Ethical Approaches in Nursing Care
Discuss about the Feminist Ethics and Social Policy.
The case study here is focused over a patient named Sam who is suffering from acute abdominal pain with previous medical history of drug-related psychosis. Self-harming, abusive and agitated behaviour of Sam has generated a threat towards the other fellow patients and healthcare professionals and these have compelled the medical team of the inner city hospital to put him under restrain. However, Camilla, the attending nurse of the Sam is against this procedure of restrain. She is of the opinion that restrain will exacerbate Sam’s agitation and will increase the tendency of self-harm. The following essay sheds light on the ethical issues and nursing conflict pertaining to this case. The essay also highlights professional code of nursing conduct and human dignity rights in relation to this particular case.
Under Utilitarian approach or consequentialist approach, decision is taken based on the calculation of greatest amount of benefits over significantly larger group of individuals. Here the outcome has strong connection with the morality of the associated intervention. This approach could be harmful towards selected individual but the net outcome is of maximum benefit for the mass (Hsieh &Kramer, 2012).
Under ethical domain of Deontology, the morality of the action undertaken is solely inclined upon the nature of the action. This means that the possible harm is acceptable irrespective of the associated consequences. This concept was first introduced by Immanuel Kant, a philosopher and hence it is also popularly known as Kantian deontology (Gray& Schein, 2012).
As per Libertarianism, a collection of political philosophies and movements promotes liberty in the domain of the nursing approach. The libertarians, who believe in the concept of libertarianism, promote political liberty and autonomy for all. They also vouch for freedom of choice, speech and individual judgment. It also gives importance to voluntary association and self-ownership. According to Rawls’s Principles of Justice, each and every person deserves equal rights to the extensive system of basic liberties prevalent in the society. The liberty is mostly restricted in two cases. One is a less extensive liberty known as possible liberty that strengthens the total liberty system for everyone. The second one is less than equal liberty and this is accepted for those who are affected (Woods, 2011).
According to the Natural Law, morality and law have deep interconnection with each other. Morality here is the parameter that is used for judging what is right or wrong or comparison between good or bad. The natural law theorists state that the laws of the human beings are guided by the morality and not by the authority as defined by the government. The term “natural law” is derived from the basic thought of morality based on the concept that human comes from the Mother Nature. The sole purpose of human is to lead a healthy and happy life such that the actions which are against those two purposes are considered to be unnatural or immoral (d'Entreves, 2017).
Utilitarian Approach and Deontology
According to the Theory of Virtue, individual’s character is of prime importance in ethics as it is one of the critical element upon which the overall ethical thinking is based. This element of Theory of Virtue stays ahead of the deontology and consequentialism. The three main virtues of ethics are eudaimonism (classical formulation of Virtue Ethics), ethics of care and agent based theories (Smith, 2011).
The concept of Egalitarianism is popularly known as equalitarianism. This school of ethics prioritizes the equality among all the people residing in the society. It also abides by the concept that all human beings are equal as per the social parameters and fundamental worth. Egalitarian theory in nursing approach emphasizes equal access to certain goods but does not promote equal sharing of the available social benefits. However, critiques consider this model as insufficient to address willingness to pay or need efficiency (Buchanan, 2010).
The concept of Feminism has been framed by the Feminist Ethics. It is an initiative to revise, rethink, and reformulate the traditional grounds of ethics to such an extent that it depreciates the women’s moral experience. Feminists have frame different gender-centred approaches in the theory of ethics. These approaches address the traditional law of ethics that have neglected women. The feminist ethicists also emphasize political, legal, ideological and economic cause and effect of women with respect to their gender status. It demands equal rights irrespective of gender (Mahon & Robinson, 2011).
The ethics in nursing care is concerned with the moral dilemmas that are originated out of the conflicts or obligation during the duty time and the other faced consequences. In case of Camilla, the major moral dilemmas faced by her are utilitarian approach and deontology. The statement of Julia (the nurse in the charge shift) is somewhat related with the ethical principal of utilitarian approach. Utilitarian approach claims that the benefit must be judged on the basis of the mass and deontology states that the morality must be solely judged on the basis of the situation irrespective of the future consequences. In case of Sam, his violent behaviour may harm the safety concerns of other patients and healthcare professionals and so he is being put under restrain to the betterment of the mass and the deontology states that the future consequences should never be considered and so the concern so Camilla is irrelevant here. However, the concept of Libertarianism states that everyone has a freedom of choice and speech which is against backed by natural law. It states that the purpose of the human is to lead a happy and healthy life and anything against is against the moral ethics. So restraining is going against the natural law as it is preventing Sam to lead to healthy and happy life. Moreover, the restraining is also going against the theory of egalitarianism as it is not giving Sam the equal rights to express his thoughts and grievances. However, the other fellow patients also have equal rights to get proper treatment and the agitation of Sam is creating a barrier against that creating an ethical dilemma further. Julia here is judging Sam as per his previous behaviour and the kid of life style he leads and hence not so considerate about his wellbeing or rather say the outcome of the restrain therapy. But Camilla on the other hand is thinking on the basis of the egalitarianism theory preach equality among all the human beings irrespective of their social status. Again on the other hand, she is also concerned with the safety of the other staffs or nurses and this is driven by the ethical concept of feminism that depreciates women’s moral experience (Kontio et al., 2010).
