Ethical Dilemma Faced by Midwife and Deontologist from Three Different Perspectives - Essay Example

Introduction The ethical issues involved in the patients’ consent regarding their treatment have increasingly become a critical factor within themedical and health industry. The consent of the patients has emerged as important issue that shows patient is aware of the pros and con of the treatment and gives his/her consent accordingly. The ethical considerations facilitate proactive participation of the patient in his/her treatment. It ensures that patient is able to make empowered decisions based on informed choices and exercise his autonomy to decide about his own welfare. But ethical dilemmas often occur as the autonomous decision of patient, regarding his/her treatment, may clash with the opinions and perspectives of the healthcare providers. In the current case of Grace, ethical dilemma has risen due to her decision for a water birth rather than birth from induction method. The paper would therefore analyse ethical dilemma as faced by midwife and as deontologist from three different perspectives using model of reflection and model of decision-making. 2. Analysis of ethical dilemma The three major objectives that are weighed in the dilemma and impact decision-making process are: patient’s past experience; patient’s welfare and autonomy; and foetal rights. 2a. Ethical dilemma faced as midwife Autonomy of patient is crucial aspect of treatment that is undertaken as per the consent given by him/her. In the case, Grace is undergoing second pregnancy and has signed a contract with a self-employed midwife to provide care for the entire pregnancy period, including post-natal period. She has opted for a water birth because of her traumatic experience in her first pregnancy where she had undergone induction of labour. At that time, she had number of complications like long hours on a syntocinon infusion, prostaglandin and artificial rupture of membrane, primary postpartum haemorrhage etc. Moreover, despite having epidural for pain management, she was also exposed to several vaginal examinations that had adversely impacted her physiological and emotional well-being. These were key issues that had influenced her current decisions for a water birth. But Grace is faced with serious health problems in the 40 weeks’ gestation. As a midwife, the major dilemma faced is Grace’s decision for water birth when it is clear that it would endanger the life of the foetal and also may have serious consequences for the mother. As an independent self-employed midwife who is under contract with Grace, the contractual restrictions that may influence the autonomy of patient pose serious dilemma for midwife as a healthcare professional (ICM, 2008). The professional relationship with Grace is based on mutual trust rather than authority (Fleming 2000; Levy, 1999). It is a partnership where the patient is in control of her treatment rather than the midwife (Pairman, 2004). This is unique aspect of professional code of conduct for midwife in New Zealand that shifts the power balance to the patient who can only act as support. But at the same time, it is also true that relationship forged with patient as midwife also conforms to the shared traditions with women and midwife that are practiced within the wider precinct of feminist theory (ICM, 2008). The relationship itself is therefore based on ethical considerations that are mutually beneficial and provides the midwife with rights to intervene when the health of the partner is threatened. Thus, as a midwife, I would act as a health advocate and inform the patient with the pros and con of the induction of labour and why it is a better option at this stage. Moreover, Foetal as independent entity is contentious issue because though in medico-legal term, foetus acquires full legal status and protection only if it is 24 weeks and above, in New Zealand, foetal is not recognized as an independent entity till after it is born alive (RCOG, 2010; Draper, 2004; Dickens & Cook, 2003). Plomer (2005) further clarifies that in early weeks, foetus’ life is dependent on the mother’s rights and interests. But there are evidences to contrary from the behaviour of Grace who is constantly assessing the health of the baby in the routine check-ups. The baby in the foetal has therefore emerged as important part of partnership between the midwife and Grace. The dilemma occurs when as a midwife, I am faced with the option to choose between the foetus and the mother who is in 40 weeks’ gestation and is having health problems. As my professional code demands that my support remains with the patient, I would support Grace to follow the treatment that would be best for her health and also for the best outcome of her pregnancy. The challenges of ethical considerations become real in situations when autonomous decisions of patient clash with the views of healthcare providers. Respecting the autonomy of patients is integral part of effective healthcare delivery (Frith & Draper, 2004). But autonomy of patient becomes effective only when he/she is empowered with relevant information and knowledge which is used in making informed decisions. Social support is also important and patients must be empowered to determine the type of social intervention they want and relevant information must be provided by the nurse (Finfgeld-Connett, 2005). As a midwife, I would not only keep her updated with the details of her health status but also support her during her pre and post-natal period, whatever her decisions regarding labour delivery. Looking back to the Grace’s traumatic experience of her last pregnancy, I agree that Grace’s decision for a water birth was right as it would facilitate her healing, both emotionally and physically and help her in overcoming the trauma of previous pregnancy. But at the same time, changing health status in the 40th week necessitates new decisions that would safeguard her health. Reflecting back on our relationship, I believe that it is a partnership which is based on trust and sharing of information. Consequently, I would disseminate essential information so that she can make the right decision based on informed choices (NMC, 2008). This would be ethically right because I not only have duty towards the patient but also towards my profession that calls for wider intervention which would impact the welfare of the patient as well as for foetus who has developed its own life. I would therefore, recommend induction of labour which would significantly reduce risk to the health of Grace and balance the risks to unborn child. But if information fails to convince the patient, I would ensure that patient signs a disclaimer regarding her decision to refuse induction of labour and continue to support her in bearing the consequences of her decision. 