Balancing the Rights of Patients and Medical Professionals Essay

Running Head: Balancing the Rights of Patients and Medical Professionals In the medical field, law and ethics play a vital role in the relationship between patients and medical professionals. Violation of these laws results in liability of the offender. Ethics considers the best interest of an individual and society.

It establishes and maintains a nature of obligations and duties. Biomedical ethics plays a significant role in guiding medical personnel on how to treat their patients. Medical [G1]professionals offer a critical service to the public and, as a result[G2], it is required of them to maintain certain principles and establish grounds for their own protection. The practice of ghost surgery goes against the ethical principles of the medical profession and, [G3]therefore, carries[G4] ethical and legal consequences. Ghost surgery occurs whenever the contracted medical doctor is not the one who carried out the actual surgery. Patients are usually unaware of the substitution due to being in an unconscious state. Medical institutions use this practice as a method of training medical students. This is done without the patient’s consent. The legal doctrine of informed consent stems from fundamental principles regarding individual autonomy and the fiduciary doctor-patient relationship (Kocher, 2002). It may also be used as protection for medical professionals.  Balancing the Rights of Patients and Medical Professionals Essay.The practice of ghost surgery has raised great concerns to the public, and also in the legal and medical sector as to who is to be held liable for mishaps due to this practice. Key features of biomedical ethics are beneficence, non-maleficence, patient autonomy, justice, and veracity. Beneficence [G5]conveys the idea that healthcare professionals have a duty to act in regard to the benefits of patients. Non-maleficence questions the possible harm to the patient. In making decisions, the benefit to the patient should outweigh the harm. Patient autonomy is also important. Patients have the right to make their own decisions in respect to treatment and to have their confidentiality protected. Biomedical ethics establishes [G6]accepted standards of which medical professionals should uphold. Professional negligence of a medical professional committed whether by oversight or an act may result in unfortunate outcomes such as injury or death of the patient. Such negligence is termed as medical malpractice and is usually due to failure to uphold these standards. Some of the most common and difficult ethical issues to navigate arise when the patient’s autonomous decision conflicts with the physician’s beneficent duty to look out for the patient’s best interests (Pantilat, 2008). Legal cases such as Tunkl V. Regents of University of California and Shorter V. Drury illustrate scenarios in which some ethical issues between patient and medical professionals are contested. They illustrate examples of the conflicts that arise between patients and medical professionals. The case of Tunkl V. Regents of University of California attempted to establish grounds on which it is valid to release a charitable research hospital from being liable for future negligence. Hugo Tunkl was a patient who sued the hospital in an effort to redress the damages of personal injury due to the medical malpractice of two physicians employed by the hospital. Tunkl later died before the end of his case and was therefore substituted by his wife. The hospital had Tunkl sign a release stating that they are not liable for the medical malpractice of its employees. Upon signing this release, Tunkl was under sedation. The defendant stated that they are a charitable organization and was in no position to compensate any damages.  Balancing the Rights of Patients and Medical Professionals Essay.The[G7] court ruled in favor of the Regents. [G8][G9] Another example of a case that challenged the ethics of phisicians and their responsibility to patients is the case between Shorter and Drury. This case was tried in the Supreme Court of Washington in 1985. This case involves a patient, Doreen Shorter who sought the medical attention of a medical practitioner Dr. Robert E. Drury. Doreen Shorter and her husband, Elmer Shorter were Jehovah’s Witness’ who were prohibited by her religion to have blood transfusions. Dr. Drury examined Mrs. Shorter and discovered that she had a missed abortion. There were three possible methods of pursuing the require treatment for Mrs. Shorter. Two of these three methods would put her at a lower degree for the risk of bleeding. Without considering the principles of beneficence, non- maleficence and autonomy, Dr. Drury chose the method that placed Mrs. Shorter at a higher degree of bleeding. Upon experiencing persistent bleeding, Mrs. Shorter was adamant on not having a blood transfusion. Mrs. Shorter refused the recommendation of a blood transfusion and signed a contract that released the medical professionals from liabilities in the case mishaps. Mrs. Shorter died as a result of the medical malpractice, coupled with her religious belief. Her husband sued Dr. Drury for malpractice. The court ruled that Dr. Drury was held liable for his negligence. However, the court acknowledged that the death of Mrs. Shorter was not the sole cause of Dr. Drury. The court stated that seventy-five percent (75%) of the damages were due to the refusal of the deceased to have a blood transfusion. The plaintiff was awarded twenty-five (25%) of the verdict costs. In administering service to their patients, medical professionals should practice certain ethical principles to maintain the integrity of their profession and to assert respect and protection for the rights of their patients. Agreements or informed consent are adopted by healthcare providers as a method of protection. Informed consent doctrine has guided medical decision making by setting boundaries or the doctor-patient relationship…. It protects patients from unwanted medical treatment and the credits the medical professional written. Informed consent in the written format, along with stipulated conditions, is a good method of maintaining a [G10]balance between the rights of the patients and the needs medical community. In signing any medical agreement, as in the case of contractual agreements, certain conditions should render the agreement valid or void. One such condition that should be considered is if the parties involved (especially the patient) are of a stable state of mind. Balancing the Rights of Patients and Medical Professionals Essay. In the case of Tunkl V. the Regents, the patient was in a fragile mental state and therefore, the agreement signed for the Conditions of Admission should not have be considered valid by the medical professionals to proceed with any medical procedure. The Regents should have ensured that the Conditions of Admission was signed when Mr.Tunkl’s mind was more stable rather than when he was influenced sedation.[G11] Such condition would be beneficial to the Regents given that they are in no position to offer redress to patients in the event of mishaps.[G12] The medical agreement in case of Shorter V. Drury may be considered valid as the parties involved were of a stable state of mind. The Shorters were adamant in refusing blood transfusion as treatment due to their religious beliefs. The doctors were not in any position to help save her life and as such, cannot be solely blamed for her death. The partial responsibility of her death is due[G13] to the malpractice of Dr. Drury. In this case, the judgment and ruling of the Supreme Court of Washington are understandable and may be considered fair[G14]. Dr. Drury’s failed to consider the harm of his choice of treatment for her initial condition of missed abortion. He failed to inform her of the other methods of treatment that would lower the severity of bleeding she would experience. As a result of this, Mrs. Shorter could not fully access her autonomy. The bioethical principles of autonomy and beneficence often pose conflicts in the relationship between patients and medical professionals. Examples of these conflicts are demonstrated in the cases of Tunkl V. The Regents of University of California and Shorter V. Drury. Patients, [G15]as well as medical professionals, have a right to protection. [G16]Upholding medical principle and the implementation of agreements enables this protection. Failure to perform medical duties in accordance with these agreements should be evaluated in an effort to release or hold the medical professional(s) liable. Conditions that validate any legal contract; such as parties being of a conscious mind state, should also be used to validate the medical agreement. Balancing the Rights of Patients and Medical Professionals Essay.

