Background of the Case Study

The essay spans around a case study based on the lawsuit that took place in relation to the breaching of one of the health care ethics- “informed consent”. In this case, the claimant was a 64 years old woman who had fractured her right humerus. She was admitted in to the emergency department of the Queen Elizabeth Hospital in Woolwich where the patient had to be given with IV line in to her arm. There was no emergency requirement for the procedure although the staff had to be ready in case any emergency arises. Due to her injured right arm, the normal practice is to use the left but the patient had undergone a recent left mammectomy and axillary node clearance in the left arm and insertion of an IV line in the left arm might increase the risk of edema. Hence, the option is either to use the left arm or to check whether IV line has to be given at a later stage. As per the claimant, the doctor made some silent and calculation and the inserted the IV line in to the left arm of the patient without taking proper official consent from the patient. This caused a permanent edema in the left arm of the patient causing a significant disability in the left arm. Ironically, when the lawsuit was conducted, the judge accepted the decision to insert an IV line as the normal practice rather than to adopt a “wait and see” approach, but the breach of the conduct had occurred on the ground that no consent was obtained from the patient before the conducting the invasive procedure. The court of appeal had agreed that allegations based on the consent were within the scope of the pleaded case, although it has not been raised in the trial.  However, after this a declaration has been provided by the court of justice that the doctor was in breach of duty in inserting the cannula without the consent of the patient.

Healthcare ethics can be defined as a cluster of moral philosophies, values and beliefs that directs the health care experts in making choices about treatment. It is the ethics that forma the base ground of the values that differ from one culture to the other (Percival 2014). Ethics in health care was being applied in health care since the time of the Egyptians. Traditionally oaths were taken and codes were adopted even in the ancient times. Advancement in medical science have brought in to new ethical and moral issues. These ethics might involve any advancements in the genetic knowledge or it may related to the preservation of the patient’s rights. In order to comprehend the moral issues, it is necessary to understand the most important ethical principles and the values (Percival 2014).  A doctor always possesses some moral obligation towards his patient based on the therapeutic relationship between the nurses. The ethical responsibility of a health care professional in a given situation solely depends upon the nature of the decisions. However, this essay will discuss about the codes of ethics- ‘informed consent”, which has been breached by the doctor in this case scenario. While reflecting on medical laws and ethics, this paper will draw attention towards the four main ethical principles in health care- Beneficence, non-maleficence, autonomy and justice. This ethical principle forms the base of any health care ethics displayed by the health care professionals (Kumar 2013).  The patients being the health care consumers are always at the vulnerable side to face situations like negligence, malpractices and breaching of the basic health care rights of the patient. In relation to this, this essay will also put forward the information about the legal issues and the consequences that might arise due to the ethical issues.

Overview of Healthcare Ethics

 The essay will aim to discuss this code of ethics in the light of the various ethical theories like utilitarian, deontology and virtue ethics.

Informed consent is an ethical idea that is an important part of the contemporary medical ethics. Informed consent is the agreement of an individual to allow any medical procedure based on the full disclosure of the benefits, risks, alternatives and the consequences of the refusal (Berg 2012). Patients should be provided with all the information and will be discussed with, regarding the risk factors of the clinical treatment and they should be given the chance to choose what is right for them. According to Department of Health Victoria (2013), informed consent for a medical treatment is reflected in the legal requirements and the doctrines. Seeking informed consent from the patient and providing freedom to the patient to make decisions within the clinical practice respect the moral integrity of a person.  According to Charter of Human Rights and Responsibilities Act 2006 (Vic), “A person might not be subject to medical treatment without his or her full, free and informed consent” . informed consent is an important aspect of the standard 1 of the National Safety and Quality Health Service Standards.

Consent should be obtained verbally before the signing of any document. A verbal discussion should be done before the consent form has to be signed. The signature on the consent form is a proof that any conversation had taken place and the patient have understood and has agreed (Berg 2012). The patient should be encouraged to ask questions and to provide input in the in to the conversation. It is the duty of the clinician to make sure that the patent understands everything fully and the implications of their decisions (Hall, Prochazka and Fink 2012). A clinician should make sure that the patient’s understanding is not passive and he/she has been agreeing to the terms and the conditions fully (Prasher et al. 2013).  It is evident from the case study that the claimant had contested with the defendant that the doctor had not obtained any consent from the claimant before the insertion of the cannula in the left arm. Hence, on that ground here had been a breach in the duty. It has to be mentioned obtaining consent from the health care providers is a legal duty of the professionals and the consent form constitutes of the legal framework. Hence, lawsuit might follow due to the breaching of this important medical law (Berg 2012).

