Beauchamp and Childress’ (1994) PDF

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190052687

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Personal and professional development

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HS1929

1,098

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“Describe Beauchamp and Childress’ (1994) ethical framework for healthcare. Outline the principles using examples to illustrate each one. Examples can be true life, from research or hypothetical.”

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September 2019, Year 1

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HS1929

Bioethics helps health professionals and public policymakers recognise moral dilemmas in health care. A code of public health ethics must emphasize positive rights and narrow the social inequalities among the populations. Duty of care comes under the legal concept of negligence which belongs to the domain of common law. A Common law is based on what is considered appropriate by society according to the situation, time and place yet not been an Act of Parliament passed. Beauchamp and Childress (1994) developed four pillars of medical ethics: Autonomy, Beneficence, Non-maleficence and Justice. These principles are intended to guide a healthcare staff while determining an optimal course of action according to the needs and desires of a patient. Autonomy In Western culture, autonomy has a range of different meanings such as “…self-rule, selfdetermination, freedom of will, dignity, integrity, individuality, independence, responsibility and self- knowledge” (Agich GJ, 2003). The principle of autonomy is usually associated with allowing patients to make their own decisions regarding their health care interventions. Beauchamp and Childress’ influential definition identifies autonomous decisions as those made intentionally and with substantial understanding and freedom from controlling influences. It is important that patients should be offered options and allowed to make voluntary choices as it protects some from unwanted interventions and support tools designed to facilitate patients such as decision aids. Research has found that making elderly people feel autonomous in their own care is central to their feeling of worth (Fetherstonhaugh D. et al., 2013) Thus, promoting autonomy is considered a key aspect of dementia care that also helps to empower and maximize their opportunities for self-actualization. However, a limitation of Beauchamp and Childress’ ethical framework is that they fail to consider those who are not competent to deliver autonomy. According to the Mental Capacity Act (2015), a person lacks capacity if he is unable to make a decision for himself in relation to a matter due to impairment, a disturbance in the functioning of the brain or mind. In such case, an adult over 18 or a parent with parental responsibility can give consent on behalf of the patient. Beneficence Beneficence addresses the principle of doing good and providing care to others (Berglund, 2007) with the moral duty of promoting well-being (Edwards, 2009). All actions of a clinician should abide by the ethical obligation to maximise benefit and refrain from causing harm. As a healthcare provider, one should act in the best interest of the patient and perform procedures with the intent of helping. For example, beneficence can take the form of a community nurse encouraging people to quit smoking, providing vaccinations within schools and raising awareness on STD preventions, all of which fall under primary care. According to the World Health Organisation (WHO), primary care practitioners must provide a wider coverage of health care, organise health services to meet health needs and responsible for the ongoing health of

their patients by preventing, diagnosing early and managing common health conditions. Such members work outside of the hospital and engage with the public in schools, workplace etc. The principle of autonomy often comes into conflict with beneficence. In the given situation where the nurse is asked to keep away the news of poor prognosis with the intention to protect the psychological wellbeing of the patient, has the potential to disrupt the trustworthy relationship built with the patient. In this scenario, healthcare professionals use paternalistic approach where physician makes decisions based on what they discern to be in the patient’s best interests. Non-maleficence Non-maleficence is an ethical principle that obliges one to not inflict intentional harm either physically, psychologically or emotionally. Traditionally, this is at the heart of medical ethics and part of the Hippocratic Oath, Primum non nocere. Healthcare members must identify potential risks and weigh them against the benefit to the patient prior to any treatment in order to avoid harm. Moreover, utilitarianism supports the idea of maximum benefits with minimised cost and risks (Mark, 2004). The professional duty of candour states: “Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress.” The Safford Hospital scandal that shamed the NHS failed to preserve safety, breaching the principles of NMC code, 2018. Hundreds of hospital patients died needlessly in the wards as people lay starving, thirsty and in soiled bedclothes with some receiving wrong medication or none whilst others’ cries for help went ignored. Non-maleficence was not achieved here by the nurses as between 400 and 1,200 patients died as a result of poor care over the 50 months between 2005 and 2009. Justice The principle of justice is sub divided into three; fair distribution of scarce resources (distributive justice), respect for people’s rights (rights based justice) and respect for morally acceptable laws (legal justice) (Gillon, 1994). An individual’s right to healthcare resources should not be affected by their age, sexual orientation, religion or race under the Equality Act 2010. The law also applies to prisoners as the Government stated that “prisoners should have access to the same range and quality of services appropriate to their needs as are available to the general population through the NHS” (DH & HMPS, 2001). Thus, in Britain justice is upheld within the National Health Service (NHS) that provides access to all citizens for free. The US however being the only industrialized country, does not have universal health care for all its citizens and instead relies on private health insurance. Research has found that income is the driving force behind the health disparities that many minorities experience. Between 2011 and 2013, 38% of those in households making less than $22,500 a year reported being in poor

