Deontology Theory In Nursing
Professional values, ethics and law
Introduction
This assignment will discuss the ethical, legal and professional issues relating to medical practice. Doctors and Nurses are often faced with legal, professional and ethical issues relating to health care. This assignment will also look into ethical and legal aspects in relation to issues of human rights and consent. There are many laws and legislations that protect patient’s rights, such as common law, Human Rights Act 1998, Mental Health Act 2007, and Mental Capacity Act 2005.
Case study one (1) has been chosen for this assignment, which is about Sara B who is forty two (42) years old woman, who has been diagnosed with multiple Sclerosis. She is in neurological ward for test as her condition …show more content…
has deteriorated over the last twelve months, resulting in her using a wheelchair and in need of considerable nursing input from her partner Louise. It was discovered that the doctors had put a ‘Do Not Resuscitate’ (DNR) note in her file. Neither Sara nor Louise is aware of this. From an ethical perspective, ethical values: utilitarianism, deontology and virtue ethics will be discussed relating to the case study. The four ethical principles in relation to this case study will also be discussed. These principles are autonomy, beneficence, non-maleficence and justice.
There are a number of professional issues around the case study in question that will be addressed. These issues are mainly around the four main principles of the Nursing and Midwifery Council codes of conduct (2008).These principles are; Prioritising the care of the patients and treating them as individuals whilst respecting their dignity Working closely with colleagues to protect and promote the health and wellbeing of the patients, their families, carers, and the wider society Providing consistently high standards of practice and care, being open and honest, acting with integrity and maintaining the reputation of the nursing profession
Legal issues arising from the case study such as confidentiality, consent, accountability, duty of care, negligence and human right will be discussed.
I will conclude with a reflection based on the Gibbs’ model and highlight insights developed from the case study and they could be how they into practice. Also in the conclusion learning needs for future developments will be identified.
Ethical Perspective of Sara B’s Case Study
Ethics is the discipline that deals with rightness and wrongness of actions. (Aiken 2004) Ethics also is concerned with duties, responsibilities, principles and accepted wisdom. (Hawley, 2007). The two most commonly applied ethical theories are utilitarianism and deontology (Shaun D. Pattison, 2009). Utilitarianism theory is concerned with repercussions of behaviour; it seeks to favour the majority. As it suggests, utilitarian theory seeks to have the best possible balance of utility over disutility of the matters at hand. It is more concerned with getting the best for the greatest number. According to utilitarianism theory, it is essential for one to have the full and adequate information of all the possible consequences related to their acts as well as all the probable consequences of every other action that is equally available at that moment.
The utilitarianism theory can be useful in analysing Sara B’s case in relation to the doctor’s action of assigning a ‘Do not Resuscitate’ note in Sara’s file without her consent. As the theory states, it is important for all medical practitioners to have full knowledge of the consequences of their acts, thus in this case, the doctor and/ or the hospital are likely to face consequences of the doctor’s actions of acting without consent of the patient. The doctor’s act should have applied with this theory in mind.
Deontology on the other hand, doesn’t look at the consequences, but rather it is rules, right-based and duty based (Shaun D. Pattison, 2009). Unlike utilitarianism theory which looks at what is best for the most; deontology looks at what is best for an individual and his interests. For deontological ethical theories, obedience to a duty determines the rightness or wrongness of an action.
In relation to the case study, deontology theory helps analyze the action of assigning a ‘Do not Resuscitate’ note in yet another view.
Based on deontology theory, the doctor should have looked at Sara’s best interests, as an individual, before making any decision in relation to euthanasia. According to the codes of conduct, the patient should have been allowed to make her decision regarding the matter of resuscitation. According to deontology theory, obedience to a duty or rule determines the rightness or wrongness of an action, thus the doctor’s action in this case deems not to be right and against the patient’s interests. Virtue ethics theory is character based. It gives guidance and assessment of what one is and should be, in terms of character. Virtue ethics theory is concerned with the character and virtuous traits one possesses. Virtuous traits are perceived to be good and connected to the person’s …show more content…
thriving.
