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Ethical And Legal Practices And Capacity

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Ethical And Legal Practices And Capacity

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Ethical And Legal Practices And Capacity

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Question:
Severe Exacerbation of his COPD with Dyspnoea on Minimal Exertion.
 
 
Answer:

Introduction:
Healthcare professionals are bound to undertake ethical and legal exasperations from patients, associated family and the healthcare administration. The interventions that are to be imparted upon the patient must be in accordance with predilection of the patient and associated family. Furthermore, but such penchant cannot always been considered by the healthcare professionals as in many cases such predilection may not be justifiable. The example of this can be insufficient knowledge towards prevailing health condition and affect to decision due to advanced age, social, cultural, psychosocial and financial factors (Herring, 2014).
The report is an analysis on the refusal of treatment and beneficence ethical and legal practices that affects the intervention treatment regulated by the healthcare professionals through the case study of Mr. Gray who is suffering from COPD.
This report outlines an overall analysis on maintaining the ethical approach while provisioning the treatment. Furthermore, two ethical and legal practices with the care that are refusal of treatment and beneficence have been undertaken for the analysis of the case study of Mr. Gray.
 
Importance of Ethical Approach:
Ethics is a philosophical approach that believes in preventing and safeguarding the moral principles of a human being that are based on their social, cultural, psychosocial, economic and financial experiences. Furthermore, ethics provide an order, recommendation and prevention of the rights of an individual in order to protect them from any misconduct by another human being (Miravitlles et al., 2013). In accordance to this concept, the healthcare professionals conduct and impart the treatment to the patients with distress. Furthermore, keeping this viewpoint in mind, the first establishment of the principles of ethics was conducted by Tom Beauchamp and James Childress in 1985 (Ebbesen & Sundby, 2015). Such principles are interrelated and provide the healthcare professionals optimal framework and guidelines for the formulation, implementation and regulation of optimal remedial treatment to the patients. The two chosen ethical and legal practice framework are refusal of treatment and beneficence (Entwistle & Watt, 2013).
Condition of Patient:
Mr. Gray is an old man who is 67 years old and is suffering from Chronic Obstructive Pulmonary Disease (COPD) along with dyspnoea. Additionally, he is suffering from dysphagia, nocturnal pyrexia and dysphasia (Incalzi et al., 2014). Furthermore, he has signs and symptoms such as high temperature, lowered oxygen saturation levels, tachycardia, high respiratory rate, normotensive and pneumonia. Additionally, along with such condition he has severe refusal towards treatment and meeting his family members, other patients in the hospital and staff members of the hospital. Refusal towards treatment is towards the consumption of the medication and undergoing Enteral Feeding. The healthcare professionals are undertaking optimal steps such as providing consent to the family members regarding the treatment require to be imparted to Mr. Gray (Pagano, 2016).
 
Comparison of Refusal of Treatment with the Care:
The right to refusal of treatment is the basic right provided to the patient in order to prevent and prohibit the pharmacological and non-pharmacological interventions as per their will. This right preserves the moral ethics, provides protection and privacy during the conduction of the treatment. In addition to this, such right preserves the integrity and decision-making of a patient but unfortunately, this right usually gets misused by the patient having no knowledge on their medical condition. Certain factors such as no awareness, advanced age, influence by social, cultural, ethical and psychosocial experiences and others affects the decision-making of a patient to a large extent. Additionally, this condition locks and prohibits the healthcare professionals from undertaking decisions related to safeguard interventions (Ryan, Callaghan & Peisah, 2015).
Similar, situation has arisen in case of Mr. Gray who has severe refusal towards pharmacological intervention of paracetamol and conduction of Enteral Feeding through the inserting of nasogastric tube. The evidence based practices need to be implemented such by informing the patient and associated family on the importance of safety of the treatment and the recovery of patient, the required voluntary treatment by the patient are not effective anymore, the benefits or advantages are way more stable and outweighs the associated risks (Loke, 2015). In conclusion to the prevailing scenario, Mr. Gray comes under the case of an adult with capacity that determines the refusal by a patient in order to satisfy themselves irrespective of the degrading repercussions that can originate ahead. Consistent and prolonged refusal by Mr. Gray has led the healthcare professionals to approach Mrs. Gray regarding the imparting of effective intervention. Mrs. Gray is open to such safeguard interventions and wants her husband to recover as soon as possible. Additionally, under such circumstances the associated healthcare professionals are open to undertake the safeguard interventions as per the consent and approval from Mrs. Gray. Furthermore, the concept of coercion must be separated from this situation as coercion is regarded as invasive and a term usually used for the treatment of the patients suffering from medical conditions but in the case Mr. Gray the treatments are non-invasive and must be conducted in accordance with the approval of Mrs. Gray (Soininen et al., 2014). Conclusively, the procedural measures for the conduction of remedial treatment for Mr. Gray have been undertaken in accordance with the rationale of refusal of treatment.
 
