This essay willbe discussing the ethical law and professionalism issues within the healthcaresector, also it will deal with how care of patients sometimes brings to theforefront many of the issues with the service users moral dilemma,confidentiality, autonomy and justice. The essay would also identify theappropriate ethical decision-making model for a case study of Ms Lisa Dent.The essay willidentify the conflict of the ethical moral dilemma with a health professionaland the legal aspect ethical in professionalism, how should health careprofessionals deal with moral principles, legal responsibilities and moraltheories while discharging duties in making ethical decisions relevant to theirown field. The essay willalso appreciate how healthcare can prepare to deal with these issues with thethoughtful use of a model to guide their decision making in a professionalmanner, uses reason as the moral justification to define what ought not to bedone (Thompson, Melia & Boyd, 1983). In thisscenario the obstetrician must understand Ms Dent and follow the principles ofprofessional responsibility, code of ethics and standards of Practice as aguide that healthcare professional used in arriving at a decision to makeethical decisions but are not unto themselves the result and must be consideredin conjunction with the current code of practice and regulations. Therefore, theprofessionals involved in her care should talk to her about the difficult andcomplex problems, about some uncertainty to request in a language which isunderstandable to her.
There must be mutual and trust because trust and honestyany decision arrived at may have moral implications and it will be less than satisfactoryto Ms Dent ( Downie & Calman, 1995). Although inconsidering the responsibilities of health care professional workers has beenidentified that the personal moral qualities of a worker sense ofresponsibility can improve the performances of official responsibilities. Butthe moral of health care professionals does not always blend with theirperformance of their treatment to patients.Healthcareprofessional involve in her care must reflect on their obligations as ahealthcare provider when making decisions and using current NMC code ofpractice to guide them in decision-making when they are faced with moraldilemmas that Ms Dent scenario present.
The NMC Act stipulates that the nurses mustact in the best interests of people always and balance the need to act in thebest interests of people always with the requirement to respect a person’sright to accept or refuse treatment (NMC code, section 4.1).A moral dilemmais a conflict in which you must choose between two or more actions and havemoral reasons for choosing each action.
(Yolanda Williams). In recognisingand describe the ethical issue in the case of Ms Dent the MDT should identifythe underlying issue, recognise the facts of the situation, issues relating tothe principles of the situation, they should also reflect on Ms Dent reasonsand ensure they do not influence her decision, and consider if she needsadditional information in arriving at her decision.The health careprofessional involve in Ms Dent treatment should also identify the bestpossible ways based on realities that follow professional code of judgment inapplying the principles while take into cognisance any regulation, guideline,standard, and policy that applies to their duties while considering the outcomethat would provide the best result and solution to Ms Dent, givingconsideration to her wants and request would be the best possible consequenceoption they are taking by using their professional judgment to assess the options before final decision isconsidered.
The Departmentof Health (2009) suggests for healthcare practitioners that it is veryimperative for them to obtain consent before treatment so that there is nouncertainty about the wishes of the patient. If a patient is touched, treatedwithout their consent then there is a risk that the patient may take up theirright to seek legal clarifications from the authorities such as the policeregarding an assault. However, if consent has been obtained from the patientthen the healthcare professional does have protection to avoid any legalpenalty (Dimond, 2008).What is mentalcapacity? It is the mental ability to make an informed decision about ownhealth issues and treatment. Ms Dent scenario must be presumed to have capacityuntil proved otherwise. Patients shouldalways be allowed to make self-determination but if the patient lack capacityto make informed decision, they have right to be communicated to in a way thatthey will understand, and the treatment should be voluntary but in someinstances, it is difficult to communicate to the patient by the career due tosome barriers. However, it is important to tell the patientthe truth before making their decision even though they have assumed thepatient lack capacity to make an informed decision because veracity decidingdepends on knowing the truth by both parties, they both have right to choosetherefore both must tell the truth. The best interest’s standard of practice insome instances validly override the previously accepted directives by formerlyautonomous patients.
