The Ethical Principles Underlying a Particular Aspect of the Informed Consent - Term Paper Example

DISSCUS THE ETHICAL PRINCILPES UNDERLYING A PARTICULAR ASPECT OF THE INFORMED CONSENT Introduction: Moral issues are a part and parcel of the daily life of an individual, be it on the personal front or on the professional front. This is more so with the nursing professions, where the results of decisions and actions have an impact on the quality of life of the patients in their care. The correctness of the moral choice thus is an area of severe concern to a nursing professional and can be summed up in these words of Johnstone, 1999, p.1, “we continue to worry about whether the moral choices we make are 'correct', and continue to suffer the moral perplexity and distress that inevitably follows from 'not getting it right' or from being unable, for various reasons, to translate our moral reflections and judgments into action”. Informed consent from patients is one activity of the nursing professional that lends a hand to the increasing “moral perplexity”. Informed Consent: Informed consent sounds simple in that it means getting the consent from patients on the procedures to be performed on them as part of the management or treatment of the disease or condition from which they are ailing. Yet, it is complex. The moral aspect of informed consent basically stems from the ethic of patient autonomy, but has a bearing on all the other ethics of in the practice of medicine and nursing namely, beneficence, non-maleficence and justice. Its complexity is derived from the fact that individuals view things from different perspectives what may be deemed as right from the perspective of the medical or nursing professional need not be right from the perspective of the patient (Sokol & Bergson, 2005). The basis of the ethic of informed consent lies in giving respect to the autonomy of the patient. Through informed consent the nursing professional provides respect to the ability of the patient to make their own informed decisions. From a legal standpoint the duty of the nursing comes to an end. For in it beneficence of acting in the best interests of the patient, non-maleficence of doing no harm to the patient, and justice of respecting the rights of the patient are met. If nursing ethics meant doing things merely from a legal standpoint and on the basis of rules there would be no cause for perplexity for all subsequent action or inaction on behalf of the patient would be right. The moral issue that arises is that nursing ethics are just not steeped in rules and regulations and the concern for the patient gives rise to a feeling of concern that all has not been right, when the nurse expressly knows that the informed consent is not in the best interests of the patient and beneficence is hardly being met. (Manning, 2001). This is more so now with the changes that have come about in the relationship between the nursing and medical profession and the responsibility to patients. Prior to the 1960s the role of the nursing professional was subservient to that of the medical professional, partly a reflection of the social status of the two professions. The nursing professional was thus responsible to the medical professional and not the patient. This equation between the medical profession and the nursing profession changed after the 1960s to the present position, whereby the primary responsibility of the nursing professional is no loner to the medical professional, but to those people requiring nursing care (Kuhse & Singer, 2001). Discussion: The first possible moral concern for a nursing issue is in the adherence to the correctness of the procedure adopted for informed consent. For informed consent to be proper, the patient needs to be provided all the required information. The operative word here is required. Required information includes the procedure itself, benefits and risks of the planned procedure and alternatives available. Who decides what the requisite information is? The attending physician may choose to provide information deemed requisite with a bias to the procedure chosen to performed. This may arise from the attitude of the physician that he knows what is best in the interests of the patient, ignoring the ethic of autonomy to the patient. The nursing professional is morally bound to stand up for the patient’s autonomy and insist that the right information be provided, or provide the information, but does it happen? Fear of later reprisals by the establishment or the medical profession cause nursing professionals to remain silent and have guilt pangs later by their lack of adherence to morals (Verona, 1994). There is a legal element involved in informed consent. The Royal College of Nursing Guidelines on Informed consent in health and social care research 2005 has three components to it in that the consent should be given by an individual with mental capacity to do; sufficient information is to be provided and understood by the patient the individual; and the consent has to be given freely. This forms the legal framework. The Nursing and Midwifery Council (NMC) Code of Conduct has set professional standards for nurses and midwives, among which is the requirement for acting within the laws that govern their professional and personal lives, failing which their very registration would be in danger. Informed consent quite often involves a power struggle between the patient and the physician (McParland, et al, 2000). The RCN guidelines and the NMC code of conduct make it clear on the position of the nursing professional in this power struggle. The consequence of failing to do so is grave and cannot be avoided by hiding behind the cloak of physician instructions. A salient point in the RCN guidelines is the need for information to be provided and understood by the patient. In a world experience globalization, diversity among the populace is increasing, bringing up the issue of differing languages among patients and nursing professionals. The role of an interpreter becomes important here. However there is a nursing dilemma in the issue for maintaining confidentiality. The best way out of this dilemma for the nursing professional is to try and find a family member conversant in English and use this family member as the interpreter (Lehna, 2005). Another issue is the working around the informant consent procedure, when a patient refuses the required procedure, as is seen in this case. A thirty-three year old African lady is admitted into hospital heavily