Carol, a 56 year old lady, was going through the menopause and was admitted to the gynaecology ward in hospital in the north west of England with symptoms of extreme lower abdominal pain and problems with urination. Following investigations she was diagnosed with a uterine prolapse which was causing involuntary urine loss and retention, and constipation. A clear explanation of the condition was given by the consultant who recommended that she undergo a hysterectomy to which she agreed because she was in severe pain. While reading the informed consent papers before theatre, Carol made an explicit request that she should not be transfused with blood or blood products even in the case of extensive blood loss following surgery. Her reasons for this were that she belonged to a group of Jehovah’s witnesses, and it was simply against her beliefs.
Ethics can be defined as the philosophical study of the moral value of human conduct and of the rules and principles that should govern it. It is the code of behaviour considered correct especially that of a particular group, individual or profession (Orme-Smith & Spicer, 2001).
The ethics theories of utilitarianism and deontology are most prominent in health care. Utilitarianism, which can be defined as ‘doing the morally correct event in the act of good’ (Winifred Tadd, 1988,) focuses on the consequences of actions, choosing those that do least harm. Linking this in with Carol’s case, if her hysterectomy was to go wrong and result in significant plasma volume loss, a decision would have to be made in her best interests. If she were to be transfused her life could be saved but her future happiness as a practicing Jehovah’s Witness would be adversely affected. However, legally and ethically, Carol is assumed to be able to make decisions regarding her own body which should be respected. The NMC (2008) states if this was to result in a deterioration of health, or even death, in terms of ethics, it is simply not permitted to go against a patient wishes, whatever the cost.
As health care professionals, we have a duty of care which we must pursue at all times. Deontology, another ethics theory, focuses on the rightness or wrongness of intentions or motives behind action such as respect for rights, duties, or principles, as opposed to the rightness or wrongness of the consequences of those actions (Orme-Smith & Spicer, 2001). The deontological moral theory was proposed by Immanual Kant, where he puts great emphasis on to the duty of care. He also proposed that the principle of respecting autonomy was of most importance. Carol has distinctly refused any blood products of any kind, so the duty of care given would be to do everything in power to solve the situation – except transfusion. Being a duty-based theory, deontology would require health care professionals to follow any rules, regulations, protocols or procedures laid down by the National Health Service and trust regardless of whether this was what the patient wanted. It can be seen that neither theory respects or works for the patients’ best outcome so a mixture of the two will normally be used to aid decision-making (Butts, 2005).
To translate the theories into practice, Beauchamp and Childress (2001) suggest that an ethics theories framework which includes autonomy, beneficence, non-maleficence and justice is helpful. Autonomy concentrates on self-directing freedom and moral...