Freedom versus control. Does a patient have the right to make choices for one’s self that may result in harm, or should the nurse prevent this choice? For example, a patient wants to stop eating, but the nurse knows the consequences will harm the patient. Does the nurse have the “right” to force the patient to eat?
Analyse and discuss the ethical concerns raised.
Please use UK Nursing and Midwifery Code (NMC), Royal College Nursing (RCN), Nursing Times and WHO when referencing using Harvard referencing. MUST BE UK (BRITISH) context BASED. please use British English.
Most of the nurses in different working areas do face ethical dilemmas when on duty or even outside when met with an emergency. No matter where they function in their various roles in the health institutions, they are faced with some ethical decisions that can affect them and their patients as well (DeLaune and Ladner, page 110). Ethical dilemma does not have either right or wrong answer since it is a problem without any satisfactory resolution. Therefore, due to the unbalanced nature of the ethical problem, the decisions the nurse will make in this kind of a situation will depend on the several principal factors like the principles the nurse learned while in school and more of the personal beliefs, values and the experience gained in the nursing environment. Perhaps, we can begin by checking the scenario where the nurse might have locked herself or himself in making the ethical decision (Benner, Tanner and Chesla, page 45)
In this case, the patients in the hospital who is being looked by one of the nurses want to stop eating. Perhaps, we can say that the patients are having problems with eating and may lack the appetite or he or she feels like vomiting or the patient just want to stop voluntarily. On the other hand, the nurse feels may not be aware of the cases mentioned above and may feel like the patients are just joking just like others in the recent past. In this situation we may have two occurrences; first, the nurse may force the patient to eat and later on being chocked or vomit and then dies. The second is perhaps when the nurse just left the victims to do his or her will and then starves and dies. Therefore, in each case, there is a risk attached, and the nurse has lean on some health ethical principles to make those kinds of decisions hence posting about the freedom and control. We may ask whether the nurses have full control over the patients or the patients have the freedom to do anything they want in the health care.
Food is an essential utility where people get necessary nutrients for strength and growth. Therefore, the patients in this scenario need the food to sustain the medication he or she might have been given. According to the WHO and other international association for the study of food that is appealing to the patients says that all the patients are to be given the right food according to the living standard of the patients and the wants. Therefore, according to various studies, the patients have the right to eat whatever they want and refuse to eat what is not appealing to them and therefore the nurses ought to make sure that the patients get whatever food they want to minimize the occurrence of such scenarios in the health care. According to an institute of medicine reports that the complexity of the health care increasingly needs that all the medical professions effectively in the interdisciplinary teams to ensure that there is efficient and reliable care for the patients through their services (Casey and Wallis, page 37).
The ethical principle
The principle that will assist the nurses in this kind of scenario will be autonomy which involves some personal rights to do something (Gillon, page 184). According to the general definition, Autonomy is the right to all individuals globally to interdependence, individual determination and perhaps goal settings. Moreover, personal autonomy is defined as ‘’ a particular rule that is free from interference control from other people around us and also from any personal limitations that can prevent meaningful choices that the individual might make it life.’’ About health care, we can define Autonomy as the patients’ rights to make his or her own medical or any other decisions regardless of the opinion from the health provider on duty (Singh and Hylton, page 54). However, there is some situation where the patient cannot hold for such rights and hence the parents, guardian, or the siblings may hold the entire interest to make such decisions on their behalf.
The joint commission on the accreditation for healthcare in the United Kingdom (JICACHO) adopted management standards for the patients in the hospital for adequate care on the right food to eat. The standards address the patient’s rights to have the whether he or she has the appetite to eat or what she or he can be comfortable to eat and constant follow-ups. Therefore, according to the commission, the patient’s education on the importance of eating is very vital and essential in the treatment period to enable the patients to have the right attitude towards food. Moreover, it is also important for the nurses to give some multi vitamins drugs to the patients under their care, before giving them any food. This will ensure that they eat to get the energy for the mediation process to take place efficiently (Glass and Cluxton, page 240).
The violation of the principle of Autonomy is the violation of human rights. The WHO code of ethics for nurses requires that nurses operate in compassion, respect, dignity, and worth at all times whether on duty or off –duty when an emergency has occurred, and the attention of the nurse is needed. Therefore, the nurses need to have a true and deep respect for all the patients in the health care holistically to accomplish the needs and the requirements of the principle of autonomy and another principle that exists to guide the ethical decisions (Kozier, page 405).
The possible ethical decision
Therefore, in this scenario, it is essential for the nurses not to force the patients to eat the food but should stand to check and find out what is making the patient not to eat. The findings will, therefore, assist the nurse to decide on whether to deal with the problems if any before making the patients eat. These decisions will make sure that the nurse has preserved the rights of the patients according to the principle of autonomy and also performed his or her duty of making sure that the patients have eaten well (McKenna, Hasson and Keeney, page 452).
It is vivid that the nurses have always been cumbered with the problem of the current ethical decisions that have been so radical to decide. Therefore, it is important for the nurses in this kind of situation to remember some ethical principles that exist alongside the profession and what the human rights say about people. Sometimes, our values and personal commitment might lead us astray since the nurse might come to some culture where the patients are forced to eat even if they don’t want. Therefore, the association for nurses should ensure that the nurses are aware of the principles to guide his or her decisions.
Benner, P.E., Tanner, C.A. and Chesla, C.A., 2009. Expertise in nursing practice: Caring, clinical judgment, and ethics. Springer Publishing Company.Pp 40-56
Casey, A., and Wallis, A., 2011. Effective communication: the principle of nursing practice E. Nursing standard, 25(32), pp.35-37.
DeLaune, S. and Ladner, P., 2010. Fundamentals of nursing. Nelson Education.pp 101-343
Gillon, R., 1994. Medical ethics: four principles plus attention to scope. BMJ: British Medical Journal, 309(6948), p.184.
Glass, E. and Cluxton, D., 2004. Freedom and control: ethical issues in clinical practice. Journal of Hospice & Palliative Nursing, 6(4), pp.232-242.
Kozier, B., 2008. Fundamentals of nursing: concepts, process and practice. Pearson Education.pp 405
McKenna, H.P., Hasson, F. and Keeney, S., 2004. Patient safety and quality of care: the role of the health care assistant. Journal of Nursing Management, 12(6), pp.452-459.
Singh, J.P. and Hylton, T., 2015. Autonomy/Respect for Persons. The Encyclopedia of Clinical Psychology.pp 54