Ethical Principles in Healthcare

The case study reveals the fact that the doctor had inserted the cannula in the left arm even after knowing that there is a risk of edema if IV is inserted in the left arm as the patient recently had a left mamectomy and axillary node clearance in the left arm and hence cannot be used. In such a case, the left had to be used even it has some chances of developing edema in the left arm. In such cases, doctors are accountable to any kinds of avoidable harms arising out of the treatment.

Consent should be given voluntarily. The health care professionals should advice to the patients, as of what they believe to be the best possible option of care. A clinician should not put any pressure or force the patient to take their advice. The patient always has the right to choose between the available treatments options (Kumar 2013). Normally a patient always have the right to withdraw their consent from the treatment. In this case, the claimant has claimed that the  doctor has done some silent calculations and performed the procedure , before the patient could actually realize anything. Consent should be taken before the commencement of any procedures. Kumar (2013) have argued that there might be situations where the patients are not competent enough to give consent , in that case the consent has to be given by their chosen representatives.

It is necessary consider certain factors during obtaining consent from the patients, such informing the purpose of the informed consent. This includes- explaining the rights of the patient regarding the refusal or consent for the treatment, explaining the right to change their mind, provision of relevant and comprehendible information, offering the information in language that comprehendible to the patient. Communication is necessary in order to realize the informed consent and physicians have to find ways for facilitating communication not only in individual relation with the patient but also in the structured context of the medical care institutions (Ploug and Holm 2015). Spatz et al. (2016) have stated that insufficiently delivered information not only restricts the autonomous decision making of the patient. A patient’s religious belied might deter him from getting any kind of treatment; in that case, the clinician has the moral obligation to inform the patient about all the health care details relevant to the current health care situation of the patient and guide him to a rational and autonomous decision-making (Giampieri 2012).  Important distinctions can be made between various types of consent. According to Beauchamp and Childress there are differences between the various types of consent. The expresses consent may be considered as the paradigm for the health care and the clinical research (Beauchamp 2007). The tacit consent is given by the failure to dissent from a predetermined course of action or that has been set previously. Implicit consent refers to the decision and the action of the patient (Spatz et al. 2016). Presumed consent can be referred to as assumptions about the decision of a person that he/she would have made, if she had the capability of consenting. Another importance is between specific and generic consent. Now the conditions under which consents are given can be summarized as adequate information, competence and voluntariness.

Legal Obligations of Healthcare Professionals

Competence- It is both a legal and a medical issue. Its basic meaning is the ability to form tasks, and here to make decisions about the health care of a person and participation in the research (Beauchamp 2007). Competence normally varies from one task to the other. There had been a lot of debate in understanding the appropriate criteria for judging a competent person (Spatz et al. 2016). The criteria includes the ability to understand he information related to the decision, to appreciate the significance for the life and situation of a person, to reason using the relevant information and to choose and express the choice. Beauchamp (2007) has argued on the fact as of who is to decide whether the patient is competent or not? The legal answer for this question is complex. It can vary from one jurisdiction to the other. In many cases, proxy consent is also applicable although in this case scenario, no such information about the participation of the patient’s family have been observed (Beauchamp 2007). Now there had been debates still going over the matter as of what are the restrictions of the surrogate decision making.  Some of the authors have argued that only the therapeutic researches should be allowed to make by a surrogate decision maker. Regarding the criteria, on the basis of which decisions are made of behalf of the patient- a common hierarchy of guidelines are generally followed. At first the patient’s advance directives are followed, if not, a surrogate puts him in the shoes of the patients and when this also becomes impossible, the best interest of the patient is finally considered. In this case scenario, it can be clearly seen, that the patient was competent enough to give consent for her own treatment and is also well aware of the consequences that might occur if situations turned adverse. In spite of this the patient was not provided with any chance to be involved in the decision making process of her own treatment.

Each health care professional is bound by the principled of professionalism and in upholding the wellbeing and the interest of the patients. There are four main ethical principles defining the ethical duties that the health care specialists owe to the patients. They are autonomy, beneficence, Non-maleficence and justice.  These four ethical principle helps a clinician to provide a holistic care to the patient.