or fair health (Health Affairs, 2020). The distribution of resources is done so on the basis of wealth and money as the US has not seen health as a human right, but as a privilege.

To conclude, Beauchamp and Childress’ (1994) ethical framework has been heavily implemented within the code of conducts such as Nursing and Midwifery council, General Medicine council and Society of Radiographers. The main rival for Beauchamp and Childress’s account, principlism, has consistently been casuistry who adapt to a case-based method of reasoning, particularly employed in business ethics and bioethics. Concerns have been raised over the difficulty associated with the quantification and conceptual overlap of the principles nevertheless Beauchamp and Childress have modified their view in successive editions of Principles of Biomedical Ethics. Thus admirably, the four ethical points continues to be widely acknowledged and discussed, both in practice and in the academic literature.

REFERENCE Beauchamp TL, Childress JF. Principles of biomedical ethics. 6. New York: Oxford University Press; 2009. Agich GJ. Dependence and autonomy in old age: an ethical framework for long-term care. New York: Cambridge University Press; 2003. Being central to decision making means I am still here!: the essence of decision making for people with dementia. Fetherstonhaugh D, Tarzia L, Nay R J Aging Stud. 2013 Apr; 27(2):143-50. S. 3 applied (1.4.2015) by The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (S.I. 2014/2936), regs. 1(5), 8(3) Retrieved from https://www.legislation.gov.uk/ukpga/2005/9/section/2 https://www.scie.org.uk/mca/introduction/mental-capacity-act-2005-at-a-glance Berglund, C. (2007) Ethics for health care. Third Edition. Oxford University Press: Oxford. Edwards, S.D (2009) Nursing Ethics: A principle-based approach. Second Edition. Palgrave Macmillan: Hampshire World Health Organisation (WHO) “Primary care” Retrieved from http://www.euro.who.int/en/health-topics/Health-systems/primary-health-care/primary-healthcare

Mack, P. (2004). Utilitarian Ethics in

Healthcare. International Journal of The Computer, the Internet and Management Vol.12No.3. Mack, P. (2004). Utilitarian Ethics in Healthcare. International Journal of The Computer, the

Internet and Management Vol.12No.3. Mack,P. (2004). Utilitarian Ethics in Healthcare. International Journal of the Computer, the Internet and Management Vol. 12 No.3 https://www.nmc.org.uk/standards/code/read-the-code-online/ http://www.gmcuk.org/Joint_statement_on_the_professional_duty_of_candour_FINAL.pdf_5814 0142.pdf https://www.cnwl.nhs.uk/about-cnwl/equality-diversity-inclusion/equality-act-2010/ http://www.ohrn.nhs.uk/resource/policy/SCMHMHandtheCJS.pdf Health Affairs. "The United States Leads Other Nations In Differences By Income In Perceptions Of Health And Health Care," Accessed Jan. 8, 2020....