Introduction
I have selected ethical trigger 2and here I am going to evaluate this scenario using the ethical principle as outline in the Seedhouse ethical grid.
Ethical Principles
In this situation where as the lady has an early dementia reusing the x ray to be taken despite the son agrees on it. From this situation it does not clearly stated that whether the lady does not have the capabilities to consent. In this essay I will discuss and treat the patient does have the ability to consent. Ethical theory is defined as ‘the study of the nature and justification of general ethical principles that can be applied to moral problems, and attempts to provide a more rigorous systematic approach to how decisions are made’ (Keatings and Smith, 2000, p.13). There are 4 Ethical principles that could relate to this study which are Deontology, Consequential, Virtue Ethics and Principleism. (Buka, P , 2008).
Deontology
Deontology, or known as Kantian ethics(Dimmock,2017), where in this case we have to be transparent on what are the good and bad, right or wrong that is determined by the action (Ginger,2012) and the patient has to know the important of having the xray done despite of the patient refusing. It is the best to discuss with the patient thoroughly. The weakness of this theory is the fact that some time an individual duties are in conflict which in this case is the son’s decision which the patient find it unacceptable. If the cray is taken as based on the son’s request for it to be done, it will then benefit the patient yet it does not comply to what she has consented. The scenario of conflicting obligation does not lead to a clear ethically correct resolutions.(Buka,P,2008). And referring to the Seedhouse ethical grid, it is important to let the patient and the carer know the risk of both having the xray done and what would possibly happen if the patient did not get the xray done.
Consequential
Ethical theories is the goal focus on teleological theories.Teleological theory or also known as utilitarianism or consequentialist theory is about judging whether the consequences of actions are good or bad. (Freeman, 2000). Based on John Stuart Mill (1806-73) if the actions lead best outcome for numbers of people, they are considered as a good action and it has been particularly influencial in areas of the world influenced by the culture. Utilitarianism has three essential elements from it, which are whether an action is right or wrong determined solely from its consequences, the value of the consequences of an action is assessed in terms of the amount of well-being caused, and in seeing the total caused to a number of people equal, equal of happiness are to have equal value, no one’s benefit is having gretater value than another. (Soas.ac.uk, n.d.) From this scenario, it can be seen that despite we follow the patient’s order as the best interest , our action may failed to benefit the patient and on fact caused harm and a great deal of suffering and may affecting the family ie. Son’s emotion. There are cons for the application as it is impractical for real life use where very serious choice has to be done and in unusual situation, individuals may well think thorough about the consequences of particular moral choices in this way. As the consequential forces the radiographer to predict the consequences, it is a great deal of subjectivity for the radiographer who measures the outcome that would result from certain action.
Virtue Ethics
Virtue ethics comes in four forms, eudaemonist virtue ethics, agent-based and exemplarist, taget-centered virtue ethics and platonistic virtue ethics.(Hurtshouse, 2018) Virtue ethics is about the virtue that make for the good life. (Thompson,2003). Virtue are nature custom that lets individuals to act accordingly to their highest potential. At such is less about outcome but rather how we approach our role in those outcome.(Jonasson,2013). In summary, this approach would depending on the radiographer’s work ethics and its logical thinking. The radiographer may proceed with the xray if she thinks what’s her best interest is the best for the patient’s benefit though it against the patients’ consent that refusing the procedure to be done.
The constraint that come with this ethics as where an agent is permitted to breach the constraint where the detrimental effects of sticking to it would be too severe,(Copp,2017) in this case the radiographer think that the outcome would not be good for the patient if she did not perform the xray for the patient. These constrain may function in a holistic way where they mat not always have positive valence in the assessment of actions as right and it allowa individuals to share the aim of promoting justice, but must on sure that the patient is just herself in this case. (McNaughton, 1995).
Principleism
The four principles approaches are, autonomy, beneficent, non-maleficent and justice that offers a common , moral analytical framework and a guiding actions. (Duncan,2010). In this situation where her autonomy is when the patient refuses the x-ray to be taken and needs to find solution to make the patient agree with doing the x-ray which is for the patient’s own best interest (beneficent). Although the x-ray would benefit for her, forcing the patient would be harmful for the patient’s emotion and needs (non-maleficient). The radiographer need to consider the impact on the patient’s choice might have an impact on her son’s financially and probably need extra care from the healthcare workers ie.nurses for her extra care and which will affect other people who would need the care from the nurses as well. In this case, the radiographer had to consider all principles of healthcare ethics for both patient and society (Justice).
And since the patient refuses the xray, it has come to our role as the professional to explain in detailed what xray might benefit vs harm her in order for her to truly understand the reasoning of why the radiograph need to be taken. From there we could meet the mutual understanding and hence she will get the idea of why the son agrees on such procedure where it falls under the code of professional conduct 1.1 (SOR.org) that we must provide the best care and based on best evidence where the patient’s safety is paramount, the measures to control infection are taken, and both radiation and general health safety. And with this, if we get what the patient really concern is that she refuses the xray to be taken, we could find a way to work this out to reach mutual understanding.
Professional Codes
Consent, there are three types of consent, implied consent(non verbal), verbal consent and written consent. Based on the standards of conduct by healthcare professionals council( HCPC), under the code of 1.4, we have to make sure we get the consent before we proceed the care treatment or any other services. Stated that we have to assure the person has the capacity to decide unless provoked otherwise despite of having early dementia. Where in this case it is appropriate to allowed the patient to be given time to decide themselves since she has refused the treatment at first try.
