Questions:
1.Describe your Practice dealing with an Ethical Dilemma encountered with a Mental Health and addiction Service User.
2.Write a reflection on your own Ethical Practice while supporting the two (2) Mental Health and addiction Service User.
An ethical dilemma: Privacy
The right of an individual towards confidentiality and privacy falls under the ethical principle of autonomy. There are four types of privacy including physical privacy, informational privacy, decisional privacy and proprietary privacy (Siriwardhana, Adikari, Jayaweera & Sumathipala, 2013). Confidentiality is a right to restrict the disclosure of the personal information. While providing mental healthcare to a Tangata Whai Ora mental health patient, I faced ethical dilemma of privacy and confidentiality. The patient has reported me certain information that is potentially harmful to himself or someone else and thus I faced dilemma as a service worker in reporting the information. Moreover, a psychiatric patient does not have a stable frame of mind for the information to be truthful. I faced ethical dilemma in reporting that sensitive information to doctor because the patient was not willing to share the same with the doctor. He has shared with me only out of sheer trust and believed that I won’t share the same information to anyone else.
Decision making process
In the domain of the disclosure of the information, patient’s autonomy is at times overridden by the ethical principal of justice and/or nonmaleficence, beneficence (DeKeyser Ganz & Berkovitz, 2012). In the decision making process, what I took as a reference is, information can be disclosed in the absence of the patient’s information only when the person are falling under a threat to themselves (non-maleficence) and when the information is in a need for providing quality care (beneficence). In my case, the information shared by the patients about his health status was misleading and has no connection with each other. This showed that the patient’s was in a complex state of mind and was unable to recollect the thoughts and hence I reported the same to the doctor via narrating his actual quotes. This I need only for the continuity of care of the patient (beneficence) (DeKeyser Ganz & Berkovitz, 2012).
Maintenance of boundaries in accordance with the wellness plan
According to the wellness plan, discussion of the issues in relation of the mental health service seekers must be done with the knowledgeable staffs for delivery of care in a safe manner (Arahura Charitable Trust, 2017). In this case, also the issues that are being experienced by the Tangata Whai Ora disclosed to the doctors as they are most knowledgeable person in the care model who will be successful in procuring quality care.
According to the organisational policies, all the staffs are legally restricted to respect the confidentiality and privacy of the Tangata Whai Ora (Kidd, Butler & Harris, 2013). This signifies that during the tenure of the work and even beyond the work hours they are required to abide by the privacy policies. In order to remain within the boundary of the organisational policies, I treated the patient with respect and did not discussed his details or personal issues in front of the unauthorised person. What I did is I discussed his concerns with the doctors and only for the betterment of his health. Doctors are the best person to provide quality care to the patients via accessing their present condition. Since it is not possible for the doctors to remain in touch with the patients 24X7, it is the duty of the associated service providers to convey the information to the doctors.
Discussion of ethical issues
The ethical issue at supervision can be described under the light of the beneficence and nonmaleficence. For the benefit of the patient, in order relief him from the mental complexicities, it is the duty of the nurse to listen careful to very information or stories that is being shared by the mental health patients. Moreover, the nurses are required to generate a strong relationship based on trust with the patients so that they feel comfortable in sharing the information. When it comes sharing the information to the patients to other healthcare professionals who holds higher position in term of hierarchy, the ethical dilemma of confidentiality or privacy can be breached on the grounds of nonmaleficence. The act of nonmaleficence means no harm to the patients and here the nurse is only sharing data with the doctors in order to prevent further mental harm to the patient (Kangasniemi, Vaismoradi, Jasper & Turunen, 2013).
Ethical issues in accordance with organization policies
Organizational policies maintain a strict rule of privacy and confidentiality concern when dealing with mental health patients. However, organization also assures quality care to the patients. In the grounds of providing quality care, a nurse can share confidential data to the doctors (included in the same health care team) in order to improve the therapy plan (Kangasniemi, Vaismoradi, Jasper & Turunen, 2013).
An ethical dilemma: Consent
The main ethical dilemma that is faced while providing support to the patients who are suffering from certain kind of addiction (drug or alcohol) is, respecting patient’s autonomy (Owonikoko, 2013). Principle of autonomy refers to the right of the individual to determine the kind of activities they want or will to participate. The principal of autonomy falls under the category of consent.