Libertarianism and Natural Law
The codes of professional codes for nurses in Australia have been framed in order to maintain a proper balance in the nursing profession. According to the professional code of conduct, nurses are required to practise in a culturally competent and safe manner while maintaining the standards of nursing profession and health care system. The nurses must also practise nursing according to the prevailing laws of nursing laws (Nursing and Midwifery Board of Australia, 2017). The professional code of conduct of nursing also states that the nurses must respect the dignity, ethnicity and cultural values of the patients who are under their surveillance. Nurses are also required to maintain confidentiality while handling patients’ personal information and medical data. During the course of the disease treatment, the nurses are required to remain honest and accurate in relation to the information related to patient’s health and health care products. Here Camilla is also honest and diligent towards health and quality care of Sam. Here her ethical right of feminism is getting hampered as Sam is abusing her but still she is trying to provide maximum quality care to Sam. Nurses are also required to promote the concept of health and well-being of the patient via informing them about their current health status and also assisting them in the decision-making process. However, Sam is not in a state of decision making process because he is has drug related psychosis and hence Camilla is doing her best and vouching for withdrawal of restrain for Sam’s betterment. The Australian nursing code of conduct also preaches the proper preservation of trust among nurse and patient relationship and this will help to generate a confidence in patient and thereby promoting wellbeing. It considers the relationship shared between the nurse and patients to be inherent. Lastly they must practise in an ethically competent manner (Nursing and Midwifery Board of Australia, 2017).
The profession of nursing protects the inherent dignity of the patient and recognises the universal human rights of the people along. These acts are considered as their moral responsibility. The human rights in nursing profession include proper recognition, respect and protecting the civil, economic, cultural, social and political rights (Nursing and Midwifery Board of Australia, 2017). This protection of rights is applicable to all the human beings. The scenario of human rights and dignity in reflection to this case lies in the fact that, Sam, the patient has been applied restrain. Though restrain was done to prevent him from self-harming but it is going against his human rights. Here Camilla is trying to trying to protect the human rights of Sam which is also the major reason of her concern apart from the her concern related to Sam’s health. But restraining is not critically acknowledging the relationship that exists in between the human rights and health. It believes that critical contribution in human rights can actually improve the health outcomes. But on the other hand, if Sam is set free, then his agitated activity will not only cause self-harm but also will harm other fellow patients who also have equal share of staying fit and well. Nursing profession actively promotes the process of safeguarding the rights of all the people the heath care domains too. Setting Sam free will also invite threats to the nursing staffs. The harm or injury of the nursing staffs will not only affect their human rights but also will indirectly hamper the well-being and quality care of the other patients (Nursing and Midwifery Board of Australia, 2017). So retraining of Sam though unethical with respect to the human rights of Sam but is beneficial for the betterment of the global human rights of the other patients and health care professional. However, Sam is not answering Camilla’s question rationally and is causing self harm via pulling out his IV cannula. So, restraining Sam, it is actually promoting the human rights of Sam of getting quality care. But the statement of Julia is absolutely against the human right as she said “patients like Sam are a waste of our time. Besides, we haven’t got enough staff rostered on today to be worried about him”.
Theory of Virtue and Egalitarianism
The ethical principle of autonomy promotes individual freedom. The autonomy has two basic concepts, liberty (the right of self-determination) and agency (the freedom to make decision). So use of physical restrain in case of Sam is going against this principle of autonomy. Sam is not allowed to take his own decision and is put into restrain forcefully. This restrain is incompatible with the principle of autonomy.
The act of beneficence on the other hand confers moral obligation upon the caregivers to act for the benefit of the concerned patient (Nursing and Midwifery Board of Australia, 2017). In case of Sam, the safety of other patients and healthcare professionals are being compromised and this justifies the restrain procedure. However, the act of beneficence must be constrained by the act of autonomy in order to prevent the rights of the patients from being subjugated to the concerned medical needs.
The act of non-maleficence signifies no harm to patient hence; physical restrain can be treated as unethical. However, non-maleficence also means prevention of harm to others and to self so restrain over a 21 year old man with previous reported cases of drug-related psychosis can be considered to be ethical. As per the case study, Sam is pulling out his IV cannula so restrain can be considered as an act to prevention of self-harm. The concept of justice is a complex conundrum when the patients are forcefully detained against their will in order to prevent the risks to others (Mohr, 2010; Nursing and Midwifery Board of Australia, 2017). Here restraining is creating justice for the others and also to Sam as it is preventing self-harm.
The first and foremost recommendation which I want to highlight is an urgent requirement for the generation alternative technique for restrain which does not harm patient’s dignity and human rights. Moreover, I also feel that there is an urgent need for designing personalised and trauma-informed interventions for the patients. It would serve as an alternative for the current authoritarian medical practise. Another recommendation which I would like to cite is the dangers which are associated with restraint. Here in case of Sam, the restrain order has been taken with a one sided approach, it failed to consider the ethical complications on the ground of libertarianism and egalitarianism. Moreover, the act of restrain has increased the threat of self harm in spite to preventing the same. However, I feel that the statement of Julia is a breach of the duty of care. As per the ethical theory and code of professional conduct of nursing, every patient has equal rights to recover from the diseased condition and to get a fair chance to lead a healthy life. Dearth in the ratio of patient: nurse can never be cited as an excuse of negligence towards any particular patient who requires extra attention or care. However, there still lies a conflict of interest issue between the wellness of Sam and the betterment of other patients (Mohr, 2010).
Thus from above discussion it can be concluded that, the act of non-maleficence, beneficence must be critically considered while applying restrain to a patient. In case of Sam, restrain has been applied in order to prevent self-harm and the harm of fellow patients. However, keeping his drug-related psychosis in mind, such restrain though supported by the law of deontology, can impact patient negatively resulting a conflict between the theories of libertarianism and egalitarianism. But again the restrain is justified on the grounds of utilitarian approach.
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