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References

Acute vs. Chronic. (n.d.). Retrieved from Diffen.com: https://www.diffen.com/difference/Acute_vs_Chronic Acute vs. chronic conditions. (n.d.). Retrieved from Medicine Plus: https://www.nlm.nih.gov/medlineplus/ency/imagepages/18126.htm Bhopal, R. (2002). Natural History, Spectrum, Iceberg, Poplulation Patterns, and Screening. In Concepts of Epidemiology (p. 138). Oxford University Press. CDC Global Noncommunicable Diseases (NCDs). (2014, September 29). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/globalhealth/ncd/ Communicable Diseases . (n.d.). Retrieved from Global Health.gov: https://www.globalhealth.gov/global-health-topics/communicable-diseases/ Direct Contact and Indirect Disease Transmission. (2011, June). Retrieved from Delaware Health and Social Services: https://dhss.delaware.gov/dhss/dph/files/directindtranspi.pdf Diseases and Conditions – Communicable Diseases. (n.d.). Retrieved from Wisconsin Department of Health Services: https://www.dhs.wisconsin.gov/disease/index.htm Kocher, S. M. (2002, January). Ghost Surgery: The Ethical and Legal Implications of Who Does the Operation. The Journal of Bone & Joint Surgery. Pantilat, S. (2008). Autonomy vs. Beneficence. Retrieved from UCSF.edu: https://missinglink.ucsf.edu/lm/ethics/Content Pages/fast_fact_auton_bene.htm Quarantine and Isolation. (2014, January 15). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/quarantine/ What is Chronic Disease? (2011). Retrieved from The Center for Managing Chronic Disease: https://cmcd.sph.umich.edu/what-is-chronic-disease.html WHO: Noncommunicable diseases. (2014). Retrieved from World Health Organization:  Balancing the Rights of Patients and Medical Professionals Essay.https://www.who.int/mediacentre/factsheets/fs355/en/ 1

The aims of my assignment are to discuss current legislation, ethical theories and principles; patient rights and responsibilities, confidentiality and professional regulation. A case study will be presented pertaining to healthcare professional dilemma, patient rights and confidentiality whether to disclose patient HIV status to his wife. In order to safeguard and protect the right and confidentiality of the healthcare professionals, patient and his family members’ real name are not used (NMC, 2008).