Decision making process
The main decision making process that is being used for resolving the ethical dilemma of autonomy while treating addicted patients is the theory of utilitarianism. According to this theory, utility must always be encouraged as the sum of all the pleasures from an action, minus any suffering of anyone involved in the action. So the principle of utilitarianism always highlights the sum of well-being and ignores any negativity that may arise while working in favour of the benefit (Grant, Kajii, Polak & Safra, 2012). I think, even if the addicted (drug or alcohol) Tangata Whai Ora is refusing to give the consent to participate in the addiction recovery service; the therapy can be applied beyond his or her consent. This is because, participation in the addiction recovery therapy, will actually help him or her to enter into a state of well-being. This quality of life will outnumber his or her negative approach in providing the consent in the long run.
Maintenance of boundaries in accordance with the wellness plan
In order to maintain the boundary of the support worker role in accordance with the organisational policies, I interacted with the Tangata whai Ora personally in order to know the exact reasons behind why he is refusing to participate in the addiction control wellness program (Holmes, 2012). What I elucidated that his concept of well-being is projected towards four basic pillars of life, as discussed in picture below.
Figure: Four Dimensions of Wellbeing
(Source: Hammell & Iwama, 2012)
After knowing the same, I tried to incline the effectiveness of the wellness programme to each of the four dimensions in life. I also tried to explain him how addiction control service will help him in stay under the good state of mental health, physical health and spiritual health and all these health status will in turn promote the family health (Hoge et al., 2-13). Thus via remaining within the boundaries of a support worker, I tried to earn the consent of the patient for his participation in the wellness program, without bridging the ethical theory of autonomy (consent).
Maintenance of boundaries in accordance with the organizational policies
As per the organizational policies, no patient can be forced or allowed to participate in a wellness program beyond his or her consent (Grady, 2015). So in order to remain within the boundaries of the organisational policies, I performed a counselling session with the patient. The counselling session helped in the identification of the dilemma which the patient is facing while participating in the wellness program. So via understanding the root of the problem, I acted accordingly, made him understand the benefit of the wellness program on an utilitarian approach and bridged the gap of autonomy (consent).
Discussion of ethical issues
The main ethical issues which are coming in supervision apart from the principal of autonomy is, the theory of libertarianism. According to this theory, there must a freedom for everything, like freedom of decision making, freedom of speech, freedom of gender equality and so on. However, the theory of egalitarianism states that there must be equality for all (Moreno-Ternero & Roemer, 2012). So under the light of the egalitarianism, the patient here also deserves quality care but is unable to receive the same on the grounds of autonomy and libertarianism. However, his concept of denial is not justified as he is unaware of the consequences of the addiction in his later stages of life so the counselling done during the supervision is justified and will help the patient for fast recovery.
Ethical issues in accordance with organization policies
Organisational policies give importance of taking consent of patient at every stage of the wellness and recovery therapy (Thiel, Bagdasarov, Harkrider, Johnson & Mumford, 2012). So in order to work in accordance with the organisational norms, the patient was counselled in order to obtain the consent and progress the treatment in an ethically correct manner
Reflection review
The main service goal for the support workers who are working for an organisation for the betterment of the mental wellbeing of the patient and addiction support regime will patient only. I feel the service workers must work in unison via applying proper ethical theories. They must always consider the wellness of a patient above anything, where contradiction of the ethical principles must also be considered. Moreover, it must also be taken into account that the ethical principals must never be bridged in the grounds of harming the patients. If the ethical principles are bridged only because of providing quality care of the patients then the act of bridging can be justified.
Reflection on ethical practices: Self evaluation
Practise approach should always directed towards the betterment of the patients and their health. I always try to emphasize that the patient must always receive quality care in order to improve their quality of life. My underlying attitude and philosophy is defined by the ethical theory of egalitarianism. According to this theory every person is entitled to receive quality care and should never be judged on other grounds which may lead to biasness. The grounds include financial, cultural, social, education and habits perceived by the patients. I examine a person solely as a patient who needs quality care for the attainment of proper health and well-being.
My personal values and believes state that the principal of beneficence and non-maleficence are interconnected. Beneficence deals with balancing the expected benefits of the treatment against the backdrop of the costs involved and the risk parameter. On the other hand, non-maleficience means avoidance of harm. Several treatments involve certain degree of harm; here the principle of non-maleficence would signify that the possible harm should never be disproportionate to the expected benefit of the treatment. However, abiding the principle of beneficence and non-maleficence may at times can cause harm to a person’s autonomy (in some circumstances) (Thiel, Bagdasarov, Harkrider, Johnson & Mumford, 2012). For example, it may be required to deliver treatment that is not expected to prevent the development of a future, more serious health related problem. The overall course of the treatment can be extremely unpleasant, uncomfortable or at times can be extremely painful. However, this might cast comparatively less harm to the patient than that would occur previously. So my self-evaluation tells me that my ethical mindset is more inclined towards the ethical principal of beneficence and non-maleficence.
