Context Of Disorders Of Consciousness: An Ethical Analysis

A clear ethical perspective on the issues

Discuss about the Context of Disorders of Consciousness.

This assignment will analyse case study 2, which explains the experience of Camilla when caring for Sam in the inner-city hospital. This paper will analyse the case study based on ethical theories, ethical principles, virtues ethics and professional requirements. Firstly, it has identified the abusive character of Sam and the application of restraints as the main ethical issues. Secondly, the ethical issues will be discussed from the perspective of deontology and egalitarianism as the alternative perspective. Thirdly, it will discuss the ethical issues in relation to respect for human dignity and human rights, my future professional code of ethics/conduct management, utilitarianism and three healthcare ethics including beneficence, non-maleficence and the respect for patient autonomy. Finally, it will recommend how health professionals can address the health issues.

The first ethical issue in the selected case study is the abusive character of Sam. According to the case study, the medical team arrives to find Sam verbally abusing Camilla. The abusive behaviour triggers a negative feeling in providers especially when the patient appears inconsiderate. From an ethical perspective, Sam and Camilla have competing rights. There is the right of the provider to be safe and deliver care without danger and the right of Sam to receive the best possible treatment. In this case, there is no balance between these two rights.  Literature suggests that health care providers experience violence often. Health professionals assert that it is demoralising to experience verbal abuse from patients (Stellenberg & Dorse, 2014).

The second ethical issue in this case study is placing Sam in restraints without addressing his concerns or accessing his condition. In fact, Julia argues that patients like Sam are a waste of time. This act can be termed as negligence since Sam requires treatment without discrimination. The public health ethics is instituted on a societal responsibility to protect and promote the health of the entire population (Buchanan, 2008). The ethical issues arise because there is a conflict between the duty to care vs. self-protection.  Camilla seems concerned about the condition of Sam and is willing to perform her duty to care. On the other hand, Camilla is concerned about the safety of the other patients. 

The ethical perspective on the ethical issues identified in the case study is deontology. The deontological ethics focus on the rightness or wrongness of an action, rather than the rightness or wrongness of the implication of that action. Based on the Kant perspective, some duties are absolute (Misselbrook, 2013).  Hence, based on deontology, the goodness or badness of an action depends on whether the action that brought it was right or wrong (Morrison et al., 2014). Julia should not have recommended Sam to be placed in restraints and left unattended. Attempting to deliver care to Sam is more important than discontinuing the treatment. This kind of harm is unacceptable regardless of its consequence. In cases, the action may be appropriate for the patient but might not produce good results. The principle of deontology is encouraged in medical practice, and hence the relationship between a health professional and a client should be deontological. In the case study, placing Sam in constraints is negligence and a breach of deontology management (Mandal et al., 2016). The right choice in an ethical situation is its conformity with a moral norm. Although autonomy is paramount in medical practice, Sam should have restrained himself from abusive and violent behaviour. Conclusively, the perspective of deontology requires providers to do good to all patients.

Discuss the ethical issues from the perspective of

The alternative perspective is the egalitarianism principle. Egalitarianism proposes equality of something and hence involves comparing two things. In the health context, egalitarianism is defined in terms of equal outcomes for different patients. As such, treatment should be equalised for patients across the population to realise equal outcomes (Abásolo & Tsuchiya, 2014). Individuals, who apply the egalitarian principle, favour equality of some kind. They note that people should receive same or be treated the same or as equals. This doctrine is founded on the background that all humans are equal in fundamental moral or worth status. Based on this principle, Sam should have been offered same treatment as the other patients regardless of his situation.

Egalitarians hold five basic principles that guide their thoughts as well as actions. Firstly, egalitarians think that inequitable life prospects have to be equalised. Secondly, they hold that equality is among the most vital constructive or irreducible worth of justice. Thirdly, the welfare of individuals should be improved. Fourthly, that social justice is comparative. Fifthly, that unfairness occurs when advantages are denied in the name of promoting justice. Finally, that there are particular absolute humanitarian concepts such as autonomy and human dignity. As a result, the primary aim of equality is to compensate for individuals with difficult family conditions or poor endowments (Ekmekçi & Arda, 2015). Julia should thus advocate for the treatment of Sam because he is experiencing a challenging situation.

