Ethical principles provide criteria on which to base judgements in relation to ethical theories (Advanced Nursing Practice Toolkit, 2012). When talking about ethics and morals, if something is ethical it is whether it is the right or wrong behaviour and morals are the beliefs and interpretations or right and wrong. There are four key ethical theories that help healthcare providers reach an ethically correct decision. The first ethical principle, known as Consequentialism, was written by Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873). This theory states that ‘the correct moral response is related to the outcome, or consequences, of the act, not its intentions or motives’ (Pearson, 2016). An example of consequentialism in health and social care would be a service user needing a liver transplant; however they are an abuser of alcohol. But would it be better to give the transplant to someone else who is healthier, younger and would benefit from it more?
The second ethical principle, known as Deontology, places value on the intentions of the individual (rather than the outcomes of any action) and focuses on rules, obligations and duties (Advanced Nursing Practice Toolkit, 2012). This theory was first written by Immanuel Kant (1724-1804) and W.D. Ross (1877-1971). It also states that you should stick to those obligations and duties as it is ethically correct. This means that rules about treatment can be applied universally and consistently (Pearson, 2016). An example of deontology in health and social care would be, for instance, a nurse changing a patient’s medication even though they are not supposed to. This is an example of deontology as the intention is relevant for the right reasons.
The third ethical principle is Principlism, which emphasises four key ethical principles which most ethical theories share and blends these with virtues and practical wisdom (Advanced Nursing Practice Toolkit, 2012). The four key principles it focuses on is Autonomy, Beneficence, Non-maleficence and Justice. Autonomy is when you allow individuals to make liberated choices about her own care and respecting the choices that they make. This may help to empower a service user, knowing they have a choice in decision with their own healthcare. Beneficence is acting in a way that not only promotes the wellbeing of individuals but benefits the patient too. To do this, you have to balance the benefits of treatment against the risks and costs (Pearson, 2016).
Non-maleficence is when you do everything you can to avoid harm. To make this work you may make sure that side effects of medication are ok for a patient and that the side effects do not cause any more harm. Finally, justice is about being morally right and fair. This includes complying with the law and the rights of people involved. The overall aim of Principlism is to bring together the best elements of the various other theories that match with most social, individual or religious belief systems (Pearson, 2016). The fourth and final ethical principle is Virtue ethics is an approach to Ethics that emphasizes an individual\’s character as the key element of ethical thinking, rather than rules about the acts themselves (Deontology) or their consequences (Consequentialism) (The Basis of Philosophy, 2008). An example of virtue ethics in health care would be diagnosing a patient and letting them speak about what they want to happen next and discuss their own personal care plan.
Additionally when talking about ethics, it is important to talk about managing conflicts. This is as you need to know how to properly handle conflict within the health and social care sector. Conflict is an active disagreement between people with opposing opinions or principles (Cambridge Dictionary, 2017). This conflict could happen with the service user or between their family and friends. To prevent conflict within health and social care, the NHS set up a checklist for managing conflict. The checklist consists of 8 do’s and don’ts. The checklist suggests that you should ‘ensure that issues are fully outlined’, ‘acknowledge emotions’, ‘make sure you have a comfortable environment in meetings’, ‘set a time frame’, ‘establish a good rapport’, and ‘use appropriate names and titles’ (The National Archives, 2012). However, the checklist suggests that you don’t and should not, ‘use jargon’, ‘constantly interrupt’, ‘use inappropriate’ or ‘do something else whilst trying to listen’ (The National Archives, 2012).
A conflict of interest is a situation in which the concerns or aims of two different parties are incompatible (English Oxford Living Dictionaries, 2017). When working in health and social care settings, you may be faced with a conflict of interest which needs an ethical solution. However, there are several ethical questions that must be considered before making a ‘right’ decision bearing in mind that ethical dilemmas don’t all have a ‘correct’ answer. These questions may include discussion about policies and professional responsibilities. For instance, having to decide on the allocation of scarce resources. This is an example of conflict of interest because you need to ethically decide who more in need of those scarce resources.
There are several ethical questions and dilemmas that need to be raised when discussing Maria, Nusrat and Alice. Firstly, would it be ethical to place Maria’s mother in a nursing home against her daughter’s wishes, even though it is best for both the mother and Maria? This is an ethical dilemma and issue that needs to be though about carefully when discussing it. This is because you need to think about what is best for Maria and her mother, but the wants and wishes of both Maria and her mother. It is best for her mother to be in a nursing home as they have specialist dementia care and it would be best for Maria as she could focus on her teaching career and concentrate at work without being tired and worrying about her mother. Another ethical issue that should be approached when dealing with Maria and Mrs Montanelli is whether it would be ethical for Mrs Montanelli to have a night sitter every night. Would that be fair on her?
There are also ethical questions and potential dilemmas that need to be raised when discussing Nusrat too. Firstly, providing Makaton provides equal opportunities for Nusrat at the centre. If this was not provided for her, this wouldn’t allow for equal opportunities and would be classed as unethical. Additionally, by having her personal plan that focuses on her skills and abilities rather than her disabilities can help to empower Nusrat. This is also ethical as it promotes equality and an anti-discriminatory practise. It also wouldn’t have been ethical for the centre to have rejected Nusrat because of her disabilities or because she needs more support e.g. volunteers or advocates.
As for Alice, there are too ethical questions and potential dilemmas that need to be reviewed when discussing her case. First of all, if Alice was to continue her habit it can damage her kidneys and liver. This may result in her having to have a kidney or liver transplant in the future. The ethical dilemma and question that may arise from this is if she did ever need a transplant and a healthier (non-alcoholic) was also on the waiting list who is equally in need of the organ, who should the transplant go to? Healthcare professionals may prioritise the healthier service user as they are less likely to abuse the newer healthier liver or kidney. However, you must look at both individuals ethically and think about who needs it more.
Another ethical issue that would have arose from Alice’s case is whether it is ethically right to make Alice stand at the back of the class, away from everyone else. Even though she is allowed into the class and can still participate in the aerobics class, standing away from everyone may lead to social isolation and loneliness. Social isolation is the lack of social contact or support; loneliness is the feeling of being alone or isolated (University of York- Centre of Reviews and Dissemination, 2014).