Virtue ethics theory gives yet another perspective of the assigning of the ‘Do not Resuscitate’ note in Sara’ file without her consent. Looking at the case study under this theory, the doctor’s action would be appropriate and is likely to affect his reputation as a professional. There are four ethical principles that are used to rationalize the behaviour of an individual in the medical field. These principles are: beneficence, justice, non-maleficence and autonomy (Beauchamp and Childress, 2009).
In application of the autonomy principle, the patients have the right and freedom to decide what will be done with their lives. (Shaun D. Pattison, 2009). Before any procedure or treatment can take place, the medical professionals needs to seek patient’s consent (NMC, 2008). A consent to be valid, it must be voluntary and informed and the person consenting must have the capacity to make decision. Voluntary means the decision to consent or not consent to treatment must be made alone and not due to pressure by medical staff. Informed means a patient must be given full information about their treatment and the risk involved. Seeking consent from a patient prior to any medical procedure builds confidence in the medical profession. In a scenario where a patient cannot offer an informed consent, the medical professional should always explain their actions and ensure that the patient comprehends and is in agreement with what is being explained by the health professional. (Nursing Standard, 2014). Nurse must respect and support a patient’s right to accept care or treatment (NMC, 2008). Although Sara B is intractably opposed to euthanasia she still has the right to be informed about her care or treatment for her to make an informed decision. In addition, the doctors overlooked the autonomy principles for not seeking consent from Sara as to whether she agrees not be resuscitated. Moreover assessment was not performed by the doctors to check whether Sara lacks capacity to make decision.
The second ethical principle is Beneficence. Beneficence means the duty to do good and not to harm the patient. It encourages the medical professionals to assist patients by supporting and protecting patients’ well being (Fry 2011). The code of Conduct of Nursing and Midwifery council (2008) suggests that the valid consent must be given by a competent person (who may be a person legally appointed on behalf of the person) and must be given voluntarily. Another person cannot give consent for an adult who has the capacity to consent. In emergency situations an adult who becomes provisionally unable to consent due to, for instance, being unconscious, may receive treatment necessary to preserve life. In such circumstances the law allows treatment to be delivered without the person in the care of a nurse or midwife consent, as long as it is in the best interests of that person. The Code supports involving people in the care giving processes. It clearly states that “You must uphold people’s rights to be fully involved in decisions about their care.” To work out the best interest. One ought to act in the patients best interests (NMC, 2008).
Non-maleficence is another principle; that advocates that no harm should be done to a patient but instead reduce any possible risks that may cause harm to the patient (Fry 2011).Health professionals should carry out assessment to establish whether a patient lacks the capacity to consent or not a medical procedure or medication. And when it is established that the patient might lack the capacity to consent, it is mostly down to the clinician providing the treatment or care and enable the patient to be of the capacity to consent. In Sara’s case, her capacity to consent was not assessed but rather it was assumed that she lacked the capacity to consent for the ‘Do not Resuscitate’ note.
Final ethical principle is justice. Justice means treating every patient in the same way regardless of their sex, race, disability and religious, age etc. In Sara’s case, a likely reason for the doctor’s action of assigning a ‘Do not Resuscitate’ note may have been based on the fact that she had been in the neurological ward, using a wheelchair and required considerable nursing from her partner. In addition to her deteriorating health over 12 months, the doctor may have felt that Sara had become a burden to her partner, the doctor and the hospital and hence acted on he thought was her best interest without consulting her.
There are a number of legal issues that health professionals need to put in mind as they make decisions in their cause of work.
Confidentiality is one of these issues. Confidentiality means keeping information of a patient private and not open to anyone else besides the patient and the health professionals concerned with the patient. In the case study, the patient’s name as well as those of other people involved should remain unanimous in accordance to the Nursing Midwifery Council, (2008) code of conduct, which states that health professionals should respect their patient’s rights to confidentiality.
