It should help define what we ought to do, by considering and reconsidering actions”. This will be tackled using the ethical framework set out by Béchamel and Childless (2009), this framework will give the structure to the complicated argument above. The ethical areas of discussion will be Autonomy, Beneficence, Malefaction and Justice; this paper will also look at Deontological and Consequentiality theories. The discussion paper will conclude with the safest outcomes and decisions the health visitor would make.
Nurses and other professionals, such as midwives and health visitors make decisions everyday and often they face the argument of what is ethical practice (Illicit et al 2010). Lurch et al (2010) cites Florence nightingales (1859) nursing notes, where she discusses ethical duties of confidentiality, communication, and the centrality of meeting patients’ needs, this reflects the same moral and ethical issues nursing professionals face today. Georges and Gryphon (2002) state that nurses often fail to recognize the moral elements of complex situations, and they often lack the skills to effectively resolve moral dilemmas.
It is therefore important that nurses are equipped with the skills and knowledge to understand ethics within their practice. Clearest (2009) comments that the role of a nurse in ethical lemmas is often seen an advocate by some, Variation et al (2005) explained advocacy as assisting patients to understand treatment processes, to safeguard patients from rights violations and to show a philosophical stance to guide patients. This discussion paper will firstly explore the theory of autonomy.
Autonomy Autonomy is a term which is used for the principle of self-governance, and to make decisions, as an individual with respect to healthcare and lifestyle (Béchamel and Childless, 2009; Atkinson 1992). The opportunity to make choices and decisions for one’s self in healthcare depends on your mental opacity. Capacity refers to the ability to understand and retain information given to them, and able to make a decision based on this ability, furthermore a person is always assumed to have capacity; unless it is proven that they do not (MAC, 2005).
To be incapacitated due to trauma or mental ill-health (for example) means that practitioners will often work in your best interests (Kulak, 2005). Situations in healthcare arise where professionals have a duty of care which often can conflict with the patient’s right to autonomy (Béchamel and Childless, 2009). In the scenario, Sally informs the health sister that she feels the baby is not hers, that she feels anger towards the baby, and does not want to be left alone with it. Sally does not want the father to be informed of these thoughts as she fears he may leave her.
The dilemmas relating to autonomy and choice in the given scenario are; does sally have the capacity to decide that her partner is not informed; and should the health visitor breech the confidentiality of Sally, and tell her partner? This is an example of autonomous principles verses paternalistic principles, which is recently less acceptable (Hendricks, 2004); unless the benefits outweigh the rent risk. Theoretically, Sally partner may come to emotional harm if he is told before consent nuances are explored; therefore it would be advisable that he is only informed as a next of kin, when the decisions on the wider situation are available.
In addition, as a health visitor, she would have a practitioner patient relationship which she would need to maintain. In terms of moral duty, whatever the Health visitor decides, should be told to Sally to maintain fidelity (Hendricks, 2004) Sally feelings of anger and worry may be symptoms of a postpartum depression or a psychosis (ICED-II ‘1. 2010). This possible crosier may have Incapacitated Sally from making rationale decisions, as her picture of reality may be distorted (ICED-II v. 2010).
DO (AAA) guidelines also state that if decisions are based on a MIS-perception of reality, not due to culture or religion for example, then it is said that the person lacks capacity. Jog moonstone (2009) comments that mental illness can impair ones capacity to make decisions, she cites Brock and Buchanan (1989) stating that when such choices arise, three points should be considered. These points are, protecting and promoting the patients wellbeing; promoting and protecting the patients eight to, and interest in exercising self-determining choices; and protecting others who may come to harm by the patients harm-causing choices.
It is also noted however, that mental illness does not always cause people to be incapacitated; mental capacity can fluctuate, and should be tested where there is doubt, at the time of making the decision (MAC, 2005). It would appear, that Sally has some insight that her feelings could be considered a risk, as she has chosen to inform the health visitor of the situation, therefore making her choices autonomous (Béchamel and Childless, 2009). This paper will now discuss the the principle of Beneficence.
Beneficence Beneficence is the principle which works towards the greatest good of the possible outcomes, to benefit the most people (Béchamel and Childless; 2009). Béchamel and Childless (2009) state there are five principles of beneficence; ‘ ‘To protect and defend people’s rights, prevent harm, remove conditions which could cause harm, to help those with disabilities, and to rescue those in danger’ (page 199). Weaver (2011) describes beneficence in health, and social care, as delivering Care in a Way which will benefit the patient or service user.