It is the concerns about patient autonomy that raises the concept of informed consent. Informed consent is not only a moral but also serve as a legal safe guard for respecting the autonomy patient. Furthermore, the informed consent has been designed for the promotion of the welfare of the patient (right of the patient to beneficence), and to avoid any harm to the patient (ensuring the right of the patient to maleficience) (Hall et al. 2012).

Importance of Informed Consent

Beneficence- Beneficence can be defined as the act of charity, kindness or mercy with a strong connotation of doing something good to the patient including the moral obligations (Kinsinger 2010). Health care professionals always have the moral obligations of doing something good to the patients. The responsibility of maintaining the highest professional standards exclusively rests with the ones that holds the trust, power and the authority. The client is always in a vulnerable and weak position entirely, because it is the client who has unmet needs.  That is why each jurisdiction has legislation and regulations for protecting the members of the public, the patients.

Several authors have discussed about ethics and in the health care mileau, beneficence embraces the concept of humanism. Each and every person; the patients have the right to be nurtured, respected and facilitated (Kinsinger 2010). Reverence towards the patients or to his suffering pays respect to the patient. According to Kinsinger (2010) practitioners would have to act in a way that contributed to the health and the wellbeing of the patient and refrain from doing anything that harms the patient. Beneficence strives for the best method of care and embracing not doing anything harmful is being extrapolated in to a generous, supererogatory category (Kinsinger 2010).

Autonomy- Patient autonomy is the important principle of the professional medical ethics. The idea that patient have the freedom to make choices about their lives, including the medical matters has become prominent in the current literature (Murgic et al. 2015). This was not the case before, when the doctors used to have paternalistic attitudes in relation to medical decisions. The concept of paternalism is just the opposite of autonomy (Murgic et al. 2013). Although the concept of paternalism might have the same good moral intention, but again it does not keep the patient in the prime position of the decision making. Paternalism has been identified as one of the traditional characteristics of the therapeutic relationship in the medicine (Murgic et al. 2013). This implies that the doctor takes decisions based on his/her own understanding based on what the doctor considers for the nest interest of the patient. This can be related to the case scenario by the fact that the judge found that the decision to insert a IV line was a not a breaching of law as an experienced doctor might feel it confident to take the risk rather than adopting a “wait & see” approach. Hence, the claimant failed at the trial. It has already been mentioned that the doctor has made some silent calculation all by himself and had conducted the procedure without taking permission from the patient. In this case the concerned doctor had exhibited paternalism, keeping in mind the current health status of the claimant, who required an IV insertion, if not immediately but may be within a few days. It is necessary to remembers that the doctor might act in accordance with the current practice but would certainly not do anything without obtaining any consent from the patient. According to this principle, teaching someone who is not a child paternalistically means treating him in an incorrect way. In the past the health care professionals lacked respect for taking informed consent from the patient and taking consent from the patient was considered to be an act of shame . Previously this was considered to be perfectly normal just like the way it was considered to be normal not to provide antibiotics for inflammation (since antibiotic were not in use then). However, it has to be noted that today’s paternalistic methods are archaic and it is not only illegitimate but is also morally wrong, if carried out with the perception of the past times. Paternalism implied two main goals-Prevention of doing something wrong to the other person and usurping the rights of decision making of the other person (Murgic et al. 2013). Hence, paternalism implies interference with the other individual against their will by usurping the rights of the patients to decide for themselves and fulfil their needs in order to qualify as human beings to be the moral subjects. Although paternalism might be justified by the aspiration to protect another person, practicing paternalism still refers to treating another person in an ethically wrong way (Murgic et al. 2013). Beuchamp has pointed out the health care professionals having utilitarian viewpoint makes efforts to show that they do not want to confuse the personal intuitive attitudes with a justifiable moral position. Doing what is morally wrong is totally unjustified and unacceptable.

Different Ethical Theories on Informed Consent

It has been already stated that the concept of wellbeing totally differs from the autonomous perspective of the patient. As per the views of some of the authors, the concept of bioethics not only consisted of accepted and verified knowledge, but also is generally perceived as a topic of disagreements and debates (Eyal 2014). In relation to this, doctors are conditioned to see the world from the perspective of the instrumental knowledge from a medical oriented perspective. Hence, the medical decision making procedure serves as prohibitions on a course of action. In moral philosophy, the concept of personal autonomy belonged to the field of self-control; the medically oriented approach becomes contradictory with the needs, desires, beliefs and the values of the patient (Rodger and Blackshaw 2017). Furthermore, there is a social perception that the clinicians or the healthcare professionals are liable to take correct decisions. Hence, all the conflicting groups work together for manifesting a collective behavior in providing paternalistic care to the patients. However the power to carry out the decisions has to be derived from the principles that are good because they ideal and not because their results were being understood from a medical perspective (Murgic et al., 2015). If somehow the treatment is not tentative to the needs of the patient, then the patient should be the authority in the decision making process. Things might change in case of patients with mental disorders yet patient autonomy is still important to be considered.

