The Utilitarianism Ethics Perspective

The ethical issue that arises in this case is whether;

1. Arthur’s actions towards his wife Nancy Johnson have the effect of causing maximum pleasure and the greatest happiness and minimizing pain.
2. There was a categorical imperative for Arthur according to Kantian Ethics to tie his wife and lock her up in the toilet.

The first issue is related to Utilitarianism Ethics.  According to utilitarianism an action is regarded to be right or wrong based on the consequences it has on an individual. Ideally, an action is regarded to ethically sound if it causes maximum pleasure and minimal pain on an individual (Mill, 2016).  Further, the action must be able to cause the greatest happiness. This is the ultimate measure of the ethical behavior that is expected from an individual. Proponents of utilitarianism contend that human beings should focus on making the world a better place by promoting happiness, increasing the pleasure on the individual and minimizing the pain (West, 2004). Ideally, utilitarianism proponents contend that an ethical action is one that avoids causing harm to an individual. The principle of utilitarianism supports the view that actions that cause los of life, loss of freedom promote pain and suffering are therefore not accepted ethical practice because they o not promote happiness and pleasure.

It can be agued that Arthur’s action does not meet the ethical standard according to utilitarian theory. This stems from the fact that the consequences of his actions caused more pain and suffering to his wife Nancy Johnson rather than causing pleasure and happiness. Arthur caused pain and suffering to his wife by tying her on the bed and locking her in the toilet. Such actions are not pleasurable because they deny ones freedom. In addition, it is a cruel and inhumane way of treating an individual who is need of medical attention.

The second issue is related to Kantian ethics. Kantian ethics is premised on the deontological moral reasoning which provides that the moral soundness of an action is not determined by its consequences but by whether there is an inherent duty act (Kant, 2012).  Immanuel Kant refers the inherent duty to act as a categorical imperative. According to Kant a categorical imperative is the most valuable ethical principle that should guide an individual’s rational thinking to determine what is morally right or wrong (Korsgaard, 2005).  A Categorical imperative is an action that should be carried out unconditionally even thought there may be resistance.  Further, it must be any action that is capable of being applied universally. Kant depart from he utilitarian view that suggest an action is morally right if causes maximum pleasure and the greatest happiness (Kant, 2012).   To him an action is morally right if it flows from a categorical imperative (an inherent duty to act even if it may cause pain and suffering.

Arthur’s actions may not be a categorical imperative because his actions cannot be applied universally. By tying his wife on the bed and locking her in the toilet he took away the dignity of the wife as a human being. Tying up an individual on the bed in the toilet may also be a necessary action so that Nancy would cause more havoc, destruction and disturbance. Such an action could also be applied universally especially to people who are mentally handicapped. In many cases such people who suffer rom extreme mental cases are subjected to solitary confinement if they pose a threat to property and could harm other human beings. Although the actions of Arthur may have caused pain and surfing to his wife, this immaterial according to Kantian ethics because he had an inherent duty to tie his wife in the toilet especially when she was about to daub faeces on the wall.

The Kantian Ethics Perspective

The ideal rule in the nursing profession is that a nurse must take his patience the way they are an must not question any particular issue facing the patient (Walker, 2003). This implies that a nurse has an obligation not to form pre-conceived negative opinions about the condition of a patient even if it is critical. Atkins et al, (2017) argues that The primary role of a nurse is to promote the health and well-being of a patient under his care.  According to value statement 1 of the Code of Ethics nurses have n obligation to respect the individual needs and the level of vulnerability of a patient under their care. As such they should not discriminate upon the patient based on his o her health status, disability or age.  They should allow the participation of significant others such as family in the care of the patient.

According to Value Statement 3 to the Australia Nursing Council (ANC) code of ethics for nurses in Australia have to focus on providing quality nursing care for all persons. For a nurse to achieve quality care nursing he or he must be competent and ensure that he practices his skill and knowledge within the accepted scope of practice. The nurse in Arthurs case has an obligation to provide quality nursing care. However, quality nursing care does not include locking up Nancy in the toilet.

