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Introduction
Healthcare ethics are moral principles grounded on judgements and values meant to guide the professional relationship between healthcare providers and patients. Better discussion of ethical issues of contemporary significance requires the understanding of the terms paternalism and informed consent.
Paternalism is a dominant action whereby a person, institution, or state decides to curtail the decision making autonomy of another party with the reason that it is in the best interest of the party whose autonomy has been curtailed.
Informed consent is the patient’s permission to the healthcare provider to have a particular intervention or process done to the patient. Consent requires that the patient fully understand, retain, and evaluate information pertaining to the intervention or process to which he or she is consenting.
This essay discusses some of the ethical issues of contemporary significance from the point of view of doctors, nurses, patients, and public health officials. The ethical issues under discussion comprise features of a valid legal consent and its relationship to advanced care directive, the importance of respecting patient’s choice, justification of paternalism when it comes to matters of health provision, and the role of healthcare professionals (HCP) in relation to the informed decision making by patients. The legal and professional framework that guides the HCP’s practice in Australia has also been integrated throughout the text.
Valid Legal Consent and Advanced Care Directive
A valid legal consent involves ethical authenticity and requires patients to be informed on the basis of the healthcare professional ethics. Basic characteristics of consent for any intervention in health care include the following aspects. Patients must give it willingly with no coercion, pressure, deception, control, or fraud. They must be advised in simple understandable medical language, which facilitates effective communication, so that they could agree with what they fully understand. It must be specific and should include the interventions or therapies administered with adequate knowledge being given pertinent to the patient’s concerns. There must be adequate time and opportunity given to the patient for full understanding. Furthermore, there must be the ability of self-ruling and comprehension on the part of the patient for them to consent (Kollmorgen, 2015. On the other hand, advance care directives are a written document which allows one to state one’s wishes towards medical interventions to be conducted in case they become incapacitated or unable to make a decision about the type of health care that they need (Kollmorgen, 2015). There are several types of advance care directives, for example, a living will. A living will is a detailed declaration of one’s wishes in the form of a written statement with regard to nutritional, medical, and other interventions in health care to enable healthcare practitioners to fulfill their wishes in the event the patients are unable to make such decisions (Vergil N. Slee, 2001). There exists a confusion regarding the legal advance care directive definition that can be enforced throughout the nation. This is due to the lack of uniformity in the way each state legislates on advance care directives. Common law might accept a legally binding ACD establishment to be transferable from one state to another if it is done procedurally. However, if the professionals in health care do not agree with the advance care directive, they are bestowed with the power to disobey it (Kollmorgen, 2015).
Advance care directive may put a doctor in an ethical dilemma in case when the patient’s family disagrees with the authenticity or understanding of the living will of the patient. The doctor may be forced to choose between the living will of the patient and the wish of family members. The best solution for the doctor is to clarify the issue at hand with family members and learn why the family opposes the living will. It could be that they have another proposal based on the previous discussion with the patient. It could also be a conflict of interests between the family members. It could be a disagreement with the way the physician has interpreted the living will. Such complicated situations require discreet dialogue between the doctor and family members to address all the concerns at hand in order to find an amicable solution. Should the doctor fail to agree with the family on the further treatment, consultations with the Ethics Committee or Ethics Consultation Committee of the hospital should take place. Such a situation should be handled similarly by Australian nurses according to the decision making frameworks enforced by the code of ethics for nurses (Pearlman, 2015).Both the valid consent and advance care directive require that the patients be given sufficient information regarding medical interventions that they are committing to. The use of clear and understandable language by the healthcare workers is emphasized in both the consent and advance care directive. This allows patients to have a comprehension of the issue and available options of treatment that best suit their social background, convictions, qualities, identity, fears, circumstances, and desires. Patients on their part should be truthful and willing to report every detail of their well-being to the physicians for effective advice (Kollmorgen, 2015).
Ethical Importance of Respecting Patient’s Choices
It is a requirement of healthcare providers to respect patient’s choices. Therefore, it is a priority in the modern healthcare system. Research has shown the effectiveness of treatment when patients are allowed to make a choice, understand and control their care. However, the legal right to respect patient’s choices may not apply in certain situations (Steve Pantilat, 2015).
Health choices should be made by patients with the full understanding of their implications and intentions and without undue external influences. Respecting these choices by doctors is a fundamental clinical ethical principle as per the Health Practitioner Regulation National Law in accordance with Australia’s legal and professional framework. Clinicians are supposed to work together with patients as they make their choices. They should do this through creation of enabling environment for the choices to be made. Respecting patient’s choices by physicians also combines respecting a patient’s self-determination right. Healthcare professionals have a role in divulging needed information, educating, calming emotions, counseling, and addressing fears which might hinder the ability of a patient to make informed choices. The respect of patient’s choices should also take into account the doctors’ and nurses’ ethical responsibility of beneficence. Beneficence is the actions aimed at prevention or removal of harm or improving other people’s situation. Balancing between the respect for patient’s choices and the ethics of beneficence poses a dilemma, especially if the patient’s healthcare choice conflicts with that of the duty of the healthcare provider, that is to provide services in the best interest of the patient. For instance, a bypass surgery patient who has decided to continue smoking or a pneumonia patient who has refused antibiotics will require a doctor’s clear evaluation. In these two examples, following the two ethical principles of respect for patient’s choice and beneficence independently would lead to a conflict. A doctor may refuse to respect such a patient’s choice after ascertaining that such a choice was made based on delusional ideas or without thorough information on its implications. But if such a choice has been made without any form of misinformation or pressure, then the doctor has no option but to respect it even while trying to advice the patient on the best solution (Steve Pantilat, 2015). According to the Nursing and Midwifery Board of Australia, the safety of the patient receiving care is the number one priority. In a similar case, if the nurse is unsure of whether or not to respect the patients choice, then the nurse should consult with the nurses supervisor or other colleagues that are trustworthy on the matter (Professional bounderies for nurses and midwives, 2015).