Case Study

Tom, 40 years old, and his wife Jane, 35 years old, both Chinese were married for 10 years. They did not have any child and had been trying to conceive for 6 years. They live with their parent-in-law in Malaysia. The couple, whom are not well educated, are working as hawker in the market. Tom’s family is a very traditional family. And his parent had been blaming Jane for unable to bear them an offspring. Tom, a male chauvinist with a big ego thinks that the problem lies with his wife and refuses to seek fertility treatment. Jane was under a lot of pressure and she had been trying to convince Tom to seek fertility treatment together with her for many years. Finally, Tom agreed. According to Directives for private healthcare institutions providing assisted reproduction services, CAP 248, REG 1 (MOH, 2006) couples whom are undergoing assisted reproduction procedures have to undergo a series of blood test including Human Immunodeficiency Virus (HIV). Consent was signed for agreeing to be screen for HIV, but HIV pre-counseling was not done as it is not a protocol in the clinic.

Tom was diagnosed with HIV, while Jane was found to be negative. Jane was unaware of his HIV status. He was in shock, not knowing what to do when the medical practitioner told him that he was HIV positive. After he came out from the consultation room, he requested Nurse A, who is on duty not to disclose his diagnosis to a third party including his wife, even the medical practitioner did not know about his decision. He even threatened with suicidal intention and denial of treatment. Nurse A was in dilemma as to whether to disclose Tom diagnosis to his wife or not and whether to inform the medical practitioner regarding his decision.

Sim (1997a) defined law as a standard conduct which one must not fall into. While Susan & Katherina (2009) defined it as the formalization of a body of rules of action or conduct that is enforced by binding legal authority. Once law are broken, one will be punished by an authority figure.Balancing the Rights of Patients and Medical Professionals Essay.  Beauchamp & Childress (2001) stated that ethics are moral ethical principles. Ethical principles act as a guide to moral decision making and action. It also acts as formation of moral judgment in a professional practice. Moral and ethic are often drawn together, both words derived from the same root. Moral is often used to describe the standard of behaviour while ethic is referred as the study of moral (Hendrick, 2000). The important of applying ethical principles in health care is increasingly recognised worldwide, as the public is more concern with the morality of medicine and health (Sim, 1997a). Healthcare professionals are often in ethical dilemma due to the given situation and specific culture belief. E.g. euthanasia and abortion

Four ethical principles include respect for autonomy; beneficence; non-maleficence and justice were developed by Beauchamp & Childress (2001). Ethical rules such as honesty, confidentiality and professional behaviour are derived from the four ethical principles (Vevaina et al, 1993). Law and ethics are basically not from the same discipline, they may sometimes conflict each others. Ethical responsibilities are frequently more stringent than legal responsibilities. Respect for autonomy is respecting the decision made by informed and competent patients. It has many prima facie implications as it requires the healthcare professionals to obtain informed consent before carrying out the treatment to help the individual (Gillon, 1995). Beneficence refers to balancing the benefits of treatment against the risks and cost, before the healthcare professionals will put into action the treatments that benefit the patients. While non-maleficence proscribes healthcare professional from doing any action that will result harm to the patient. Justice refer to the moral obligation to distribute benefits, risk and cost in a fairly manner (Beauchamp & Childress, 2001).