According to Value Statement 5 nurses have an obligation to remain accountable and responsible in their role. Ideally, nurses are regarded to be morally autonomous professionals who during the decision making process should adhere to the moral and ethical obligations to ensure that they provide safe competent nursing care. It is imperative to note that nurse have a right to decline to take part in any procedure that will violate their legal and moral obligation.  They should thus take reasonable and practicable measures to ensure that the quality of nursing care that is given to the patient is safe and not compromised. Value Statement 5 of the Code of ethics for nurses Australia further imposes an obligation on nurses to ensure that they report any unethical or unsafe practice.

The nurse should involve Arthur in the decision making process. However, if Arthur is adamant about locking up Nancy in the toilet the nurse is not obligated to follow such advise if contravenes the nursing code of conduct and ethics.

According to the Code of Conduct for nursing that was brought to force by the Nursing and Midwifery Board of Australia (NMBA)  nurses have a obligation to consult the patient, family or friends of the patient and other health professional during the decision making process. This is envisaged in principle 2 of the code which requires nurses to maintain a person-centered practice. The nurse should take a person centered approach when taking care of the patient. The code provides that nurses have an obligation to take care of the people that are under their care. In addition, nurses must provide their services while observing the highest form professional behavior which is underpinned by honesty, integrity, respect and compassion.  According to principle 2.2 of the code nurses should refer a medical condition that is beyond their scope of practice to another health practitioner with greater skill and knowledge. It further provides that when treating the patient a nurse should focus on he best interest o the patient.

The Code of Ethics for Nurses in Australia

According to principle 2.4 of the code of conduct for nursing NMBA 2018 in case of any adverse event that occur during the time the nurse is taking car the of the patient, the nurse is required to repot the events. However, if the nurse is capable of dealing with the problem he should act immediately by resolving the problem to protect the safety of the patient. The nurse should not take any punitive measures with regard to any event that may have ben caused by the patient.

In this case the nurse ought to repot any serious cases such as where Nancy smears her faeces on the wall or when she is stubborn.  If the nurse is capable of dealing with the problem he should act immediately by resolving the problem to protect the safety of Nancy Johnson. If the nurse is not able to handle cases where Nancy may be violent he should report such cases to other health professional.  It is worth noting that the nurse should not take any punitive measures such locking up Nancy in the toilet. It should be noted that locking up Nancy in the toilet is not a healthy form of medical treatment. In fact locking Nancy in the toilet may expose her to other serious health risks. .  

Principle 3.3 of the code of conduct for nursing NMBA 2018 provides that the nurse should ensure that there is effective communication with the patient and the family of the patient. This includes ensuring that the patient or his guardian understands any information concerning the medical condition that is passed to them. Principle 3.3 (e) provides that the nurse should not be judgmental towards the patient, avoid referring to the patient in a non-professional manner either verbally or by correspondence, and avoid any behavior that may be regarded as being harassment or bullying the patient or his family. The nurse should make the Arthur understand information about the medical treatment that Nancy should receive. This is to make Arthur avoid taking measure such as locking up Nancy in the Toilet.  The nurse should also make Arthur understand the significance of giving  Nancy the appropriate medical treatment.

According to principle 4.1 of the code of conduct for nursing NMBA 2018 a nurse is required not to exceed the professional boundaries while exercising his role. This is achieved by actively managing the expectations of the patient and his family. In addition the nurse should avoid any conflicts or risks that may arise when providing car for a patient. Typically families and their patients rely on the expertise and trustworthiness of the nurse who is giving medical advice or treatment to the patient. In the practice of nursing a conflict of interest may arise when the nurse has a professional objection to certain form of treatment that should be given to a patient. Principle 4.4 provides that when a nurse is facing such a conflict he is under an obligation to consider the best interest of the patient and not his own personal interest. It further provides that the nurse should exercise his right to refuse to provide or participate in any treatment responsibly. The decision of the nurse in this case should be reasonable and be made objectively. In case a conflict arises in the nursing practice, the nurse must respectfully inform the patient or his family of his objection.