Justification of Paternalism in Health Provision
Health care paternalism is a philosophy stating that particular decisions pertaining to the patient’s health (for example, removal of life support machine or undergoing surgery) is best decided by the health professionals handling the patient. Medical paternalism was previously welcomed by both the patients and healthcare providers as a standard practice with the argument that healthcare providers knew what was best for their patients. However, the current patient’s rights to informed consent before any medical intervention are paramount. Doing otherwise has potential ethical, professional, and legal ramifications. Public health professionals have got some health situations that justify paternalism. For instance, smoking may be discouraged since it is a health hazard, especially for chronic chain smokers who are willing but are unable to quit. Public health policy makers may propose levying heavy taxes on tobacco products to discourage smoking for the benefit of both the smokers and people around them. This is a morally justifiable paternalism (Paternalism in social policy when is it justifiable?, 2015). In a bid to control the spread of a particular infection, quarantining of those already infected may be done for the general safety of the public. Nurses have the responsibility of telling their patients every detail concerning the medical conditions they are seeking to treat so that the patient can be able to have autonomy in deciding on their health options. They can do this by empowering, guiding, and supporting patients through their quest of seeking health. This is a fundamental nursing ethical principle of doing well towards achieving good health (Autonomy vs paternalism in healthcare, 2015). Paternalism is less likely to be done in the case of a patient with an advance care directive, more so if the doctor is aware of the existence of the patient’s ADC and if the convictions plus values of the ADC are clear to all the concerned parties (Kollmorgen, 2015).
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The Role of Healthcare Professionals (HCP) in Informed Decision Making
Healthcare professional have a clear cut mandate of enlightening patients with all the relevant information, both desirable and undesirable, concerning a particular medical intervention before the patient can make an informed decision. This is the principle of maleficence and non-maleficence. Therefore, the principle of autonomy facilitates the informed decision making by the patient. In cases when the patient is not in the position to make their health decisions or the advance care directives are being challenged by their relatives, the doctor has the ethical mandate to act in the best interest of the patient after properly addressing the conflicting parties. The process of designing an ADC should involve the doctor so that the patients know the type of document they are signing. For example, patients who wish to receive no resuscitation, no life support, and no organ donation must be exhaustively taken through all the alternative options available and the implications of each one. If this process is clear and procedural, then in case the conflicts like family refusal of withdrawal of life support arise, the doctor has a clearly documented ADC to follow (Pearlman, 2015).
Legal and Professional Frameworks that Guide Health Profession in Australia
Legal and professional framework in Australia has its mandate based on what the Health Practitioner Regulation National Law has outlined. It is in accordance with the National Law in every state. The nursing and midwifery profession is guided by The National Board which has several roles. First, they monitor the general safety of the patients by putting in place measures that allow only ethical and highly qualified nurses and midwives to practice. Secondly, they set the models for enrolment, the ethics, codes and rules of the health care profession. Thirdly, the National Board monitors the healthcare workers who have been enrolled to if they practice within the models of competency and decision-making frameworks as per the National decision making system (Professional bounderies for nurses and midwives, 2015).
Conclusion
In conclusion, the above discussion clearly shows the need for every healthcare worker and patient to be well-conversant with various ethical healthcare provision issues of nowadays. Patients must know that it is their right to be well-informed by the healthcare workers about every intervention before they consent to them. They should also know that they are at liberty to refuse any form of intervention that they are uncomfortable with without fear of being victimized. The healthcare providers must be conversant with the advance care directive and know that its validity depends a lot on the clarity with which it has been designed by law. The respect of patient’s choices by healthcare professional is protected by the ethical principle of autonomy and the healthcare worker required by law to obey it. However, the patients should be guided through their choices by means of exploration of all available options. It is only after this that an informed choice is made. Therefore, before making a choice, a patient should clearly understand its benefits, its demerits, how it is to be done, and all the available alternatives. Healthcare providers should be aware of the fact that the practice of paternalism from a few decades ago is no longer acceptable. Therefore, they should be careful when exercising the ethical principle of acting in the best interest of the patient through professional consultation with the patient before they perform any medical interventions. For this reason, the role of healthcare professionals in patient decision making is to inform, advise, and clarify medical issues to the patient without coercion as well as give the patients time and room to reflect on that information before deciding on the type of intervention they are willing to submit to.