In order to reflect on the role of the society in the paternalistic issues, Alasdair Macintyre had reasonably argued over the fact that the issue of medical ethics is entirely the problem of the patients, and the physicians are not responsible for this (Lo 2012). Patients belongs to the groups with acute care needs and if the services available to them rest on moral values and reasons then they will become consistent with their authentic interests, which will make things much easier both for the health care professionals as well as the patients.

Despite of the complementary features of the beneficence and autonomy, these two principles contradicts each other. The autonomous preferences of the patient might contradict with the best interest of the patient. For example, in this case scenario it is revealed that the patient had developed an edema after the insertion of the IV line in to his left hand, which ultimately lead to partial disability. From the case scenario it cannot be estimated as, what would have happened, had there been no cannulation. If the doctor would have taken the approach “wait and see”, that might have brought about adverse effects in the patient. However, coercing a patient in to agreeing to the cannulation fail to respect the autonomous preference of the patient. In relation to this it should be admitted that it is often unclear whether the claimants possessed the conditions required for autonomy or give a consent in written. Two conditions are extremely important for meeting the autonomy- Is the patients in a state to understand the credibility of the situation and the give consent on their own? Is the patient free from coercion in taking the decisions? These questions reflect the idea that autonomy implies the freedom to decide ( Lo 2012).

Consequences of Breaching Informed Consent

Non-maleficence- Non maleficence is an ethical principle that can be traced back to “Oath of `Hippocrates”, which states – “do not harm” or to refrain from engaging in any acts of maleficence in the clinical context , any act that would harm the patient . An act of maleficence can be intentional as well as un-intentional and a large percentage of the unintentional act occurs die to indifference of negligence on part of the health care professionals. . In the health care context, non-maleficence is personified in the principle of primum non  nocere and is also found in the Hippocratic Oath- “Physician-do no harm”. Due to the intimate relationship between the principle of non-maleficence and the beneficence, it is possible to construe the violation of either as the violation of the other principle. A failure to uphold the principle of beneficence also causes a breach in the other. The case scenario clearly reveals the fact that there was no immediate need of putting IV in the left and could have been postponed considering the past medical history of a left mammectomy and axillary node clearance in the left arm. Hence, these complications might have been avoided and such as act indicates towards the breach of the ethical standards. In order to raise the question and in order to find out whether the principle of non-maleficence has been applied or not, it is important to identify the clinical context in which this has to be applied, such as the potential risk of the treatment options or the presence of any alternative options. In many cases the potential benefits of the recommended treatment options overshadow the benefits (Hall et a. 2012). In such cases, it is necessary to calculate the risk ratios. For a health care professional who fail to render such calculations and make them understand to the patients, violates the theory of non-maleficence.  

 In some cases, clinicians have to face for ethical dilemma to balance the rights of the patients and the beneficent intent of the caregiver.  For instance, in this case scenario, a dilemma must have aroused in the clinician, to wait for the IV insertion one hand, considering the risk of developing edema. According to Smebye et al. (2016) autonomy is essential for a good quality of life as well as being able decide independently, but Kumar (2013) have argued that with age patients often lose the decision making capacity and in such cases it is the clinicians who often have to serve as the patent advocates. Hence, in such cases the decisions of the clinicians might not serve the preferences of the patients.

Conclusion

Justice – The ethical principles of justice states the extent to which the health care is delivered in an equitable fashion. Justice is not applicable to any particular decisions or the actions of the attendants but the principle of the justice mainly intended to provide guidance that is important for ensuring that, considered in conjunction with one and another, the decisions and the actions of the clinicians are consistent with one another (Kumar 2013). The question of justice is the degree to which patients are treated in a fair and equal manner. In this case scenario, although the claimant is an elderly women, yet her right to get sufficient care should have been preserved and the clinician should have looked for the risk factors before the commencement of this invasive procedure. Older people are vulnerable to injustice in terms of access to health care. Older people should be treated fairly regardless of the age, gender or disability.

