Ethical Dilemma in Health and Social Care

This essay discusses a case study of a professional ethical dilemma in health and social care. It explores the use of restraint and the implications of the Mental Capacity Act.

A written ethical essay
describing the case study
provided of a written analysis
of a professional ethical
dilemma from health and
social care.

Table of Contents
INTRODUCTION ..........................................................................................................................3
MAIN BODY...................................................................................................................................3
Right for individual to be supported to make their own decision- .............................................6
Knowledge about their disease: .................................................................................................6
Relevant interests: ....................................................................................................................6
Least restrictive: .........................................................................................................................7
CONCLUSION................................................................................................................................9
REFERENCES..............................................................................................................................10

INTRODUCTION
Ethical dilemma can be defined as decision-making problems that takes place in a situation
where there are two different possible moral imperatives are specifically being taken into
consideration (unambiguously acceptable or preferable). In health and social care sector, the term
ethical dilemma can be understood as a condition, where rise in differing morals among patients
and healthcare workers can be considered as something that brings complexities while
considering every single thing in an ethical manner.
On the other hand, mental capacity' can be considered as a state where an individual be able
to take decisions by his or her own. However, in many cases where an individual is dealing with
illness or disability like mental health problems or learning disability, it becomes really very hard
to specifically understand the information given to them about a particular decision. This may
result into negative outcomes related to mental health outcomes. This essay will be considering
the case study of Emma Jones where, decisions will be made in relation with restraint that was
applied on her to take her at home or hospice was justified or not within Mental Capacity Act,
2005(Chang, 2018).
MAIN BODY
According to the case study, Emma Jones has started dealing with severe congenital heart
disease and learning disabilities. Also, she was living with parents and also in every two months
she has to visit young adult hospice in one week. When she visited hospice, Emma got
overexcited and communicated well with staff as well as different occupants. Her mind-set and
general prosperity improve and this improvement goes on for at any rate like from seven days
after she gets back from hospice. Notwithstanding, Emma thinks that its troubling and becomes
upset when she is needed to get into a vehicle to head out to and from the hospice. She started
and attempts to get once more into the house or hospice. To get her into the vehicle it is
important to put some pressure on her. Also, it has been analysed that her parents and hospice
staff wonders that whether this restraint that was put on them is justified or not.
Including this, under Section 6(4) of the Mental Capacity Act 2005 states that restraint is at
the point when somebody utilizes power (or takes steps to) to cause somebody to accomplish
something they are opposing, and when somebody's opportunity of development is confined,
regardless of whether they are standing up to. any remaining less prohibitive methods for

accomplishing this have been attempted. In context with Emma Jones, nurses basically stayed
responsible for encouraging, giving, advancing and also upholding the most ideal patient
consideration and to make a move when quiet security and prosperity are undermined, including
when choosing to apply limitations. On the other hand, Emma Jones would have to take into
consideration of key accountabilities sketched out in the Professional Standards, Revised 2002.
There are three kinds of restrictions: physical, emotional and natural. Actual limitations limit a
patient's development. Substance restrictions are any type of psychoactive medicine utilized not
to treat ailment, but rather to deliberately repress a specific conduct or development. Natural
restrictions control a patient's versatility.
Medical care groups use restrictions for an assortment of reasons, for example, shielding
patients from hurting themselves or others, after any remaining intercessions have fizzled.
Limitations should be utilized uniquely for the briefest time when anticipation, de-heightening
and emergency the board methodologies have neglected to guard the individual and others. In
crisis circumstances, attendants may apply restrictions without assent when a genuine danger of
damage to the patient or others exists and simply after all elective mediations were fruitless.
Restriction use should be constantly surveyed by the medical services group and decreased or
ended as quickly as time permits(Cottone, and Tarvydas, 2016).
Based on case study as Emma is dealing with significant issues in context of mental health
issues and more. She feels uneasy and tends to become uncomfortable as she goes in car and
takes departure to go home or hospice. Every person in life may encounter these issues in almost
every aspect of life, including personal, social or professional as well, but in today's engaged life
mostly all of the individuals avoid these feelings until & unless it becomes major issue for them.
It can cause serious mental health issues. In case of Emma, it has been found that she was
dealing with different mental health related issues where isolation and congenital heart disease in
which a patient deal with respiratory or breathing issues, they were the two major problems that
created situation like this. Putting pressure on patients similar to Emma may create ethical
dilemma to them, as considering through perspective of parents and carers taking her through car
may be better for her but they should think about the condition of Emma or the patient whether it
is favourable for her or not, due to congenital heart disease and many other issue may it feel
distressing for her for that she can take legal actions against towards them. To overcome this
episode of mood of Emma, replacement of means of transport may be beneficial for her

