Ethics in Health and Social Care

The ethical theories, tools and moral principles utilised to guide and assist in healthcare decision formulation

According to Bringedal et al (2018), from a definitive perspective, the different dimensions of ethics could be understood as differential moral principles which could govern the behaviour of a person. This could further encompass the conduction of the activities of any professional as that of health and social care.

According to Buchbinder et al (2016), the collection of normative theoretical constructs, defined as Consequentialism, could be considered to be indicative of the appropriateness of the outcome of any conduct as the basis on which judgemental perceptions could be formulated. Dennis, Blanchard and Bessenaar (2017) have stated that the consequentialist approach entails the perception that the benefit drawn from the consequence of any decision could justify the moral effectiveness of such a decision. Cowley (2016) has stated that this is intertwined with the significance for the nurses to undertake their actions to facilitate abortion in spite of the probable antagonistic attitude towards abortion which could prevail in the concurrent social environment. This becomes especially significant when unsafe abortion could lead to serious consequences such as unwanted pregnancies having to be carried by women till the completion of the gestation period or having to suffer possibly life threatening health conditions. According to Cameron, Lohr and Ingham (2017) an approximate measure of 13% of the global maternal mortifications, amounting to in between 68000 to 78000 deaths per annum, could be attributed to unsafe pregnancies or complications emerging from late abortion.

Derbyshire (2017) has highlighted the ethical viewpoint of Humanism which emphasises on the value of rationalism and pragmatism against dogmatic thinking. Gerdts et al (2015) have stated that it is essential to understand the value of prioritisation of the wellbeing of the patients in this context, over that of other considerations by the nurses, which could reflect the empirical and rational decision making processes under the purview of the Humanist approach. Hanschmidt et al (2016) have opined that influence of personal commitment based convictions, as health professionals, for the nurses, have compounded their dilemma into an ethical complication from the perspective of the nurses for having to decide the manner in which they could remain committed to the core objective of standardised care provisioning and securing the health of patients under adverse circumstances such as differing social and legal stipulations governing the right of the women to undertake clinical abortion.

According to Unnithan and Dubuc (2018), the ethical obligation of the nurses to care for the patients, often comes into conflict with the value social, moral, religious or perceptual orientations and perception of the working nurses. This becomes especially significant when the nursing staff could be required to decide whether to perform an abortion or to save the life of the pregnant patient. This leads to the ethical problem of enforcing the policy of right to care of the patients with maximum fairness.

Thus, out of the juxtaposing imperatives of ethical theories, promoting the wellbeing and safety of the patients through precluding the harmful situations for them and the preservation of the right of the patients to exercise their own will could be best performed by the Consequentialist ethics.

Influence of laws, professionalism and ethics on healthcare the dilemma

According to Lord et al (2018), the nursing professionals have had to consistently encounter a range of different difficulties of political and professional nature regarding disagreements, on moral grounds, at their workplaces, concerning the issue of performing or desisting from abortion. According to O’Rourke (2016), the registered nurses generally encounter the dilemma of having to balance the accommodation of the legal and societal requirements such as existing customs and laws, the ensuring of the safety of health of the female patients and their personal convictions. Sedgh et al (2016) have stated that the nurses have the ethical obligation of not becoming judgemental about the behaviour of the patient and remain committed professionally towards the care responsibilities. This could bring them into conflict with the predominant social and religious value perception of the society.

Goldbeck-Wood et al (2018) have stated that decision making processes in the health and nursing care, thus, have to contend with these differing moral and ethical perspectives regarding obtaining permission to perform any form of abortion. The fundamental dilemma lies in having to balance the seemingly antagonistic propositions of ensuring the sanctity of life with that of the urgency of preserving the health and security of pregnant women who could be suffering from particular physiological conditions under which abortion could be determined to be the only curative aspect available.

According to World Health Organization (2015) Article 25 of the Universal Declaration of Human Rights stipulated by the United Nations clearly outlines the fact that every person has the right to avail standardised living conditions which could be adequate enough for ensuring health and wellbeing for the respective person as well as for the dependents on such a person. This standardised living condition involves the necessary medical care services as well. Harris et al (2018) have suggested this access to standard medicinal and therapeutic care as the pivotal aspect in the argument of ethical dilemmas concerning the fact of abortion. According to Yang et al (2016), the Common Law is reflective of the nursing ethics and the legal responsibilities which could be termed to be the collective principles for the purpose of guiding the collective behaviour of the registered nursing individuals. These also outline the necessity of establishment of trust based relationships in between the health service users such as the patients and their representatives and the nursing staff. The key responsibilities are the ensuring of Patient Autonomy, Beneficence, Non-maleficence, Justice and Fairness of nursing operations and Safeguarding (of the personal and confidential information of the patients).