Informed consent applies to the nurse and the doctors and they vary from state to state. In general the informed consent assumes that the person is able to make legal decisions and through the same process on the behalf (British Medical Association, 2012).

In March, the supreme court of the United Kingdom made a unanimous decision, that doctors should ensure that the patients are always aware of the risks of any kinds of treatments that they offered and the availability of any reasonable alternative treatment (Department of Health Victoria. 2013). Failure to abide by the code of law might bring about legal lawsuit over the person, and might be show caused by the medical board hampering his professional career forever. This can also move to the extent causing a cancellation of the licensure of the medical professionals.

Ethical theories are hard to understand due to the abstract nature of the theories and irrelevant practices. However, it the ethical theories that forms the basis of the all-moral codes of conduct. It is this theory that helps a clinician to take care of the patient in an ethical and a holistic form.   

Utilitarianism is a widely accepted moral theory, which is a best-known example of the theory of consequentialism, a class of moral theories that are concerned about the consequences of the actions, whether they generate the desired results (Tännsjö 2014). In utilitarianism, moral or the good actions are those that causes an increase in pleasure, happiness and wellbeing, referred to as the utility. As per this theory, an act is considered as good if it brings more pleasure than pain and the deed is wrong if it brings more pain than pleasure. This can be related to this case scenario by the way that, that the invasive procedure conducted by the doctor on this patient did not bring any pleasure or utility to the patient.  In spite of the intentions to be moral, the act brought about harm to the patient and hence this act cannot be considered as a utilitarian act.

Tännsjö (2014) has argued that lack of informed consent cannot be treated as a welfare loss which can be compensated for by the other welfare gains, but informed consent is actually a requirement that is independent of the welfare gain or loss calculations (Kumar 2013). The utilitarian might claim that any paternalistic attitude can be justified as it creates more benefits than harm. It might be this utilitarian mentality of the judge that compelled him justify the act of the alleged doctor to be a utilitarian act, although the act finally turned opposite, although none can be held responsible one cannot foresee deterioration of heath care.

Tännsjö (2014) have stated that one of the major difficulty in calculating the utility can be difficult. For example, it is not clear that an act that is better for an individual should also be beneficial for the entire patient. For example in this scenario, putting an IV insertion in the left arm is the correct practice, but the situation here is different as patient had a risk of developing edema in the left hand, the procedure that might be correct for other patient might bring about considerable harm to this patient. The person might act with the intention of utilitarian approach, but it is the health care status, that decides whether the care has a utilitarian approach or the procedure would bring about harm to the patient.

In utilitarianism, the moral rightness of an action is determined by the consequences. Whereas the deontological theory is the ethics of duty where the morality of the cation depends upon the nature of the action.  The concept was introduced by the philosopher Immanuel Kant and is widely accepted as Kantian deontology (Mandal et al. 2016). Unlike the utilitarian, the deontologists does not accept the concrete actions just because of their beneficial implication in a generalized way. They consider some acts wrong in spite of having some good consequences. Experts have confirmed that utilitarian or deontology does not come in entirely pure form in health care hence the orientation of the activity might not be identified initially. Paternalism appears under circumstances where understanding the best interest of the patient from medical perspective differs from the understanding of the best interest of the patient from the perspective of the patient (Mandal et al. 2016). Beauchamp have referred to the initial model as the beneficence model of moral responsibility in the field of medicine and the second model considers the best interest of the patient from the point of view of the patient (Beauchamp 2007). With a question to understand the responsibility of a physician to a person whose autonomy had been reduced, it is obvious that the custom does not provide any answer that is satisfactory.

 Macario Alemany had claimed that paternalism always implies the requirement for justifying the activity of the stronger side.  As per his opinion, paternalism refers to collection of the criminal laws aimed at protecting the individuals from themselves (Messer 2014). In this context, it is extremely important to distinguish the violation of the moral rules from the failure to protect the moral ideas. According to the concept, consent any kind of harm is unacceptable. It is evident from the case study that the act has harmed the patient to a considerable extent causing both the breach of duty and ethics. Deontological systems has an added advantage over the utilitarianism in which they imply many scenarios that might seem to be intuitively incorrect such as immoral. Deontology is concerned with certain factors of the action itself. As per the deontological system, there are certain duties or rules that has must be followed for acting morally (Kumar 2013). Patients have certain human rights that should be considered in the treatment of the patients like the right to consent, right to privacy and dignity. The deontological theory also encompasses codes of conduct encapsulating the moral and the clinical duties of the health care professionals (Kumar 2013). There are certain actions that needs to be avoided even it is foreseen that they would bring about some good. In this case, scenario the doctor might have thought that medical procedure would bring some good to the patient and so they went on with the procedure without taking consent of the patient.