The Code of Conduct for Nurses in Australia

Arthurs expectation are that Nancy would recover from her medical condition. Therefore, the nurse should actively and responsibly manage Arthurs expectation. The conflict that may arise in this case is whether it is appropriate to tie Nancy on the bed if she is very stubborn and destructive. The nurse should consider the best interest of the patient, Nancy Johnson and not his own personal interest. However, the nurse must exercise her right to right to refuse to provide or participate in treatments such as locking up Nancy in the toilet. The nurse must respectfully inform the Arthur of his objection

It is instructive to note that a nurse owe he patient a duty of care. The standard of car that is expected from medical practitioner was set out in the case of Bolitho v. City and Hackney Health Authority (1996). The House of Lords held that the actions of a medical practitioner must conform to the practice of a reasonable body of professional opinion. The court relies on the professional opinion given by a recognized medical body. This implies that Australia nurses must strictly adhere to the code of practice that has been set out by professional medical bodies such as the Nursing and Midwifery Board of Australia and the Australia Nursing Council since thy be called to give a professional opinion where there is an allegation of  medical malpractice. Suffice to say, according to Bolam v Friern Hospital Management Committee (1957) a medical practitioner will or beheld to be negligent if hi practice adheres to a practice that has been supported by a body of professional opinion.

The Supreme Court in Albrighton v RPA Hospital (1980) declined to apply the ‘bolam test’ that provide that a medical practitioner cannot be held negligent if he acted according to the general practice  of medical practitioners. The court reasoned that applying this test would be dangerous because the general body of medical practitioner may sometimes give a wrong opinion or their practice may have given rise to fatalities. Therefore the court held that the test that should be applied is an objective one where one determines what a reasonable and ordinarily skilled medical practitioner would do.

It is imperative to note that medical practitioner owe their patients a duty of care with regard to the medical advise they give. In the case of Hedley Byrne & Co. Ltd. v Heller & Partners Ltd. (1964) it was held that a medical practitioner would be liable if a patient reasonably relied a patient. This implies that nurses have an obligation to give accurate medical advice to their clients or their families. In Montgomery v Lanarkshire Health Board (2015) it was held that medical practitioners have an obligation to inform heir clients of the risk that may be involved in a proposed treatment. However, if the patient or heir family dos not wish to be informed of the risk involved with a proposed treatment medical practitioner dos not have n obligation to do so. If the patient is of unsound mind the doctor has an obligation to inform the guardian or family of the risks.  If the medical practitioner reasonably exercises his medical judgment and determines that he patient would suffer any detriment after disclosing any risk to him or her he should desist from making any disclosures. It bears noting that the skill and judgment of the medical practitioner should be accepted by professional medical body or should be hat an ordinary skilled judge would have done. Therefore, nurses should observe the acceptable skill and expertise.

It can be argued that the nurse in this case owes the patient Nancy Johnson duty of care. Therefore, the actions of he nurse in this case must conform to the practice of a reasonable body of professional opinion. The medical bodies that the nurse should conform his practice to include Nursing and Midwifery Board of Australia and the Australia Nursing Council. If Nancy Johnson is of sound mind the nurse has an obligation to explain to her the risks that may arise if a certain medical treatment is subjected to her. On the other hand, since Arthur was attending to Nancy at home and he old tie her on the bed and in the toilet it would be prudent for the nurse to explain to him the appropriate care that he should give to Nancy. This would avoid any injuries that Nancy would sustain if she is tied on the rope or in the toilet.   

References

Albrighton v RPA Hospital (1980) 2 NSWLR 542.

Atkins, K., De Lacey, S., Britton, B., & Ripperger, R. (2017). Ethics and law for Australian nurses. Cambridge University Press.

Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 i

Bolitho v. City and Hackney Health Authority [1996] 4 All ER 771

Code of Conduct for Nursing 2018 (Nursing and Midwifery Board of Australia NMBA)  

Code of Ethics for Nurses Australia Nursing Council (ANC)

Hedley Byrne & Co. Ltd. v Heller & Partners Ltd. [1964] AC 465

Kant, I. (2012). Fundamental principles of the metaphysics of morals. Courier Corporation.

Korsgaard, C. M. (2005). Fellow creatures: Kantian ethics and our duties to animals. Tanner Lectures on Human Values, 25, 77.

Mill, J. S. (2016). Utilitarianism. In Seven Masterpieces of Philosophy (pp. 337-383). Routledge.

Montgomery v Lanarkshire Health Board [2015] UKSC 11

Walker, K. (2004). Whither nursing? Reflections on fate and futurity.

West, H. R. (2004). An introduction to Mill’s utilitarian ethics. Cambridge University Press.