2b. Ethical dilemma as deontologist As a deontologist, I have a duty to satisfy the needs of my patient and look after her welfare. The consequences become irrelevant on the wider context of patient’s needs and requirements. Veracity becomes important factor within medical field as it helps to disseminate correct information to the patients so that they can make decisions based on informed choices. Though Grace’s initial choice of a water birth was right but the changing circumstances of her health in the 40th week require reassessment of the situation and fresh decisions regarding treatment. I would discuss the pros and con of the current pregnancy treatment as well as the importance of induction of labour. I will leave the final choice to the patient but would encourage her to make decisions regarding induction of labour that would considerably reduce risk to her health and increase chances of safe delivery. Deontology highlights duty and rational decision making that is based on informed choices and actions that are deemed good. The principles of deontology emphasize that decisions must be based on the circumstances and not on the consequences (Beauchamp & Childress, 2009; Jones, 2000). As such, deontological ethics are reflected in the fulfilment of an agreement or other duty or right which are linked to interaction with others. Emmanuel Kant’s principles of deontology encompass categorical imperatives that propose rules of Rules of Universality; and Rules of Respect. Categorical imperatives basically emphasize moral obligations of individuals (2004). He asserts that people at all times must act appropriately and respect the rights of others because well-being of others is as important as our own welfare. Thus, one must act in manner that he/she would expect others to act towards oneself. As such, the welfare of Grace is major concern and I would empower her with relevant information so that she can make rational choice that would not only take into consideration her own well-being but also ensure the safety of the unborn child. I would therefore inform her that the best choice would be to go for induction method of labour as it would reduce risk to her as well as to the child. Kantian ethical theory is widely respected and used by others as it has universal appeal and fundamentally relies on truthfulness. Kant has espoused the concept of categorical imperatives because they encourage actions based on rational decision-making. It is important that individuals need to be treated not as means to end but as an end itself so that mutual respect could be develop to forge constructive long-term relationship. This is hugely critical aspect in the healthcare industry, especially between the patient and the midwife or nurse. The relationship is strengthened when patient is well informed about the pros and con of the treatments and his/her autonomous decisions are backed by the healthcare providers. It calls for accountability based on our ethical obligations and as a deontologist, I would therefore encourage Grace to reassess her decisions and opt for one that would reduce risk to her health. Principles of deontology also promote relationship based on sharing of critical information. Autonomy of patients and their consent in the treatment therefore is important issue within effective healthcare delivery. Consent needs to be voluntary, competent and based on informed choices (Freegard, 2007). Thus, consent to the treatment must be given voluntarily without any external coercion including financial inducement, familial or emotional pressure etc. (NHS, 2012). At the same time, it must be ensured that the consent is given by patient who is competent and empowered to decide about himself/ herself. In the case, ethical dilemma has emerged as the consent to the right treatment is withheld voluntarily and it makes it difficult for the healthcare providers to act in the manner that would benefit the patient and reduce risk to her health. I would ensure that patient is informed in details about the risks of a water birth and advantages of induction of labour at this stage and recommend the later for safe outcome of pregnancy. Ethics of Utilitarianism can also be applied in the case. Utilitarian ethics defines actions based on their consequences. Thus actions that produce maximum happiness for maximum number of people would be considered good. Bentham’s utilitarian philosophy emphasizes morally justified actions which results in the benefits of others (Rosenstand, 2002). The end justifies the means. Looking from the broader perspective of ethical considerations, good health and safe delivery of child is important factor for Grace to agree for induction of labour. She has developed health complications like hypertension and rising uric acid level that are associated with perinatal morbidity and mortality and risk to foetus which could be relatively balanced with induction of the labour (Gilbert & Harmon, 1998). This necessitates change of decision that could lead to improved outcome of the pregnancy. The principle of beneficence and non-maleficence also support the concept of consequences of treatment that would benefit the patient (Beauchamp & Childress, 2009). Since the providers are better equipped with more knowledge about the treatment, this may result in paternalism and violate the autonomy of the patients. But, the end objective of reducing risk to the health of the patient is important consideration for overriding the wishes of the patient. Hence, as a deontologist, I would ensure that she changes her decision for this option. 3. Conclusion Ethically delivered healthcare involves morally and ethically correct practices that encourage dissemination of information regarding pros and con of the treatments. It help ensure that conflict of interest do not obstruct effective delivery of healthcare. More importantly, it makes sure that patients are fully informed and health providers do not violate the personal dignity or autonomy of the patients while discharging their duty. Reflection is important part of midwife as shared information is rationally used for the benefit of the patient. Moreover, it is vital part of effective decision-making process that helps to combine our practical experiences with the theoretical. In the case, personal experience and personal value system greatly helped to make ethically correct decision regarding methods to be used in labour. Promoting the cause of induction of labour was found to be the best option because it incorporates the health complications and would benefit the patient by reducing the risk to her health. (words: 2135) Reference Beauchamp, T L., & Childress, J F. (2009) Principles of Bio-medical ethics, 6th edition, Oxford: Oxford University Press. Dickens, B., & Cook, R. (2003) ‘Ethical and legal approaches to ‘the fetal patient’’, International Journal of Gynaecology and Obstetrics, vol. 83, pp. 85–91. Draper H (2004) ‘Ethics and consent in midwifery’, in L. Frith and H. Draper (eds) Ethics and Midwifery: Books for Midwives, London: Elsevier. Finfgeld-Connett D. (2005) ‘Clarification of social support’, Image. J Nurs Scholar, vol. 37, no.1, pp. 4-9. Fleming V. (2000) ‘The midwifery partnership in New Zealand: past history or a new way forward?’ in M. Kirkham (ed.) The Midwife-Mother Relationship, Basingstoke: Macmillan Press. Freegard, H. 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