Analysis of an Ethical Dilemma - Working in the Antenatal Clinic - Essay Example

?Analysis of an Ethical Dilemma During my second placement in the first year, while working in the antenatal clinic a thirty years old client came for a regular visit. The midwife present at the clinic met her in a very warm manner. The client's pregnancy had entered the 40th week by that time and she was willing to get the baby delivered within the next two days due to reasons of convenience for family event. The midwife who had already examined her and was satisfied with her overall health condition, immediately offered her services for a sweep and told her how expert she was at doing this procedure. Since the client was not willing to undergo IOL, the option of a sweep appeared attractive. The midwife briefly explained the procedure to the client and told her that the procedure will be stopped immediately if the client is uncomfortable with it. The client agreed to the procedure, and after she gave her consent I helped her take-off her bottom part of clothing before she climbed the examination couch. When the client was ready for the procedure, the midwife performed a vaginal examination. I noticed that the gloves she was using were not non-sterile. I felt that this was not in accordance with the standards of hygiene. A few moments later, the midwife commenced the procedure. I noticed that this was considerably discomforting for the client and only a few moments after the procedure had started, the client was screaming out loudly and begging the midwife to stop immediately. To my utter surprise, the midwife totally ignored the client's request and continued with her medical procedure against the woman's verbal and physical objection. I noticed the client being tearful and pushing the midwife away begging her to stop; yet the midwife responded by climbing up on her to continue with the sweep as she was not considerate of the client's requests. I clearly saw how the client's will was utterly neglected by the midwife; yet being a new student I was not aware of my responsibility at the point and did not know how I should have responded. Feelings As I was new to the setting, I was a keen observer of the incident since I am not very comfortable in new situations. I was thinking and expecting that the midwife will guide her through the process of learning new things during my stay there. Contrary to my expectations, the midwife bypassed all the rules and regulations and in doing so made me feel helpless and confused, not ready to accept what was really going on before my eyes. When the client agreed to the procedure, I was expecting that she has been told enough about the expected discomfort of the procedure and that she will react in a less apprehensive manner. But when the patient screamed with pain, I felt that she was not prepared for this level of discomfort, or perhaps the midwife hid the details of the procedure regarding the aspect of pain. The midwife's reaction to the client's complaint was beyond my comprehension capability. She was the one who explained the procedure to the client herself; and later on, it was the same midwife who failed to respond to the client's requests for mercy. Moreover, she met the client as a friend when she arrived and later on she failed to prevent her from infections since she used non-sterilized gloves for examination. Overall, the outcome of the procedure was such that I failed to learn anything new about the procedure; instead I learned a lot about the ought-nots of the ethics. Evaluation Decision making model Knowledge of ethical aspects is a legal requirement in UK for pursuing a career in nursing or social work (Icheku, 2011). For this reason it seems logical to base my decisions on a standard framework of ethical principles. The Gilbert’s framework used for ethical decision making is depicted below (Gilbert, 2011); a) Recognizing the ethical issue: The issue that was identified relates to the autonomy and safety of the client. The issue involves the choice of a pathway that is legally and ethically acceptable or otherwise. b) Getting the Facts: The relevant facts of the situation are well understood by me and as I'm well informed I find myself capable of making a decision. In the given scenario, the safety and autonomy of a patient is at risk and so I would consider that the patient's interest is at stake. c) Evaluation of alternative actions: The various available options can be explored based on different ethical approaches. The utilitarian approach helped me choose the pathway which produce maximum happiness. The rights approach helped me determine the rights of all who are at stake. The justice approach assisted me in finding a pathway to treat all equally in every aspect. The common good approach guided me in finding a pathway to serve the community. d) Making and testing decisions : After considering the above mentioned approaches, I find it attractive to choose the utilitarian approach to base my decisions upon as it will not only allow me to bring improvement in my work, but will also serve to focus upon the ultimate outcome of the whole process. e) Act/reflect on the outcome: Based on my decision, I have analyzed the situation at hand and I have found that the utilitarian approach is the most suitable for this scenario. Utilitarian theory Often considered a form of consequentialism, the utilitarian point of view stresses the need of achieving greater happiness as a result of our actions (Barrow, 1991). In the view of John Stuart Mill, there are a number of subordinate rules which if followed with care may bring about the happiness that is expected. These rules include keeping promises, abiding by the law, avoiding cheating and stealing (Draper and Frith, 2004). These rules which are nothing more than commonsense morality may be used to weigh this situation in the light of utilitarian concept (Johnstone, 2009). First and foremost is the notion of keeping promises; the midwife failed to keep her promise of withdrawing herself from action when the patient demanded the procedure to be stopped. This failure to keep the promise is ethically unacceptable (Jones, 2000), and it was for this reason that the patient lost trust in