Case 2 ??? The Drinking Problem Mr. Collins has dysphasia and enjoys a beer with his son each day in his private room on ward B. Roma (RN assigned to care for Mr. Collins) reads a note in the case notes, that Doctor Rich and the speech therapist have ordered thickened fluids for Mr. Collins. That note was written 5 days ago. The current nursing care plan also states ‘thickened fluids’. Mr. Collins tells Roma that he has discussed the matter with the doctor and the speech therapist and is aware of the risks.
He says that his son will be making his usual visit at midday today and they intend to have a beer together. The argument that this piece of writing will present is whether or not Mr. Collins autonomy is intact and should continue to have a beer with his son daily or directions as per the care should be adhered to, which was to be put on strictly thickened fluids only. I will be defending the fact that Mr. Collins should be allowed to continue having a beer with his son strongly. I will also draw on objections to my argument discussing the moral decisions of Roma the RN.
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As Mr Collins states that he is aware of the risks I will be using this as my rebuttal in the argument. I will look at ethical principals related to both sides of the argument and discuss the same. SUPPORTING ARGUMENT Firstly, Mr Collins has been ordered thickened fluids due to his dysphasia, by the Doctor as well as the speech therapist. Mr Collins claims that he has discussed this order with them and will continue to have a beer with his son despite the care plan saying that thickened fluids have been ordered. I believe that Roma should allow Mr Collins to continue having a beer with his son.
Ethics is a broad term used for referring to a variety of ways of understanding and investigating the ‘moral life’ (Crisp and Taylor 2009 p332). More exclusively, ethics involves a gravely reflective activity, fundamentally concerned with a methodical focus of living morally, and is intended to clarify what we ought to do by asking us to think about and reconsider our ordinary actions, judgements and justification (Crisp and Taylor 2009 p332). It is also important to clarify the use of the term morality in discussions on ethics as both terms are used interchangeably.
Morality generally refers to a person’s personal standards of behaviour as well as values and lifestyle (Thompson, Melia et al. 2006 p 13). When we look at ethical issues ourselves, we generally reflect our own life experiences, attitudes and cultures. Our actions and decisions may therefore embody implicit theories of ethics (Kerridge, Lowe et al. 2009 p10). Deontology is known as one of the major schools of moral philosophy and is known as intrinsicalism due to the fact that it embodies the concept that things or actions are right or wrong in and of themselves (Kerridge, Lowe et al. 009 p10). Consequentialist theory is that the rightness and wrongness of an action is based exclusively on the consequences of doing it; the right act is defined as that which leads to the best consequences (Kerridge, Lowe et al. 2009 p11). The tension between different types of ethical theories has contributed hugely on the growth of moral philosophy, such as deontology and consequentialist, yet all theories have significant theoretical and methodological deficiencies (Kerridge, Lowe et al. 2009 p36).
Beauchamp (1982 as cited in Austin 2007 p81) believes that moral philosophers are yet to link their theories to authentic problems. According to Beauchamp and Walters (1982 cited in Thompson, Melia et al. 2006 p179) respect for personal autonomy is a fundamental ethical principle. Autonomy as defined by Kerridge, Lowe and Stewart (2009) is self determination, liberty, rights and ‘free will’. There are many theories and definitions of autonomy but most all generally make reference to individual liberty or independence, and the capacity for intentional or rational action (Kerridge, Lowe et al. 009 p83). It appears that Mr. Collins autonomy remains intact and can therefore have the right to make a decision regarding this. This basically means that Mr. Collins should be free to choose and is entitled to act on his preferences, provided that his decisions and actions do not stand to violate, or impinge on, the significant moral interests of others. In accordance with the respecting autonomy principle, it is wrong for Roma to violate Mr. Collins considered and autonomous choice about continuing to have a beer with his son.
The Code of Ethics for Nurses in Australia (ANMC 2005) supports, in particular Value statement 5, that Roma should be committed to valuing the legal and moral right of Mr. Collins to participate in the decision making concerning his care and treatment, and assist him to determine his care on the basis of informed decision making. Mr. Collins has made it clear that he has discussed this issue with the people concerned and even after this he has still decided that he will continue to have a beer with his son, therefore I believe that Roma should respect this moral decision by Mr.
Collins. The issue of Mr. Collins rights should be of obvious importance to Roma. Patients rights are merely statements about particular moral interests that a person might have in health care contexts and that require special protection when a person assumes the role of a patient (Burkhardt and Nathaniel 2008 p281). Patient’s rights tend to include a mixture of civil rights, legal rights and moral rights. Many of these rights statements derive from the broader moral principles of autonomy, non-maleficence, beneficence and justice. OBJECTIONS
Despite Mr. Collins autonomy being intact and him having the moral right to make a decision regarding his care and treatment, one of the ethical principles that Roma is faced with is beneficence, which is defined as active well-doing, altruism, or conduct aimed at the good and well-being of others (Kerridge, Lowe et al. 2009 p87). By encouraging Mr. Collins to cease the beer drinking daily with his son, Roma is benefiting Mr Collins and Roma will not suffer any morally significant consequences as a result of her actions should something go wrong.