Virtue ethics can be consider as the oldest of the four ethical theories that we had been explaining. This theory originates back to Aristotle in the 4th century B.C and was developed further by Thomas Aquinas in the thirteenth century. This theory is becoming prominent day by day with its genuine application in the field of health care (Faden et al. 2013). According to MacIntyre, current methods to the ethics (Kantian and the utilitarian theories) will not be effective in terms of modern healthcare, as they are try to provide justification for the notions of ethics in isolation from the moral and intellectual tradition within which the concepts were located originally- Plato, Aristotle and their predecessors (Faden et al. 2013).  This action emphasis more on what we become? More than what we do. According to this theory doing anything right is not about following the sets of deontological rules or trying to bring about pleasure or happiness, rather this ethical theory emphasizes on becoming a person that by acquiring certain virtues and values. “An action is right if and only if it is what an agent with a virtuous character would do in the circumstances”(Oakley, p 88). Virtue ethics can be directly applicable to health care ethics as health care professionals are expected to exhibit some moral values required in providing care to the patient, which are compassion, honesty and preservation of the human rights of an individual (Moreau et al. 2012). The possession of these values is part of a person’s characters. The moral decision making of a person depends upon the ethical values that a person should poses (Moreau et al. 2012). Some of the authors have connected virtue ethics with a conception of the patient- physician relationship as the covenant. The concept of covenant comes from a moral concept with its roots in the Christian or the Hebrew culture, where it refers to a binding agreement between the god and the people. In the health care concept, this is similar to the therapeutic relationship between the physician and the patient. As per the covenantal understanding, paternalism or informed consent can be understood as an appearance of the professional virtue of the fidelity. As advocated by Paul Ramsay consent is “the cardinal canon of loyalty joining men together in medical practice and investigation” (Messer 2014). He had identified both the positive as well as the negative reasons for its importance. This indicates towards the fact that the there has to be a twofold aspect of the practice of informed consent. In case, obtainment of consent is a safeguard against any forms of distortions . It is also a safe guard against any kind of abuses of the medical covenant and the procedures of the consent must be in place and should be observed rigorously. At first, it will include the signing of the consent form. Nevertheless, if the consent can be defined as an expression of the fidelity in the medical convent, it should be taken as a part of a relationship, that is open ended and where clinical decisions should be done in the course of an open, honest dialogue between the professional and the patient.

Conclusion

Health care ethics is a sector of applied ethics possessing a vast number of decision-making situations that can arise in the field of medicine. New moral issues are being raised every day with the advancement of health care. The practice of the each professionals reveals the ethical issues that are endemic to the professional field in question and this is no different in the health care fields.

Informed consent or the concept of autonomy is one of the important codes of ethics in medical science be it in clinical settings taking care of the emergency patient or in various clinical trials. A patient does poses the moral rights of self-determination. It is intended not only considered as a moral right but also acts a legal safe guard for the patients with respect to the autonomy of a person. Furthermore, informed consent is also designed for promoting welfare to the patient. While discussing about the case scenario, where that a lawsuit has been conducted and the doctor had be alleged with the charge of breaching the codes of conduct. In order to discuss about the ethical issues. This paper has critically discussed about the different ethical principles- Beneficence, non-maleficence, autonomy and justice. As discussed the principle of autonomy had often been breached in case of dealing with the elderly patients. Hence, informed consent and preservation of the dignity and integrity of the patient is still a matter of concern for the patients. The different medical ethical guidelines have repeatedly emphasized on the self-determination rights of the patient, in spite of this, many clinicians still could not come out of their utilitarian thoughts of doing morally good acts, without even looking at the consequences in individual patients. While analyzing the utilitarianism and the concept of deontology, this paper has also reflected on the subtle differences between these theories, where in each of the theories the informed consent is perceived in a different way. In the utilitarian concept, not taking consent from the patient or paternalism might be considered as a moral act with good intentions, which is entirely different from the deontological or the ethics of virtue concept. However, in conclusion it can be said that informed consent is a process rather than simply signing form. It should provide the health care consumer with the relevant information and the understanding required to authorize any medical treatment. Hence, emphasis should be given on taking written permission from a patient or the family of the patient. The recent medical laws in United Kingdom has to be more stringent to after the rights of both the patients and the doctors.

