Ethics and Contrastivism | Internet Encyclopedia of Philosophy

RUNNING HEAD: Ethics 0
Clinical Ethics

ETHICS 1
Table of Contents
Introduction................................................................................................................................2
Scenario......................................................................................................................................2
Ethical Care................................................................................................................................3
Paternalism.............................................................................................................................3
Autonomy...............................................................................................................................4
Code of Ethics for Nurses......................................................................................................4
Ethical Rounds...........................................................................................................................5
Facts.......................................................................................................................................5
Feelings..................................................................................................................................5
Values.....................................................................................................................................7
Evaluation..............................................................................................................................7
Conclusion..................................................................................................................................8
Bibliography.............................................................................................................................10

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Introduction
In this essay the student chooses to write about a patient who was a habitual offender, was
restrained and who underwent mental and physical traumas. The student describes the
situation as per her clinical experience with the patient and how by adopting the best practise
ethically the student proceeded with the best of her knowledge the author managed the
situation.
The student describes the nursing ethics along with principle of paternalism and medical
autonomy for a better understanding of the situation. The student also provides the reasoning
behind the decision that she thinks is fit, ethical and legal in the given circumstance and
which according to her is the ideal decision. In this paper the student justifies the application
of weak paternalism and explains in what situations application of weak paternalism is ethical
and lifesaving.
Scenario
The Student came across a patient while working as a healthcare assistant in an acute setting,
student was part of the team looking after the patient. The patient was restrained and was
about 60 years of age he had mild intellectual disability with Autism from his records. The
patient was restrained as he had committed a crime against another person and was beaten
badly since he was profusely bleeding, his pupils were dilated and he had suffered a brain
damage as a result of this. He was in a very bad shape as he was seen continuously muttering
to himself and he was seen to be growing restless. This is not the first time he would be
getting into trouble as he was a habitual offender. Though considering his mental condition it
is difficult to say if he committed the crime knowingly and intentionally.

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The patient was suffering mentally and physically, and he had no family member to take care
of his health. And there was no family member from whom the nursing staff or the hospital
authorities could take permission to perform the appropriate surgery on the patient. And thus
the healthcare professionals deemed it a fit case to exercise the principles of paternalism here.
The patient’s condition was so poor that he was about to die and thus here arises the debate of
whether to choose the principle of autonomy or paternalism in such situation.
Ethical Care
There are times when people have to choose to act from the available options even when the
other person has signified no will of his own. In this case the patient was suffering mentally
and physically and he had no family member from whom the nursing staff or the hospital
authorities could take permission to perform the appropriate trial on the patient (Osmtman et
al., 2019). So given the circumstance let us first study the principles of autonomy and
paternalism to understand the situation in a better way.
Paternalism
The principle of paternalism is most prevalent in health care. It is that action taken by person
to protect the interest of person who is not in the condition to choose his best interest. And
this also means sometimes to act in the best wishes despite the expressed wish. These
practises prevailed in early mid 20th century and lacked the respect for a patients choice (Jr,
1983). Paternalism is categorised into two further categories strong and weak paternalism,
strong paternalism is one where the doctor has determined better course of action for the
patient and so the doctor disagrees with the patients wish whereas weak paternalism is one
where the physician go against the patients request only when he thinks that the patient is not
of sound mind and incapable of forming a rational decision (Jr, 1983). Thus the cases where

