All patients that hold capacity have an autonomous right (Beauchamp & Childress, 2001). (Beauchamp & Childress, 2001) explain “ To respect autonomous agents is to respect their right to hold views, to make choices and to take actions based on their personal values and beliefs”. In the scenario the ODP should act on the choice Sophie has given and not try and persuade her in any way. It does not matter what personal beliefs the ODP holds every patient has the right to exercise his or her autonomy in consenting or indeed refusing surgery (Beauchamp & Childress, 2001).
Only adults aged 18 or older have the right to refuse treatment (McHale, 2002). Young adults aged 16-17 have the right to consent but not refuse treatment (Carey, 2009). McHale (2002:104) Quotes “An action in battery may be brought if treatment is given in the face of an explicit refusal of consent”.
In Britain the law states adolescents can consent to treatment but cannot refuse (Carey, 2009). This is well known as the Gillick/Frasier competence. It has strict guidelines to assess whether or not a child is deemed mature enough to make up their own mind (NSPCC, 2009). All patients wishing or needing invasive surgery have a concept of choice (Balance & Duxbury, 2000).
The Operating Department Practitioners (ODP) role is to act as an advocate for Sophie (Ballance & Duxbury, 2000). Guido (2009:18) Quotes “Advocates are those who defend and speak for such a cause or issue”. The ODP has to ensure the rest of the team including her mother respects her wishes. There are three main types of advocacy recognised in a clinical practice setting the first one being the most popular (Guido, 2009). The rights protection model, practitioners advocate for the legal and ethical rights of the patient (Guido, 2009). Second is autonomy model which practitioners will assist patients in asserting their autonomy rights (Guido, 2009). Finally values-based decision model, this approach requires practitioners to assist the patient by discussing his/her needs and desires also helping the patient make important decisions that are consistent with that particular patients values and lifestyle (Guido, 2009). Whilst the surgeon and anaesthetist where outside with Sophie’s mother, Sophie took the chance to tell the ODP that she did not want the surgery and wanted to be left alone to die. ODP’s are not employed to make decisions for patient’s so therefore must put aside their own beliefs and act upon the patient’s requests (Guido, 2009). It is now the ODP’s job to act as an advocate for the patient and tell the surgeon and anaesthetist Sophie’s wishes (Griffith & Tengnah, 2008). This must be done in a professional manner making sure the patient is not coerced in any way by her mother or any other person present (CODP, 2007). (Carey, 2009) suggests the right to consent and the right to refuse are two separate issues in English law. After the Gillick/Frazier competence became apparent children’s rights in England and Wales seemed to start diminishing (Carey, 2009).
Another point I will analyse is the word beneficence and what it means. Beneficence means in the medical context ‘taking actions in the best interest of patients’ (Cribb, 2002). The doctors in this scenario are trying to act in a way to help Sophie without coercing her. There is a very fine line between beneficence and coercion in a health care setting and healthcare professionals of all levels have to know their own limits (Cribb, 2002). Sending the patient back to the ward to think about her decision by not forcing the decision on her was the correct way to deal with Sophie. Non-maleficence means firstly do no harm before doing good to your patient (Cribb, 2002). This relates to enthusiastic practitioners who are too hasty to using treatments they believe will do good before evaluating if they can cause any harm to the patient (Cribb, 2002).
The healthcare professionals also have to take into consideration if Sophie has had and any pre operative medication (Diamond, 2008). If she has this will cloud her judgement and may make her act more theatrically than usual (Carey, 2009). Cohersion is another important point to look at, to be coerced means to be pressurised into something your not happy with (Cribb, 2002). In the scenario you get the impression Sophie’s mother has been putting a lot of pressure on Sophie to have all these operations, not because she wants her to suffer but because she wants the best for Sophie.
Confidentiality and communication are important skills that all ODP’s must hold (Health Professions Council, 2008). This is highlighted in the scenario when the surgeon Mr Jones asks to speak to the anaesthetist and Sophie’s mother outside. (Hendrick, 1997) Suggests if a child below the age of 16 is Gillick/Frasier competent they should be treated as an adult therefore a duty of confidence is owed to them. It can be assumed that Sophie has agreed to this before hand but if she hasn’t the healthcare professionals have failed Sophie in treating her as an individual adult.
Although Mr Jones and Dr Thomas are letting Sophie exercise her autonomous right this may now lead to a parents intervention as she is refusing treatment (Department of Health, 2001). Being Gillick/Fraser competent does not give under 18’s the automatic right to refuse treatment, this now gives parents and healthcare professionals the right to decide what is in the best interest for Sophie (Department of Health, 2001). If after this nothing was decided Mr Jones the surgeon could resort to the courts system (Department of Health, 2001). This would be the last resort for any surgeon as it can cause stress to the patient (Hendrick, 1997). Mr Jones would have to apply to the courts to overrule Sophie’s decision to refuse treatment and therefore have a valid consent to treat Sophie (Department of Health, 2001). This is a very complex issue in modern ethical issues today. This is because a multi disciplinary team has to get together and weigh up the benefits to Sophie’s health by the same time treating the patient with the respect they deserve (GMC, 2010).