Reference

Beauchamp, T.L., 2007. The ‘four principles’ approach to health care ethics. Principles of health care ethics, 29, pp.3-10.

Berg, J., 2012. All for one and one for all: informed consent and public health. Hous. L. Rev., 50, p.1.

British Medical Association, 2012. Medical ethics today: the BMA’s handbook of ethics and law. John Wiley & Sons.

Department of Health Victoria. 2013. Human Resources: Charter of Human Rights and Responsibilities Implementation Guide for DEECD Policy Officers. Accessed at: https://www.education.vic.gov.au/hrweb/Documents/Charter-Implementation-Guide-DEECD.pdf

Eyal, N., 2014. Informed consent, the value of trust, and hedons. Journal of medical ethics, 40(7), pp.447-447.

Eyal, N., 2014. Using informed consent to save trust. Journal of medical ethics, 40(7), pp.437-444.

Faden, R.R., Kass, N.E., Goodman, S.N., Pronovost, P., Tunis, S. and Beauchamp, T.L., 2013. An ethics framework for a learning health care system: a departure from traditional research ethics and clinical ethics. Hastings Center Report, 43(s1), pp.S16-S27.

Giampieri, M., 2012. Communication and informed consent in elderly people. Minerva anestesiologica, 78(2), pp.236-242.

Hall, D. E., Prochazka, A. V., and Fink, A. S. 2012. Informed consent for clinical treatment. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 184(5), 533-40.

Hall, D.E., Prochazka, A.V. and Fink, A.S., 2012. Informed consent for clinical treatment. Cmaj, 184(5), pp.533-540.

Kinsinger F. S. 2010. Beneficence and the professional’s moral imperative. Journal of chiropractic humanities, 16(1), 44-6.

Kumar N. K. 2013. Informed consent: Past and present. Perspectives in clinical research, 4(1), 21-5.

Laurie, G.T. and Porter, G., 2016. Mason and McCall Smith’s law and medical ethics. Oxford University Press.

Lo, B., 2012. Resolving ethical dilemmas: a guide for clinicians. Lippincott Williams & Wilkins.

Mandal, J., Ponnambath, D. K. and  Parija, S. C. 2016. Utilitarian and deontological ethics in medicine. Tropical parasitology, 6(1), 5-7.

Messer, N.G., 2014. Professional-patient relationships and informed consent. Postgraduate medical journal, 80(943), pp.277-283.

Moreau, A., Carol, L., Dedianne, M.C., Dupraz, C., Perdrix, C., Lainé, X. and Souweine, G., 2012. What perceptions do patients have of decision making (DM)? Toward an integrative patient-centered care model. A qualitative study using focus-group interviews. Patient Education and Counseling, 87(2), pp.206-211.

Murgic, L., Hébert, P. C., Sovic, S., & Pavlekovic, G. (2015). Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country. BMC medical ethics, 16(1), 65. doi:10.1186/s12910-015-0059-z

Percival, T., 2014. Medical ethics. Cambridge University Press.

Ploug, T. and Holm, S., 2015. Doctors, patients, and nudging in the clinical context—four views on nudging and informed consent. The American Journal of Bioethics, 15(10), pp.28-38.

Prasher, S., Klimatsidas, M., and Mahmood, Z.2015.The Evolution of Consent Law in the UK. Journal of Cardiothoracic Surgery, 10(Suppl 1), A202. doi:10.1186/1749-8090-10-S1-A202

Roache, R., 2014. Why is informed consent important?.

Rodger, D. and Blackshaw, B., 2017. An introduction to ethical theory for healthcare assistants. British Journal of Healthcare Assistants, 11(11), pp.556-561.

Smebye, K. L., Kirkevold, M., and Engedal, K. 2016. Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study. BMC health services research, 16, 21. doi:10.1186/s12913-015-1217-1

Spatz, E.S., Krumholz, H.M. and Moulton, B.W., 2016. The new era of informed consent: getting to a reasonable-patient standard through shared decision making. Jama, 315(19), pp.2063-2064.

Tännsjö, T., 2014. Utilitarianism and informed consent. Journal of medical ethics, 40(7), pp.445-445.