, 2016). The acts govern the principles such as respect and dignity, efficiency, equality, and least restrictive options and maximum freedom. (Richards,2019) In this act there is a need for urgent treatment for mental disorders who are at risk of harming themselves or others. The key purpose of the legislation is to safeguard persons with disabilities who are treated without their consent where necessary to prevent them from harming themselves.
Autonomy in ethics is a human dignity principle which allows the respect of decisions made by others concerning their own lives. Emily is admitted onto the breeches unit at a local national healthcare service with an eating disorder. She has been previously been diagnosed with anorexia and eating disorder that led to detrition of her mental health and weight loss. She is refusing medical intervention and food this will make her weaker leading to more problems. (Tiddy,2020) According to the autonomy principle nurses have to respect her decision.
Right autonomy and self-determination meaning that the person has the right and capability to make choices about their medical attention and treatment they are given as long as the choices are within the law limits. The mental health act also should ensure that nurses offer the best assessment and treatment to the patients. The legislative law offers obligatory treatment even if the patient holds the ability to make a decision. Morals of fairness and justice play an important part in Emily’s case also the dignity of the patient should be observed by the nurse. Nurses here are in dilemma but they have to influence Emily’s to make the correct and right decision and what is in their best interest that will allow her to take food and accept a nasogastric feeding tube. This principle allows healthcare to provide education to the patient but not to make decisions for them. The health care workers should educate and communicate with Emily on her mental disorder. If she refuses after been communicated the mental legislative act should apply where the nurses need to put a nasogastric tube on her nose without her conscience to save her life.
Mental health act (1983) requires urgent treatment for health disorders that are at high risk of harming themselves. The act ensures that the rights of people with a mental disorder are protected and make sure that the patient is admitted to the hospital against their wishes when it is unconditionally necessary. This happens when the disorder can put the patient at high risk. According to Emily’s situation health professions are given empowerment to give Emily treatment without her consent, this act is in her best attention to prevent her against any impairment but working against her self-rule. (Pellegrino,2019) In this case now the nurses should force-feed her with the nasogastric feeding tube to prevent the harm of letting her die because it is against the moral of ethnics.
Beneficence is a moral value that reports the impression of doing good. Doing what is best for the patient. Thus, the nurses’ actions should promote good deeds. The principle promotes the virtues of mercy, kindness, and connecting it to doing good to others as well as moral obligations. According to Emily’s scenario, healthcare can promote the good deed by forcing her to feed using the nasogastric tube, to save her life and improving her weight and body mass index. It is against her autonomy but promote the beneficence which is according to the mental health act of 1983.
This principle supports the moral rules such as preventing harm, rescue, and protection of persons in danger. The aspect of this code is offering the benefits and weighing the advantage and the harm. From the case the nurses forcing Emily to use a nasogastric tube was beneficial to rescue her life. (Janis,2008) These benefits overcome the harm that is why her autonomy was not followed. The mental act follows the value of beneficence and neglects the opinion of autonomy that allows the patient’s rights and decisions to be followed. Human rights protect the privileges of persons living with disabilities giving them the freedom and right to a decision. Emily’s rights are violated in the case of nurses forcing the nasogastric feeding tube to her.it is the way of promoting good deeds but is against human rights. This brings a moral dilemma to the health workers of letting her die which is not moral ethics or forcing her to feed which is against her self-rule and human rights.
The human privileges act 1998 of article two declares that the right of every person must be protected by the state, refrain from the legal kill, and saving lives. Forcing Emily to feed is against her rights and decision but this act protects the health workers, which means that the health workers have the right to force her feed to save a life. In this way, health care promotes the idea of doing good and providing treatment and care which is the moral ethic. (Elzakkers,2019) Psychological capacity is presented to defend and empower to assist persons like Emily who are not able to make their personal choice concerning whether to refuse or admit health interference that is useful to them.
Non-maleficence means inducing the least possible harm to a beneficial outcome. The relationship between physician and patient should be fiduciary. Patients always have trust that physicians have qualified skills for the patients’ attention and usefulness and the physician would do nothing to harm them. As per the universal value of health ethics, “A doctor must always bear in mind the obligation of preserving life.” Non-maleficence principle entails the concept of no harm. (Banks et al.,2016) Harm results in pain, which will lead to suffering. Damage may not only be incidental and planned but also inherent.
Incidental injury is as a result of imprecision and neglect, planned harm on the other side is measured the exacted pain. Inherent harm is deliberately harming a person and hence violates the negative duty not to harm. In medical non-maleficence recommends not to harm. The four categories of medical non-maleficence include dedication oneself to the safety of the patients, provision of suitable care, proper analysis of the condition and finally making proper beneficial assessments.
Medical non-maleficence is the act of imposing no risks as well as inflicting no actual harm. Based on the fiduciary relationship between them it is the role of the patient to prevent patients from any form of harm. (Winkler et al.,2018) Physicians inflict harm to patients in real life but aim at achieving good and no harm. A moral dilemma comes about when the physician inflicts pain to produce no harm and this is because negligible harm is because of detriment-benefit analysis in the patient’s favor.
