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Deontological Theory

Deontological Theory maintains that the justness of an action dwells in its acquiescence to duty irrespective of the consequences of such action. Thus deontological ethics are against the concepts of utilitarianism or pragmatism (Deontology, 2005). Deontological theory follows rules in order to justify an action or policy instead of consequences. Immanuel Kant propounded this well known deontological theory in the eighteenth century. This theory is termed, after Kant, as Kantianism and refers to the significance of rules and duties and their prominence.

Kant strongly supported the rules inherent in this theory like abstaining from lies, adhering to the promises that one has made and not engaging in the act of killing others. Immanuel Kant considered these rules to be based on reasonable grounds. The fundamental rule established by Immanuel Kant states that one must do what one expects others to do in a similar situation. Thus all rules should comply with a categorical imperative and are unconditionally necessary (Deontological Theory). Kantians stressed the significance of leading a life governed by moral rules and laws.

The moral principle categorical imperative requires that moral rules should be capable of being rendered universal. Moreover, these rules should be applied to all rational, moral members of the community and not just to a select group or an individual. Human beings are ends in themselves and they are not the means, therefore, all persons should be treated as ends in themselves. While enacting laws there should be an active participation of members comprising the moral community. Furthermore, all members of the community should abide by these rules (Deontological Theory).

Non – malfeasance requires that the patient or individual participating in medical research should be protected from harm that may result from participation in any medical study (Faden RR, 1986). Fidelity connotes the trust that is generated between participants and medical researchers (Parahoo, 1997). Due to the overbearing nature of the patient medical professional relationship, many patients become participants in research and it is incumbent upon the researchers to afford the maximum possible protection to such participants.

Justice is another principle in this context, which requires researchers to give greater importance to the interests of the research participants rather than to the goals of the research (Parahoo, 1997). Veracity is akin to the principle of respect for freedom or autonomy and the non – disclosure of information that affects them infringes their freedom and constitutes a violation of the principle of respect for freedom (R, 1985c). Taking the consent of the patients for medical examinations and surgical treatment should be made essential because obtention of such consent comes under moral and legal obligations.

Patients are empowered to reject any medical care or medical practices to be performed on them even if they are wrong in avoiding such treatment or such rejection would place their life at risk. They have the absolute right to accept or reject medical care. A medical practitioner who fails to provide sufficient information to patients regarding their illness and its treatment would be guilty of indulging in an act that would be tantamount to clinical negligence. Thus the doctors should always provide adequate information about the illness and the proposed treatment procedure to the patients (Shaw, 2001).

In Re F (1990) 2 AC 1, the House of Lords examined the probability of sterilisation on the grounds of the interests of an incompetent adult female patient in order to prevent pregnancy. It considered that certain aspects in that case, such as the treatment and sterilisation were in the best interests of the patient, if the proposed sterilisation would save the patient’s life, bring about an improvement in the patient’s health and prevent the further worsening of the physical and mental health of the patient. These guidelines of the Court are applicable to every instance of medical practice (Re F, 1990).

However, the concept of best interests is more elaborate than that of a consideration of medical issues. The extant literature on ethics discusses the interpretation of best interests in great detail. In the event of providing a wide area interpretation for best interests, there is scope for considering the interests of individuals other than the patient. However, such a wide interpretation would repeal the best interests of the patients in the light of legal and ethical decision making factors (Ethical considerations).

In the case of Re Y, the patient was twenty five years of age. She was mentally incompetent and physically disabled. In her family, one of her three sisters had suffered from leukaemia. A bone transplant procedure was required in order to save her life. The plaintiff, Y, was the only donor whose bone marrow was best suited for her sister. The Court held that Y, wanted to donate bone marrow to her sister, which would come under her best interests in doing so, despite the fact that such transplant would not provide any benefit to the plaintiff therapeutically.

The risk involved in this procedure was negligible to the plaintiff. The Court considered in its holding that the best interests in the case were Y’s emotional, social and psychological interests. Had she refused to donate bone marrow, her sister would have undoubtedly expired. Y’s mother would be required to take care of her sister’s child, which would result in Y’s mother being unable to visit Y who was in the nursing home (Re Y, 1996). In the field of Community nursing practice, the issue of Nurses’ Prescription has been contentious.

