Introduction
This paper examines ethical concerns and dilemmas in health and social care. The report will analyze two case studies that exemplify distinct facets of ethical dilemmas within this domain. The initial case study will delve into informed consent, whereas the subsequent case study will scrutinize the conflict between beneficence and autonomy. The provided case studies will be utilized as a foundation for the examination and discourse of ethical concerns and predicaments. This analysis will examine ethical principles, professional ethics, codes of conduct, legislation, policy, and the influence of personal and professional values on the selection of appropriate resolutions. The report will conclude with an extensive discussion and final remarks.
Informed Consent
The principle of informed consent is a crucial ethical tenet in healthcare, mandating that healthcare practitioners furnish pertinent information to patients or individuals involved in research endeavors. This enables them to exercise their autonomy in making informed decisions about their healthcare or involvement in research activities (Doherty, 2020). In this case, Mr. Thomas is a 68-year-old man with diabetes, hypertension in his periphery, and ulceration on his right heel. His doctor recommends amputation after ineffective wound therapy. Even though Mr. Thomas agrees with the doctor, his wife worries that he will be forced into an amputation since he is sick of tending to his wounds. The case study illustrates the importance of informed consent as an ethical issue for nurses (Faubion, 2023).
Patients or their legal guardians must provide their approval before any medical treatment or operation may proceed. Educating patients on the pros and cons of proposed therapies and providing them with choices is essential. The nurse must show compassion for Mrs. Thomas, take her concerns seriously, and reassure her. In addition, the nurse needs to report Mrs. Thomas’ comments and worries to the head nurse and doctor. Mr. Thomas has the last say in his treatment, but addressing his wife’s concerns is crucial.
Beneficence vs. Autonomy
Beneficence pertains to the ethical responsibility of healthcare practitioners to prioritize the patient’s best interests, advance their overall welfare, and mitigate or eliminate any potential harm. The process entails making informed decisions and implementing strategic actions to optimize the advantages and mitigate the potential hazards for the patient (Faubion, 2023). In contrast, autonomy emphasizes an individual’s entitlement to exercise independent judgment and choice without being subject to external intervention or compulsion. The statement acknowledges the significance of self-governance and demonstrates a reverence for individuals as independent entities capable of making decisions following their values, preferences, and objectives.
In this case study, the doctor has warned Mr. Simms and his family that additional therapy is unlikely beneficial and may worsen his quality of life due to cancer recurrence. The doctor has suggested hospice care, including pain medication and other comfort measures. However, Mr. Simms is unwilling to take painkillers since he doesn’t want to become drowsy and lose quality time with his loved ones. His wife approaches the nurse and inquires whether Mr. Simms’ discomfort may be treated secretly. The case presents the complex ethical problem of beneficence vs. autonomy (Faubion, 2023). The nurse’s duty of beneficence requires them to look out for the patient’s best interests, but the patient’s autonomy guarantees them the freedom to make their own choices. The nurse should reassure Mrs. Simms that she knows her worries but must respect Mr. Simms’s desires due to ethical and legal considerations.
Ethical Issue and Ethical Dilemma
Ethical issues entail moral conflicts; it occurs when opposing ideals, interests, or principles must be balanced. Conversely, ethical dilemmas arise when two or more morally righteous actions collide. The ethical issue in case 1 is how best to inform Mr. Thomas about the potential outcomes of the intended amputation and his available treatment options. Patients’ ability to make an informed decision regarding their treatment is based on their access to relevant information. Mr. Thomas’s right to make decisions regarding his health and the obligation to address Mrs. Thomas’s worries provide a possible conflict.
The ethical dilemma in case 2 includes striking a balance between the principle of beneficence, which prioritizes the patient’s health and happiness, and the patient’s right to exercise informed consent to treatment (Faubion, 2023). The doctor stresses the projected loss in Mr. Simms’ quality of life if he undertakes treatment. The moral problem arises when Mr. Simms rejects pain medicine while suffering pain symptoms out of worry. Mrs. Simms, on the other hand, is upset by her husband’s reluctance and looks for a covert method to administer anesthetics to him.
Role of Ethical Principles, Professional Ethics and Codes of Conduct and Legislation and Policy in Choice of Solution
Utilitarianism is a moral framework that assesses the ethical worth of actions by considering their collective outcomes and endeavors to optimize happiness or utility for the maximum number of individuals. Within healthcare, applying utilitarian thought entails making decisions that emphasize maximizing the overall benefit or welfare for the majority (Zastrow and Hessenauer, 2022). In case 1, Utilitarian ways of thought can inform the professional answer to the case study, but they take different perspectives in dealing with the challenge. The guiding premise of utilitarianism is to increase the number of happy or satisfied people (Doherty, 2020).
