To maintain confidentiality the name of the patient has been changed. The patient D is 60 years old male who had kidney cancer he had been admitted to the hospital for further treatment. On the following investigation the patient had been diagnosed with the last stages of cancer which meant it had spread into the surrounding tissue. Prognoses were poor, palliative was to be offered. The family had requested that the patient should not be informed therefore, D was not aware about his current condition. The patient could not understand why medical staff only made him comfortable and were not taking a different approach to his treatment. Consequently, he lost faith in the staff and his will to live and refused everything that was given to him. The nurses made a decision to inform him of his terminal illness, believing this to be in his best interest. He understood the situation and expressed a wish to die at home. Legal aspects
The situation that the nurses faced in this scenario was uncomfortable for both the patient and the healthcare professionals. The nurses had a dilemma of legal and ethical aspects on one hand, and patients legal rights on other hand. In any discussion of ethical issues in medicine, legal aspects may arise. Both of them set standards of conduct, where law often shows a kind of minimal ethical societal consensus (Emanuel et.al. 1999, p2). The study of law expresses a process of legal thinking and applying legal doctrine to the real-life situation in the healthcare setting (Flight and Meacham 2011). A deontology comes from the Greek term deon, meaning duty (Jones and Beck 1996). White and Baldwin (2004) state, deontological is fundamental in medicine as it means do no harm and act in the patients best interest (p.54). Using deontology approach in this case, healthcare providers were following the rule Act in the patients best interest. The problem that occurred in this situation is that it was difficult for the healthcare professionals as from a legal point of view the patient had a right to know the truth if he wish.
The NHS Constitution (2013) states, that a patient has the right to be involved in discussions and decisions about his the health and care, including end of life care, and they be given information to enable the patient to do this (p.9). Healthcare professionals were acting according to the Hippocratic Oath and following a set of rules, which are established as a framework of the NHS. One of the rules states, that nurses must safeguard and promote interests of individual patients and client (Tingle and Cribb 2007, p.16). Medical professionals must always act in the best interest of the patient. However, difficulty may be experienced in certain situations as the borderline between legal issues and ethics is narrow. The important professional concept of nursing is accountability for their actions to deliver appropriate care for their patients. This accountability is applicable in the legal context and important professionally, it is based on knowledge and understanding.
Therefore, legally it is closely related to negligence and duty of care (Young 1995). In this scenario the nurses felt that they were acting as an advocate for the patient by following the rules. Montgomery (1995), state that accountability, responsibility and duty of care are closely linked. Irrespective of professional standing responsibilities, healthcare staff are still accountable, with regard to duty of care within the expectation of their job (Fletcher and Buka 1999). In this case, the patients anxiety could have been alleviated if he had been fully informed of the severity of his medical condition. This would then enable him to understand and accept this news, and would not lead the further complications in his psychological condition. Kravitz and Melnikow (2001) suggest that patients participation in the decision making process about their care is necessary.
Analysing this situation I felt that patient D had a lack of autonomy. A patient should be fully informed about the diagnosis, and consent should be obtained for the treatment proposed; otherwise the autonomous being would be disregarded (Fletcher et al 1995). The importance of patient autonomy came from Nuremberg Trials codes of ethics, which was established in 1948 and stated that The voluntary consent of the human subject is absolutely essential (Washington 1949 p.181). The autonomy of D was disregarded by his family as they believed it would not be beneficial for him to know the truth. However, D had the capacity to make autonomous decisions, such as whether or not he wanted to receive information about his current condition.
The issue that medical staff came across was to respect patients autonomy that had been breached in the described situation. Pearson et al (2005) states that patients are individuals, they have the right to be involved in making the decision process about themselves and their future. This belief refers to patient autonomy which is defined as freedom of making decisions within their limits of competency. Being unaware of his medical condition patient D had been deprived of his autonomy. Hendrick (2004) described autonomy as the ability to think about their lives and act accordingly to a chosen set of rules. Respecting autonomy means treating a person as an individual, involving him in discussion about his planned treatment, allowing him make his own decision. This is an essential part of any document of patients rights. OConnell et al (2010) states that there are some ethical principles in nursing which include two important elements such as beneficence and non-maleficence.
Both of them have significant implications for nurses. Hendrick (2000) supporting this view states that, in healthcare settings beneficence appears to be a straight forward term, and means to do good. In this situation there had arisen a massive ethical dilemma, and to choose the right approach to do good was not very easy for nurses. From one side, we had the patient who was not suitable for any medical treatment, as he was terminally ill but still had the right for palliative care, hence staff had to comply with all ethical principles. One of them was beneficence, as it seemed beneficial in the beginning not to tell the patient the truth about his condition, according to his family wishes. The family believed that patient Ds unawareness of reality would help him cope with his progressive illness. However, nurses whose responsibility it was to protect the patient from psychological stress and follow another ethical principle, which is non-maleficence. Beauchamp and Childress (2009) state that, the principle of non-maleficence dictates an obligation not to harm.
Both beneficence and non-maleficence were described in the Hippocratic Oath as I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them (Greek medicine 2010). The patient Ds reaction to the atmosphere surrounding him determined the medical staff to change the original approach to his care and give him the correct information about his prognosis. Respect should be shown to the patient; a simple obligation to give him a realistic picture of his condition. The patient had a right to know the truth, as he was approaching the end of his life. He might need to discuss some questions with his family and carers in order to arrange his affairs (Nicoll 1997). Basford and Slevin (1999) state, the principles of autonomy and justice as, are vital in healthcare practice and are dominant in many arguments within medical and nursing ethics. Consequently, there is a conflict between the patients right to know and the carers duty of care. Honesty is an important part of any relationship. Jeffrey (2006) suggests that communication would become meaningless if there was no overriding moral obligation to be truthful (p. 64).
In any ethical dilemma healthcare staff should follow the government polices according to the Code of Conduct. As they are responsible for peoples health and have an honour to represent the National Healthcare Service, therefore, they cannot take any situation emotionally and personally. The healthcare professionals attitude to clinical judgement seemed to have increased during the last decade. Considering this, healthcare staff were taking into account new views of recognition of patient rights, to make an autonomous choice. The patient D had an opportunity for choice and made a decision to die at home. The argument in this situation was that all medical professionals should be telling the truth whether or not the patients family agreed. In this case I believe the medical staff were acting professionally and the patient received the attention he required in time, and there were no regrets afterwards.
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