Ethics is thought as. ". . the basis on which people. . . decide that certain activities are right or incorrect and whether one ought to take action or has a right to something"(Rumbold, 1986). As far as ethics is concerned in medical services, "Nursing decisions have an effect on people. . . nurses have the energy to good or injury to their patients" (Bandman et al, 2002). This article is intended to focus on the most crucial ethical pinpoints and ideas of the circumstance of Evan--a Scottish hospital patient--will stage out the differing degrees of possible outcomes and decisions utilizing DECIDE Model for Ethical Decision-Making as outlined by Thompson et al (2000), and can declare a posture on the best possible decision that could be made as a nurse in this example.
In "Defining the condition", the initial step that in one's tactical way in moral decision-making, the highlighted basics are that Evan is an individual commited to a psychiatric medical center, he's also a wedded (to a female) man who contracted HIV during a homosexual relationship which his better half is unaware. With regards to this, he is adamant that his partner not find out about his medical illness. The stakeholders involved directly are: Evan, who does not need his family to find out about his disease or affair; his nurse, who is under increased strain fretting about the responsibility of, perhaps, having to break the confidentiality entrusted in him; Claire, is the most direct stakeholder as she may have contracted HIV; Evan's partner through the affair is also at risk of contracting HIV and his following lovers are also in danger; the other members of personnel, are in continuous fret over Evan meaning they cannot concentrate fully on their other patients; Evan's family is also engaged directly because they are worried about his well-being. There are also stakeholders indirectly involved in this circumstance. They will be the patients, who may not be receiving sufficient care if the personnel is so entwined in Evan's circumstance. Evan and the other patients have a right to confidentiality; therefore, legitimately his HIV position can't be disclosed to the other patients (HIV/Psychiatric manual, 1997). In evaluating Evan's protection under the law and the obligations of the nurse, Evan has the right to confidentiality, trust, prepared treatment decisions and quality health care. An Bord Analtrais "Code of Professional Carry out" (2000) areas that the nurse is appreciated to dutifully embark on these rules. However, Claire's health insurance and that of the ex - partner are at stake. The nurse will break the confidentiality and trust rules by telling Claire of Evan's illness. The nurse has a responsibility towards other professionals therefore prepared decisions and quality care will never be carried out until information of Evan's HIV position is divulged. The last facet of "Defining the condition", is to recognise the main honest problem to be attended to which is whether or not to dismiss patient-nurse confidentiality and trust in order to get sufficient healthcare for Claire and Evan's other partner.
In determining the guidelines and concepts of Evan's case, the author will use "Ethical Review", the next stage of your respective approach to ethical decision-making, in doing this element of the ethical evaluation of Evan's case. The main ethical process is "respect for autonomy" which. ". . generates an responsibility to respect the choices which others make relating to their own lives" (Edwards, 1996). In respecting Evan's dignity the nurse must continue to be confidential about his disorder. However, truth revealing to is considered as non-negotiable, legitimately and morally, as the well-being of Claire, Evan's spouse and the sufficient care and attention of Evan is the focus of the results of the nurse's breach of confidentiality. Another rule is that of 'beneficence'. This concept. ". . creates an obligation to do something in ways which promote the well-being of others" (Edwards, 1996). The nurse is promoting Evan's health giving him treatment for HIV. However, as Evan's partner and family are unaware of his HIV position, Evan is battling with a guilty conscience, that will only promote a pessimistic prospect. The quote says to. ". . promote the well-being of others. . . " including Claire, and Evan's past partner. By committing to confidentiality, the nurse is not promoting the nice health of Evan, Claire or the other partner. The next process in this case is 'nonmaleficence'. "Being a registered nurse. . . you. . . must: ensure that no action or omission on your part, or within your sphere of responsibility, is damaging to the pursuits, condition or security of patients and clients" (UKCC, 1992). This deals with the rule that no patient should be physically unsafe in another's health care. Evan is in safe hands but the hands of his nurse are bound by the confidentially rule. Claire and Evan's other partner are at risk of being bodily harmed, as they are still not obtaining treatment. The final principle, 'justice' "generates obligations to take care of others pretty" (Edwards, 1996). There is certainly hardly any justice being given to Claire. Both the health system and her own man are unjustly lying down to Claire. As the nurse is becoming more conscious of the moral decision he must make, it is triggering Evan to slide into further denial about his HIV status. . ". . He behaves as if nothing has occurred. . . he mainly talks about what they'll do together when he gets out of hospital. . . " and is also increasing the risk to her health insurance and Evan's other partner. In cases like this study, there are essential concepts in relation to medical ethics. There is an issue of 'advocacy', which is very very sensitive in this case. ". . because without advocacy. . . there are no privileges (Bandman et al, 2002). Evan needs the nurse to be his advocate and uphold his right to confidentiality. There is also a concern of 'caring' in cases like this. "Caring is a form of doing good and keeping away from harm and thus. . . is central to nursing ethics" (Bandman et al, 2002). Evan happens to be under psychiatric treatment and his guilty conscience is having a negative affect on his well-being. The nurse has been ignorant of the hazard to Claire and Evan's partner's health by not promoting their pursuits.