A utilitarian perspective may weigh the pros and drawbacks of amputating Mr. Thomas’ foot. The nurse would have to research how likely Mr. Thomas’s wound will heal after amputation and how this will generally affect his quality of life. The nurse must consider how this might affect Mr. Thomas’s family. The professional address may agree with the doctor’s suggestion for amputation if, from a utilitarian perspective, the advantages of amputation exceed the dangers and if it is likely to enhance Mr. Thomas’ overall well-being and quality of life. However, the nurse must also consider Mrs. Thomas’ anxieties and include her in decision-making to guarantee that her perspective is considered.
In case 2, the utilitarian worldview would influence the professional reaction to the case study. From a utilitarian point of view, the expert’s reaction to the case study would be to weigh the possibilities in terms of their cumulative effects (Zastrow and Hessenauer, 2022). The nurse would weigh the pros and drawbacks of giving Mr. Simms pain medicine without his awareness and the consequences for his loved ones. This method, however, would go against Mr. Simms’s autonomy and his stated want to avoid the medication’s adverse effects. The nurse may feel justified in taking such action if they believe that Mr. Simms and his family would benefit from the concealed administration of pain medicine.
Deontological Ethics
Deontology is an ethical framework that centers on the moral duties and obligations linked to human actions, prioritizing them over their outcomes. The term “deon” originates from Greek, specifically from the word denoting duty or obligation (Doherty, 2020). Deontology is frequently compared with consequentialism, a moral framework that assesses an action’s moral correctness or incorrectness by considering its consequences. Deontology places significant emphasis on moral obligations that possess a universal and obligatory nature, applicable to all individuals irrespective of contextual factors. These responsibilities are derived from rational principles and are perceived as intrinsic to the nature of human beings.
As initially proposed by the renowned thinker Immanuel Kant, the philosophical notion of the categorical imperative occupies a pivotal role within the framework of deontological ethics. The categorical imperative posits that individuals ought to conduct themselves so that the principles underlying their actions can be universally adopted without encountering logical inconsistencies (Faubion, 2023). In essence, if an action possesses moral righteousness, it should be feasible for all individuals to engage in the same action under comparable circumstances. In case 1, from a deontological standpoint, the nurse must determine if Mr. Thomas’ foot ulcers have been adequately treated before deciding on amputation. Assessing whether all potential therapies, such as specialized wound care, diabetic foot care education, and consultations with wound experts, have been exhausted to enhance wound healing and prevent amputation is part of this process.
The application of deontology in the context of health and social care holds significant implications for ethical decision-making. The presented framework offers healthcare professionals a structured approach to effectively address intricate ethical dilemmas and make decisions grounded in moral considerations. Deontological ethics, which values personal autonomy and informed healthcare decisions, emphasizes informed consent (Shanafelt et al., 2019).
Healthcare practitioners are morally obligated to provide patients with complete and accurate information to help them make informed medical decisions. In addition, deontological ethics emphasizes healthcare workers’ patient confidentiality responsibilities. The act of divulging confidential patient information without a legitimate justification or the patient’s explicit consent is widely regarded as ethically inappropriate.
The Principle of Human Rights
Human rights theory argues that everyone has the right to life, liberty, security, equality, and non-discrimination. The notion holds that governments, institutions, and people must uphold these rights and that violating them is unethical and can cause injustice and suffering. In the first case, human rights theory can help experts understand the case study and develop practical solutions. By keeping the principle of human rights in mind, professionals can see the value in informing patients of the potential downsides and upsides of a treatment plan and their other available choices (Shanafelt et al., 2019).
They need to make it easy for Mr. Thomas and his wife to talk to one another to gather all the information they need to make a well-informed decision. Human rights concepts are used in this situation by respecting Mr. Thomas’ autonomy while resolving Mrs. Thomas’ concerns. On the other hand, violating human rights norms would mean disrespecting Mr. Thomas’s right to self-determination and knowledge (Varkey, 2021). The value of respect for the dignity and autonomy of persons is at stake if healthcare providers like Mrs. Thomas’ are dismissive of her concerns without effectively addressing them. An ethical problem and a breach of professional conduct may result from failing to protect human rights.
