Within healthcare, practitioners often have to make difficult decisions regarding the care of their patients. This could be to do with giving or withdrawing treatment, or as simple as sharing risk information (Glover, 1997). Ultimately, the practitioner must be able to rationalise any decision they have made (Morrison, 2009). With this in mind, the following assignment will draw upon an ethical dilemma and explore how theoretical perspectives can be utilised within the decision making process. Therefore it will also be pertinent to draw upon the law, and how this influences actions within health care. To facilitate this discussion, I will identify a scenario from practice that has presented an ethical dilemma. Due to the reflective nature of this assignment, I feel it appropriate to proceed in first person narrative (Webb, 1992). However, I must point out that, in accordance with university and professional guidance, the confidentiality of patients, colleagues and services will be protected throughout (Nursing and midwifery council, 2008).
I feel it reasonable at this point to define the point of interest for this essay. ‘Ethics’ is an important term within health care (Edwards, 2009). As Johnstone et al (2008) states, ethics is about doing the right thing. Though this is not always clear and the answer not always readily available. Therefore, one must rely on experience, inherent knowledge, instinct. There have been many theories that attempt to take a systematic approach to reaching a decision from an ambiguous situation, and these date back to BC350, with the work of Aristotle (Cohen, 2000). Some of these will be explored and analysed in relation to the chosen scenario, in the hope that some recommendations can be identified.
The case I am going to draw upon for this essay is that of 'Mary' and her carers. Mary has been known to mental health services for around three years, and is currently being treated for a psychotic illness. Mary is suspected to have a learning disability, though formal assessment of this has not been available, as Mary has moved around the country a great deal throughout her life. Mary has lived with two carers for the past twelve years, since the passing of her mother. Mary identifies these carers as her grandparents, and calls them as such. During a routine visit with her care coordinator a few months ago, Mary became very tearful and disclosed that she had been suffering verbal and physical abuse from both carers. Mary had a visible bruise on her shoulder, which she stated was caused by a punch. This was understandably very concerning, and as such, Mary was not able to return home. Emergency accommodation was sought and safeguarding protocol was instigated which involved contacting the police and senior managers. After two days in respite care, Mary became very distressed and subsequently retracted her accusations. Mary stated that the disclosure was false, and had been the result of commanding auditory hallucinations. An urgent outpatient appointment with the consultant psychiatrist was arranged and Mary was subsequently admitted to hospital due to relapse of symptoms. Since then, Mary has maintained that the accusations were false and has explicitly stated that she did not want further action to be taken, and that she wants to maintain a relationship with her carers. Mary was assessed as having capacity to make decisions about where she lives. Safeguarding was closed and no action taken by police. Mary remains in hospital and is having contact with her carers but this is being supervised by staff, despite there being no substantiated concerns. This presents an ethical dilemma: are the service justified in infringing Mary's privacy, even though her vulnerability is only perceived and there is no evidence to suggest any actual abuse? I will now draw upon theory to explore what actions should be taken by the professionals....