According to the principle of respect for autonomy, individuals should have control over their own lives which include control over personal information without unjustified interference from others (Thongkrajai, 2000). Balancing the Rights of Patients and Medical Professionals Essay. Relating to my case study, under the Infectious Disease Act (Cap 137) Section 25, concealing one’s HIV status while maintain sexual intercourse with his spouse can be seen as a deliberate action by the husband as it put his spouse at risk of early death. Johnstone (1999) stated that individual has the right to consent or deny any medical treatment without affecting the rights of others. The state law and the healthcare professionals have an obligation to protect the well-being of the community. The seriousness of the threatened grave injury to another outweighs the harm to the patient by breaching the confidentiality. In order to prevent harm to others, the obligation of confidentiality has to give way (Kipnis, 2006). Therefore, Nurse A has the right to inform the medical practitioner about Tom’s decision and the medical practitioner have the right to disclose Tom’s HIV status to his wife as the medical practitioner believes that Tom will pass HIV infection to his wife and their unborn child. In this case, patient’s respect of autonomy was override and confidentiality was breach as there was no voluntary consent by the patient to disclose his HIV status to third party. It also breach the principles of non- maleficence by disclosing Tom’s HIV status to Jane that may lead to embarrassment, hostility, stigmatization or discrimination. It may jeopardize Tom’s treatment and he may commit suicide. However Bianco & Pagani (2000) argued that privacy and confidentiality are the main human right for people living with HIV. In order to respect these rights, the healthcare professionals are not supposed to disclose Tom HIV status to Jane without Tom consent.

In Jane’s point of view, the principles of beneficence and justice actually benefit her whereby she is informed of Tom’s HIV status, hence reducing her risk of being infected with HIV by Tom. But for Tom, there are no benefits as he threatened with suicidal intention and denial of treatment. Ethically, is this right for Tom? His human right and confidentiality had been evoked! A person infected with HIV is also a human being and has his own individuality. Tom has the right to keep his HIV status a secret however this right is potentially in conflict with the rights of Jane of not being infected and the right of her unborn child. But on the other hand, is it fair for Jane and her unborn child, who is innocent? Jane also has the right to be informed of the risk so that she can protect herself. By not telling her the truth will entail potential harm to her and her unborn child. By knowing the truth, she can use contraceptive measure or seek treatment at the earliest opportunity to reduce the risk of HIV transmission to the unborn child. If the unborn child happens to be HIV positive, who will take the responsibility to support and look after the poor child and the HIV positive mother? The ethical challenge emerges between medical confidentiality and the duty to protect imperiled third party. Both Tom and Jane were patients to the healthcare professionals, therefore the healthcare professionals also have the obligation to look after Tom’s health as well as Jane’s health. Before making any decisions, healthcare professionals should look into the reason why Tom refuses to disclose his diagnosis to his wife. Study done by Warner (2003) shown that more than 1 in 10 people don’t inform their sexual partners about their HIV status. Another exploratory study done by Ssali et al (2010) looks at reason for disclosure and non-disclosure of HIV status; who they disclose to. The semi structured interview shown that only 54% of the participants disclose their HIV status to their spouse, while 46% discloses it either to the other family members, friends or colleagues. The most common reason for disclosure was to gain psychosocial and physical support therefore fulfilling the responsibility to someone they love. The most common reason for non-disclosure was fear of abandonment; stigmatized and the individual maybe concerned about how their spouse will cope the aftermath of disclosure.

Confidentiality means the keeping of promises. It also establishes the trust between the healthcare professional and the patient (Gates and Fink, 2008). Common law of confidentiality states that any information pertaining to the patient is not to be divulged without his/her consent unless there are legitimate reasons supporting it (Sim, 1997b). According to the Code of Ethics and Professional Conducts for Nurses and Midwifery mentioned, to safeguard the confidentiality of all client-related information, disclosure of confidential information only when consent is given by the client, unless there is risk of harm to the patient or other persons, or when there is a legal obligation to disclose the information (SNB, 2006). It is also nurses’ responsibility to maintain the anonymity of clients upon disclosing confidential information to other healthcare professional in circumstances such as emergency or due to legal obligation (SNB, 2006 and NMC, 2008). However confidentiality does not mean hiding relevant information from those who are likely to be harm of that information (Kishore, 2000). In the principle of beneficence, nurses are obligated to protect, prevent harm and maintain the best interest to patients. The challenge of bioethics occur when ethical principles and rules conflict, which made the nurse in the ethical dilemma not knowing who shall she protect.Balancing the Rights of Patients and Medical Professionals Essay. Whether it should be Tom or Jane? Under the code of conduct, Nurse A should inform the medical practitioner who is on duty regarding Tom’s decision within clinic premises. In this case, she did not breach the confidentiality of the patient as the medical practitioner who is on duty on that day already knew about Tom HIV status, but she is not in a position to disclose Tom HIV positive status to Jane. Tom told Nurse A about his decision because he trusted her. She will breach the trust established, confidentiality and the duty of care, if Nurse A did disclose Tom HIV positive status to Jane. The duty of care would be breached. The duty of care by the nurse was established when there was a patient- nurse relationship that creates that duty and she owe the duty of care to prevent any harm to the patient (Pozgar, 2007). Professionalism is important in nursing as it safeguard the interest of the public and serve as a beacon of ethics. In order to maintain the high standard of quality care, nurses are not allow to discuss issues pertaining to patients outside the clinic setting or public area; leaving patient medical files unattended and disclose patient information to third party without patient’s consent are prohibited (Roberta, 2007). Nurses are responsible and accountable for their own judgement and action made in the course of nursing practice, irrespective of the organisation policies.