In case 2, by recognizing and protecting people’s fundamental rights, the concept of human rights aids professionals in making sense of the case study’s potential solutions. Mr. Simms’s right to privacy is at the forefront of this lawsuit. His wife and the medical staff may disagree with his treatment choices, but the nurse must still honor his autonomy. Freedom from needless suffering is likewise protected under human rights (Shanafelt et al., 2019). This, however, must be weighed against the autonomy principle of the nurse. While Mr. Simms must get pain medication, no one has the right to force him to take it. A nurse can address his worries about pharmaceutical side effects by maintaining an open line of communication, providing information about pain management alternatives, and considering alternate treatments.
UK Mental Capacity Legislation and Policy
Professionals in the UK can benefit significantly from the guidelines provided by the Mental Capacity Act 2005 and other policies on mental capacity. The act establishes a legal framework to aid people who may lack decision-making ability, protecting their best interests when choices are made on their behalf (Sim and Waterfield, 2019). It is possible that the Mental Ability Act can still be used to encourage Mr. and Mrs. Thomas to make decisions together if Mr. Thomas is found to have the ability. Professionals may make sure that decisions are made legally and following the concepts of autonomy, best interests, and engagement of relevant persons by looking at the UK’s mental capacity legislation and policy (Dall’Ora et al., 2020). Disregarding laws and policies about mental ability, on the other hand, may lead to law and professional ethics violations. The values specified in the act and the professional response might be undermined without conducting a capability assessment of Mr. Thomas or including Mrs. Thomas in the decision-making process, as appropriate.
In case 2, if it is determined that Mr. Simms lacks the mental ability to make decisions about his pain treatment, the healthcare team must do what is in Mr. Simms’ best interests under the mental capacity act. If Mr. Simms is competent, however, the nurse must respect his autonomy and accommodate his wishes, even if they contradict his wife or the healthcare team. To ensure that decisions are made in an individual’s best interests, the law protecting those with diminished mental capacity offers a framework to guide decision-making (Sim and Waterfield, 2019). It aids professionals in making moral and legal judgments when a patient’s decision-making abilities are disputed.
Role of Personal and Professional Values in Choice of Solution
The focus of virtue ethics is on nurturing admirable moral qualities and conduct. According to virtue ethics, the nurse’s professional reaction to Mr. and Mrs. Thomas should be empathetic, compassionate, and understanding. Mrs. Thomas should feel heard and supported by the nurse as she expresses her worries and shares her feelings. Relationships and interdependence are crucial to making morally sound decisions in care ethics (Varkey, 2021). Care ethics can guide the nurse’s attitude in this situation if she considers Mrs. Thomas’ job as a caregiver and her deep love for her husband. The nurse must show that she understands Mrs. Thomas’s concerns and includes her in decision-making to feel heard and valued.
Understanding and respecting one another’s personal narratives or life stories is at the heart of narrative ethics. The nurse can help Mr. and Mrs. Thomas talk about their feelings, hopes, and worries about the impending amputation by taking a narrative ethical approach. The nurse can better comprehend the patient’s perspective and offer individualized treatment and assistance. Narrative ethics emphasizes the significance of human narratives and stories; virtue ethics emphasizes particular character attributes, and care ethics stresses connections and interconnectivity (Doherty, 2020). While theoretically distinct, these philosophies often overlap and supplement one another to help healthcare providers provide more comprehensive and empathetic treatment.
Gender roles and cultural expectations may influence individuals’ perceptions of healthcare decisions and the expression of concerns. Mrs. Thomas may feel safer confiding in the nurse because of the nurse’s position as a caretaker or because of the nurse’s gender. Understanding and empathizing with patients’ needs necessitates sensitivity to these considerations (Sim and Waterfield, 2019). Individuals’ perspectives on medical procedures, end-of-life care, and decision-making can be influenced by their religious beliefs and values. For instance, certain religious tenets may place a premium on spiritual well-being above physical health, while others may place a premium on the sanctity of the body.
Different age groups may see healthcare options from different angles. Maintenance of autonomy and quality of life in the elderly may take precedence over therapeutic measures in the young (Zastrow and Hessenauer, 2022). Age-related experiences and generational disparities may also influence attitudes toward medical treatments. In terms of mobility, independence, and quality of life, people with disabilities may have particular worries and considerations that should be taken into account when receiving medical procedures.
The professional approach to the case study can be enriched by the insights provided by virtue, care, and story ethics. An individual’s character and moral qualities are the primary emphasis of virtue ethics, which stresses developing admirable characteristics and practices (Faubion, 2023). In this scenario, a nurse who practices virtue ethics would place a premium on kindness, empathy, and patient liberty. The nurse’s goal would be to treat Mr. Simms compassionately while honoring his wishes regarding pain medication. Likewise, the nurse would know it’s crucial to be forthright and honest while explaining the issue to Mrs. Simms so that she may grasp the underlying ethical principles at play.