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the consent of patient cannot be obtained or the patient is not in a condition to understand the
severity of his condition in such cases weak paternalism can be applied.
Autonomy
The shift from paternalism to medical autonomy started after the Nuremberg Trials, in the
mid 20th century, and a concept of informed concept came into being (Weindling, 2001). The
principle of patient autonomy lays that the patient has the right to choose his treatment and it
is with his consent the doctors and nurses perform his treatment. Since the patient was in no
condition to express his willingness to perform the treatment so here the medical staffs has to
take decisions as per the situation (Stanford, 2020). Though patient autonomy is a
fundamental principle and a core factor in day to day doctor patient equation but it also is
considered to be a challenging principle in medical ethics. This principle has become most
prominent in medical literature and the concept that a patient should be given freedom to
choose the medical treatments in their lives is gaining momentum in medical healthcare.
Autonomy cannot be exercised when the patient has impaired judgment and lower decision
making capacity (DMC) (Suhas, 2019).
Code of Ethics for Nurses
The purpose of Code of Professional Conduct and Ethics by the Nursing and Midwifery
Board of Ireland (NMBI) is to guide mid-wives and nurses in their daily practise and to help
them understand and form an effective decision in taking care of patient’s safety in an ethical
way (NMBI, 2020). It provides that nurses and midwives should demonstrate high standard
of professional behaviour aimed at protecting the patient’s right and appropriate management
of health care. It also provides that a nurse should provide immediate care to a patient when

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there is a threat to the patient’s life (KFK, 2019). The norm’s included in the code of ethics
for nurses are influenced by the day to day lifestyle of a healthcare professional, as a result,
the code of ethics include universal norms like consent of patient, confidentiality of the
information of patient and his treatment etc (Vicky, 2012).These values guide the decision
making of a healthcare professional and inform the public about the intention and assure the
patients about our approach and our policy (Davis, 2018).
Ethical Rounds
The stakeholders in this situation are the restrained patient, staff nurse (my preceptor), the
prescribing doctor, student nurse (me) and the pharmacist.
Facts
The patient was a 60 years old man with a record of autism and mental instability. He was a
habitual offender who had committed crime against a person and thus was restrained when he
came to the healthcare facility. Looking at his condition it could be made out that he was
heavily beaten by police as his face was swelling up, he had red patches on his body and he
was bleeding heavily. He was not a man with sufficient means and could have been a road
peddler as he was wearing torn and untidy clothes. He had no family and no one to take care
of him. The patient was continuously muttering to himself and when asked about his
condition he got scared and was shouting at the healthcare professionals to not to touch him.
Since he was beaten up and was hallucinating so was not able to make out the difference and
shouted that he did not want any treatment and he did not do anything.
Feelings
The true feelings of other stakeholders cannot be accessed however possible feelings have
been stated by the student. The restrained patient felt painful and scared in presence of police

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authorities. Since the patient was autistic and mentally unstable therefore was not able to
access the situation correctly and was refusing any treatment.
The staff nurse felt compassionate and concerned for the patient and wished to administer
treatment to the patient. Being a healthcare professional it was a duty to provide immediate
treatment to a suffering patient. Though autonomy is exercised as recognising the predictable
errors inspires call for individual choices and thus individual choices are preferred (Trobec &
Starcic, 2015). But since no other viable option was present thus paternalism was exercised as
it became a matter of life if not acted upon immediately.
The student felt remorseful for the whole situation as the patient was in a bad condition and
felt furious at the system for restraining a person who was in no way able to harm any other
person. When constant human attention is applied to a situation the result is successful
decision. After seeing the pitiable condition of the patient and also acknowledging the fact
that the patient was not consenting to his treatment and had no relative or any other person
who could consent to his treatment the staff nurse felt that the principle of paternalism were
applicable here.
The doctor may have been feeling satisfied since the patient was bleeding so heavily that if
not operated he would have died in hours. If in such cases delay is administered in taking
appropriate decisions at the right moment a patient may loose a life only because of inability
of a professional to decide whether to act or not to act.
The physician must have felt happy to administer medicines to the patient on time and
avoiding any further delay.

