The first principle ofBeauchamp and Childress is respect of autonomy, which adherence to respectindividual’s right and choices (Griffith and Tengnah, 2014). In the health carecontext, consideration of respect for autonomy focuses on the patient’s rightto make the decision of their own regarding their treatment (Griffith andTengnah, 2008). Moreover, Miola (2009) postulates that prior to performing anyinvasive procedure obtaining informed consent from the patient is very essentialin order to protect patient autonomy. The author further suggests that informedconsent also safeguards patients’ rights and ensures that they understand thebenefits, risk and alternatives of the procedure in advance. However, in the case of Margaretshe was not able to make her own decision due to her progression of diseases.
Spike (2017) postulates that the standard process of obtaining consent formedical intervention is interrupted when an individual lack capacity. But,Brown and Vaughan (2013) argue that the health professional should implementthe principles of best interest or use Lasting Power of Attorney (LPA) when thepatient lack capacity to make decisions for themselves. Nevertheless, whenMargaret had a capacity she had declared her son as the attorney of LPA for herhealth and welfare.
According to the MentalCapacity Act (2005, section 9) the person who holds the health and welfare ofthe attorney provides the legal authority to a person to make decisionsregarding treatment and consenting to medical procedures on behalf of anincapacitated person. This emphasises that Margaret son has full legal rightsto decline the treatment. He articulates the nurse that the use of the syringedrive can deteriorate his mother’s condition. To adherence with the Human RightAct (1998) that every individual has a right to exercise their freedom inviews, religion and thought. Consequently, the team faces dilemma whether toproceed with the treatment or not as it was not legal to perform the treatmentwithout the authorisation of LPA. Griffith (2014) believes that when thedecision is not acted upon patient best interests, the nurse can challenge thedesignated decision maker and try to resolve the issue.
Thus, the nurseinformed the son about the consequences of refusing treatment can furtherdeteriorate the patient’s health condition leading to dehydration, depressionand electrolyte imbalance due to excessive vomiting (loss of fluid) (Harris,2010). To exercise patient choices while making an informed decision, it isvery critical that the nurse should provide honest and accurate information(NMC, 2015). Following the second principlesof beneficence which is defined as the obligation to do good and provide carethat benefits the patient (Beauchamp and Childress, 2013). Griffith and Tengnah(2014) argues that the principle of autonomy can clash with the principle ofbeneficence when the patient or their relatives makes a decision that thehealth professional believes that will not benefit the patient and conflict canoccur. Ellis and Abbott (2012) postulates conflict as an action of disagreementbetween one or more individuals that occur because of different opinion, orneed. In relevance to Margaret case,the conflict occurred between health professionals and family member whilemaking crucial decisions, when Margaret son disagreed with treatment as he wasnot sure that the use of the syringe drive would benefit Margaret healthcondition. However, the NMC’s code (2015) underpins a professional and moralobligation to all the registered nurse to provide overall benefits to patientand should act on patient best interest.
In this context, the nurse should bein a position to act as an advocate for their patient as well as providingrealistic information to the patient and their family (Griffith, 2014). Therole of the nurse as an advocacy involves safety of patient values, expectationand concerns (Choi, 2015). In Margaret scenario, the nurseused effective communication and provided realistic information. The nurse alsoinformed the son the team decision to use antiemetic drugs via syringe drivewould act in the best interest of Margaret as it helps to promote comfort andaids to relieve the pain (Foy and Blowers, 2009).
Griffith and Tengnah (2014) postulates thatthe nurse has an obligation to provide accurate and clear health information tothe patient and family as part of their duty of care. Similarly, Choi (2015)supports that effective communication while dealing with the complex situationcan create change in perception and behaviour regarding the treatment. Afterthe deliberation with team member the son agreed with the treatment and actedin patient best interest. Non-maleficence is the thirdprinciple which defined as an obligation to do no harm and to safeguard othersfrom harm (Griffith and Tengnah, 2014). The principle to do no harm alsocomprises the professional standards of care and evidence- based assessment ofrisk and benefits (Marquis and Huston, 2009). The decision made by a health professional to administer antiemeticmedicine via syringe drive did not harm the current status of Margaret. Infact, Margaret responded to the treatment and course of care. Her nausea andurge to vomit was controlled and she was more settled and comfortable.
Anti-emetic medication works as a neurotransmitter-blocking agent and send amessage to the chemoreceptors thus blocking the vomit centre in the brain that transmitsthe feeling of nausea (Harris, 2010).The fourth principle ofBeauchamp and Childress’s is justice, which underlies the obligation to treatothers equally (Griffith and Tengnah, 2014). Justice includes the principles oftreating others with fairness and equality with regardless of their age, sex,religion, gender, belief and disability (Equality Act, 2010). In this case scenario, the wish of the son wascontemplated as he holds LPA. Although the son contested the treatment at first,later he gave his consent when the MDT detailed the benefits of using a syringedrive for the treatment.
Finally, the principle of justice was met as thedecision was done with mutual understanding by applying all the relevant laws.