According to Giubilini (2016), the moral responsibility of remaining dedicated towards personal religious and social convictions could highlight this dilemma regarding the obligation of the nurses to adhere to the collective principles of health professionals which guide their behaviour at care facilities. However, McCall et al (2016) have outlined the ethical dilemma associated with the termination of pregnancy through both therapeutic and non-therapeutic measures in terms of the ethical theories of Consequentialism and Deontology. Smyth and Lane (2016) have stated that the ethical and philosophical theory of Consequentialism could underpin particularities of this issue. Lugo (2017) has elaborated that this could be perceived to be the theoretical perspective through which the orientation of nursing care could be shaped towards utilisation of the actions through which the overall greatest result could be obtained. Such a result could indicate the core objective of proper care provisioning through ensuring the security of health conditions of women, when pregnancy could be the context of the ailment. The emphasis is on the achievement of the results which could be the most beneficent for the patients. The Abortion Act (1967) as well as the pursuant legal stipulations have established the argument that the surgical processes of abortion, mostly undertaken by the physicians and surgeons, could also be performed by the midwives and nurses during particular and critical circumstances.

Professional and legal responsibilities of nursing

According to Wainwright et al (2016) the registered nurses have to perform the following professional responsibilities:

1: Establishment of rapport with the patients and their representatives so as to identify the requirements of care.

2: Establishment of psychological and emotional support for the patients through empathy and compassion based functions.

3: Sharing information with the patients and their representatives regarding the medications, treatment procedures and the conditions of care as well as care monitoring skills for the purpose of patient independence promotion.

4: Ensuring of care quality through adherence to the standards of therapy, health outcome measurement against the objectives of care regarding particular patients, treatment recommendation and adjustment formulation and compliance to nursing practice act.

5: Utilisation of multidisciplinary strategic approaches to resolve problems of patients.

6: Ensuring of the most optimum hygiene within the working environment of the hospitals through compliance with the regulations and procedures.

7: Implementation of the policies of infection control policies to effectively protect the patients.

8: Documenting the necessary information regarding undertaken care actions and further necessities to maintain the continuity within teams of different carers.

9: Completion of the procedures necessary to perform the preventive maintenance of different medical equipment including the updating of inventories, summoning the technical support department personnel to rectify malfunctioning equipment, evaluation of inducted equipment and associated techniques and adherence to the regulations meant to impose substance control.

10: Supply inventory management through reviewing stock maintenance reports and through determination of the levels of the inventory.

11: Ensuring proper collaboration between different nursing teams through communication of vital and necessary information in a timely manner.

Watt (2016) has listed the analogous duties of the registered nurses with those of specifications established by the NMC Code (2015). These are as the following:

Hanschmidt et al (2016) have outlined the relevant conventions enshrined in the Human Rights act (1998) as the right to life, the right of the patients to be protected from subjugation to the most degrading or inhuman treatments, the right of the patients to have extensive liberty and independence concerning the exercising of their sovereign will, the right to have proper safety and security for themselves and the right of the patients under treatment to have their respect maintained in terms of their privacy. These conventions are the most relevant ones concerning the provisioning of effective health and social care facilities by the registered nurses. These outline the legal responsibilities for the legally registered nurses as well.

Unnithan and Dubuc (2018) have stated that the registered nurses are legally liable by the Common Law to desist from the commission and omission of acts which could jeopardise the established and standardised practices of care. This could be envisaged to be the legal indication to the terminology of medical or nursing malpractice. Cowley (2016) has underlined the factors of malpractice as damages caused to the patients, breaching of the duty of care to the patient which could result in direct or indirect harmful repercussions and the negligence of the duty of establishment of the most secured environment for the patients. Furthermore, Giubilini (2016) has defined the legal obligations of the registered nurses under the Criminal Law of UK to report abuse of patients, life-threatening and non-lethal injuries, the contraction of various contagious and communicable diseases and other unsafe practices which could be the contraventions accepted standards of legal practices. Ultimately, the NMC Code of nursing conduct mandates the nurses to utilise effective inter-disciplinary professional skills for management of therapeutic collaboration.

Accountability of the nursing practitioners pertains to them being legally obliged to meet the legal requirements regarding the care services which they could be providing. The registered nurses are accountable to the civil and criminal courts as well as to their employers to follow the contract of their duties and adhere to the care standards. Furthermore, the registered nursing practitioners and midwives only are professionally accountable to the regulatory institutions regarding meeting the terms and conditions of practices of standardised patient care. The legal framework of UK encompasses care duties from simple ones, such as manual handling and sanitation ensuring of patients to execution of complicated surgeries. Registered nurses have to ensure that their work should not supersede their competence levels and they have to inform or provide referral to the competent personnel when their competency comes to an end regarding resolving the complicated treatment conditions of the patients. This conditionality distinguishes the registered nurses and midwives from the unregistered nurses.