ODP’s must have a rigorous knowledge of UK legislation to avoid any legal implications being brought against them (Health professions council, 2008). In the national health service (NHS) today all staff must be accountable for their individual actions (Royal college of nursing, 2004).
Relevant and up to date documentation is essential in circumstances like this because of the complaints procedure and also the relevance of Sophie’s care plan. The theatre manager will now require statements off all the healthcare professionals involved with Sophie’s case. This is extremely important to gather clear, accurate and precise evidence to avoid any legal action being brought against the trust (Royal college of nursing, 2004). Health Professions Council (2008:13) State “Making and keeping records is an essential part of care and you must keep records for everyone you treat”. When Sophie gets sent back to the ward her mother is extremely angry and submits a formal complaint to the theatre manager. Without the correct documentation the ODP may be held accountable for not being able to produce evidence of what exactly happened in the anaesthetic room (Balance & Duxbury, 2000).
ODP’s have the responsibility of duty of care to all patients. This is now well known as the bolam test (Balance and Duxbury, 2000). The duty of care requires all healthcare workers regardless of experience or rank to provide the same high level of care to all patients (Balance & Duxbury, 2000). Medical and non-medical staff are asked to seek advice or help if they are required to undertake a task beyond their scope of practice (Balance & Duxbury, 2000).
To conclude the scenario had quite a number of legal and ethical issues buried inside. It painted a vast picture of the problems incurred by staff in most NHS trusts across the UK. I also realised that a patient’s choice does not just effect themselves it effects healthcare professionals caring for that patient and indeed the patient’s own family members. When I started this assignment I had no idea of the concept of autonomy for patients or how the governing bodies that register all healthcare professionals’ police legal and ethical issues. I realise out of all the legal and ethical principles brought up in the scenario the most important aspect is always the patient. The patient must be at the forefront of any decisions made about their own care. In Sophie’s case the doctors acted beneficently towards Sophie to ensure her autonomous right remained with her. Also acting in a way to do Sophie no harm and act in her best interest as a young depressed minor. The assignment has given me a big insight to problems I may come across in the future as a registered ODP. Assessing the needs of all my patients on an individual basis, giving them autonomy but also staying between the law and ethical boundaries of acceptable practice.
Bibliography
Balance, J. & Duxbury, P. (2000) ‘The operating department practitioner, the patient and the law’ in: Davey, A. & Ince, CS. (eds.) Fundamentals of operating department practice. New York: Cambridge university press. Pp 9-20.
Beauchamp, T.L & Childress, J.F. (2001) ‘Respect for autonomy’ Principles of biomedical ethics. Oxford: Oxford university press. [Accessed 12 July 2010].
Carey, B. (2009) ‘Consent and refusal for adolescents: the law’ British journal of nursing. 18 (22) Pp 1366-1368.
College of operating department practitioners (CODP). (2007) ‘Legal and ethical complications’ Education. [Accessed 20 June 2010].
Cribb, A. (2002) ‘The ethical dimension: Nursing practice, nursing philosophy and nursing ethics’ in: Tingle, J. & Cribb, A. (eds.) 2nd ed. Oxford: Blackwell science Ltd. Pp 19-29.
Department of health. (2001) ‘Consent: A guide for children and young people’ Publications. [Accessed 03 July 2010].
Diamond, B. (2008) ‘Consent to treatment and informing the patient’ Legal aspects of nursing. London: Pearson. [Accessed 10 July 2010].
General Medical Council. (GMC) (2010)’Guidance on good practice’ 0-18 years guidance: If a young person refuses treatment. www.gmc-uk.org [Accessed 8 July 2010].
Griffith, R. & Tengnah, C. (2008) ‘Consent to examination and treatment’ Law and professional issues in nursing. London: Learning matters Ltd. [Accessed 11 July 2010].
Guido, GW. (2010) Legal and ethical issues in nursing. London: Pearson education.
Health Professionals Council. (2000) Standards of proficiency: Operating department practitioners. CMSPUBODPSOP. London: Health professions council.
[Accessed 25 June 2010].
Hendrick, J. (1997) Legal aspects of child health care. London: Chapman & Hall.
McHale, J. (2002) ‘Consent and the capable adult patient’ in: Tingle, J. & Cribb, A. (eds.) Nursing law and ethics. 2nd ed. Oxford: Blackwell science Ltd. Pp 100-118.
National society for prevention of cruelty to children (Nspcc). (2009) ‘What is gillick competency? What are fraser guidelines?’ [Accessed 20 June 2010].
Royal college of nursing. (2004) ‘Interpreting accountability’ Data-assets. [Accessed 03 July 2010].
Tschudin, T. (2003) ‘Making ethical decisions’ Ethics in nursing: the caring relationship. London: Butterworth-Heinemann. [Accessed 11 July 2010].
Wicker, P. & O'Neil, J. (2006). Caring for the Perioperative Patient. Oxford: Blackwell Publishing.
Michael Parry Dip 15 20604696