Another legal issue is consent. According to NHS, consent is “the principle that a person must give their permission before they receive any type of medical treatment. Consent is required from a patient regardless of the type of treatment being undertaken, from a blood test to an organ donation."
The code of conduct of Nursing Midwifery council (2008) state that every adult must be assumed to have the mental capacity to consent or refuse treatment, unless they are not capable to take in or hold information provided about their treatment or care, incapable to understand the information provided and not able to weigh up the information as part of the decision-making process. Assuming that, upon a mental capacity assessment, based on Mental Capacity Act 2005, and Sarah was found lacking adequate mental capacity to consent, then, a decision in her best interest ought to be made according to Mental Capacity Act 2005 (Legislation, gov.uk). A health professional should adhere to the governing laws of the state in which they are practising (NMC, 2008). Griffin et al (2009) states that ‘the need to assess capacity only arises where the behaviour or circumstances of the person triggers a doubt in your mind about their ability to make decision. All patients who lack mental capacity have the right of support from an independent advocate (Barker and Baldwin, 1992). Sarah was, however, denied this right by the medical team. Doctors could have contacted Sarah’s power of attorney to seek consent for euthanasia.
A third legal issue is duty of care. Duty of care is the legal obligation to ensure the well being of a patient. In relation to Sarah B case study, the health professionals such as the doctors involved in the case have the duty of care to obtain consent from Sarah or Sarah’s partner (Louise) before putting a ‘Do Not Resuscitate’ (DNR) note in her file.
Negligence is yet another legal issue to be considered by health professionals. Negligence is one of the breaches of duty. It mainly entails doing something, in line of duty as a health professional, that a cautiously rational person would not do and/or not doing something that a cautiously rational person would do. A breach of duty must occur and the patient in question must experience harm or is likely to experience harm caused by the breach of duty. (Beauchamp and Childress, 2009). In the case of Sara, the doctor could have been charged and faced criminal prosecution that could lead to a fine due to negligence for carrying out unlawful actions of writing a ‘Do not Resuscitate’ (DNR) note on Sarah B’s file.
A hearing under the civil law would ideally assess whether the action taken was done under the Act of parliament which could include ill treatment or negligence.
Any assessment or decision carried out by medical professional must be documented with all important information integrated such as the reason behind the ‘Do not Resuscitate’ note on Sarah’s file which was done without her consent and which other professionals approved this action such as the court decision notes.
The final legal aspect is accountability. Accountability is the legal obligation health professionals have to their patients for being responsible for their actions. In the case study, the doctor is accountable for his action of assigning the ‘Do not Resuscitate’ note in Sara’s file without her consent. He thus should take full responsibility of his account
Nursing and Midwifery Council code of conduct (2008) stipulates that a nurse should at all times strive to Prioritise the care of ones patients as their first concern, treating them as individuals whilst respecting their dignity, work with one’s colleagues to protect and promote the health and wellbeing of the patients, their families, carers, and the wider society, provide high standards of practice and care consistently, being open and honest, acting with integrity and maintaining the reputation of the nursing
profession
These are the main professional guidelines, which are the main principles of the NMC (2008), that govern the nursing fraternity and to some by extension health professionals.
From the case study, there are issues of integrity arising of the health professions under whose Sara’s care was. It was lack of integrity and a risk to the reputation of the health professionals, and the hospital at large, to act out of the consent of a patient.
It is also evident that Sara was not treated with dignity and as an individual with her best well being first, as she was denied the opportunity to speak her wishes regarding her health and decision on euthanasia. Human rights Act (2007) article 10 states that everyone has the right to freedom of expression. In the case of Sarah B, the Doctors actions of putting a ‘Do not Resuscitate’ (DNR) note in her file without Sarah’s consent was against this article. In addition to this, Sarah’s right of expression was violated as she was not given the opportunity to express her wishes as to whether or not she wanted a ‘Dot Not Resuscitate’ (DNR) note to be put in her file. If this was done as an assumption of Sarah’s lack of mental capacity, the doctors are still not justified to make their own decision.