situation. She can be taken through transport which open as she struggles with closed area due to
her breathing issues, so taking her to home through buses or public transports where she will be
socially active may help her in case(Cusumano, 2018).
There can be millions of logics which can lead a person to deal with ethical dilemmas.
There are conditions which observed in an individual that must be there for a situation to be
stated as ethical dilemma. When a person enables to decide between two or three choices given
or we can say ability to loose making decision for their life or for themselves. In this case, Emma
perhaps dealing with ethical dilemmas which may be extreme in her case from that she feels
consequences while going in car to home. As she shows shift in behaviour when she goes to
young adult hospice, where she enjoys herself and interacts well with staff and other locals in the
hospice which are enhance the disease more mentally.
As Emma also dealing with learning disabilities which is considered symptom of Mental
Capacity Act (2005). Under this abnormality person is not able to make appropriate decisions
which also termed as in lacking capacity, mostly patients who are dealing with mental health
problems, dementia or learning disabilities. More symptoms of affected patients are: sometimes
they do not adapt or understand the information given to them about particular a decision,
excessive fear or worrying about something, feeling sad or low moods, senile feeling or having
problems in concentration and learning any context as well as extreme mood changes including
uncontrollable or feelings of euphoria(Maxwell, and Schwimmer, 2016).
In Emma Jones's case, she debits a behavioural change when she gets back home after
one week, due to these abnormalities perhaps she feels displease at home. Sometimes suffering
individual gets annoy when treated as a patient by everyone so they show their way to express
their feeling in their own way. These patients are delicate in nature so at the first they should be
listened by someone whom with they feel safe, keeping them indulge and occupied may be
helpful to the patients to understand their situations, conflicts in behaviour may get reduce by
changing their surroundings until the person heal with abnormality and develop them.
Individual with psychological disorders are at great risk for decreased quality of life,
educational difficulties, rate of productivity becomes low and low poverty. They also deal with
social problems daily, vulnerability to abuse, and additional of health problems makes their life
to tackle more obstacles. As these individual are less likely to pursue their education, enter high
school or college, as compared to their mates without mental illness. Mental illness “interact in a

negative cycle” in which poverty play as a risk factor for mental illness, and mental illness
increases the risk that individual will “remain in poverty”. This negative cycle perhaps also
contributes to high rate of suicidal tendencies among individual’s mind with mental health.
When depression, mental illness, anxieties schizophrenia other disabilities enter a family, the
emotional cost can be increased and high and all members can be deeply affected. As the
circumstances occur, they may react and struggle to the situations differently. They should learn
to cope with their situations and encourage their loved one(Golightley, and Goemans, 2020).
As the Mental capacity act have determined some principles which are for an individual:
Presumption of capacity-
In this principle, an adult has right to determine or able to make his or her own decisions
and must assumed or pretend to do so until & unless it is proved. None of any member or a
person can object on their decision, so in case of Emma she can deny to go home after visiting
hospice if she feels better to stay there(Perc, Ozer, and Hojnik, 2019).
Right for individual to be supported to make their own decision-
As it’s a right of individual to determine their own decision and they should be supported.
She should be supported by their family members and be in her favour and she should be given
appropriate help to her if needed by an individual.
Knowledge about their disease:
An individual should make learn about their disease. There are several cases in respect of
mental health issues in which proves that sometimes these individual do not accept that are ill.
These patients must retain the right to make what might be considered as unwise decision or
eccentric.
Relevant interests:
An individual must express their personal interest, so whatever steps taken for or on
behalf of people without capacity in their field, by that an individual can develop their skills
which help them to heal fast as soon as possible. Sometimes these patients prefer to choose any
stream and they get proved best at their interest, for example: if one wants to become a painter as
a short term hobby and get prefect on it, thus in the case of Emma one should understand her
personal interest and should make her engage to it, to avoid distress feeling episode of her.