Human rights, including the right for every person to obtain the highest attainable standard of health, are founded on enhancing and promoting human dignity. As such, human rights and human dignity are directly related. The universal declaration of human rights (UDHR) recognises the intrinsic dignity as well as the equal and indefeasible rights of all people as the foundation of human rights (Chapman, 2015). Human rights are directly related to health (Freegard, 2012). Based on this analysis, Julia failed to observe human dignity and human rights by suggesting that Sam should be placed in constraints. Human right is profoundly linked to the concept of human rights. Due to this connection, health professionals cannot promote human rights without promoting human dignity.

The concept of human rights is thought to be the basis of human rights. Health professionals have the challenge to observe human rights as well as human dignity since the patient might be restricted in expressing their dignity. A patient may be restricted to express their dignity because of their illness (Jones, 2015). Sam might be restricted to express his dignity because of his condition and the experience of substance abuse. Inhumane treatment of patient limits their right to receive the best possible care. For instance, restricting Sam would prevent him from receiving care. Human rights further protect the right of a person against discrimination, which has been applied towards Sam.

Most professions contain, at least implicitly, a professional morality with standards of conduct that are acknowledged by those in the profession (Beauchamp & Childress, 2012). The case study has triggered the need to observe professional codes of ethics, professional codes of conduct and legal requirements. In my future practice, I would value the quality of care for every patient, respect and kindness for others. Valuing the quality of care entails nurses embracing accountability for the standard of care delivered, assisting to improve the standard of care and taking action when the standard of care is unacceptable (Australian Nursing and Midwifery Council, 2008). The nursing role, in this case, includes the role to question and report unethical treatment and behaviour. In the case of Sam, I would report his unethical behaviour and also question the unethical action taken by Julia. On the other hand, valuing respect for others entails valuing the moral worth and dignity of others. Kindness demonstrates acts of gentleness and consideration for others. I would be considerate when taking the vital signs of Sam and attempt to understand his situation. On the professional code of conduct management, I would observe the conduct statement four according to the NMBA. This conduct statement requires nurses to respect the dignity, values, culture, ethnicity and beliefs of people getting treatment and care. Besides, nurses should promote the interest of the patients and offer care without inflicting any harm. Based on the professional code of conducts and ethics, my future practice would be guided by the virtues of gentleness, compassion, humaneness and considerateness.

In this section, I will use the ethical theory of utilitarianism to analyse the ethical issues in the case study. The utilitarianism theory is also referred as consequentiality since the result of an action determines its morality (Tordjman, 2017). Utilitarian’s select a decision that would result in the greatest benefit for a large number of people. In the case study, Julia decided to have Sam placed in constraints so that the available staff would focus on caring for the other patients. Julia’s decision might cause harm to Sam, but the result would be a maximum benefit since the staff would care for other patients who are cooperative. Literature suggests that utilitarianism is founded on the calculated harm or benefits for a decision (Petrini, 2010).

Utilitarianism can either be rule utilitarianism or act utilitarianism (Playford, 2015). Act utilitarianism occurs when a decision is made after the potential harm and benefit are calculated. This kind of utilitarianism results in a good outcome. Current and past evidence might be used when determining the plausible benefits and harms of an action. However, resources and time are wasted when this kind of decision-making process is adopted. Contrarily, in rule utilitarianism, a decision is made without considering the potential benefits or harms. The situation portrayed by Camilla indicates that the harms and benefits of placing Sam in constraining were not considered.

The principles of health care ethics that apply to the ethical issues in the case study are beneficence, respect for patient autonomy and non-maleficence. Julia failed to promote the principle of beneficence when reviewing the issue of Sam. Beneficence is considered to mean doing good and the promotion of charity and kindness. Also, it is considered as an action that is done to benefit others. In medical ethics, beneficence is the principle of requiring that providers deliver positive benefits like good health and prevent harm. Under beneficence, health professionals must assist patients physically, morally and psychologically (Mawere, 2012).

Non-maleficence is another health care principle that is depicted in the ethical issues. Non-maleficence implies "first do no harm". This principle can be achieved by careful decision making based on the presenting situation (Avasthi, 2013). In the case of Sam, it is evident that the virtue of non-maleficence was ignored. Camilla expressed her concerns that Sam might hurt himself due to the decision made by Julia. The last health ethics that applies to the ethical issues is the respect for patient autonomy. Respect for patient autonomy allows patients to make decisions about the treatment they will receive (Entwistle, 2010). All decisions should involve the patient since they are the ones who would be affected. In the selected case study, Sam was not involved in the decision-making process.