Patient’s participation in the process of treatment decision, is the principal pillar of health care. This can be related to the highest levels of patient’s satisfaction, adherence to the treatment and improved health outcomes. The level of patient’s participation is the process of treatment decisions in dependent on the intrapersonal (patient’s characteristic) and interpersonal (communication styles between the patient and the care provider) (Morse, Salyers, Rollins, Monroe-DeVita & Pfahler, 2012). As per my evaluation, my communication style is strong enough in modulating the patient’s mindset, while making the patient to actively participate in the healthcare decision making.
References
DeKeyser Ganz, F., & Berkovitz, K. (2012). Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care. Journal of advanced nursing, vol. 68(7), pp. 1516-1525. 10.1111/j.1365-2648.2011.05897.x
Grady, C. (2015). Enduring and emerging challenges of informed consent. New England Journal of Medicine, vol. (9), pp. 855-862. DOI: 10.1056/NEJMra1411250
Grant, S., Kajii, A., Polak, B., & Safra, Z. (2012). Equally-distributed equivalent utility, ex post egalitarianism and utilitarianism. Journal of Economic Theory, vol. 147(4), pp. 1545-1571. https://doi.org/10.1016/j.jet.2011.04.001
Hammell, K. R. W., & Iwama, M. K. (2012). Well-being and occupational rights: An imperative for critical occupational therapy. Scandinavian journal of occupational therapy, vol. 19(5), pp. 385-394. https://dx.doi.org/10.3109/11038128.2011.611821
Hoge, M. A., Stuart, G. W., Morris, J., Flaherty, M. T., Paris Jr, M., & Goplerud, E. (2013). Mental health and addiction workforce development: Federal leadership is needed to address the growing crisis. Health Affairs, vol. 32(11), pp. 2005-2012. https://doi.org/10.1377/hlthaff.2013.0541
Holmes, D. (2012). Prescription drug addiction: the treatment challenge. The Lancet, vol. 379(9810), pp. 17-18. DOI: https://dx.doi.org/10.1016/S0140-6736(12)60007-5
Kangasniemi, M., Vaismoradi, M., Jasper, M., & Turunen, H. (2013). Ethical issues in patient safety: Implications for nursing management. Nursing ethics, vol. 20(8), pp. 904-916. https://doi.org/10.1177/0969733013484488
Kidd, J., Butler, K., & Harris, R. (2013). Maori mental health. Mental Health: A Person-centred Approach, 72. Cambridge University Press. vol. 1. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=FFtkAgAAQBAJ&oi=fnd&pg=PA72&dq=Tangata+Whai+ORa&ots=FqDhJGaxHB&sig=wXSqS13btQBpnPRqRtzZkL2-Puk#v=onepage&q=Tangata%20Whai%20ORa&f=false
Moreno-Ternero, J. D., & Roemer, J. E. (2012). A common ground for resource and welfare egalitarianism. Games and Economic Behavior, vol. 75(2), pp. 832-841. https://doi.org/10.1016/j.geb.2012.03.005
Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341-352. https://doi.org/10.1007/s10488-011-0352-1
Owonikoko, T. K. (2013). Upholding the principles of autonomy, beneficence, and justice in phase I clinical trials. The oncologist, vol. 18(3), pp. 242-244. doi:10.1634/theoncologist.2013-0014
Providing community based support for people experiencing mental health difficulties. (2017) (1st ed., pp. 9-26). New Zealand. Retrieved from https://www.arahura.org.nz/files/3113/7280/4874/Services_Users.pdf
Siriwardhana, C., Adikari, A., Jayaweera, K., & Sumathipala, A. (2013). Ethical challenges in mental health research among internally displaced people: ethical theory and research implementation. BMC medical ethics, vol. 14(1), pp. 13. https://doi.org/10.1186/1472-6939-14-13
Thiel, C. E., Bagdasarov, Z., Harkrider, L., Johnson, J. F., & Mumford, M. D. (2012). Leader ethical decision-making in organizations: Strategies for sensemaking. Journal of Business Ethics, vol. 107(1), pp. 49-64. https://doi.org/10.1007/s10551-012-1299-1
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