This can only happen if the appointed surrogate gives adecision that could be detrimental to the patient best interests, this kind ofdecision can be morally repudiated except the patient in question saysotherwise (Downie & Calman,1995). Autonomy is theprinciple that addresses the concept of independence. The purpose of autonomyis the right to self-determination (Staunton & Chiarella, 2003). To respect aperson as an autonomous or respect a person is to consider in one conduct thatthe patients have autonomous nature and self-governing that desires feeling,and the reason is to employ all the four moral principles (Downie & Calman,1995).
It is theability to control what happens to us and how we behave (Leah, 2000). Whenpatients are incapable of making informed choices, consent should the fromfamily members or significant others. The scenario ofLisa Dent the MDT has to make judgement that she does not have the capacity tomake informed decision at this time, therefore, her life and that of her unbornbaby life is at risk in this case, in her best interests it is advisable thatthe obstetrician administer the anaesthetic intravenously after MDT has decidedthat Lisa does not have the capacity to make informed decision to give consentto go ahead with caesarean by administering anaesthetic by intravenous transfusion.However, ethicsis somehow distinct from that of morality because in most cases moral problemswill crop up more frequently within the healthcare setting than another sphereof life.All healthcareworkers must attempt to have in them the capacity for feeling with others, butbenevolence, compassion requires active answer. Compassion also is the term wehave accepted to show the mode of dealing with the autonomous persons who haveexperienced ill-health.
The main moraldilemma in this scenario is that Lisa Dent has been in labour for eight hoursand Ms Dent cervix is not dilated. However, Ms Dent raised crucial ethicalissues, because respect for Ms Dent autonomy appeared to clash with the dutiesof beneficence that is doing no harm. Regarding thoseinvolved with Ms Dent care, respecting her wishes by not administer theanaesthetics by intravenous transfusion. MDT could base their argument on bestinterest to Ms Brent’s because if they followed Ms Brent’s wishes byadministering it inhalational anaesthesia it carries 50% risk of gastricinhalation which they believed could be fatal for her and the unborn baby. NMCcode of conduct, 2015 section 6.1 stipulated that health care provider shouldalways practise in line with the best available evidence to achieve this,nurses and other healthcare must ensure that any information or advice given isevidence-based, including information relating to using health services.There is amoral conflict between Ms dent and the health care practitioners while it willbe paramount in this scenario to distinguish some point of views, theobstetrician, the patient (Ms Dent) and that of MDT however, because of moralconflict between them the MDT would need to ignore the ideal of treatmentsuggested by Ms Dent and carry out the procedure to save the life of the unbornchild and that of Ms Dent in accordance to the prevailing consensus in theprofession at this given time. Healthcareprofessionals also entitled to autonomy in dealing with this scenario, the dutyto protect life has fallen on them now so they need to act and decide whetherto accept or reject what is proposed as a duty of care.
In order words utility,justice is moral-ethical principles that must temper the implementation of MsDent wants.There is implicationto them if they defer against their better judgement to the demand of Ms Dent.The moral argument can now be conducted to the reason why they did not concordwith her request for treatment without assuming that they must always be right.But in the overallinterest of the patient if those involved in treatment approach it with themoral argument she can as well change her mind because in the health careprofession there must always be the decision as to what needs to be done whensaddled with this kind of moral conflict.Althoughadminister of anaesthetics by intravenous transfusion to Ms Dent can beconsidered arm to her it is important to have the caesarean section safelybecause the code of ethics provides a framework for ethical analysis and decisionmaking is non-negotiable to all healthcare practitioners.Also, we aremost likely to succeed in bringing about a good/beneficial situation by tellingthe truth (consequentialism) while it will be morally right, to tell the truth,and it is morally wrong to lie the patient (deontology). Consequences ofgoing against her wishes could be contested in the court of law to seek clarityat why the treatment was given against her wish, it left to for the court oflaw dispense the judgement in line with the law governing the ethics andprofessionalism.