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Reference List

Bringedal, B., Rø, K.I., Magelssen, M., Førde, R. and Aasland, O.G., 2018. Between professional values, social regulations and patient preferences: medical doctors’ perceptions of ethical dilemmas. Journal of medical ethics, 44(4), pp.239-243.

Buchbinder, M., Lassiter, D., Mercier, R., Bryant, A. and Lyerly, A.D., 2016. Reframing conscientious care: providing abortion care when law and conscience collide. Hastings Center Report, 46(2), pp.22-30.

Cameron, S., Lohr, P.A. and Ingham, R., 2017. Abortion terminology: views of women seeking abortion in Britain. J Fam Plann Reprod Health Care, 43(4), pp.265-268.

Cowley, C., 2016. Conscientious objection and healthcare in the UK: why tribunals are not the answer. Journal of medical ethics, 42(2), pp.69-72.

Dennis, A., Blanchard, K. and Bessenaar, T., 2017. Identifying indicators for quality abortion care: a systematic literature review. J Fam Plann Reprod Health Care, 43(1), pp.7-15.

Derbyshire, S.W., 2017. Abortion laws and their relationship to ideas about pain and fetal pain. The Routledge Handbook of Philosophy of Pain, p.425.

Gerdts, C., DePiñeres, T., Hajri, S., Harries, J., Hossain, A., Puri, M., Vohra, D. and Foster, D.G., 2015. Denial of abortion in legal settings. J Fam Plann Reprod Health Care, 41(3), pp.161-163.

Giubilini, A., 2016. Conscientious objection and medical tribunals. Journal of medical ethics, 42(2), pp.78-79.

Goldbeck-Wood, S., Aiken, A., Horwell, D., Heikinheimo, O. and Acharya, G., 2018. Criminalised abortion in UK obstructs reflective choice and best care.

Hanschmidt, F., Linde, K., Hilbert, A., Riedel‐Heller, S.G. and Kersting, A., 2016. Abortion stigma: a systematic review. Perspectives on sexual and reproductive health, 48(4), pp.169-177.

Hanschmidt, F., Linde, K., Hilbert, A., Riedel‐Heller, S.G. and Kersting, A., 2016. Abortion stigma: a systematic review. Perspectives on sexual and reproductive health, 48(4), pp.169-177.

Harris, L.F., Halpern, J., Prata, N., Chavkin, W. and Gerdts, C., 2018. Conscientious objection to abortion provision: Why context matters. Global public health, 13(5), pp.556-566.

Lord, J., Regan, L., Kasliwal, A., Massey, L. and Cameron, S., 2018. Early medical abortion: best practice now lawful in Scotland and Wales but not available to women in England.

Lugo, N.T., 2017. Ethical dilemmas in abortion due to congenital abnormalities.

McCall, S.J., Flett, G., Okpo, E. and Bhattacharya, S., 2016. Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data. J Fam Plann Reprod Health Care, 42(2), pp.133-142.

O’Rourke, C., 2016. Advocating abortion rights in Northern Ireland: Local and global tensions. Social & Legal Studies, 25(6), pp.716-740.

Purcell, C., Cameron, S., Lawton, J., Glasier, A. and Harden, J., 2017. The changing body work of abortion: a qualitative study of the experiences of health professionals. Sociology of health & illness, 39(1), pp.78-94.

Sedgh, G., Filippi, V., Owolabi, O.O., Singh, S.D., Askew, I., Bankole, A., Benson, J., Rossier, C., Pembe, A.B., Adewole, I. and Ganatra, B., 2016. Insights from an expert group meeting on the definition and measurement of unsafe abortion. International Journal of Gynecology & Obstetrics, 134(1), pp.104-106.

Smyth, D. and Lane, P., 2016. Abortion in modern health care: Considering the issues for health‐care professionals. International journal of nursing practice, 22(2), pp.115-120.

Unnithan, M. and Dubuc, S., 2018. Re-visioning evidence: Reflections on the recent controversy around gender selective abortion in the UK. Global public health, 13(6), pp.742-753.

Wainwright, M., Colvin, C.J., Swartz, A. and Leon, N., 2016. Self-management of medical abortion: a qualitative evidence synthesis. Reproductive health matters, 24(47), pp.155-167.

Watt, H., 2016. The ethics of pregnancy, abortion and childbirth: Exploring moral choices in childbearing. Routledge.

World Health Organization, 2015. Health Worker Role in Providing Safe Abortion Care and Post Abortion Contraception. World Health Organization.

Yang, C.F., Che, H.L., Hsieh, H.W. and Wu, S.M., 2016. Concealing emotions: nurses' experiences with induced abortion care. Journal of clinical nursing, 25(9-10), pp.1444-1454.