pregnant. The foetus is in distress and an urgent caesarean section is required to save the baby and prevent any complications for the mother. The patient refuses on the grounds that her religion and culture and do not permit a caesarean section. The medical and nursing professionals wait for the patient to become unconscious and then perform the caesarean section saving the baby (Sokol & Bergson, 2005). The moral argument here in favour of the action would be that in saving the baby, beneficence was provided to both mother and child. The argument against the action lies in that beneficence may have been provided for the baby, but not beneficence to the mother. How is she to make peace in her mind with her faith? Are she and her baby not going to face ostracism from her community and possibly from her husband? Has not her faith in the medical and nursing profession been destroyed? Moral questions for the nursing professionals involved to be worried about. This example brings into focus another aspect of informed consent and that is in the ethic of beneficence in relation to the ethic of patient autonomy. The medical and nursing profession place a lot of emphasis on the ethic of beneficence, as they derive a lot of satisfaction form their profession in their doing good and acting in the best interests of their patients. Yet, this emphasis on beneficence is detrimental to the actual beneficence derived by the patient, as the patients are the beneficiaries and know what is best in their interests. This example illustrates the discomfort to patients and the qualms of the rightness of the action taken for nursing professionals, when beneficence from the perspective of the medical professional is given precedence over that of the patient. (Higgs 1999). The same is the issue with non-maleficence, which is doing no harm. To the medical professional the decisions taken in the management and treatment may represent doing no harm, but to these patients it may represent doing harm, with the nursing professionals caught in between. (Childress, 2001). A sixteen year old girl having renal complications required a kidney transplant. Her father was to be the donor of the kidney. The girl confided in the nursing professional that she would prefer not to have the kidney donated by her father, as he would feel guilty and indebted to him for the rest of her life. She requested the nursing professional to convince the physician against the procedure using the kidney donated by her father. The nurse informed the physician of the girl’s lack of consent, but the physician told her to ignore it in the interests of the girl’s quality of life later on as postponing the procedure would not do her any good. The procedure was successful and the girl left the hospital, but the parting words of the girl about her loss of confidence in the nursing professional still lingers. (Sokol & Bergson, 2005). Nursing professional thus face moral problems as a part of their responsibility to those needing nursing care. Some of these issues may be slight, while others more complex and thus the range of distress caused may slight to severe. So how do nursing professionals cope with these moral issues that arise from the ethic of informed consent? The first step is the development of strategies that prevent the occurrence of moral problems in the care of their patients. Development of the skills to distinguish between moral problems and other sort of problems are the first step, followed by the ability to distinguish between different types of moral problems. Johnstone, 1999, p. 161 points out that “the clue to making this distinction lies in the degree to which the moral dimension of a given problem might be deemed 'weightier' and thus prima facie as 'overriding' of the other dimensions of the problem”. In the changing face of the healthcare system nursing professionals will encounter but “like other health care professionals, have a fundamental and unavoidable moral responsibility to be able to identify and respond effectively to the moral problems they encounter (whether 'simple' or 'complex')” (Johnstone, 1999, p.161). Conclusion: The primary responsibility of the nursing professionals to the people seeking nursing care has brought with the added burden of moral problems as the wade through the maze of nursing ethics of autonomy, beneficence, non-maleficence and justice. Issues relating to informed consent from the ethic of patient autonomy and its interaction with the other ethics give rise to moral problems for the nursing professionals in their workplace. To cope with these moral problems the nursing professionals will have to develop understanding of the moral problems and the skills to handle them. Literary References Childress, J. F. 2001, ‘A principle-based approach’, in A COMPANION TO BIOETHICS, eds. Helga Kuhse & Peter Singer, Blackwell Publishing, Oxford, pp. 61-71. Higgs, R. 1999, ‘On Telling Patients the Truth’, in BIOETHICS: An Anthology, eds. Helga Kuhse & Peter Singer, Blackwell Publishing, Oxford, pp. 507-514. Johnstone, M. 1999, Bio-ethics: A Nursing Perspective, Harcourt Saunders, Sydney. Kuhse, H. & Singer, P. 2001, ‘What is bioethics? A historical introduction’, in A COMPANION TO BIOETHICS, eds. Helga Kuhse & Peter Singer, Blackwell Publishing, Oxford, pp. 3-11. Lehna, C. 2005, ‘Interpreter services in pediatric nursing’, Pediatric Nursing, Vol. 31, No. 4, pp. 292-296. Manning, R. C. 2001, ‘ A care approach’, in A COMPANION TO BIOETHICS, eds. Helga Kuhse & Peter Singer, Blackwell Publishing, Oxford, pp. 98-105. McParland, J., Scott, P. A., Arndt, M., Dassen, T. & Gasuli, M., Lemonidou, C., Valimaki, M., Leino-Kilpi, H. 2000, Autonomy and clinical practice: Issues of patient consent, British Journal of Nursing, vol. 9, no. 10. pp. 660-665. Nursing and Midwifery Council. ‘The Code of Conduct: Professional standards for nurses and midwives’, [Online] Available at: http://www.nmc-uk.org/aDisplayDocument.aspx?DocumentID=3221 (accessed on Oct. 13, 2007). Sokol, D & Bergson, G. 2005, Medical Ethics and Law, trauma Publishing, London. The Royal College of Nursing. 2005, ‘Informed consent in health and social care research: RCN guidance for nurses’, [Online] Available at: http://www2.rcn.org.uk/__data/assets/pdf_file/0003/56703/informedconsentdec05.pdf (accessed on Oct. 13, 2007). Verona, T. 1994, ‘Ethics, morality and nursing’, in NURSING PRACTICE AND HEALTHCARE, Second Edition, eds. Susan M. Hincliff, Susan E. Norman & Jane E. Schober, Edward Arnold, London, 328-343. Read More