Paternalism refers to the doctor, who believes that he or she is making the best decision in regard to patient’s care. It occurs when the principal of beneficence and respect of autonomy are in conflict (Gates and Fink, 2008). In the principal of beneficence, paternalism had been argued that the critique of paternalism had swept away the rhetoric of autonomy. Paternalism derives from the relationship of father and child. E.g. Children are not trusted in making important decisions due to not being mature enough and the lack of experience as to knowing what is good and bad for them. Therefore their parent will make the decision for them. Paternalism is commonly used in the past where the healthcare professionals believed that the patients are incompetent of making important decisions. Hence healthcare professionals thought that they are doing good for the patients by deciding which treatment options are the best for them. Not knowing that it diminishes the principle of autonomy as they did not consult the patients’ opinion (Yeo and Moorhouse, 1996).Balancing the Rights of Patients and Medical Professionals Essay.

In the modern society, this is no longer acceptable as individual placed on liberty and individual right. They demand to be more involved in decision making process pertaining to their healthcare. They have more knowledge about human rights, medical and legal issues. Therefore paternalism had become a history in the field of the health care. The recent changes, liberating the NHS, encourages individual to take part in decision making and get involve in their treatment (DOH, 2010). Patient’s right are widely discussed. In modern paternalism, patients’ values and interest are taken into account in determining what is best for the patient (Weiss, 1985).

If the case scenario happened in olden days, the healthcare professional would have disclosed Tom’s HIV status to Jane despite his decision not to. They would think that Tom is incompetent as he was not well educated and believed that by disclosing Tom HIV status was considered being beneficence to both Tom and Jane. But under the code of conduct (NMC, 2008), Nurse A did not have the right to disclose Tom’s HIV status to his wife although it helps prevent Jane from being infected with HIV by Tom. This is where critical thinking and decision making skills are required. Nurse A should reflect on the reason behind Tom’s reluctance to disclose his HIV status. Nurse A should assess Tom’s knowledge of HIV since Tom was newly diagnosis with the disease, he may not know what HIV is and the impact of it may have to his wife, his family and the public in general.

According to Fry and Veatch (2006) nurses have the obligation to protect the rights of an individual with regards to HIV testing, treatment and counseling. At this moment, counseling and educating Tom would be important for him rather that forcing him to disclose his HIV status to his wife. The Code of Ethics and Professional Conducts for Nurses and Midwifery value statement 2(SNB, 2006) states that providing necessary information from appropriate sources required by the patient enables individual to make informed decisions concerning their own care therefore counselling involved the legal implications and the ethical obligations of the healthcare professionals in the event of his reluctance to disclosure his diagnosis. Nurses’ skill and knowledge must be updated in order to give competent and valued quality nursing standard of care. When the needs of the patients are beyond the qualifications and competency, nurses have the responsibility to continue learning and to upgrade themselves (Mahlmeister, 1999). According to Thompson et al (2006), in order to preventing any harm to the patients, nurses is legally accountable for the patients in their care. They have to be competent to perform the task that is assigned to them. Pertaining to my case study, Tom might not know the ethical and legal issues faced by the healthcare professional and his knowledge deficit about HIV as he was not well educated. He might feel betrayed and angry when the healthcare professional breaches the confidentiality. He would probably not received treatment and selfishly and purposely put others into danger or attempt suicide. In the duty of care, nurses should provide counselling for Tom on HIV. Inform him the importance of disclosing his HIV status to his spouse, how is HIV being transmitted and the preventive measures to reduce HIV transmission. Support should be provided upon making the disclosure. Nurse A should also consider about the stigma and discrimination faced by Tom after he had made the disclosure about his HIV status. Both Jane’s and Tom’s family should also be counselled. Letting them know how to cope with the disease and the stigma they are going to faced by the public. What is the duty of care here? It is the obligation of a nurse to perform and maintain the standard of care to a patient (Staunton and Chiarella, 2004). Even thought the respect for autonomy and confidentiality are breached, the duty of care is in place for Tom. After gaining the knowledge of HIV, Tom may disclose his HIV status to his wife and agree to receive treatment without having the suicidal thoughts.

