Making informed consent in both ethics and law is fundamental in medical treatment. Patients are guaranteed the right to access information and make inquiries concerning recommended procedures. It enables them to come up with the most appropriate and informed decisions about their care. Trust and support existing between the relationship of the health care professional and the patient, which promotes shared decision-making, is significantly fostered by successful communication ( Doody& Noonan, 2016). The communication results in authorization from a patient to allow the caregiver to proceed with the medical interventions. Managements and other health workers face dilemmas regarding medical treatments and practices. For instance, caregivers confronted by a scenario requiring them to counter outrightly incorrect decisions from patients can be prolonged, like where a patient refuses to take blood transfusion. Moral and ethical issues handled in the healthcare department differentiate between what is right and wrong. This research paper comprehensively develops analysis and provides a rational pathway for health physicians to undertake when making informed consent and ethical decision making to medical treatment.
Blood transfusion is referred to as a routine medical procedure where blood donated from one person is taken to another person's body by use of a tube introduced in the vein. The exercise is vital as it saves life by replacing lost blood due to surgery or injury. Besides, blood transfusion aid if disease inhibits your body from making blood or some of your blood's components in the right manner.
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According to Kilinc and Kockar (2018), several ethical issues are concerned in the practice of blood transfusion since blood comes from human beings and is regarded as an essential resource. In 1980, the first formal ethics was introduced by the international society of blood transfusion and later adopted by both WHO and Red Cross societies. However, later in the year 2000, the code of ethics was revised for donations and transfusions. Blood donation as a gift implies that donors, confidentiality, notification, consent, and the right to refuse are guaranteed to them.
Moral Analysis and Justification Using Ethical Principles
Basing the analysis on the case study by the Standard Jehova Witness, in a scenario where a patient refuses to take blood transfusion, which was capable of saving their life. The respect for person principle conditions the medical practitioner to comply with the wishes presented by a competent adult patient regardless of the nature of the consequences-favorable or unfavorable, (Kilinc & Kockar 2018). However, the other ethical principles, nonmaleficence, argue in the opposite direction of the same judgment, implying that the health worker has a right to override on the decision of the patient of refusing to take the blood transfusion.
Amer (2019) posits that the nonmaleficence principle requires a health-worker to avoid harm to the patient as much as possible. Therefore avoiding to conduct blood transfusion to the recipient-benefiting their survival is likely to have consequential harm. Although it is understood that not executing a treatment is not an action but an omission, it is a deliberate action from the health-worker, therefore, implying a course of action. In this case, a medical practitioner should, therefore, critically analyze the above principles, and on the merit of them, patients and the entire community execute the medical exercise.
The principle of beneficence, which is closely related to nonmaleficence for this case, requires the medical physician to maximize benefits and minimizes harm to patients and others. A physician should incorporate this in support of administering a blood transfusion even if there are some traces of denial from the patient, ( Butts & Rich 2019). This is due to the health-worker maximizing benefit-life and reducing harm, which is the possible speculated death or other related diseases like anemia. Besides, when the physician saves the recipient's life, other parties benefit like family members and other beneficiaries and dependents.
On the contrary, it should be noted that sometimes implying the above methodology; no clear resolutions can be arrived at on the health-workers' dilemma basing on the four principles. As argued by Doody and Noonan (2016), the four principles do not provide a method of choosing. Besides, they are not even a set of rules for referring and reaching rational conclusions. The major criticism of the principles is that they have a deductive system, presumably being hard to use, making complex ethical dilemmas. Furthermore, there is another criticism but, on the contrary, point in the opposite direction about the method used at arriving on solutions, however, it sounds deficient since it lacks clear answers concerning troubling moral quandaries, (Amer 2019).
However, the above two criticisms are outweighed, and according to the research, physicians should not incorporate in when practicing medicine. Opposers of the critics' claim that moral agents should come to their answers at the same time using preferred moral theories as well as involving moral commitment incorporated in the four principles. The inflexibility of the principles should not form the potential ground of their nullifications or just because they fail to render unique solutions to moral dilemmas.