Care ethics focuses on building connections of care and catering to people’s unique requirements and vulnerabilities. A nurse guided by care ethics would notice Mr. Simms’ and his wife’s concerns and work to alleviate them with empathy, open dialogue, and comfort measures. Within professional ethics, the nurse would put Mr. Simms’ and his wife’s health and happiness first by addressing their concerns and meeting their needs. Personal narratives and storytelling’s power are central to narrative ethics (Doherty, 2020). The nurse would use narrative ethics by conversing with Mr. Simms and his wife to learn about their worldview. These overlapping ethical frameworks can help the nurse give Mr. Simms and his wife the best care possible while protecting their dignity and independence.
Case study respondents may react differently to the challenges presented depending on their culture, gender, race, religion, age, sexual orientation, ability, and other factors. Cultural norms may influence personal freedom, decision-making, and hospice care perspectives. Mr. Simms, his wife, and the nurse’s point of view may be influenced by cultural norms such as those that place a premium on family input and consensus-building. The gender, ethnicity, and age of a person all have a part in the social and cultural expectations placed on that person (Shanafelt et al., 2019). These elements may influence Mr. Simms, his wife, and the nurse’s emotions, altering how they view autonomy, decision-making, and the tension between beneficence and autonomy.
A person’s sexual orientation or disability may affect how they feel pain, express it to others, and choose to be cared for and supported. The nurse must be mindful of these elements because of their potential to affect the patient’s independence and happiness. To provide culturally competent care, the nurse must be aware of and respect these variations to meet each patient’s requirements (Dall’Ora et al., 2020). Engaging in honest discourse, providing appropriate education, and modifying care delivery methods may be necessary to achieve this goal.
Discussion and Conclusion
Taking a consequentialist stance means thinking about the possible harm that might result from ignoring the wants and concerns of patients and their loved ones. Professionals in the medical field have specific duties that are highlighted by the duty framework. The nurse’s role is to educate the patient, facilitate shared decision-making, and advocate for the individual’s health and well-being. The virtue framework emphasizes the practitioner’s personal qualities. The nurse’s goal should be to empathize with the patients and their loved ones, to speak clearly and honestly, and to operate with integrity at all times. Philosophy’s insights are highly relevant to the decision-making process in health and social care. Various ethical frameworks are available to help with this analysis and decision-making process, including consequentialism, duty-based, and virtue ethics. Given the complexity of ethical challenges in healthcare, these factors must be considered when formulating day-to-day reactions and decisions.
Decisions in the scenarios above may be influenced by conservatism, a philosophy that stresses preserving and preserving the status quo. The nurse’s concern for Mrs. Thomas’s well-being and the need to alert the charge nurse and physician in Case 1 is consistent with retaining patient confidence and preventing harm. Preserving Mr. Simms’ power and agency in his end-of-life care by respecting his autonomy and enabling him to make decisions about his pain management reflects a conserving strategy. Resolving Mrs. Thomas’s worries and protecting Mr. Thomas’ decision-making process from the effect of any misconceptions are two of the expected outcomes of the recommendation in Case 1. Case 2’s proposed action protects Mr. Simms’ autonomy and guarantees his wishes and values are respected. This supports ethical practices and emphasizes caring for the individual patient.
Reference List
Dall’Ora, C. et al. (2020). ‘Burnout in nursing: a theoretical review.’ Human Resources for Health, 18, pp.1-17. Web.
Doherty, R.F. (2020). Ethical dimensions in the health professions-e-book. Elsevier Health Sciences.
Faubion, D. (2023). 20 Most-Common Examples of Ethical Dilemmas in Nursing. Nursing process. Web.
Shanafelt, T.D. et al. (2019). ‘Healing the professional culture of medicine.’ In Mayo Clinic Proceedings 94(8), pp. 1556-1566. Elsevier. Web.
Sim, J. and Waterfield, J. (2019). ‘Focus group methodology: some ethical challenges.’ Quality & Quantity, 53(6), pp.3003-3022. Web.
Varkey, B. (2021). ‘Principles of clinical ethics and their application to practice.’ Medical Principles and Practice, 30(1), pp.17-28. Web.
Zastrow, C. and Hessenauer, S.L. (2022). Empowerment series: Introduction to social work and social welfare: Empowering people. Cengage Learning. Web.