Consent is essential for all treatment and procedure, it must be given freely as it imposes obligation on healthcare professionals to respect individual’s autonomy (Ahronheim et al). An adult decision will be respected if he/she has the mental capacity and makes a voluntary and informed decision to refuse treatment. Under the children act (1989), children who are under 16 years old are consider legally competent if they have sufficient knowledge and maturity to enable them to fully understand what is being proposed. For example Gillick competency, she foresees that she might get pregnant if she did not take the contraceptive pills. The doctor perceived by giving the contraceptive pills was at the patient best interest even without parental consent. Balancing the Rights of Patients and Medical Professionals Essay. Pertaining to my case study, consent were not obtainable as the patient and his wife had gone back to Malaysia for treatment and the healthcare professionals that were involved either resigned or were transferred to other hospitals.

Due to the growing importance in nursing law and ethics, critical, efficient and ethical decision making skills are essential in the current practice of nursing. It does not only require nurses to improve and maintain the standard of nursing care, nurses must also be responsible and accountable for their own action. Therefore having a wide knowledge and well-verse of the code of ethic, policies and law are important. The moral and values of the nurses are equally important in ethical decision making. Nurses are often in ethical dilemma, thinking which principles to fulfil whether it should be the respect for autonomy, beneficence, non-maleficence, justice or all the four principles. While making decision, nurses should weigh the pros and cons of the situation then reflect on it.

To conclude, although the healthcare professionals have the right to disclose Tom’s HIV status under the infectious disease act, it would be good for the healthcare professionals to find out the reason why Tom was reluctant to disclose his HIV status. From my point of view, healthcare professionals should weigh the pro and cons of the situation. Provide counselling sessions for Tom to let him understand the situation, and discussion sessions to help to work out possible solutions that will benefit both Tom and Jane. Rather than forcing him to disclose his HIV status to Jane when he was newly diagnoses. By doing this, confidentiality and the four ethical principles of Beauchamp and Childress will not be breached. Tom would agree to seek treatment after the disclosure of his HIV status to his spouse, without having suicidal intentions.

All civilization has faced health challenges from ancient times to the present. In traditional practice, ethicist usually used casuistry case-based approach as a method of analysis for centuries in Jewish medical ethics. Therapeutic paternalism assumed as usual practice by most health care pros and their patient’s believed that whatever done by health care team will be better for them. Hence, the queries of medical ethics have been argued since the early development of Western medicine. “Ethics is a philosophical approach that covers entire associations of belongings and involved with good and bad, moral duty, obligations and values” (Lindberg, J.B. et al 1994). Potter and Perry, (2010) present that it is a human fundamental right and moral decisions in health care should be practiced by four principles. Beauchamp and Childress addressed the four moral and health care principles. Balancing the Rights of Patients and Medical Professionals Essay.

Scenario: “a nurse is an assigned to a patient who has been diagnosed with an inoperable tumor and is terminally ill. The medical staff and the family insist that she is not to be told about her prognosis. She keeps asking the nurse, “Am I dying”. What should the nurse do in this situation?”

Consideration of the ethical issue using the Four Principles framework

Respect for autonomy: Respect for patient autonomy. It means that the patients have the rights to decide, which track of action good for them. The notion of autonomy is a basis and keystone of nursing practice as a due respect for patient. Autonomy concept is nothing. Miss Y may not be independent and not legally competent to respect for autonomy, but this does not mean that ethically her views should not be considered and respected as far as possible. She has spoken her wish clearly; she wants to know about her condition.

Beneficence: The ethics of beneficence such as ethical behavior is obliged to do well.

The benefits of acting beneficently would need to be weighed against the dis-benefits of failing to respect Miss Y’s autonomy. (From a legal point of view the wishes of a competent patient cannot be override in her best interests).

Non maleficence: the moral obligation to do no harm is familiar within both medical and nursing practice. Here, Miss Y would be harmed by telling about her end stage of disease. Which course of action would result in the greatest harm?