"Considering Options", is the third stage of your respective approach to ethical decision-making. At least one option would consider breaking the confidentiality code instilled in medical care. One option would be to respect Evan's autonomy and continue to treat him for HIV without the data of his partner and family. The second option would be for the nurse to tell Claire about Evan's HIV position and to guide her to have a HIV test done. The 3rd option is always to enable Evan and then for Evan to share her of his HIV status. The last option is always to tell the doctor responsible for Evan to share Claire or, complete it onto her own medical doctor to share Claire. The nurse would require help from a counsellor in encouraging Evan to share Claire about his HIV position. The nurse should not take this situation into his own hands and really should consult the assistance of both Evan's and Claire's medical professionals on how best to approach a decision.
"Investigating Outcomes", is the fourth stage of one's approach to ethical decision-making. The one good thing about not showing Claire about Evan's disease is the actual fact that the nurse would be respecting his autonomy. There are plenty of disadvantages to the results of this action. Claire would continue to go untreated for HIV, as would Evan's spouse through the affair. The affects of untreated HIV would erupt into full-blown Assists, which leads to death. One drawback of the second option would be that the nurse would be breaking the confidentiality code instilled in the nurse-patient romance. The main drawback is that, legally, it can only just be the medical professionals of Claire or Evan, general public health government bodies or Evan himself that can notify Claire that she actually is in danger at having contracted HIV (HIV/Psychiatry Manual, 1997). Options three and four would be the most feasible because they are legal and promote the well-being of all get-togethers. Option three is one disadvantage as it might take a long time to persuade Evan to tell his better half about his disorder. Option four would be considerably faster in working with the situation and people would become more likely to start to see the moral reasoning behind the physician revealing to Claire that Evan has HIV than the nurse. Doctors remain thought to be more 'professional' and their decisions have emerged as more superior and morally right.
"Choose Option" element of the DECIDE Model, is the fifth level of one's approach to ethical decision-making. The author decided that consulting a counsellor and the medical professionals of both Claire and Evan was the ultimate way to get across the way the author felt that this sensitive case should be approached. Their ideas would be asked but the writer felt that, as it was the most legal and quickest method, the physician should notify Claire about Evan. Claire could get treatment and counselling immediately and the nurse could notify Evan that his wife now knew about his health issues. He'd probably need more counselling for a while afterwards, particularly if his wife determines that their marriage is over. Her counsellor would advise her to support Evan as he too is at a sensitive talk about of mental well-being.
While using the "Evaluate Results" aspect of the DECIDE Model, the ultimate stage of your respective approach to honest decision-making, the writer chose that in. ". . compromising. . . own greatest good for the nice of others. . . " (Mill, 1861 cited in cost, 2000, p299), one continued to be true to one's figure, which is central to the provision of care. The author greatly weighed up the results of having Evan's physician find out Claire that her man was HIV positive and it was a massive moral concern. In executing an ethical research, the author revealed the most crucial ethical principles of Evan's case, outlined the several stages of one's ethical decision-making by employing the utilization of the DECIDE Model and decided upon particular actions one would take as a nurse in this example. . ". . According to Utilitarian, serves are right in so far as they maximise benefits or minimise harms" (Edwards, 1996).
American Nurses' Relationship. (1997) Chapter 18: Legal and Ethical Issues in HIV. The HIV/ Psychiatry Manual.
An Bord Analtrais. (2000) The Code of Professional Do.
Bandman, E. , and Bandman, B. (2002) Nursing Ethics: Through the Life Span. 4th ed. New Jersey: Prentice Hall.
Edwards, S. D. (1996) Medical Ethics: A Principle-Based Methodology. 1st ed. Hampshire: Palgrave Macmillan.
http://www. ethicsweb. ca/guide/
Mill, J. S. (1861) Utilitarianism. Cited in cost, J. A. (2000) Beliefs through The Ages. 1st ed. Australia: Wadsworth.
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Tadd, W. (2004) Ethical and Professional Issues in Nursing. 1st ed. Hampshire: Palgrave Macmillan.
Thompson, I. E. , Melia, K. M. , Boyd, K. M. (2003) Medical Ethics. 4th ed. Edinburgh: Churchill Livingstone.
UKCC (United Kingdom Central Council for Nursing, Midwifery and Health Browsing) (1992) Code of Professional Carry out for the Nurse, Midwife and Health Visitor, 3rd ed. London: UKCC