She continues to say that it IS an important part of care as it involves both the protection of individual welfare and the promotion of the common welfare (Weaver, 2011; Béchamel and Childless 2009). In the dilemma, the health visitor would have to make a decision based on the greater good, is the decision that he/she makes, for the greater good of Sally, or for the greater good of the baby? As a health visitor she has a duty of care to protect both parties, however, the interests of the child comes first (RCA, 2008, DO 2004, DOCS 2010).
Interventions that are intended to prevent harm ND benefit others, despite risky decisions, are autonomous; this is known as hard paternalism (Béchamel and Childless; 2009). Hard paternalism is justified in healthcare if the action will probably prevent harm, and when the risks of an action, outweigh the potential risks to a patient (Béchamel and Childless, 2009). Consequentially is a philosophical theory, and its ethical principle is utilitarianism. Classic utilitarianism suggests that the outcome of a dilemma should maximizes the greatest good, for the greatest amount of people (Johnston, 2009).
However, a more recent evaluation of the theory old deem it appropriate to attempt to “maximizes the overall satisfaction of preferences, for the greatest number of people” by maximizing autonomy (Johnston 2009, page 64). Following the recent description of theory, the health visitor would have to assess each person’s preferences; Sally, her by, and her partner if knowing. The solution from this perspective is to protect the child, as the health visitor’s responsibilities are favored in the child’s preferences but additionally, Sally has admitted she ought not to be left alone with the baby.
This paper will now explore the principles Of malefaction. Malefaction Malefaction is the principle which states; that above all else, do no harm, but also impose no risk of harm (Béchamel and Childless, 2009). In the given scenario, according to malefaction, the health visitor should impose no risk of harm; thus protect the child from harm. Arguably, by breaking confidentiality the health visitor may be harming the relationship of herself and Sally, she may also be harming sally emotionally, or even be harming the bond between mother and child (Muzzy et al 2013).
However, long term, those issues may be resolved, and the immediate risks that may be imposed upon he child, are paramount. Munroe (2007) has argued that a conflict between mum and baby, and health visitors relationships, occur nonetheless with increased surveillance as set out in DO policies (Bibb) The NC (2008) states that you must respect a persons’ right to confidentiality, however, it states that also, “you must disclose information if you believe someone is in harm, in line with the law of the country tattoo are practicing in”.
The health visitor should explain this to Sally that t is her jobs protocol, and she is doing it for the safety of Sally, and of the baby; as disclosing the concern for sally mental Tate will safeguard both of them. The health visitor would therefore by telling the truth about the situation to sally, which could be regarded as acting deontological; as demonology states it is a moral obligation to tell the truth irrespective of the consent nuances, as your intentions are what your actions are judged on (Hendricks, 2004 page 10). This paper will now discuss the principles of Justice.
Justice The principle of Justice relates to the fairness and desert of situations, it has been stated that ‘the holder of a valid claim based in justice has a right, and is due something’ (Béchamel and Childless; 2009). Aristotle refers to justice as equal desert (Richardson-Lear, 2013; McIntyre, 1988). Reaches (1966) shows the 6 points of material justice which have been proposed as a valid principle of distributive justice (Béchamel and Childless, 2009). The second point is “to each person according to need”. In the given dilemma, the baby is most at need of assistance as it cannot take care of itself.
Following this principle In this situation it appears the health visitor is not being fair to the baby or sally ends up in hospital, however in the long term, it would be unfair to them both to deny them of any help. Conclusion: There are four key points from the NC (2008) code which indicates guidance which can be applied to the scenario. Firstly, the code states that ‘You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support”; then “you must disclose information if you believe someone may be be at risk of harm.. ; it also states “you must support people in caring for themselves to improve and maintain their health” and fourthly, “you must act without delay if you believe that anyone else may be putting someone at risk”. All Of the above would be implemented alongside one of the ethical principles discussed above. In terms of autonomy the health visitor should explain to sally when she would have to breech confidentiality. At that point in time, it is her main concern to ensure the baby is safe.
Following the NSF (DO, 2004) and safeguarding children (DOCS, 2010) the health visitor would follow safeguarding procedures as there is a potential risk to the child, as sally does not want to be left alone with it. The health visitor would inform her line manager as procedure. It may result in an emergency assessment by the child safeguarding practitioners’. Acting in accordance with ethical principles can often protect healthcare professionals from legal action where patient’s rights, such as autonomy have been overridden (Bingham, 2012).
