Free Nursing Dissertations - The Question Is Complicated Further By The Fact That A Patient May Be
The question is complicated further by the fact that a patient may be judged competent to make decisions relating to their healthcare even if they are not competent to make others. A case in point would be the typical elderly lady who may not be judged competent to make complex investment decisions relating to her personal money but is clearly quite able to decide if she wants a ‘flu vaccination. (Winter R et al 1999)
One of the major ethical problems that arise in this context is who can give consent other than the patient themselves and in what circumstances. Legislation or case law cannot exist for every conceivable situation and therefore it is for this reason that professional guidelines are produced (see on) to help the healthcare professional in making what may be difficult and ethically complex decisions.
It follows that if a patient is not judged to be competent, for whatever reason, then others cannot give consent for them. (Donaldson 1993). Relatives or close friends can certainly give information and evidence to the healthcare professional and may be asked to sign a form which shows that they are happy with the decision made, but they cannot give direct consent themselves. This does not, however, preclude treatment. The treating professional would have to make the decision in the patient’s best interests. This would have to take into account all available factors which are actually much wider than their medical interests.
Such a decision would ideally be made in consideration of factors such as the wishes and beliefs of the patient (if they were previously competent), their current wishes, together with such factors as careful consideration of both their religious and their spiritual welfare. Such a consideration should also take careful account of any previously professed wish that was expressed when the patient was competent as strong evidence of how they would be likely to consent in their current circumstances. (Dougals C 2002)
If the patient has never been competent then clearly there is no previous knowledge of many of these factors, but careers or family may be in a position to give valuable information as to their known needs or preferences.
If an incompetent patient has clearly indicated in the past, while competent, that they would refuse treatment in certain circumstances (an ‘advance refusal’), and those circumstances arise, you must abide by that refusal (Sugarman J & Sulmasy 2001)
The ethical situation becomes enmeshed in the legal consideration when one considers the issues surrounding the permanent vegetative state. Clearly patients cannot give consent. The important ethical consideration and in fact, the judgement of past case law, is that the question to be considered is not whether it is in the best interests of the patient that he should die.
Dissertations - Free Nursing Dissertations
