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Beth is 86 years old and resides in a nursing home. She is alert and has no signs of dementia. Unfortunately she is very unsteady on her feet and has a history of falls. The nurses are becoming increasingly concerned that she may injure herself seriously one day and it is highly likely that if she falls she may break her hip and may never walk again. They have spent a lot of time explaining this to Beth and she says she is aware of the dangers. The nurses have been asking Beth to call for help when she wants to walk, but she has not been doing this as she likes to be independent. They have also organised a walking frame for her which she is refusing to use, even though she is capable of using it properly and the nurses have explained the benefits. They have also included her family in the discussions to try and persuade her to use the walking frame and call for assistance but Beth is adamant that she wants her freedom. They have now suggested to Beth that when she sits down she wears a belt which is tied to her chair. The nurses hope this will remind her not to get up without asking some-one to walk with her and will also prevent her from getting up unaided. Beth objects. She is unwilling to give up her ability to move about the nursing home as she chooses. In desperation a nurse tells Beth that she must use the belt as it is a new rule of the nursing home (this is not the case). Beth reluctantly agrees to wear the belt because she is scared of the consequences of breaking the rules at the nursing home. The nurses are all very relieved that Beth is now using the belt.
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Ethics refer to a framework of moral principles which tend to govern an individual’s behaviour or the manner in which he/she may conduct activities of daily living. An ethical dilemma on the other hand can be defined as a situation where a professional might have to choose between two seemingly correct ethical options (Park et al, 2012). Ethical dilemmas are common in the nursing profession as respecting patient decisions for their own care often tend to clash with steps and processes that might be medically beneficial for the patient (Sellevold et al, 2013). A similar ethical dilemma has been presented in this case study. In the present case study, Beth, an 86 year old patient has decided against the use of walking aids. All nursing professionals responsible for caring for Beth have attempted to explain the importance of these aids for her and have clearly elaborated on various risks in case Beth stays firm on her decision. Beth on the other hand suggests that she clearly understands all implications of not using walking aids and would like to maintain her freedom. A particular nursing professional in the residential care facility however feels that Beth might fall down thereby breaking her hip and permanently losing her ability to walk again. In order to avoid such a circumstance, the professional has lied to Beth and has indicated that it is necessary for her to make use of a belt at all times and request for walking assistance in line with new rules of the residential care facility. This lie however has led to an ethical dilemma which would be explored in the following sections. Ethical and legal principles involved in the case study will be discussed. Conflicts between these principles will also be explored.
Autonomy is the first ethical principle involved in the case study as Beth is adamant on retaining her right to freedom. The ethical principle of autonomy clearly indicates that every patient has complete right to decide further course of medical treatment (Sellevold et al, 2013). The principle further suggests that it is the ethical and moral responsibility of healthcare professionals to comply with the patient’s wishes with the only exception being situations where the patient might not be mentally healthy and might not completely understand the implications of his/her decisions (Riahi et al, 2016). In this case Beth is mentally stable and clearly understands all consequences of her decision. Under these circumstances, it was the ethical responsibility of nursing professionals to honour Beth’s decision and respect her autonomy. The principle however has been violated in the case study as the nursing professional lied about making the use of walking aids compulsory.
In addition to autonomy, the ethical principle of veracity is grounded in the value of being truthful to patients under all circumstances. The principle clearly states that it is necessary for professionals to respect individuality and allow patients to make their own decisions by supplying all information that might be necessary (Park et al, 2012). This principle has also been violated in the case study as the concerned professional was not truthful.
Ethical principle of fidelity has also been grounded in placing truth over and above everything and being honest about patient prognosis and decision making. Values of loyalty and dedication are strongly supported by this ethical principle (Burston & Tuckett, 2013). This principle again has been violated in this case as Beth was lied to and forced to use a Belt against her wishes. Further, the professional who lied to Beth did not acknowledge the fact that Beth was an individual and her dignity needed to be respected.