According to Mental Capacity Act 2005, every adult is presumed to have mental capacity to make decision, unless there is an illness present that inhibits with the patient having mental capacity (McHale and Tingle 2007). Even if the patient has the mental illness there is a criterion available in Mental Capacity Act 2005, which offers guidelines to assess mental capacity.
In additional to the general legal authority to act in that one reasonably believes to be in the best interest of an incapable patient, the lasting power of attorney could be appointed for short, which are responsible to make decision or consent on behalf of incapable patient. All such decision is reasonably considered to be on the best interest of the patient. Moreover Under article 2 of European Convention of Human Right, states that every person has a right to life and that failure to resuscitate in circumstances favourable to the patient is denial of this right (Bridgit Dimond 2009).
According to human right a patient has the right to be resuscitated if the procedure is practically good prognosis following resuscitation. Failure to provide necessary treatment in such situations could amount to murder or manslaughter (Bridgit Dimond 2009).
Reflection
This is a typical case that is likely to happen in one’s nursing profession, but probably in different scenario; given that every patient has to give consent to each and every procedure done to her. Sara’s case is not an exemption in that the health professionals in this case should have ideally gotten consent from the patient or her partner; in a situation where she was assessed and found not capable to consent.
My first response to the case study was that the actions of the doctor was justified based on Sara’s health condition; considering that she was in a neurological ward for over 12 months and her health was deteriorating. I also felt that the doctor might have opted to assign the DNR note in her file, based on the knowledge that she is intractably opposed to euthanasia and that she was then likely not to consent of it. However after a closer look into the case study, I felt that the doctor’s action, of assigning a ‘Do not Resuscitate’ note into her file without her consent, was unacceptable and unprofessional because, as a health professional, one needs to have knowledge and understanding of ethics and law, as well as respect individual values and beliefs. Health professionals should always put the patient’s best interests first, above their own personal judgements and values whilst following the laws.
In evaluating the likely consequences of the doctor’s action, in a scenario where Sara needed to be resuscitated and she did not receive this attention and died due to the note in her file, the doctor and/or hospital could be sued by her partner for negligence and breach of duty which damage reputation and trust of the hospital and loss of a practising licence or imprisonment for the doctor.
The most ideal and professional step that the health professions under whose Sara’s health was, would have been to assess her mental capacity to consent. According to Mental Capacity Act 2005, every adult is presumed to have mental capacity to make decision, unless there is an illness present that inhibits with the patient having mental capacity (McHale and Tingle 2007). Even if the patient has the mental illness there is a criterion available in Mental Capacity Act 2005, which offers guidelines to assess mental capacity.
If her mental capacity is found capable to comprehend issues related to her health and can consent, then the next step would be to inform her of her options as well as discuss them before arriving at a DNR decision. By doing this, rapport between the patient, her partner and the health professionals will be built as the health professionals will have gained trust from Sara and Louise due to informing them of every step taken.
Human Rights Act, Patients Association and other equally informative organisations, enable patients and their families to become well informed of their rights and are more confident to question health care decisions such as DNR orders. Health professionals should understand the laws and keep up to date with the laws, to make sure they are making the best decisions for their patients, as the laws are ever changing.
References
Beauchamp, T.L and Childress, J.F. (2009) Principles of biomedical ethics. (6th) ed. New York: Oxford University Press.
Dimond, B. (2009) Legal aspects of nursing. (2nd Ed). London. Quay Books.
Fletcher, N. &Holt, J. (1995) Ethics Law and Nursing. Manchester. Manchester University Press.
Fry, T., Veatch, M. & Taylor, C. (2011) Case Studies in Nursing Ethics (4th Ed). Canada.Jones and Bartlett Learning.
Hawley, G. (2007) Ethics in Clinical Practice. Essex. Pearson Education ltd
Hendrick, J. (2000) Law and ethics in nursing and health care. United Kingdom: Nelson Thomes ltd.