Least restrictive:
An individual should not feel bounded or restricted by a person or carer, it may be
harmful for their mental health. Treating them as serious or special one make them feel more
sick and their mind will accept the facts and work like that way. In case of Emma, if she feels
distress while going in a car may this shift of nature shows she is not happy with that decision.
She should explain her priorities, likes and dislikes so she may get heal soon from
disease(Hindley, and Font, 2017).
Assessment of abnormalities is specific for each and every individual decision at any
particular situations or time. People are said to lack capacity if patients have a defacement which
causes them to unable to think and take specific decision. Independent mental capacity advocates
should be provided or appointed to represent people who suffers from these abnormalities. As
there many ways to help these patients to heal and cope up. Intake of healthy diet, proper
medication and meditation may improve their mental health rapidly. Although it is a time taking
process an individual as well as family members should have patience and should belief in
ongoing process. According to studies, it is said to be “to meditate is to live simply and honestly
in the world as it is” — Jonathan C. Smith. Many studies have proven and suggested that meditation
may help and enhance mental health of a person. Literally, millions of people over past years have
come to this conclusion on the basis of their personal experiences. Many studies have explored that
the meditation may promote rate of healing even faster and help in diminish of psychiatric illness,
heart disease, anxieties and learning disabilities etc. As meditation helps to increase focus power and
memory power which no man-made medicine can do it better. The introduction of theories like
(DBT)dialectical behavioural therapy, made treatments way better easier. It is successful integration
of mindfulness meditation with psychotherapies. It is beneficial to legitimize meditation as a credible
component. Many studies have proven and indicated positive impacts of mediation reducing stress,
refining skills and enhancing general well-being etc.
In case of Emma Jones, as she deals with abnormalities in this case meditation can help her to
attain learning power and it can also develop her intellectual skills. Yet, this is long process which
may take year also but following daily this routine may be helpful to her. Communication is a key of
every problem. By communicating and understanding her may increase her power to express as she
interacts everyone in hospice(Wenwen, and Xiaoyan, 2018)
After the ceasing limitations, inter professional groups ought to question with the patient,
patient's family, or substitute chief to examine intercession, past mediations and options in

contrast to restrictions. With any intercession, for example, limitation use, medical attendants
need to guarantee they effectively include the patient, patient's family, substitute leaders and the
more extensive medical services group. Medical attendants are additionally responsible for
recording nursing care gave, including appraisal, arranging, intercession and
assessment.According to the Mental Capacity Act, no individual can apply their force on other
individual and make them do something forcefully. It was not right at the part of the hospice
authority and the family members of Emma Jones to forcefully get her into the car. Emma Jones
is entitled to her opinion and wish and if she did not wanted to enter the car than she should not
be forced to do the same(LAURIE, and Dove, 2019). She was already dealing with the major
health issues and concerns and the authorities and the patients family should take that into
consideration while dealing with her. If they do the same thing again and again , it will enhance
the fear in the patient and the current condition may get more adverse. The authorities and family
members should know these consequences before taking an action in regard with the patient.
They are already in a vulnerable state and that is the reason that they act so impulsive and restrict
themselves to do certain things. Emma must have been through the same and that is the reason
why she did not wanted to sit in the car and the patient's family and the hospice personnel should
have been empathetic to this and should take such decisions while keeping in consideration the
current state of the patient.
Such dominant behaviour and action has the possibility of hurting the sentiments and
emotions of the patient. These actions may lead to adverse and negative impacts on patients
health. They could have adopted other feasible options as well in order to convince her to sit in
the car. They could have been more polite to her and made her understand patiently. If she did
not wanted to travel in the car, they could have waited and thought of some other mode of
transportation with which Emma was comfortable. The mental health of patient is more
important and such severe actions of force and dominance and can affect the same. At least the
family should have been careful about the same and should not have indulged in this act. The
hospice is responsible for treating the patients peacefully and be kind to the same in order to
make them feel loved and courage them to get better soon. But despite of taking care of the
patient and finding an alternative solution of getting Emma Jones in the car, they also became
apart of the forceful act(Welland, and Pugsley, 2018). According to this case study there is some
positive aspects also like Emma Jones is enjoying at hospice because in that place she feels very