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Values
The student cannot be sure of values of all stakeholders however potential values being held
by stakeholders are stated below.
Patient- the patient was not in a condition to decide on any outcome and was incapable in
deciding any treatment for his own self.
Staff Nurse- being concerned about the patient felt it necessary to follow the doctors orders as
the patient needed immediate attention and care.
Doctor- valued his patients life and thought that since the patient is not mentally stable and
not is a mental state to take a rational decision and there was no other option to obtain
consent to perform operation so felt it ethical and rational to conduct an operation on the
patient.
Student nurse-values the decision being taken by the doctor studying the situation. She feels
it’s the best usage of weak paternalism in the given scenario.
Evaluation
The student considers the decision of applying the principle of weak paternalism in the
current scenario to be an ethical and strong decision as it related to patients right to life. As a
decision to not operate in this scenario would have lost the life of a mentally instable patient
who had no relative or family member from whom the healthcare professional could have
informed and sought consent. The decision of proceeding as per weak paternalism has
avoided serious evil and is a justified decision.
This scenario taught the student the importance of taking a right decision at correct time as
the student was constantly faced with the question whether applying the principle of
autonomy could have saved the life of the patient? Thus paternalism is always considered in

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negative connotation but in the present case paternalism saved the life of a patient who was in
dire need of being operated and who had no way of communicating about his treatment.
Autonomy could have been exercised had the patient been a mentally unstable patient while
admitted in health care system and after proper care and medicines he recovers and then
commits a crime against another person and gets restrained and beaten up by police. In such a
case exercising autonomy would have been a preferable option since the patient recovered
and was mentally stable to understand the situation and choose his treatment.
Conclusion
Nurses are supposed to act as soon as the patient reaches at their door or the information
about a patient reaches their ear without being judgmental about who and what the person or
the patient is, a nurse only studies the symptoms of patients and how to provide best
treatment and no other external factors influences their judgment. In the present scenario the
student was faced with such a situation where the patient needed immediate care and the
student provided immediate care to the health and well-being of the patient irrespective of the
fact that the patient was a criminal in the society.
The ethical issues faced by nurses are different from the ethical issues faced in the society. In
this whole exercise the student learnt the value of providing immediate care to a patient and
how to take effective decision at the appropriate time even though such decision may on the
outer side be called as negative but well-being of a patient is the atmost priority of a
healthcare professional.
Though the case here justifies the use of weak paternalism but this in no way certifies blatant
use of the principle. Paternalism has to be exercised only in rare cases where the patient is not

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in a strong position to make out the difference between good and bad and is unable to decide
for his own well-being. Only in such cases should the principle of paternalism be resorted to.

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Bibliography
Davis, C., 2018. Ethical decision making. Nursing made incredibly easy, 16(2), pp.4-5.
Jr, C.J.a.M., 1983. Who should decide?. Paternalism in health care, pp.352-57.
KFK, S., 2019. Ethical implications of population ageing in the intensive care unit. Irish
Journal of medical science, pp.699-702.
NMBI, 2020. NMBI. [Online] Available at: https://www.nmbi.ie/Standards-Guidance/Code
[Accessed 29 March 2020].
Osmtman, L., Nasman, Y., Eriksson, K. & Nystrom, L., 2019. The heart of ethics and health.
Nursing Ethics, pp.26-36.
Stanford, 2020. stanford.edu. [Online] Available at:
https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2018/03000/
ethical_decision_making.1.aspx [Accessed 29 March 2020].
Suhas, C., 2019. Current psychiatry. [Online] Available at:
https://www.mdedge.com/psychiatry/article/199862/practice-management/paternalism-vs-
autonomy-why-watching-our-words [Accessed 29 MArch 2020].
Trobec, I. & Starcic, A., 2015. Developing nursing competences online versus in the
traditional classroom. Nursing Ethics, pp.352-66.
Vicky, L.D., 2012. Applying the ethics of care to your nursing practise. Ethics Alw and
Policy, 21(2), pp.112-16.
Weindling, P., 2001. The origins of informed consent: the International Scientific
Commission on Medical War Crimes, and the Nuremberg Code. Bulletin of History of

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medicine, pp.37-71.