Health professionals experience numerous challenges when managing violent and verbally abusive patients. In the case study two, the health professionals should identify the root cause of Sam’s behaviour and work to address it. Verbal abuse in a healthcare setting should be viewed as a symptom of the problem. For instance, Sam has a history of substance abuse, which might be the cause of his behaviour. The providers can acquire robust skills in conflict resolution. Additionally, they require dedicated personnel in the inner-city hospital which can be called to help resolve heated conflicts. In the current situation, the health professionals should attempt to establish a balance between the need for the safety of the health provider and the right of the patient. Thus, they should try to negotiate and compromise to accommodate Sam in the hospital. The hospital administration can also adopt zero tolerance workplace principle (Morrison et al., 2014). The safe environment should however not be compromised in the facility.

Conclusion

As discussed in this paper, the abusive character is a major ethical issue in the healthcare settings. The application of constraints for a patient who requires investigation for acute abdominal pain is also an ethical issue. These ethical issues can be solved by establishing a balance between the respect for patient autonomy, the duty of care and safety of the provider. In my future practice, I would observe the virtues of gentleness, compassion, humaneness and considerateness. This paper recommends the inner-city hospital to have dedicated personnel who can solve conflicts. The health professionals can also acquire robust conflict resolution skills to help in caring for verbally abusive and violence patients such as Sam.

References

Abásolo, I., & Tsuchiya, A. (2014). Egalitarianism and altruism in health: some evidence of their relationship. International journal for equity in health, 13(1), 13.

Australian Nursing and Midwifery Council (2008). Code of ethics for nurses and midwives in Australia. ACT: Australian Nursing and Midwifery Council.

Avasthi, A., Ghosh, A., Sarkar, S., & Grover, S. (2013). Ethics in medical research: General principles with special reference to psychiatry research. Indian journal of psychiatry, 55(1), 86.

Beauchamp, T. L., & Childress, J. F. (2012). Principles of Biomedical Ethics (7th ed.). New York: Oxford University Press ?Berglund, C. (2012). Ethics for health care. (4thed.). South Melbourne: Oxford?

Buchanan, D. R. (2008). Autonomy, paternalism, and justice: ethical priorities in public health. American Journal of Public Health, 98(1), 15-21.

Butts, J. & Rich, K. (2016). Nursing Ethics: Across the Curriculum and Into Practice. (4thed). Burlington MA: Jones & Bartlett Learning Sydney: The Federation Press.

Chapman, A. (2015). The Foundations of a Human Right to Health: Human Rights and Bioethics in Dialogue. Health & Human Rights: An International Journal, 17(1).

Ekmekçi, P., & Arda, B. (2015). Luck Egalitarianism, Individual Responsibility and Health. Balkan medical journal , 32 (3), 244-254.

Entwistle, V., Carter, S., Cribb, A., & McCaffery, K. (2010). Supporting patient autonomy: the importance of clinician-patient relationships. Journal of general internal medicine , 25 (7), 741-745.

Freegard, H. (2012). Ethical practice for health professionals. (2nded.). Melbourne: Cengage. Available at: https://ebookcentral.proquest.com/lib/acu/detail.action?docID=4814208 ?

Jones, D. (2015). Human Dignity in Healthcare: A Virtue Ethics Approach. The New Bioethics , 21 (1), 87-97.

Mandal, J., Ponnambath, D., & Parija, S. (2016). Utilitarian and deontological ethics in medicine. Tropical parasitology , 6 (1), 5.

Mawere, M. (2012). Critical reflections on the principle of beneficence in biomedicine. Pan African Medical Journal, 11(1).

Misselbrook, D. (2013). Duty, Kant, and deontology. Br J Gen Pract, 63(609), 211-211.

Morrison, E. E. & Furlong, B. (2014). Health Care Ethics: Critical Issues for the 21st Century. (3rdEd.). Sudbury. MA: Jones and Bartlett. ?

Petrini, C. (2010). Theoretical models and operational frameworks in public health ethics. International journal of environmental research and public health , 7 (1), 189-202.

Playford, R., Roberts, T., & Playford, E. (2015). Deontological and utilitarian ethics: a brief introduction in the context of disorders of consciousness. Disability and rehabilitation , 37 (21), 2006-2011.

Stellenberg, E. L., & Dorse, A. J. (2014). Ethical issues that confront nurses in private hospitals in the Western Cape Metropolitan area. Curationis, 37(1), 01-09.

Tordjman, G. (2017). Issues in Bioethics: A Brief History and Overview. Issues in Bioethics , 1-77.