Legislations and acts. www.legislation.gov.uk
McHale, J. & Tingle, J. (2007) Law and Nursing (3rd Ed). London. Churchill Livingstone.
Nursing Performance and Ethics For Nurses And Midwives. Available From: Performance and Ethics for Nurses and Midwives. Available From:Http://Nmc-Uk.Org.( Accessed 14/05/14)
Pattinson, S.D. (2009) Medical Law and Ethics (2nd Ed). London. Thompson Reuters.
Royal college of nursing. www.rcn.org.uk
Introduction
This assignment will discuss the ethical, legal and professional issues relating to medical practice. Doctors and Nurses are often faced with legal, professional and ethical issues relating to health care. This assignment will also look into ethical and legal aspects in relation to issues of human rights and consent. There are many laws and legislations that protect patient’s rights, such as common law, Human Rights Act 1998, Mental Health Act 2007, and Mental Capacity Act 2005.
Case study one (1) has been chosen for this assignment, which is about Sara B who is forty two (42) years old woman, who has been diagnosed with multiple Sclerosis. She is in neurological ward for test as her condition …show more content…
has deteriorated over the last twelve months, resulting in her using a wheelchair and in need of considerable nursing input from her partner Louise. It was discovered that the doctors had put a ‘Do Not Resuscitate’ (DNR) note in her file. Neither Sara nor Louise is aware of this. From an ethical perspective, ethical values: utilitarianism, deontology and virtue ethics will be discussed relating to the case study. The four ethical principles in relation to this case study will also be discussed. These principles are autonomy, beneficence, non-maleficence and justice.
There are a number of professional issues around the case study in question that will be addressed. These issues are mainly around the four main principles of the Nursing and Midwifery Council codes of conduct (2008).These principles are; Prioritising the care of the patients and treating them as individuals whilst respecting their dignity Working closely with colleagues to protect and promote the health and wellbeing of the patients, their families, carers, and the wider society Providing consistently high standards of practice and care, being open and honest, acting with integrity and maintaining the reputation of the nursing profession
Legal issues arising from the case study such as confidentiality, consent, accountability, duty of care, negligence and human right will be discussed.
I will conclude with a reflection based on the Gibbs’ model and highlight insights developed from the case study and they could be how they into practice. Also in the conclusion learning needs for future developments will be identified.
Ethical Perspective of Sara B’s Case Study
Ethics is the discipline that deals with rightness and wrongness of actions. (Aiken 2004) Ethics also is concerned with duties, responsibilities, principles and accepted wisdom. (Hawley, 2007). The two most commonly applied ethical theories are utilitarianism and deontology (Shaun D. Pattison, 2009). Utilitarianism theory is concerned with repercussions of behaviour; it seeks to favour the majority. As it suggests, utilitarian theory seeks to have the best possible balance of utility over disutility of the matters at hand. It is more concerned with getting the best for the greatest number. According to utilitarianism theory, it is essential for one to have the full and adequate information of all the possible consequences related to their acts as well as all the probable consequences of every other action that is equally available at that moment.
The utilitarianism theory can be useful in analysing Sara B’s case in relation to the doctor’s action of assigning a ‘Do not Resuscitate’ note in Sara’s file without her consent. As the theory states, it is important for all medical practitioners to have full knowledge of the consequences of their acts, thus in this case, the doctor and/ or the hospital are likely to face consequences of the doctor’s actions of acting without consent of the patient. The doctor’s act should have applied with this theory in mind.
Deontology on the other hand, doesn’t look at the consequences, but rather it is rules, right-based and duty based (Shaun D. Pattison, 2009). Unlike utilitarianism theory which looks at what is best for the most; deontology looks at what is best for an individual and his interests. For deontological ethical theories, obedience to a duty determines the rightness or wrongness of an action.
In relation to the case study, deontology theory helps analyze the action of assigning a ‘Do not Resuscitate’ note in yet another view.