Comparison of Beneficence with the Care:
Beneficence is one of the four principles of ethics formulated by Tom Beauchamp and James Childress in 1985 (Ross, 2016). This principle provides effective remedial actions that are essential and required to be implemented to benefit and provide relief to the patient under distress. Beneficence is a broad concept that allows the healthcare professionals to provide effectual concoction of pharmacological and non-pharmacological interventions in accordance with the circumstances, somatic and mental wellbeing of the patient. Such interventions are required to be implemented with the help of experienced skills and high level of knowledge towards the condition and effective interventions (Martela & Ryan, 2015).
Beneficence principle goes in accordance with the case of Mr. Gray as this ethical approach has provided every possible measure to the healthcare professional for the conduction of the treatment in Mr. Gray. Furthermore, the concept of consent is also attached to the beneficence as consent allows optimal awareness of the existing condition, possible safeguard interventions and their extent of affects on the patient. In accordance with the beneficence, Mr. Gray has been optimally diagnosed and treated well. Furthermore, patient-oriented strategies and protocols have been formulated in respect to different medical conditions occurring in Mr. Gray. Additionally, consent has been implemented in Mrs. Gray regarding the continual refusal towards treatment by his husband. Such communication over consent has provided approval of treatment by Mrs. Gray that legally allows the healthcare professionals to proceed with the treatment irrespective of the approval by Mr. Gray (Corvol et al., 2013).
Chronic Obstructive Pulmonary Disorder (COPD) is a condition that affects the lungs and degrades it making the patient incapable enough of breathing (Dharmarajan et al., 2016). Certain signs and symptoms of COPD are wheezing, shortness of breath, severe weakness, coughing and tight chest. Maintaining optimal nutritional level and healthy diet under such condition becomes extremely tough and provision of enteral feeding is undertaken when oral feeding is not possible as in the case of Mr. Gray. The level of nutrients is manually handled by the healthcare professionals (Prince et al., 2015). This is mainly a non-invasive method and is frequently undertaken by various healthcare professionals to provide remedial treatment and has fewer side effects. Provision of nasogastric tube for Mr. Gray will allow optimal levels of nutrients in the body as he is continually refusing for the intake of food orally. Furthermore, optimal level of nutrients will allow the regulation of the antibiotic therapy in Mr. Gray provided for the treatment of pneumonia and other prevailing severe health condition in him (Reeve et al., 2016). Conclusively, the procedural measures for Mr. Gray in order to conduct remedial treatment have been undertaken in accordance with the beneficence rationale.
 