Justice: the principle of justice suggests that ethical behavior is a manner that treats people fairly (“Ethical issues,” 2001).

Moreover in the context of Pakistani system, Pakistan Nursing Council (PNC) offered the professional code of ethics with job description for registered nurses. It gives direction for decision-making regarding ethical matters and serves for self-evaluation and reflection regarding ethical nursing practice. Balancing the Rights of Patients and Medical Professionals Essay.

Compare and contrast between four ethical principles

Nurses are ethically compelled to deliver safe and sound, experienced and moral care to all patients. These main beliefs give us understanding about the nature of obligations associated with these principles. (Proof) Beauchamp and Childress explain that ethics leads us to proceedings, but we still need to judge a condition and express a suitable response. This judgment and response learn from training as much as from moralities (Limentani, 1999).

According to given scenario, as patient is in critical condition with diagnosed case of cancer and in the stage of terminally ill. Nurse might not decide either she should gave the answer or not. In this critical condition, may answer create emotional tragic situation to the patient and may patient ailment become more deteriorate due to emotional disturbance or in this situation therapeutic freedom seems sensible. Moreover, the notion of ethical application in serious condition is the balance between respect for autonomy of the patient and wish to do in a beneficent attitude may results in dissimilarity and tension (Campbell 1994).

This type of moral dilemmas arise due to clashes between moral principles, such as truth telling decisions, autonomy, obligations of beneficence and non-maleficence. These three ethical codes can build conflict with the principle of justice. Mostly two types of issues arise from nursing practice. There is a conflict between obligations to respect of autonomy and obligations of beneficence and non-maleficence. In reality, there are many other types of situations in which this type of conflict occurs, such as feeding, giving medication to a patient against their wishes, and trying to prevent a patient from committing suicide etc.Balancing the Rights of Patients and Medical Professionals Essay.  It is remarkable that conflicts happen in health care institutions across the country on a daily basis. Although most health care professionals are now qualified communication skills, they are not taught the compromise and conciliation needed to deal with severe disagreements.

One drawback of the “Four Principles” approach is that when different persons involved in an ethical decision might differ about the virtual weight to each code. For example in a given scenario, a patient who wants to know about their critical condition and asking you “Am I dying?” This might be arguing that the principle of autonomy should be uppermost, while the other clinical staff may maintain beneficence and non-maleficence on top priority. The health care principles do not portray and point out a hierarchical ordering by them. In this example, if patient need spiritual and religious support and nurse decides to tell them reality in the favor of respect of autonomy, they will lose the role of paternalism. In this way, autonomy will be high weighed and patient may be getting a golden chance to do pray for forgiveness from Allah. If they do not tell the real situation to the patient and keep a paramount of beneficence and mal-eficence then paternalism will be weighed but patient might be so far to pray and some special religious practice. Actually, there will be no justice for the principle of justice. In nursing, justice often focuses on equitable access to care and fair scarce resource distribution. It is the requirement for nurses to focus on the patient’s particular care needs, vision, preferences and to acknowledge the individual’s unique practice (Wilson-Barnett 1994).

Arber and Gallagher (2004) stated that any news which is not warmly accepted is known as a bad news. Any insensitive approach increases the suffering of recipients of bad news, can exerts a long lasting impact on their ability to adapt and adjust, can lead to anger and increased risk of legal action. Furthermore, the situation becomes more complicated because some patients misinterpret messages that they hear. For breach bad news, strong communication are required which should base on both compassionate and kind attitude. Balancing the Rights of Patients and Medical Professionals Essay.

Analysis

Not to telling a truth, is an essential skill for health care provider because many of them find it challenging to communicate bad information, especially when involves a life-threatening situation. Some feel untrained while others fear the news will be distressing and adversely affect the patient, family, or the therapeutic relationship. Some colleagues embark on a very positive approach; giving the patient and relatives artificial expectation and believing that the patient is more ideal in her ignorance. Some of them take a middle pathway and explain all the facts to the relatives while keeping the patient in the dark. Mohandas (1995) stated that, few describe at some degree about their opinion regarding patient’s prognosis, and the severity of disease, expected possibilities of treatment, adverse effects, economic burden and short and long term prognosis. In this regard they upset some patients and families. The persons involved in this situation where my patient with a cancer diagnosed lady and me (as a staff nurse). The ethical principles involved in this situation where my patient’s autonomy and veracity verses non-maleficence. The ethical dilemma confronting to me that if I (as a staff nurse) did not deliver the news then might I was not following the ethical principle of veracity and patient’s autonomy. However, if I disclose the news to the patient then I would be violating the principle of non-maleficence. Veracity (telling the truth), although distressing in the short term, but will result in more benefit than harm in the long term (Sokol, 2006). Keeping the principle of non-maleficence in my mind if I delivered the information to the patient intentionally then it would be resulted the intrinsic effect of harming the patient that violates the negative duty not to harm.