Most of the time, physicians inflict fatal harm using double effect which is to the benefit and interest of the patient. The dilemma is if the infliction of fatal harm that violates the obligation of non-maleficence is in the patients’ interests, benefits. (Ye et al,2018) The intended and non-intended actions are differentiated by this effect. Both actions are associated and the intended effect is good and primary.
The double effect principle must always fulfill the following conditions; The actions itself must be morally good and neutral. The mediator’s aims must be moral and not bad. The evil effect might either be predicted, endured, and allowed but not be planned. The evil effect should not be a means of bringing an end to a moral effect. The outcome should outweigh the evil permitted.
According to Emily’s scenario, the non-maleficence aims at not harm. However, Emily is refusing nasogastric feeding the care team at promoting good and that is improving her lost weight and body mass index (BMI). The care team should therefore forcefully induce the nasogastric feeding method in the benefit of Emily despite going against her interests.
Justice means fairness and in healthcare it is the distribution of resources equally. Two types of justice comprise of distributive justice and rights-based justice. Respect for peoples’ rights that is applied in healthcare is the right based justice. (Mohtashami et al.,2019) Every person has a right to seek healthcare and participate in his or her care plan. According to Emily’s scenario, though the care team does not consider fairness in decision making since Emily does not agree with their decision, the care team is in a dilemma on whether to follow the patient’s wish or make a decision on their own but for the benefit and good of the patient. The care team is being forced to violate the justice rule and hence save Emily’s life by giving her a nasogastric feeding tube.
Professional standards describe the competency levels. These standards always reflect a wanted and attainable performance against the nurse’s presentation level can be compared. Professional standards’ aims are to direct and uphold a safe and clinically most experienced nursing training. The importance of these values to our profession is to encourage and guide clinical practice. These standards offer a framework for clinical competency checklists and sometimes used as an evaluation tool to assess a nurse’s care if he/she is suspected of unsafe working conducts or doesn’t adhere to structural policies.
Professional values assist us, the organization team in the development of safe staff practices, allocation of tasks. They are majorly patient-centered, encourage the most favorable results, and reduces risk exposure. (Van between et al.,2018) These morals persistently promote us to improve our skills through practice, education, and updated strategies. Any clinical officer is responsible for their clinical choices and activities
The moral of ethics for nurses has seven provisions that guide the nurses in their professional practices. The first provision is that nurses should exercise with sympathy and admiration for the integral self-respect, worth, and exclusive characteristics of each individual. Any individual should be valued by the nurses and allow dignity regarding care and communication. Families to the patients should be respected concerning their relationship with the patient. Nurses should work with other health workers and the patient’s relatives in the exercise of their professional guidelines in communication and work. (Shaw et al.,2017) According to Emily’s case, the care team is supposed to involve her family in the decision they make even if Emily does not agree to it. Professionally, the care team would have exercised their profession appropriately
The second provision is that the patient is the nurses’ primary commitment whether as an individual. In the healthcare setting, the patient should always be the priority. The nurse must recognize the importance of patient inclusion in care practices. The nurse’s actions have to always be shared with the patient and must promote the good always. (Ramos et al.,2018) It is necessary to collaborate with any teams internally and externally to enhance the betterment of the patient. Nurses should also understand professional boundaries and their relation to the outcome.
The third provision the patient’s rights, health, and safety should be protected, promoted, and advocated for. All privacy guidelines with regards to the patient should be well understood by the nurses. The aspect of contribution including learned consent and exposure to the patient by nurses doing research should be understood. Institutional standards should be understood in case the nurses’ performance needs to be reviewed. The nurses should demonstrate competence in clinical and documentation skills.
The fourth provision is a nurse has the control, responsibility, and obligation for nursing practices, choices, and actions taken with the commitment for best patient care. A nurse should make decisions that she will be accountable for. The authority must be applied professionally in all features of independence and patient, moral concerns. Decisions in nursing must be well thought, intended, and applied responsibly.
The fifth provision states that the nurse obligates the same responsibilities to themselves as to others as well as the promotion of health and care, character preservation and honesty, capability maintenance, and enhance individual and professional development. Nurses should ensure that there is an upkeep of themselves as well as others. (Rees et al.,2017) An ideal nurse upholds safe healthcare practices within the healthcare setting and at home. Nurses should always uphold integrity as well as concern for personal growth regarding continue learning of the profession.
The sixth provision reports that the nurse through personal or collective effort creates, upholds, and improves a moral environment of the work set and situations of employment that are harmless and of valuable. In the nursing occupation, ethics must be stipulated within and exterior to organizations of work dictating the moral requirements of care and deviations from correctness reported.
The seventh establishment states that collaboration through other medical professions and public the nurse should protect human privileges, encourage health negotiation, and decrease health inequalities. Association between members of a discipline enhances the maintenance of the thought that health is correct for any individual and channels best practice possible.
According to Emily’s case, the care team must professionally think critically and make a decision that will benefit the patient and do good by improving her health and later improving her general health.
In conclusion, there seems no perfect answer to any ethical dilemma. In most circumstances it is difficult to choose one principal over the other and the ethical decision tells us to choose the perfect principle possible. However, the choice made might not be as perfect but maybe of more good than harm. While making a perfect decision and choice of principle, the framework that guides nursing practice and the patients’ bill of rights should be considered. In any situation, advantages and disadvantages, as well as risk and benefits, should be weighed
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