Ms Dentscenario has raised difficult ethical issues because respect for her autonomyseems to clash with the duties of beneficence (providing care) andnon-maleficence (doing no harm). Therefore, to those involved in her care,respecting her wants and needs by administering inhalational anaesthesiatreatment appeared to be both no harm and do respects her wishes but theanaesthetist is unwilling to administer in this manner because of the riskinvolves.The healthprofessional involve should bear in mind the duty of justice to Ms Dent is aduty to make sure Ms Dent get what she wants although any one of these can takeprecedence over the other, however, the MDT should agree that Ms Dent deservestreatment that would not override her autonomy. Each one of all other virtuesis a species of moral excellence for the four virtues (Oderberg, 1999).The ethicaldilemma in this scenario is that the MDT decide without reference to Ms Dentbelieving that decision need to make in her own best interest, therefore, MDTdecision should take uppermost in deciding on whether to go ahead with thecaesarean section in administering the anaesthetics intravenous transfusion.,However, thelaw imposes on the health care providers to act in some professional manners,obey the law and to avoid conflict of interest while discharging their civicduties to patients and not to put their own interest ahead of patients in theircare, therefore it is the responsibility of healthcare to preserving life andalleviating any kind of suffering by their patients.
The questionthat arose in this case now is that the if MDT has caused bodily harm to MsDent without recourse to the provision of law that govern ethics law andprofessionalism. Non-maleficence is the duty to do no harm (Maria, 2005).Deontology moral duty to respect is absolute therefore Ms dent is absolute thehealthcare involves should her of the decision in absolute term.
Kant isresponsible for prominent of deontological ethics. Kant’s moral ethical theory is based on a viewof the human being as having the unique liberty for their reason. However,consequentialism in this scenario is that a moral action taken by the MDTjustified in view of the benefit that Ms Dent would derive by administering theanaesthetics intravenous transfusion but the problem of consequentialism is howto predicting the outcomes of the action being taken by the MDT, situation likethis always difficult to assumed that certain acts are good while onconsequentialism is concerned about the subject matter itself and does not takeinto cognisance the consequences of the action taken.
However, in MsDent scenario the obstetrician has a duty to create practice in whichhealthcare involve in treatment can deliver a safe, quality patient care butfrom the scenario, administer an anaesthetic by intravenous transfusion to MsDent can be considered harm to her but it is considered for her own bestinterest it is necessary so that she will able to deliver her baby safely is abenefit.Nice suggestedthat If these alternatives are not feasible within the time frame necessary toprevent further morbidity or suffering, then in accordance with the NMC code ofconduct and moral Principles of ethics, treatment should go ahead with totalreasonable compliance to the patient’s wishes being mindful of the Ms Dentautonomy.It isrecommended by NMC code of confidentiality, honesty and professionalism shouldalways adhere to while given or discharging civic responsibilities to patients. NMC emphasised that act without delay if youthink of any risk to the patient in your care if possible escalate the issueand any concerns in line with standard coder of practice in the workingpractices that there is a risk to patient safety or public protection NMC codeof conduct, 2015 (section,16.1).
Consequencesfor not following NMC code conduct 2015 stipulated that while discharging careof duties to patients could be enormous and detrimental to patients andpractitioners, it could lead to suspension order, striking-off order, prison sentenceand death to the patients. Grossnegligence charges could also be filed against nurses involved in the patientscare if it leads to death which could be distressing and arrest could follow,therefore, it is very imperative to follow the code of practice to later whenon duty. Ethics are thebasic requisite behaviour which healthcare professional is to act on wheneverthey are caring for patients or individuals (Tschudin,1986; Edwards, 1996;Holland et al, 2008; Kozier et al, 2008).
Although moral is one’s personalstandard of the difference between right and wrong in conduct, and attitude. Moralprinciples as enriched in the NMC Code of conduct 2015 stated that healthcareproviders are accountable for their ethical conduct (Kozier, 2008). Ethics andmorality are sometimes used concurrently. Beauchamp & Childress (1989,2009) developed a framework that state there are four moral principles thatnurses can work under.
The healthcareprofessional must have professional accountability and responsibility inrespect of how difficult the case may pose, they are personally accountable fortheir action and inaction while they are answerable for any act or omissioncommitted while undertaking their duties.in conclusion,in the case of Ms Lisa Dent the party involve in her care have a duty to ofcare to provide for her although there is was breach of duty for respect herautonomy and does breach the principle of deontology which state that patient’sautonomy must be respected in respective of what they are saying whether goodor bad for them. But the care provider acted non-maleficence because they migh bringabout a good beneficial situation by doing so in preference to the code ofconduct ethics and law that guide their profession.