Looking at the case study from the perspective of nursing professionals, the role of ethical principle of beneficence can be acknowledged (Burston & Tuckett, 2013). This principle indicates that healthcare professionals need to initiate and undertake actions which are beneficial for the patient’s health (Riahi et al, 2016). In other words, it is the ethical and moral responsibility of professionals to provide best possible care to the patients and allow them to benefit from the same. This principle was followed in this case study as compelling Beth to use a belt and call for assistance whenever she needed to walk was an attempt to ensure that she does not fall down and break her hip thereby completely losing her ability to walk.
Lastly, the ethical principle of non-maleficence can be recognised in action in the case study. The ethical principle indicates that healthcare professionals need to refrain from undertaking any such action which has a potential to harm the patient in any manner (Sellevold et al, 2013). In this case, lying to Beth cannot be justified on the grounds that it has an ability to shatter her trust in the healthcare system. Further, in case Beth learns that she has been lied to, she might become extremely rigid and might not be willing to comply with any treatment measures that are suggested in the future.
Several conflicts might be observed in the case study, the first being between the principles of beneficence and autonomy. The principle of beneficence was obeyed in the case study and Beth was lied to. This however did not agree with Beth’s autonomy and her dignity was compromised (Gastmans, 2013).
Principles of veracity and fidelity can also be seen in conflict with beneficence. Both, principles of veracity and fidelity are grounded in truth telling and being fair to the patient. Both these principles were violated in the case study so as to comply with beneficence (Park et al, 2012). Beth’s dignity was not respected and she was lied to even if it was to protect her from future damage.
Ethical principles of beneficence and non-maleficence might also be seen in conflict in the case study. The aspect of lying had a potential of permanently breaking down Beth’s trust in the system and putting her at stake for greater damage (Butts & Rich, 2012). Despite this, immediate beneficence was obeyed and she was lied to.
Looking at the case study from a legal perspective, false imprisonment can be applied. This principle suggests that it is illegal to devoid any individual of his/her fundamental right or dignity without his/ her consent. The only exception to this principle can be considered in situations where patients are mentally unstable and might cause harm to themselves or others in case they are not restrained (Wiegand & Funk, 2012). In this case study, Beth was told that use of a belt has been rendered compulsory in line with new principles of the residential care facility. Although in Beth’s benefit, this claim was completely false.
Legal principle of informed consent also comes into play in this case study. This principle suggests that it is necessary that the concerned patient provides his/her consent before any medical action can be initiated (Riahi et al, 2016). It is also necessary that healthcare professionals ensure that the patient truly understands the intended course of action and all consequences before he/ she provides consent (Burston & Tuckett, 2013). In this case, the nursing professional lied to Beth so as to obtain her consent. This does not classify as informed consent.
Medical negligence can also be applied to this case study. Medical negligence is defined as breach of duty of care by healthcare professionals (King et al, 2016). However, in order to prove medical negligence, it is necessary that the patient in question is harmed. Although this principle does not directly apply to this case study, it might be argued that nursing professionals has to lie to Beth so as to avoid being charged of negligence (Cowen & Moorhead, 2014).
Principles of informed consent and false imprisonment might be seen in conflict with each other in the case study. Compelling Beth to make use of a belt went against the principle of informed consent as she was falsely restrained (Markides & Newman, 2013).
Another major conflict in the case study could be noted in the form of negligence and informed consent. Seeking informed consent from Beth had the potential of putting nursing professionals at a danger of being charged with negligence (Wiegand & Funk, 2012). Therefore, Beth was lied to and steps were taken so as to ensure that she does not fall thereby defying the principle of informed consent.
In summary, it can be suggested that several ethical and legal principles can be seen in action. These include principles of autonomy, beneficence, non-maleficence, veracity, fidelity, informed consent, false imprisonment and medical negligence. Major conflicts between these principles were also identified in the case study. Identified conflicts mainly emerged owing to the fact that complying with one ethical option resulted in disobeying another ethical alternative.
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