the midwife altogether which was manifested by the client pushing the midwife away from her. As far as the aspect of following the law is concerned, here again the midwife failed to fulfill the expectations. Once the consent for procedure is withdrawn, the law does not allow touching of client's body, no matter what the intentions. Here again, the midwife failed to follow the ethical and legal standards. Furthermore, during the start of the incident the midwife introduced her sweeping skills in a way that allowed the client to bestow her trust on the midwife as an expert. However, during a later stage, the client realized that she had made a mistake by allowing the inexperienced and unethically working midwife to perform a procedure. This cheating is ethically unacceptable and keeping in view the utilitarian view, cannot be bring happiness in the end (Ha?yry, 1994). Deontological argument In contrast to the utilitarian theory, where consequences are directly related to one's actions, the deontological ideology focuses on the duties of individuals without given any importance to the consequences of actions (Veatch, 1997). Therefore, according to this viewpoint telling the truth is a duty which should be followed even if the potential harm of telling the truth outweighs its benefits in the end (White, 2001). Law According to law, any touching is unlawful if done without the permission of the person. Individuals have the right to determine the purpose, nature and intent of touching and any unlawful touching is actionable even if carried out with best motives (Griffith & Tengnah, 2010). In the given scenario, although the client allowed the midwife to proceed with the procedure, the client was not satisfied with the procedure later on, so she demanded the midwife to stop. It should be kept in mind that consent is a continuous process – it can be provided or taken-back by the client at any time during the procedure (Kleinman, 1991). Moreover, 'informed consent' is not required in the UK law (Jones, 2005); even in this scenario the consent provided was 'implied consent'. Since the midwife failed to comply with the demand of the client, her carrying-on with the procedure falls under the category of unlawful touching which is therefore actionable by law (Simmers et al, 2009). Duty of care to the woman In the words of Lord Judge Atkins 'you must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbor…'(Gostin, 2008). Generally speaking my duty of care involves the aspects of fidelity, reparation, gratitude and non-maleficence (Beauchamp and Childress, 2009) Keeping in view the situation, it can be said that although I did not act to incur harm to the client, yet my quiescence can be regarded as a mistake of omission. Despite knowing that the midwife was committing mistakes one after the other, I failed to intervene to stop her from doing harm to the client. My duty of care demands that I should have taken measures to stop the midwife from doing harm to the client. So, when viewed retrospectively, my omission equates to negligence as it was my failure to act which resulted in harm to a patient (Kennedy, 2009). Analysis Overall, the experience was a mixture of pleasant and unpleasant happenings. The midwife's way of greeting the patient was appropriate. The midwife performed the routine examination in a professional manner and the client was happy and satisfied till that time. Her expertise in establishing rapport with the client was beyond ordinary; this was reflected by the fact that the client was very comfortable with the midwife in the start and discussed her concerns without any hesitation. The later happenings were however not satisfactory and it appears that the midwife tricked the client into believing that the midwife was an expert in performing the said procedure. Moreover, the patient's right to abort a certain procedure due to inconvenience was forfeited due to the paternalistic behavior of the midwife (Raynor, 2010). The pain and misery felt by the client was not given due consideration and the only intention that appeared to prevail throughout the procedure was to complete the procedure at any cost. Conclusion The given scenario was judged based on ethical and legal basis. The findings reveal that there are a number of basic rights of individuals that should be kept in mind by all the health care providers at all levels. These rights are not only ethically accepted, but are also conferred upon individuals by the laws of country. Midwives are responsible for safeguarding these rights of individuals and this is only possible if they have a sound knowledge regarding the ethical and legal issues of individuals' rights. The given scenario depicts an exemplary setting where the right to autonomy of a patient was violated by a midwife; and the quiet bystander failed to intervene due to lack of experience and confidence. Such actions can have legal implications and it is therefore mandatory for midwives to understand the delicate nature of care that is expected from them in their professional practice (Foster & Lasser, 2011). Action plan Responsibility as a bystander and future recommendations Negligence in legal terms considers the errors of omission as crimes. For this reason, there are a number of responsibilities that should be fulfilled by health care professionals even if they are not the direct participants of a procedure. My action plan in future would consist of the following; a) Staying prepared to assist the patient in getting ready for the procedure b) Informing the patient about the expected level of pain and how to cope with it in order to minimize the discomfort c) Informing the client about the duration of procedure d) Informing the client about any possible complications e) Gaining an informed consent prior to the start of procedure (NHS, 2012). f) Staying prepared to call for help; should an incidence of trespassing occur. g) Reporting such incidents to authorities to prevent the occurrence of such procedures in future. (Thomasma & Kushner, 2001) References Barrow, R. (1991). Utilitarianism: A contemporary statement. Hants, England: E. Elgar Pub. Co. Beauchamp, T. L., & Childress, J. F. 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