happy and motivated there so for few time of period if she gets angry and she forced by their
family to sit in the car and go for hospice from home and from hospice to him because after that
anger when she reached there , she feels great there(Layman, 2020)... Generally it says that
forcing somebody is good its against the mental capacity act but she do not like to sit in the car
but she like to go hospice because there she found herself so better(Little, 2018). So for her
happiness and encouragement it is good to force her because can not effect their health from that
force she become good and feel relaxed their. Emma Jones feels so distress in the car and in the
home also like she can not leave their for like long days or for long time because that create
effect on her so from that force result create happiness in their lives so sometimes it better to do
theses things because someday its helps that person towards the happy life and motivation.
CONCLUSION
From the above mentioned report it can be concluded that Ethical dilemma is outlined as
decision taking issues that create a place in a condition where two various assorted accomplish
able motivation peremptory are generally taken into thinking. And from the other side in this
report a mental capacity act has been defined and this is advised as a point where every
individuals or person have rights to take decision their own. In this report Emma Jones is dealing
with unwellness or bad condition like that intellectual wellness difficulty or any learning
disablement, this becomes very difficult for her to deal with condition because somehow she is
forcing by their own family for treatment or for anything sometimes its really hurt her and some
times that create happiness, so from this context it has been analysis that according to the act of
mental capacity its not right to force anybody for doing something but sometimes its better for
her health and that create happiness in her lives so there is both aspects in this condition that for
somebody's happiness forcing is better but sometimes its not better(López, and Gadsden, 2016).

REFERENCES
Books and Journals
Chang, 2018. Medication-assisted treatment for youth with opioid use disorder: Current
dilemmas and remaining questions.The American journal of drug and alcohol
abuse,44(2), pp.143-146.
Cottone, R.R. and Tarvydas, V., 2016.Ethics and decision making in counseling and
psychotherapy. Springer Publishing Company.
Cusumano, E., 2018. The sea as humanitarian space: Non-governmental search and rescue
dilemmas on the Central Mediterranean migratory route.Mediterranean Politics,23(3),
pp.387-394.
Golightley, M. and Goemans, R., 2020.Social work and mental health. Learning Matters.
Hindley, A. and Font, X., 2017. Ethics and influences in tourist perceptions of climate
change.Current Issues in Tourism,20(16), pp.1684-1700.
LAURIE, G.H. and Dove, E., 2019.Mason and McCall Smith's law and medical ethics. Oxford
University Press.
Little, D., 2018.The paradox of wealth and poverty: Mapping the ethical dilemmas of global
development. Routledge.
López, N. and Gadsden, V.L., 2016. Health inequities, social determinants, and intersectionality.
Maxwell, B. and Schwimmer, M., 2016. Professional ethics education for future teachers: A
narrative review of the scholarly writings.Journal of Moral Education,45(3), pp.354-
371.
Perc, M., Ozer, M. and Hojnik, J., 2019. Social and juristic challenges of artificial
intelligence.Palgrave Communications,5(1), pp.1-7.
Wenwen, Z., Xiaoyan, W., Yufang, Z., Lifeng, C. and Congcong, S., 2018. Moral distress and its
influencing factors: A cross-sectional study in China.Nursing Ethics,25(4), pp.470-480.
Welland, T. and Pugsley, L., 2018.Ethical dilemmas in qualitative research. Routledge.

Layman, E.J., 2020. Ethical issues and the electronic health record.The health care
manager,39(4), pp.150-161.