Based on deontology theory, the doctor should have looked at Sara’s best interests, as an individual, before making any decision in relation to euthanasia. According to the codes of conduct, the patient should have been allowed to make her decision regarding the matter of resuscitation. According to deontology theory, obedience to a duty or rule determines the rightness or wrongness of an action, thus the doctor’s action in this case deems not to be right and against the patient’s interests. Virtue ethics theory is character based. It gives guidance and assessment of what one is and should be, in terms of character. Virtue ethics theory is concerned with the character and virtuous traits one possesses. Virtuous traits are perceived to be good and connected to the person’s …show more content…
thriving.
Virtue ethics theory gives yet another perspective of the assigning of the ‘Do not Resuscitate’ note in Sara’ file without her consent. Looking at the case study under this theory, the doctor’s action would be appropriate and is likely to affect his reputation as a professional. There are four ethical principles that are used to rationalize the behaviour of an individual in the medical field. These principles are: beneficence, justice, non-maleficence and autonomy (Beauchamp and Childress, 2009).
In application of the autonomy principle, the patients have the right and freedom to decide what will be done with their lives. (Shaun D. Pattison, 2009). Before any procedure or treatment can take place, the medical professionals needs to seek patient’s consent (NMC, 2008). A consent to be valid, it must be voluntary and informed and the person consenting must have the capacity to make decision. Voluntary means the decision to consent or not consent to treatment must be made alone and not due to pressure by medical staff. Informed means a patient must be given full information about their treatment and the risk involved. Seeking consent from a patient prior to any medical procedure builds confidence in the medical profession. In a scenario where a patient cannot offer an informed consent, the medical professional should always explain their actions and ensure that the patient comprehends and is in agreement with what is being explained by the health professional. (Nursing Standard, 2014). Nurse must respect and support a patient’s right to accept care or treatment (NMC, 2008). Although Sara B is intractably opposed to euthanasia she still has the right to be informed about her care or treatment for her to make an informed decision. In addition, the doctors overlooked the autonomy principles for not seeking consent from Sara as to whether she agrees not be resuscitated. Moreover assessment was not performed by the doctors to check whether Sara lacks capacity to make decision.
The second ethical principle is Beneficence. Beneficence means the duty to do good and not to harm the patient. It encourages the medical professionals to assist patients by supporting and protecting patients’ well being (Fry 2011). The code of Conduct of Nursing and Midwifery council (2008) suggests that the valid consent must be given by a competent person (who may be a person legally appointed on behalf of the person) and must be given voluntarily. Another person cannot give consent for an adult who has the capacity to consent. In emergency situations an adult who becomes provisionally unable to consent due to, for instance, being unconscious, may receive treatment necessary to preserve life. In such circumstances the law allows treatment to be delivered without the person in the care of a nurse or midwife consent, as long as it is in the best interests of that person. The Code supports involving people in the care giving processes. It clearly states that “You must uphold people’s rights to be fully involved in decisions about their care.” To work out the best interest. One ought to act in the patients best interests (NMC, 2008).
Non-maleficence is another principle; that advocates that no harm should be done to a patient but instead reduce any possible risks that may cause harm to the patient (Fry 2011).Health professionals should carry out assessment to establish whether a patient lacks the capacity to consent or not a medical procedure or medication. And when it is established that the patient might lack the capacity to consent, it is mostly down to the clinician providing the treatment or care and enable the patient to be of the capacity to consent. In Sara’s case, her capacity to consent was not assessed but rather it was assumed that she lacked the capacity to consent for the ‘Do not Resuscitate’ note.
Final ethical principle is justice. Justice means treating every patient in the same way regardless of their sex, race, disability and religious, age etc. In Sara’s case, a likely reason for the doctor’s action of assigning a ‘Do not Resuscitate’ note may have been based on the fact that she had been in the neurological ward, using a wheelchair and required considerable nursing from her partner. In addition to her deteriorating health over 12 months, the doctor may have felt that Sara had become a burden to her partner, the doctor and the hospital and hence acted on he thought was her best interest without consulting her.
There are a number of legal issues that health professionals need to put in mind as they make decisions in their cause of work.
