Law and Ethics in Nursing. The aim of this assignment is to reflect back on a critical incident that happened whilst on placement. The incident will include an ethical issue with an elderly lady who has dementia and refused to take her medications whils

Authors Avatar

The aim of this assignment is to reflect back on a critical incident that happened whilst on placement.  The incident will include an ethical issue with an elderly lady who has dementia and refused to take her medications whilst under our care.  The author will discuss how the situation arose and why there was a need to covert her medication and will look at law and ethical issues surrounding covert medication.  Laws on consent and mental capacity which are in place to protect patients will also be looked at.  A model of reflection will be used to reflect back on the incident, looking at each of the stages of Gibbs model of reflection to help breakdown the incident.  Moral theories and principles and how they influence decision making in nursing will be discussed and related to the patient.  For the purpose of this assignment and to comply with the NMC, (the code 2008) on confidentiality my patient will be called Mrs M.

Nurses are required to work within the law and according to the requirements of the NMC the code.  These rules and legal obligations are set out for nurses and midwives who have a legal and professional duty to care for patients when under their care and are accountable for their actions; this is to protect patients so they are not harmed by your acts or omissions (Griffith & Tengnah 2008).  Fremgen (2009) quotes that law is a system of principles and rules of human conduct prescribed by society and enforced by public authority.  Buka (2008) states for a law to be effective it should have sanctions for punishing those who fail to adhere to its stipulations. Laws are developed in response to the needs of society and the survival of the law depends on customary usage.

With the Human Rights Act in force, Patients Association and other informative organisations, patients and families are becoming more aware of their rights and are more open to challenging healthcare decisions such as end of life issues or do not attempt resuscitation orders (DNAR).  Nurses need to understand the law and to make sure they are making the right decisions for their patients.  The NMC the code (2008) states that ‘As a professional, you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions’.  Knowledge of legal principles helps nurses to recognise and understand lawful boundaries and act within the law should a situation arise.  It is also important for nurses to keep up to date with new legislations.  The NMC state that is the duty of the nurse to keep up to date with, and adhere to, relevant legislation, case law, national and local policies (NMC 2008).    Insufficient knowledge of the law is not a valid excuse for breaking the law (Boylan-Kemp, 2009) whilst Dimond (2005) quotes “ignorance of the law is no defense and the nurse should be aware of the limits which the law imposes on her, and also the power it gives her”.  As a result nurses must have the knowledge and understanding of the law to work within its boundaries.

Ethics can be defined as the study of standards of conduct and moral judgment (Fremgen 2009) whereas John's (1995) refers to ethics as knowing what is right and wrong and being committed to act on this basis.  The terms ‘ethical’ and ‘moral’ can be used interchangeably (Chaloner, 2007).  Masters (2009) describes morals as the ‘must and ought to of life’ and for ethics the ‘why and wherefore’s, the moral being all patients must be treated with respect and the ethics why must all patients be treated with respect’.  Individual morals are based on beliefs and determine how a person acts and behaves and being able to determine what is right and wrong.  These morals can be influenced by a person’s upbringing, values, religion, experience and education.  Having knowledge of ethics helps the nurse to develop the skills to resolve ethical problems in practice, as well as enabling the nurse to form their own sound ethical beliefs, that can withstand questioning and be used as reasoning in ethical decision making (Allmark, 2005).

Beauchamp & Childress (2001) developed four principles which is a principle based approached to ethical decision making.  The four principles by Beauchamp and Childress are: justice, autonomy, beneficence and non maleficence.  Ashcroft et al (2007) state ‘the principles are understood as the standards of conduct on which many other moral claims and judgements depend, therefore a principle is forming the basis of moral reasoning’.  The principles are applied to actions or situations in a ‘prima facie’ way; which means that the significant features in the incident and the extent to which each individual principle applies to the incident will determine the most important ethical principle in the situation (Dawson, Garrard, 2006).  

The principle of respect for autonomy involves:

"respectful attitude" as well as "respectful action". That is, it is to be acknowledged that every individual has the right to hold views, make choices and take actions based on personal values and beliefs. Furthermore, the individual's autonomous actions should not be subject to constraints by others so long as no serious harm be inflicted on other persons (TSAI, 2005).  

The moral principle respect for autonomy requires nurses to accept choices resulting from personal values made by patients who have capacity, the ability to make their own decisions (Fry and Johnstone, 2002).

Beneficence looks at an act that will benefit and promote the well being of others, the obligation to do good whereas non maleficence is the principle to do no harm to patients.  Beneficence has to be considered alongside the principle of non-malifience with the purpose to ensure benefit with as little harm as possible.

‘A nurse must adopt the principle of beneficence; helping patients to help themselves and supporting patients unable to help themselves, and also non-maleficence; not deliberately causing harm to patients and reducing risks that may cause harm’ (Fry and Johnstone, 2002).  

Masters (2009) say that ‘conflict can occur when a ‘nurse may decide to act in a way that they believe is in the patients best interest rather than allowing patients to exercise their autonomy’.

Justice is the fourth principle

‘ it demands fair, equitable and appropriate treatment in the light of what is due or owed to persons. Injustice, therefore, means a wrongful act or omission that denies peoples their due benefits or fails to distribute burdens fairly (TSAI 2005)

All individuals must have equal access to healthcare and the nurse must assign resources ethically to match patient need (Fry and Johnstone, 2002).

Deontology and Utilitarianism are both theories which offer a framework to develop a comprehensive understanding of the specific meanings of moral value and moral worth when applied to thinking, values and beliefs and choice of action in practice. (Kenworthy et al, 2002).  Utilitarianism is the theory where an action is morally right if it brings about good consequences, the goodness or badness of the consequence of the action that makes it right or wrong.  Tuckett (1998) states an action is morally ‘right’ if it increases happiness and reduces unhappiness.  However ethical decisions made using the utilitarianism approach to have limited reasoning as they are based on no other factors than the actions predicted consequences (Robertson and Walter, 2007).      

Deontology is when an action is right if it accords with a moral rule or wrong if it violates such a rule, regardless of the end or purpose of the action (Gillon, 1990).  This perspective makes decision-making easier as its requirement is to obey rules and by doing so, one is doing the right thing regardless of its consequences (Naidoo and Wills 2000).

Join now!

As part of continued professional development reflection is a necessary part of the nursing profession, it is a useful tool to make sense of practice and to help integrate theory and practice.  Reid (1993) states ‘Reflection is a process of reviewing an experience of practice in order to describe, analyse, evaluate and so inform learning about practice.  Whilst Boyd and Fayles (1983) states:

Reflection encourages a deeper approach to learning.  Reflective learning is the process of internally examining and exploring an issue of concern, triggered by an experience which creates and clarifies meaning in term of self, and which ...

This is a preview of the whole essay