Overall, Beneficence requires Roma to act in ways that benefit Mr. Collins, so by Roma stopping Mr. Collins from drinking the beer she will be doing this. The practical expression of beneficence therefore requires good judgment and genuine concern for the well-being. In other words, beneficence towards individual’s patients such as Mr. Collins, like the other major moral principles, presents an obligation that may be over-ridden by other considerations (Kerridge, Lowe et al. 2009 p87). If Mr. Collins autonomy is over-ridden due to a concern for beneficence, this is known as paternalism. Strong’ paternalism is an approached based upon the belief that it is sometimes ethical and proper for the health care worker to effect beneficent actions even if the patient is competent and disagrees with the decision made. In Roma’s case she may feel that this is necessary after considering the risks related to Mr. Collins drinking the beer. Value statement 1 (ANMC 2005) supports that Roma will actively participate in minimising risks for Mr. Collins and supporting quality practice environments. Therefore Roma will be committed to persuading Mr.
Collins to drink thickened fluids only to minimise the risks associated with drinking unthickened beer. Value statement 6 (ANMC 2005) also supports that Roma will play a key role in the detection and prevention of errors and adverse events in health care settings, and support and participate in systems to identify circumstances where Mr. Collins is at risk of harm. Roma will act to prevent or control such risks through prevention, monitoring, early identification and early management of adverse events (ANMC 2005).
In accordance with this, Roma has identified that there are risks associated with Mr. Collins drinking beer and by stopping him from doing so will prevent further harm to him. Also by putting a stop to drinking the beer Roma will no longer have impaired ability to deliver quality care due to the fact that Mr. Collins is engaging in activities that Roma knows is a risk to his condition. Another point to take into consideration is the fact that Mr. Collins states that he has spoken to the doctor and the speech therapist about the risks involved if he continues to drink beer, unthickened.
This is only Mr. Collins word against Roma’s as there is no documentation to support this. REBUTTAL Now that I have presented reasons for and against my argument the rebuttal that I will put forward is the fact that Mr. Collins has stated that he is aware of the risks related to him drinking the beer and not having thickened fluids, but continues to tell Roma that he intends to still have a been when his son visits that day. Choices of health care practices belong to Mr.
Collins and the codes of ethics (ANMC 2005) universally supports respect for individuals and individual choice, and are not restricted by considerations of social or economical status. Furthermore, Roma must not be affected by Mr. Collins moral decisions and as health care practices is an integral part of Mr. Collins’ backgrounds, customs and beliefs, refusal to participate in drinking thickened fluids, regardless of the outcome, is the prerogative of Mr. Collins, and must not affect the care given by Roma.
Mr Collins should not be labelled in a negative way as a result of making a moral decision which Roma does not agree with. I believe that it is not appropriate for professionals such as Roma who express the belief that all competent patients, such as Mr. Collins, have the right to autonomous choice to make value judgements about the choices made, and subsequently label Mr Collins as noncompliant. In conclusion, I think that the argument put forward in defence of Mr. Collins is that of a strong one and it is quite clear that despite the risks associated with Mr.
Collins behaviour, he is aware of the consequences and has made Roma aware of that. If Roma was to enforce the issue of strictly having thickened fluids despite Mr. Collins refusal it would appear that she was performing unethically. Although clear, ethics is basically a matter of questions; questions that require honesty among others, thought, self-questioning, doubt and consideration. References: Austin, W. (2007). “The Ethics of Everyday Practice : Healthcare Environments as Moral Communities. ” Advances in Nursing Science 30(1): 81-88. Burkhardt, M. and A. Nathaniel, Eds. 2008). Ethics and Issues in Contemporary Nursing. Clifton Park, NY, Delmar Learning. Crisp, J. and C. Taylor, Eds. (2009). Potter ; Perry’s fundamentals of nursing. Chatswood, NSW, Luisa Cecotti. Kerridge, I. , M. Lowe, et al. , Eds. (2009). Ethics and Law for the Health Professional. Riverwood, NSW, The Federation Press. Thompson, I. , K. Melia, et al. , Eds. (2006). Nursing Ethics. Philadelphia, USA, Elsevier Limited. ANMC 2008, Code of Professional Ethics for Nurses in Australia, ANMC, Canberra Available at: http://www. anmc. org. au/professional_standards/index. php.