Conclusion:
The right to refusal of treatment was made to preserve the ethical integrity and likings of the patient while it has been manipulated by patients with the help of voluntary and involuntary refusal. This right also provides provision of continuum of care in accordance with the approval by the associated family members. Mr. Gray is an old man who is 67 years old and is suffering from Chronic Obstructive Pulmonary Disorder (COPD), dysphagia, pyrexia, dysphasia, pneumonia, dyspnoea and haemoptysis. Such condition requires consumption of antibiotics orally and intake of optimal healthy diet. Refusal to both has been seen in Mr. Gray in order to satisfy themselves irrespective of competent enough regarding the degrading consequences of the refusal. Symptoms such as shortness of breath, wheezes, weakness and others has led the healthcare professionals to come up with enteral feeding and must be regulated by the approval of Mrs. Gray.
Besides this, beneficence also goes along with the case study of Mr. Gray that allows the provision of effective treatment by respecting the ethical and moral integrity of Mr. Gray and his family by not forcing Mr. Gray on consuming oral antibiotic and oral consumption of food. Additionally, another possible method of treatment is enteral feeding that is non-invasive in nature to which patient is again showing refusal. Beneficence allows generating and enhancing the consent of the family members as in this case is Mrs. Gray and proceeding further with the treatment in accordance with the approval by Mrs. Gray.
 
References:
Corvol, A., Moutel, G., Gagnon, D., Nugue, M., Saint-Jean, O., & Somme, D. (2013). Ethical issues in the introduction of case management for elderly people. Nursing ethics, 20(1), 83-95.
Dharmarajan, K., Strait, K. M., Tinetti, M. E., Lagu, T., Lindenauer, P. K., Lynn, J., … & Krumholz, H. M. (2016). Treatment for multiple acute cardiopulmonary conditions in older adults hospitalized with pneumonia, chronic obstructive pulmonary disease, or heart failure. Journal of the American Geriatrics Society, 64(8), 1574-1582.
Ebbesen, M., & Sundby, A. (2015). A Philosophical Analysis of Informed Consent for Whole Genome Sequencing in Biobank Research by use of Beauchamp and Childress’ Four Principles of Biomedical Ethics.
Entwistle, V. A., & Watt, I. S. (2013). Treating patients as persons: a capabilities approach to support delivery of person-centered care. The American Journal of Bioethics, 13(8), 29-39.
Herring, J. (2014). Medical law and ethics. Oxford University Press, USA.
Incalzi, R. A., Scarlata, S., Pennazza, G., Santonico, M., & Pedone, C. (2014). Chronic obstructive pulmonary disease in the elderly. European journal of internal medicine, 25(4), 320-328.
Loke, P. C. (2015). Refusal of Treatment by Critical Patients. Encyclopedia of Trauma Care, 1398-1402.
Martela, F., & Ryan, R. M. (2015). The Benefits of Benevolence: Basic Psychological Needs, Beneficence, and the Enhancement of Well?Being. Journal of personality.
Miravitlles, M., Soler-Cataluña, J. J., Calle, M., & Soriano, J. B. (2013). Treatment of COPD by clinical phenotypes: putting old evidence into clinical practice. European Respiratory Journal, 41(6), 1252-1256.
Pagano, F. (2016). Therapeutic compliance in elderly patients with COPD. Official Journal of the Italian Society of Gerontology and Geriatrics, 147.
Prince, M. J., Wu, F., Guo, Y., Robledo, L. M. G., O’Donnell, M., Sullivan, R., & Yusuf, S. (2015). The burden of disease in older people and implications for health policy and practice. The Lancet, 385(9967), 549-562.
Reeve, E., Denig, P., Hilmer, S. N., & Ter Meulen, R. (2016). The ethics of deprescribing in older adults. Journal of bioethical inquiry, 1-10.
Ross, L. F. (2016). Theory and Practice of Pediatric Bioethics. Perspectives in biology and medicine, 58(3), 267-280.
Ryan, C., Callaghan, S., & Peisah, C. (2015). The capacity to refuse psychiatric treatment: A guide to the law for clinicians and tribunal members. Australian & New Zealand Journal of Psychiatry, 49(4), 324-333.
Soininen, P., Putkonen, H., Joffe, G., Korkeila, J., & Välimäki, M. (2014). Methodological and ethical challenges in studying patients’ perceptions of coercion: a systematic mixed studies review. BMC psychiatry, 14(1), 162.

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