This issue has been in existence from a considerable period of time. In the year 1991, the legal process to implement changes in this area was initiated due to Rogers Sims, MP, who introduced a private members bill in this context. The culmination of these efforts was the passage, in 1992, of the Medicinal Products: Prescription by Nurses etc. Act that helped to modify the 1968 Medicines Act and the 1977 NHS Act. It was recommended to permit nurses to prescribe under three categories, namely:

First, making out prescriptions on the basis of a list of medicines that could be prescribed by them and such prescribing was to be done by either the district nurses or health visitors. Second, to prescribe within a group protocol, which implies that nurses who provide care in surgery or who advise in continence cases could prescribe drugs that pertained to the specific area of treatment that they dealt with. Third, empowerment to change the quantity and time of administration of drugs, strictly within the protocol that would be patient specific.

It was also held that nurses who cared for diabetics, MacMillan nurses or community mental care nurses could under some explicitly defined circumstances prescribe drugs to patients. It is essential to use the available medicines correctly; otherwise they would not be of much advantage to the patient. Moreover, incorrect medication could result in serious and even critical side effects, which is the bugbear of allopathy. Any nurse who is guilty of either failing to take cognizance of adverse reactions or of prescribing medicines in an inappropriate manner is liable for civil and criminal action.

In such cases they could be accused of having exhibited malafide intent and negligent behaviour. Clause 7 of the code of conduct for nurses requires them to attend to patients regardless of their ethnicity, religious denominations, the disease from which they are suffering, etc. Furthermore, this code of conduct establishes the ethicality of the treatment to be accorded to patients by nurses (The Code of Professional Conduct and Scope of Professional Practice documents, 1992).

Consequently, nurses cannot provide inadequate treatment, on racial grounds, to patients afflicted with dread diseases like hepatitis B and AIDS. Some scholars have adduced informal proof that treatment based on such precepts has been of immense help to patients as it has reduced the travelling and waiting times and has also provided timely treatment (Alderson, 1995). Accordingly, it is mandatory for community nursing to foray into this novel area and such a venture requires the acquisition of research critique and analytical skills.

Furthermore, a further enhancement of competence levels is to be attained so as to serve the interests of the patients in a much more comprehensive manner. It would be wrong to assume that such a course of action is nothing more than legalising extant practises, because of the accountability involved in discharging their duties in a legal and ethical manner, which is a neoteric development. Moreover, nurses are governed by the Code of Professional Conduct, in respect of the manner in which they deal with their patients and it is mandatory for them to develop and protect the interests of patients.

The foundation of health care is to better the health of the patient and to refrain from causing them harm (Faden RR, 1986). The objective of any form of medical research should be to better the lot of not only individuals but also society at large (Parahoo, 1997). However, no research should engender social benefit at the cost of the individual. The implication of this is that patients who are made to participate in any research programme should not suffer as a consequence (Faden RR, 1986).

It was categorically established that the medical care accorded to patients had to conform to what common medical opinion would construe to be fitting to their medical status. Moreover, medical professionals were required to exercise adequate care in the discharge of their duties. Medical treatment should not infringe an individual’s freedom, further it should not affect that person’s physical or mental integrity. Accordingly, in Mallette v. Shulman, the plaintiff, a Jehovah’s Witness, who was administered blood transfusion to save her life, brought a battery action against the defendants.

This action was allowed by the trial court and upheld by the appellate court. Consequently, patients can choose which treatment to accept and can even refuse to accept treatment that could save their life (Malette v. Shulman et al, 1990). There are several occasions wherein the court is unable to decide whether a defendant was negligent, due to insufficient evidence. Thus in Ashcroft v. Mersey the defendant was given the benefit of doubt and not held to be guilty (Ashcroft v. Mersey Regional Health Authority , 1983).

The rule established as a consequence, was that no negligence was involved in choosing one course of treatment over another, provided both courses of treatment were considered to be valid by the medical profession. Therefore, in Maynard v. West Midlands a patient with two diseases was treated for the more critical of them resulting in damage to the left laryngeal nerve. The court opined that if such a line of treatment was supported by a competent body of medical professionals then a claim for legal damages was untenable (Maynard v. West Midlands Regional Health Authority , 1984).

In Wilsher v. Essex HA the appellate court opined that a nurse could not exhibit the same competence as a consultant and that a junior doctor’s professional capability was objective and independent of the defendant’s status or personal status (Wilsher v Essex Area Health Authority , 1988). John a newly-qualified staff nurse is employed in the acute psychiatric unit, which is chronically under staffed. There has been a gradual increase in the amount of drugs being administered to acute manic patients. John administered these doses without consulting the patients.