Confidentiality is one of these issues. Confidentiality means keeping information of a patient private and not open to anyone else besides the patient and the health professionals concerned with the patient. In the case study, the patient’s name as well as those of other people involved should remain unanimous in accordance to the Nursing Midwifery Council, (2008) code of conduct, which states that health professionals should respect their patient’s rights to confidentiality.
Another legal issue is consent. According to NHS, consent is “the principle that a person must give their permission before they receive any type of medical treatment. Consent is required from a patient regardless of the type of treatment being undertaken, from a blood test to an organ donation."
The code of conduct of Nursing Midwifery council (2008) state that every adult must be assumed to have the mental capacity to consent or refuse treatment, unless they are not capable to take in or hold information provided about their treatment or care, incapable to understand the information provided and not able to weigh up the information as part of the decision-making process. Assuming that, upon a mental capacity assessment, based on Mental Capacity Act 2005, and Sarah was found lacking adequate mental capacity to consent, then, a decision in her best interest ought to be made according to Mental Capacity Act 2005 (Legislation, gov.uk). A health professional should adhere to the governing laws of the state in which they are practising (NMC, 2008). Griffin et al (2009) states that ‘the need to assess capacity only arises where the behaviour or circumstances of the person triggers a doubt in your mind about their ability to make decision. All patients who lack mental capacity have the right of support from an independent advocate (Barker and Baldwin, 1992). Sarah was, however, denied this right by the medical team. Doctors could have contacted Sarah’s power of attorney to seek consent for euthanasia.
A third legal issue is duty of care. Duty of care is the legal obligation to ensure the well being of a patient. In relation to Sarah B case study, the health professionals such as the doctors involved in the case have the duty of care to obtain consent from Sarah or Sarah’s partner (Louise) before putting a ‘Do Not Resuscitate’ (DNR) note in her file.
Negligence is yet another legal issue to be considered by health professionals. Negligence is one of the breaches of duty. It mainly entails doing something, in line of duty as a health professional, that a cautiously rational person would not do and/or not doing something that a cautiously rational person would do. A breach of duty must occur and the patient in question must experience harm or is likely to experience harm caused by the breach of duty. (Beauchamp and Childress, 2009). In the case of Sara, the doctor could have been charged and faced criminal prosecution that could lead to a fine due to negligence for carrying out unlawful actions of writing a ‘Do not Resuscitate’ (DNR) note on Sarah B’s file.
A hearing under the civil law would ideally assess whether the action taken was done under the Act of parliament which could include ill treatment or negligence.
Any assessment or decision carried out by medical professional must be documented with all important information integrated such as the reason behind the ‘Do not Resuscitate’ note on Sarah’s file which was done without her consent and which other professionals approved this action such as the court decision notes.
The final legal aspect is accountability. Accountability is the legal obligation health professionals have to their patients for being responsible for their actions. In the case study, the doctor is accountable for his action of assigning the ‘Do not Resuscitate’ note in Sara’s file without her consent. He thus should take full responsibility of his account
Nursing and Midwifery Council code of conduct (2008) stipulates that a nurse should at all times strive to Prioritise the care of ones patients as their first concern, treating them as individuals whilst respecting their dignity, work with one’s colleagues to protect and promote the health and wellbeing of the patients, their families, carers, and the wider society, provide high standards of practice and care consistently, being open and honest, acting with integrity and maintaining the reputation of the nursing
profession
These are the main professional guidelines, which are the main principles of the NMC (2008), that govern the nursing fraternity and to some by extension health professionals.
From the case study, there are issues of integrity arising of the health professions under whose Sara’s care was. It was lack of integrity and a risk to the reputation of the health professionals, and the hospital at large, to act out of the consent of a patient.