Under the code 2.3 (HCPC) that we must give them the information that they can understand as this will help in providing mutual understanding and get the reasoning on what benefit the patient could get from getting the x-ray done. The son’s favor can be done only if the son is registered as an attorney where under the Adults With Incapacity (Scotland) Act 2000, a proxy can make decisions on their behalf. In this situation where the radiographer can refer the matter to some other resources available ie.
Senior or Head Of Departmen if the matter is beyond limitations as advice in code 2.2 (Code of Professional conduct) that we must practice within the limits of our competence and refer to another qualified practitioner ie.senior to handle the case. In my own departmental, we would refer this matter back to the clinic that requested the x ray needed to be done to discuss the matter with the patient and the carer.( Departmental Scope of Practice, act 9.0, 2016) . in hospital standard of practice code 3.0, 2016 stated that the professionals have to talk, explain, write, to the patient in a way that doesn’t hide any hidden meanings and all transparency, in a polite way. This is the communication key part where politeness takes in despite of having to tell what might sound unease to the patient.
Ethical Grid
The use of the ethical grid is to check how the situation looks like. If the grid is well used and the issue have been thoroughly clarified, clear hypothesis have been tested, factors of philosophical, evidential and moral been put into account, the affairs have been open, it will have been documented in any type of ways, when one or more boxes been selected and decisions with reasoning been made. (Seedhouse, 2008)
Linking these to Seedhouse ethical grid, we could use the resources availability ie.senior, requested physician, head of department to help us in this matter as they are more exposed and more experienced in this matter. This would help us to laid out all the steps and precautions that we needed to take. The risk are well informed to the patient as mentioned under the code of 2.3 (HCPC). The risk of not having the x ray done would not benefit and might cause more harm as the next step of action is not attainable due to not having the x ray done.
Where under mental incapacity act, the law is serve as the individuals being supported to make their own decisions and is not treated as lacking of capacity and anything done for or on behalf of a person if only the carer has the power of attorney and that if only the patient herself is truly incapable to decide for herself. (GOV.UK, n.d.) The consequences that would benefit in this if we abide to what the carer’s say and consented is that the patient would get the xray done thus the patient could get all of her the treatment planed out and probably a surgery if needed and may recover in a short term but then again, this is against the law if the carer is not the attorney and as by consequences to the society, it does not gives any benefit because if she refuses the xray to be done, then she cant get any of her possible treatment or surgery done and she might have to live in pain.
With that she need additional support and live independently on how she did previously. She needs further assistance and more support. The social services might have to call and aid a helper to feed her and help her in her daily living and it might cost her financially. (NHS.UK, 2018) In this situation where wishes of others which are the family members cannot be abide as it will be against the law of consent that has been given to the patient as the son is not the attorney of the patient. In this case, the wishes of others that’s in ethical grid cannot be applied despite it will give good to the patient and hence gives good to the society but it is against the will. In the seedhouse ethical grid, there are four types of non maleficence which are keep promises, do most positive good, tell the truth and minimizing harm.
As a practitioner, it is our job to tell the truth on what might come and happened to the patient if she refusing to get the xray done as stated in (HCPC) code 9, that we have to tell the truth. This grid deos not provide solutions, but gives us decision making layout that could help us into making the right, lawful, choices. This will help us to act all professionally instead of making all emotional based decision. (Kattan,2009) Not all ethics are applicable in a situation where the irrelivent from a point from the ethical grid is because it does not give us any or give us less benefit into contributing moral reasoning to help us into the right decision making.(Stuthbury,2009).
Standard of Practice
And in Malaysia, there is no code of conduct for radiography yet to established so hospitals are solely using each own departmental standard of practice. And in my departmental codes of practice or known as the standard of practice stated that the truth has to be told to the patient about the procedure, the side effects, and the benefit outcome.(departmental SOP, act 5.0, 2016) and this is when communication really takes part. And as by the departmental SOP code of 11.0, 2017 stated that patient with special needs include those who are critically ill and those who needs isolation, physically and mentally incapable would require an attorney to make decision on their behalf. In this scenario, this code cannot be apply as it it not celarly stated whether the son is officially has the power of attorney and it clearly did not stated that the patient is mentally incapable of making the decision for herself.
And as for consent, in SOP code 4.0 2016 stated that it is our duty to get the patient to consent before doing or starting any procedure, and only perform the duty once consent are gained. From this case, the radiographer should not proceed the procedure or xray to be taken as the patient has refuse the consent for the particular procedure to be done and should not abide to the son’s decision of wanting to get the xray to be done.
Conclusion
In summary for this situation, it is important to put the basic 4 ethical principles into the account of decision making. When we get to questions all of the factor from the ethical grid and implies the law that has been amended into the government or specific body that relate to the departmental, from there we can see our ethical point of view whether our judgement and our action will go by it or against it. When the code of practice is not applicable due to the unavailable resources from the government, it is important we refer the matter back to our standard of practice from the services that we provide to help us justify our reasoning in our department. (The importance of professional standards, 2014).
In this matter where the son is not the attorney, he is not able to decide for the patient herself and since it is unclear that the patient is not mentally incapable to make owns decision, she deserved to be treated like she has the capability to think and make her own’s decision.(Alzheimers.org.uk), we are ought to abide her refusal to give consent for the procedure. In this case, the power to consent and the power of attorney are the main things that needed to be focused on.