Arguments and counterarguments

The literature support that it is ethically right to tell the truth to the patient. Sokol (2006) described that not telling the truth may breach the trust of patient-nurse relationship and leads to loss of trust. Veracity, although upsetting in the short term, but will result more good than harm in the long run. The patients should have full disclosure of awful news should tell the truth if this is their wish according to the scenario. Disclosing the information prevent further argument and loss of trust if the patient later discover the truth. The Islamic point of view regarding veracity is very clear as, it was narrated that “Abd-Allaah ibn Mas’ood said: The messenger of Allah (PBUH) said: “Truthfulness is righteousness, and righteousness leads to Paradise. Balancing the Rights of Patients and Medical Professionals Essay. Lying is evildoing, and evildoing leads to Hell”. If patient is in acute condition and revealing the reality may affect adverse consequences, it would cause an excessive psychosocial or spiritual burden on patient. In this critical situation then not telling the truth is favorable for the well-being of patient (Tse et al., 2003). The therapeutic privilege provides opportunity to the physician in few conditions when expose the truth is forbidden as it resulted in actual and expectable damage in patient’s health status. It is also a fact that doctors do not have a duty to disclose the whole facts about a patient’s medical condition in respect of beneficence and maleficence.

Advantages of truth telling: Disclosure is essential to future informed consent. The patient who are not communicated about their prognosis, and kept unaware may be at risk of future misdiagnosis. Veracity promotes trust between patient and health care providers. Truthful disclosure may minimize the probability of legal liability.

Disadvantages of truth telling: Patient may misinterpret the information. The other possible harm may be patient lose the hope. Patient health is the most important issue for the health care provider, which can be affected by truth telling, and patient may go to shock. Patient may develop stress and anxiety.

Implementation

Veracity (telling the truth) to the patient needs extraordinary focus, because now a day’s patients are, comparatively to earlier, more vulnerable to face serious harms if they are not completely acknowledged regarding their health status. Not only patient’s self-government destabilized, as well as patients who are not informed the actual truth about an intervention, practice a loss of truth which is mandatory for remedial process. Honesty counts to patients because they are not well exposed to the disease, and disturbed with lots of questions in their mind which require veracity. A bad news is always a bad news. But the manner in which it is conveyed can have a profound effect on both the patient and the health care provider. Breaking bad news suggested an approach which supports the health care providers to tell the truth in the critical circumstances.

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Buckman (2005) suggested the S-P-I-K-E-S protocol a strategy to disclose the bad news and tell the truth by minimizing the hazardous effects of bad news. In this respect, the most important factor is setting. Balancing the Rights of Patients and Medical Professionals Essay. It includes isolation, involvement of the significant family member and kind and calm behavior. Before breaking the news, an accurate patient’s perception is necessary. It facilitates the health care providers a clue, that how patient view the meaning of the situation and calculate the facts and figure of the medical situation. What did you think something is going on with you? Such type of open ended question is helpful to understand patient’s perception. Invite the patient through indirect permission, and respect the patient’s right to know and ask for example that, how much extent you required information regarding your treatment and diagnosis? Before delivering information, provide the patient a few moments that she prepared psychologically. The last intervention is empathetic response. Empathetic approach can stabilize the patient’s emotions through acknowledge that you are feeling their emotions.

Conclusion

Keele (2008) described that according to Kant, veracity is a very important to learn that is categorical in nature, one should do their duty even it cause harm to others. Veracity is the medical principle which matter for the health of the patient. But in spite of all these facts according to health care system and the medical profession in our context, trust is the basic element to develop therapeutic relationship with patient. The image of health care providers would be destroying if they would not represent the real situation in front of patient. Truthful exposure of relevant information is a legal and ethical duty of medical professionals to be explored in front of patient. In this way, there is no final conclusion and nurse should do accordingly by their experience, honesty, wisdom and use the futility and theory of utilitarianism. Balancing the Rights of Patients and Medical Professionals Essay.