It is also evident that Sara was not treated with dignity and as an individual with her best well being first, as she was denied the opportunity to speak her wishes regarding her health and decision on euthanasia. Human rights Act (2007) article 10 states that everyone has the right to freedom of expression. In the case of Sarah B, the Doctors actions of putting a ‘Do not Resuscitate’ (DNR) note in her file without Sarah’s consent was against this article. In addition to this, Sarah’s right of expression was violated as she was not given the opportunity to express her wishes as to whether or not she wanted a ‘Dot Not Resuscitate’ (DNR) note to be put in her file. If this was done as an assumption of Sarah’s lack of mental capacity, the doctors are still not justified to make their own decision.
According to Mental Capacity Act 2005, every adult is presumed to have mental capacity to make decision, unless there is an illness present that inhibits with the patient having mental capacity (McHale and Tingle 2007). Even if the patient has the mental illness there is a criterion available in Mental Capacity Act 2005, which offers guidelines to assess mental capacity.
In additional to the general legal authority to act in that one reasonably believes to be in the best interest of an incapable patient, the lasting power of attorney could be appointed for short, which are responsible to make decision or consent on behalf of incapable patient. All such decision is reasonably considered to be on the best interest of the patient. Moreover Under article 2 of European Convention of Human Right, states that every person has a right to life and that failure to resuscitate in circumstances favourable to the patient is denial of this right (Bridgit Dimond 2009).
According to human right a patient has the right to be resuscitated if the procedure is practically good prognosis following resuscitation. Failure to provide necessary treatment in such situations could amount to murder or manslaughter (Bridgit Dimond 2009).
Reflection
This is a typical case that is likely to happen in one’s nursing profession, but probably in different scenario; given that every patient has to give consent to each and every procedure done to her. Sara’s case is not an exemption in that the health professionals in this case should have ideally gotten consent from the patient or her partner; in a situation where she was assessed and found not capable to consent.
My first response to the case study was that the actions of the doctor was justified based on Sara’s health condition; considering that she was in a neurological ward for over 12 months and her health was deteriorating. I also felt that the doctor might have opted to assign the DNR note in her file, based on the knowledge that she is intractably opposed to euthanasia and that she was then likely not to consent of it. However after a closer look into the case study, I felt that the doctor’s action, of assigning a ‘Do not Resuscitate’ note into her file without her consent, was unacceptable and unprofessional because, as a health professional, one needs to have knowledge and understanding of ethics and law, as well as respect individual values and beliefs. Health professionals should always put the patient’s best interests first, above their own personal judgements and values whilst following the laws.
In evaluating the likely consequences of the doctor’s action, in a scenario where Sara needed to be resuscitated and she did not receive this attention and died due to the note in her file, the doctor and/or hospital could be sued by her partner for negligence and breach of duty which damage reputation and trust of the hospital and loss of a practising licence or imprisonment for the doctor.
The most ideal and professional step that the health professions under whose Sara’s health was, would have been to assess her mental capacity to consent. According to Mental Capacity Act 2005, every adult is presumed to have mental capacity to make decision, unless there is an illness present that inhibits with the patient having mental capacity (McHale and Tingle 2007). Even if the patient has the mental illness there is a criterion available in Mental Capacity Act 2005, which offers guidelines to assess mental capacity.
If her mental capacity is found capable to comprehend issues related to her health and can consent, then the next step would be to inform her of her options as well as discuss them before arriving at a DNR decision. By doing this, rapport between the patient, her partner and the health professionals will be built as the health professionals will have gained trust from Sara and Louise due to informing them of every step taken.
Human Rights Act, Patients Association and other equally informative organisations, enable patients and their families to become well informed of their rights and are more confident to question health care decisions such as DNR orders. Health professionals should understand the laws and keep up to date with the laws, to make sure they are making the best decisions for their patients, as the laws are ever changing.
References
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Legislations and acts. www.legislation.gov.uk
McHale, J. & Tingle, J. (2007) Law and Nursing (3rd Ed). London. Churchill Livingstone.
Nursing Performance and Ethics For Nurses And Midwives. Available From: Performance and Ethics for Nurses and Midwives. Available From:Http://Nmc-Uk.Org.( Accessed 14/05/14)
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