Moreover, John is convinced that the enhanced dosage makes it easier to control patients. However, a number of patients showed severe side effects due to the increase in the dosage. As per the decisions in the following cases based on the Bolam and Bolitho tests, John is not liable for any legal action, since he is a newly appointed nurse and had merely followed the existing medical practices. These practices required the administration of over doses of drugs to control the mental patients’ aggressive behaviour. As such John has not committed any act of medical negligence.

Relying on the Bolam and Bolitho cases John has not infringed the principle of standard of care. In the Bolam case it was decided that the principle of standard of care was not breached if a responsible body of similar professionals supported the practice that resulted in the damage. In practice, several choices are available to doctor who is treating a patient and in the Bolam case it was opined that the choice of even the least popular of such options was not tantamount to medical negligence if supported by sufficient number of personnel of the medical fraternity (Bolam v Friern Hospital Management Committee, 1957).

Similarly in the Bolitho v. City and Hackney their Lordships held that there was no unreasonable behaviour exhibited by the doctors who had failed to attend upon a child suffering from labored breathing, due to the fact that even if they had attended to that child they could not alleviated its misery (Bolitho v City and Hackney Health Authority , 1997). Morally, John cannot justify his actions, because after analysing the theories specified above, it becomes evident that John prescriptions aim to reduce the problems attendant on the availability of a lesser number of staff and is in no way beneficial to the patients.

Moreover, the overdose of drugs had caused severe adverse side effects in the patients and John has been persistent in administering such overdoses, despite being aware of these adverse side effects. Most of the moral theories, pertaining to the best interests of the patients in contrast to the interests of society, state that any administration or withholding of treatment to individuals who cannot decide for themselves has to be done with their best interests in mind.

Moreover, nurses are governed by the Code of Professional Conduct, in respect of the manner in which they deal with their patients and it is mandatory for them to develop and protect the interests of patients. The foundation of health care is to better the health of the patient and to refrain from causing them harm (Faden RR, 1986). The objective of any form of medical research should be to better the lot of not only individuals but also society at large (Parahoo, 1997). However, no research should engender social benefit at the cost of the individual (Faden RR, 1986).

Therefore, John is guilty of professional misconduct, since he had not adhered to any of the guidelines established by the Code of Professional Conduct. Furthermore, he had breached the principles inherent in the Code of Professional Conduct by harming the patients without their consent. References Alderson, P. (1995). Consent to research: the role of the nurse . Nursing Standard , Vol. 9. Pp. 28 – 31. Ashcroft v. Mersey Regional Health Authority , 2 All ER 245 (1983). Bolam v Friern Hospital Management Committee, 2 All ER 118 (1957). Bolitho v City and Hackney Health Authority , 4 All ER 771 (1997). Deontological Theory. (n. d.

). Retrieved September 17, 2007, from UK Clinical Ethics Network: http://www. ethics-network. org. uk/educational-resources/a-practical-guide-to-clinical-ethics-support-2/section-c/? searchterm=kant Deontology. (2005). Retrieved September 16, 2007, from In The Hutchinson Unabridged Encyclopedia including Atlas: http://www. credoreference. com/entry/6420599 Ethical considerations. (n. d. ). Retrieved September 17, 2007, from UK Clinical Ethics Network: http://www. ethics-network. org. uk/ethical-issues/conscent/ethical-considerations Faden RR, B. T. (1986). A History and Theory of Informed Consent . Oxford: Oxford University Press.

Malette v. Shulman et al, 72 O. R. (2d) 417 O. J. No. 450 Action No. 29/88 (Ontario Court of Appeal March 30, 1990). Maynard v. West Midlands Regional Health Authority , 1 WLR 634 (1984). Parahoo, K. (1997). Nursing Research: Principles, Processes and Issues. London: Macmillan. R, G. (1985c). Deontological foundations for medical ethics. British Medical Journal , Vol. 290, Pp. 1331 – 1333. Re F, 2 AC 1 (The House of Lords 1990). Re Y, 35 BMLR 111 (The House of Lords 1996). Shaw, M. (2001). Competence and consent to treatment in children and adolescents . The British Journal of Psychiatry , Vol. 7 Pp. 150 – 159 .

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