Fundamentals of Nursing and Midwifery 2e

Unit II Foundations of nursing and midwifery practice

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Director of Proceedings. The Code of Health and Disability Services Consumers’ Rights sets out ten rights, which include the right to be treated with respect, to be free from discrimination or exploitation, to dignity and independence, to services of an appropriate standard, to give informed consent, and to complain (Health and Disability Commis- sioner, 2009; Parliamentary Counsel Office, 2004). Often the ethical issue involved in a patient’s rights is not immediately obvious because it might be due to an omission rather than to something someone does or says. Consider this point in the following scenario. Rebecca Wright, a 48-year-old woman who has just recently undergone extensive surgery to treat uterine cancer, is experiencing several serious postoperative complications. She states: ‘I don’t know why all of these things are happening. I ask the doctors. So does my family. But we get no answers. We just want to know what is happening.’ The nurse is surprised to observe that not only does the surgeon not answer Rebecca’s questions, but that he also dismisses her fears without any explanation. The nurse would likely feel that the surgeon and medical team are not being faithful to their responsibility to address the patient’s questions and fears. Unless the nurse can effectively advocate for Rebecca with the medical team, her own ability to be faithful to Rebecca and accountable for her well-being will be compromised. In this scenario the ethical issue is situated in an omis- sion. What patient right was contravened in this situation? How could you use your knowledge of patients’ rights to ensure the questions from Rebecca Wright and those of her family are acknowledged by the treating doctor and answered appropriately? ETHICAL DECISION MAKING Two types of ethical problems commonly faced by nurses and midwives are ethical dilemmas and ethical distress. In an ethical dilemma, two (or more) clear moral principles apply but support mutually inconsistent courses of action. Ethical distress occurs when you know the right thing to do but either personal or institutional factors make it difficult to follow the correct course of action. You need sound analyti- cal skills and the ability to engage in ethical reasoning to resolve ethical dilemmas and ethical distress. Resources for ethical decision making are highlighted in Box 11-4. Making ethical decisions Every nurse and midwife needs to be confident in using a process of ethical decision making. Using the process of person-centred care to make ethical decisions involves fol- lowing the steps discussed below. The accompanying care study illustrates this model of ethical decision making (Box 11-5).

• Reflect on your own value system. What principle in the code that covers your country is the most mean- ingful to you? • Is there a value you believe is important for you that is not captured in the International, Australian or New Zealand codes? Now think about these questions: • Which ethical principles are involved in assessment of clinical practice standards? • How might the assessee’s moral judgement be taken into account in the assessment decision? • How might the underlying power structure inherent in the assessor/assessee relationship contribute to the assessment outcome? Should this be taken into account when making the assessment decision? Patients’ rights The principle-based approach to bioethics identifies auton- omy as the first principle in a list of four (Beauchamp & Childress, 2009), acknowledging the individual’s right to make choices based on personal values and beliefs. The rights of the individual to question the quality of their healthcare, and to have their personal views and beliefs about their health taken into account during the planning of their care, are supported in Australia by the Australian Charter of Healthcare Rights, developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC, 2012). This charter sets out the following rights for patients in the Australian health system: • Access to healthcare • Safe, high-quality treatment • Respect, dignity and consideration • To be informed about services, treatment, options and costs • To be included in decisions and choices about care • To privacy and confidentiality • To comment on care and have concerns addressed. Similar patient charters have been developed by state and territory governments (e.g. Patients’ Charter of Rights, Queensland Health, 2002). They are regularly audited for compliance through quality accrediting bodies such as the Australian Council of Healthcare Standards (ACHS). With care moving increasingly from the hospital to the commu- nity, nurses and midwives must be familiar with how different institutions and professional groups define patient rights and responsibilities. New Zealand also has a system dedicated to the preserva- tion and monitoring of patient rights. The Health and Disability Commissioner Act 1994 of New Zealand created the Office of the Health and Disability Commissioner, whose role is to promote and protect the rights of health and disability consumers. The office is also charged with the res- olution of complaints in a fair and timely manner. A national network of advocates implements the services under the Director of Advocacy and an independent prosecutor, the