Furthermore, sometimes conflicting ethical principles brings them into congruent. For instance, the contradictory principles of respect of persons and beneficence earlier discussed in this article arrived in an agreement. Generally, it is apparent –at least prima facie that respect of person conditions a health-worker to supersede the patients, will of denial on blood transfusion, ( Kilinc& Kockar 2018).
On matters concerning harm and value, a patient’s calculus of value is utilized. According to mathematics, the harm occurring out of receiving a blood transfusion is greater than the harm caused by refusing to take the transfusion. However, it is dependent on religious faith like Jehovah's Witness. As for them, refusing to take blood transfusion-implying eternal salvation sounds rational to them and of a favorable balance of benefit over harm. In this case, an adult Jehovah's witness person's autonomy should be upheld with deontological reasoning of value and human dignity. Exceptions are made in a scenario where there is a life-threatening emergency, and there are no advanced directives or legal consent from the patient or the family members, the clinician has to act in the best interest of the parents. Therefore, in such a case, the rational, informed decision the physician should undertake is to respect a patient's autonomy to religion, beliefs, and self-determination.
However, in other situations, the expense of non-blood transfusion alternatives should be considered before overriding on the decision of the patient to refuse the transfusion. Also, the rights regarding legal and justice taking the patients' wishes, as the reference point should be thoroughly scrutinized before the physician arrives at a rational decision. If the considerations are in favor of the patients' preferences, the overriding becomes harder.
Other Applicable Scenarios
A precise application of confidentiality in health care is a scenario where a client seeks treatment after crashing their vehicle. As the doctor executes treatment, it is discovered that the client is drunk and has been driving under the influence of alcohol, which is illegal. The caregiver contemplates whether to inform the police or ignore the crime. In this regard, the doctor should consider the clear, unambiguous legal duty to disclose such information to authority ( Doody& Noonan, 2016). Besides, withholding information about a crime may put the caregiver on the wrong end.
Also, there are two other related scenarios where one, a man, informs a doctor that he has been sexually abusing her daughter, and he needs advice, but no one should know. In another case, a female client visits a doctor due to her mental illness and informs the doctors that she wants to kill her neighbor since he is oppressing her. In the two cases, the doctor contemplates whether to address the child’s office and the police, respectively. In these situations, the doctor is recommended to follow formal guidelines that support or require disclosure of the confidential information (Butts & Rich,2019). Failure to disclose the information may endanger the life of a third party.
In the practice of healthcare, health physicians are often required to arrive at and make informed decisions in line with their duty. The decisions executed are required to confer with the ethical principles stipulated in the nursing fields as well as the moral values. More often, the medical practitioners are confronted with dilemmas and contradicting scenarios making it harder for them to arrive at solutions quickly. The majority of such cases are evident in blood transfusion. One of the codes of ethics by the WHO requires the recipient and donors' anonymity, whereas infringing the donors' right to free consent leaves a physician in a critical situation to reach a solution. However, the physicians are advised to incorporate the moral values regarding the four ethical principles as well as ethical theories to arrive at the most appropriate solutions that serve the best interests of the patient, health facility, community, and the nation at large.
References
Amer, A. B. (2019). Understanding the ethical theories in medical practice. Open Journal of Nursing , 09 (02), 188-193. https://doi.org/10.4236/ojn.2019.92018
Butts, J. B., & Rich, K. L. (2019). Nursing ethics . Jones & Bartlett Learning.
Cahn, S. M. (2016). Utilitarianism. In Seven masterpieces of philosophy (pp. 337-383). Routledge.
Doody, O., & Noonan, M. (2016). Nursing research ethics, guidance, and application in practice. British Journal of Nursing , 25 (14), 803-807. https://doi.org/10.12968/bjon.2016.25.14.803
Kilinc, S. & Kockar, C. (2018). Determination of conditions that may prevent the effective use of blood in blood transfusion. Medical Science and Discovery , 5 (2), 119-123.
