Professional and legal implications Essay

This naming countenance explore the nonrecreational soulfulness and wellnessy suggestions of a scenario which took place within a wellness apportion noniceting during the last year. health distribute is very(prenominal) complex and finishs ab step to the fore how services atomic number 18 provided tail assembly return a huge effect on peoples lives. on that pointfore it is dogmatic form that the aid called has the beaver chance of benefiting a coarse-suffering and non harming them. that, in the pastime scenario a finality do by a healthcargon original for the scoop out rice beers of their tolerant is challenged by the longanimouss niggle. To entertain confidentiality the real names of the individuals manifold set about been changed (NMC, 2008). Katie is a 24 year old woman who has been admitted to hospital with a severe chest infection. Katie suffers from recur chest infections over delinquent to her condition and also has noetic palsy, l earning disabilities and epilepsy. payable to these conditions Katie is unable to communicate, requires a Naso Gastric Tube for feeding, is doubly incontinent and has unitary to ane billing from a wellness Cargon Support proletarian for all her personal and clinical needs.Katie lives with her induce at home, who provides her maintenance during the night. The medical police squad discovered that her chest infection is Pneumonia and begin the relevant interference, hitherto believe that ascribable to Katies quality of action she should be non for Resuscitation (NFR) in the event of a cardiac fascinate. However, Katies induce argues that her girl should be resuscitated and the determination should be make by her, because she is her m opposite and that the health cargon team are neglecting her daughters reppair to animateness and are acting illegally by make much(prenominal) a ratiocination. Katies mum also believes that the health care team are basing their closi ng on Katies learning dis readiness preferably than her lift out interests. This testify volition encompass the honorable considerations that need to be sought when a finale much(prenominal)(prenominal)(prenominal) as NFR is made. Taking into score the legal and headmaster implications this has on the health care team involved. ahead reservation either decisiveness the health care captain give need to consider if the Katie has the noetic cater, what are in the her best interests and hold dear the her human correctlys. All these topics entrust be included in this evidence. This essay lead also explain why it is important for a health care superior to take into account the Bolam Test and percentage 4 of the genial readiness Act (2005), taking into consideration a tolerants best interest when they lack capacity, before they necessitate any determination. The medical examination Team mustiness act in accordance with the executethat is accepted at that eon a nd by a recognised passkey body (Dimond 2008). All these issues are relevant in this scenario. Making a decision much(prenominal) as NFR is taken very seriously due to the have sexn expiration in the event of a cardiac arrest.A Not For Resuscitation (NFR) decision indicates that a decision has been made non to advert the resuscitation team if in the future that diligent, much(prenominal) as Katie, suddenly dinero breathing or suffers cardiac arrest. Resuscitation decisions are very controversial and have been the subject of much media interest. Especially when that patient has a learning harm. There is evidence of this in the appendix at the back of this essay and it will be reasoned further on in the essay.A decision such as NFR is the responsibility of the most senior clinician for the particular proposition(prenominal) patient, according to a revised advocate of cardiopulmonary resuscitation (2007). Every health board should have a resuscitation policy. The Local He alth Boards policy involved in this scenario can be rear in the appendix of this essay. The policy, create in (2009) states that cardiopulmonary resuscitation ( cardiopulmonary resuscitation) should be obtaind unless the patient has refused cardiac resuscitation the patient is at the mitigatory stage of illness or the burdens of the treatment outweigh the benefit.The Health Care Team are needed, before they confide any decision to determine if Katie has mental capacity and if she is able to clear and contribute to the decisions of her treatment. If Katie had capacity and was non meditateed about the decision thusly the heath care schoolmaster could be seen as acting unlawfully and the decision kneadr would be legally and professionally responsible (B v An NHS curse 2002). The psychological Capacity Act (2005) describes capacity as an individuals ability to retrace a certain decision at a specific time and not on their ability to cook decisions generally. Legal ca pacity depends on the patients understanding kind of than their wisdom. They should be able to retain and understand the cultivation that they are given and then communicate their decision with the appropriate professional (Simpson, 2011). A patients competency to capacity should not be presumed.An assessment of capacity should be made before a person can be said to be incapacitated (NMC, 2008). Nurses have the ability to assess capacity, if they feel that it is needed. However, they do not have the authority to make a decision such as NFR (Hawley 2007). so, they mustrefer to a doctor or psychologist to assess the patients capacity and make such a decision (Hutchison, 2005). Katies mental capacity, following the Mental Health Act (2005), will need to be assessed by a doctor or a psychologist due to the significance of the decision. The Case of Re C (1994) helped produce the 3 stage test of capacity and this has prove to be a suitable test used in the assessing run of capacity. However, the introduction of the Mental Capacity Act resulted in a fourth Stage being added (Section 3 MCA).The test trys whether the individual is able to perceive and retain information, Believe information given and weigh it up, balance the risks and needs, make a choice. The fourth stage is to communicate the decision. In this particular scenario, afterwardwards an assessment of Katies Mental Capacity using this test, resolved that Katie did not have the Mental Capacity to make decisions due to her inability to understand the information and communicate the decision. This enables the team to make this decision for her as long as it is in her best interests. Katies mother believes that she should be the one to make this decision for her daughter because she is her next of kin and Katies causality of attorney. The Mental Capacity Act (2005) allows a person to legally set up a lasting power of attorney.The chosen person or persons have the power to make decisions on the ind ividuals financial and personal behalf. The act does not allow enduring power of attorneys to be set up however those already in existence can continue to be used. The lasting power of attorney has the power to give consent on behalf of a patient who is incapacitated if it is in their best interest (Thomson et al, 2006). However, the lasting power of attorney does not have the power to order a patient who is NFR or who is suitable NFR, as in this scenario, to be resuscitated if a health care professional has assessed that the outcome would not be in the best interest of the patient. There is no obligation to give treatment that is futile or burdensome as seen in the case of Re J (A Minor) (Wardship Medical Treatment 1990). As in the case of R (Burke v General Medical Council 2004) no person has a legal right to insist on specific treatments either for themselves or relatives.The health care professional is not oblige by law to resuscitate Katie irrelevant weather Katies mother is next of kin or has power of attorney. It was discovered afterwards that Katies mother was not her power of attorney because Katie had never had the capacity to nominate one. The health care professional will make their decision after assessing the patient and following the appropriate legal examples which are set to protect them and the patient and examining what decision would be in Katies best interests. Section 4 of the Mental Capacity Act (2005) sets out the legal framework for a best interest decision to be made, for people without mental capacity. This can be found in the appendix of the essay. The Act states that the health care professional making the decision must not make it simply on the basis of the patients age or appearance. The patients condition and aspects of behaviour must not assume the judgements of best interests and duty of care.The health care professional making the decision must consider all the relevant circumstances and consider the possibleness of the patient gaining capacity (MCA, 2005). However, if this is not possible then the health care professional must revise the past and present wishes of the patient, especially if an climb directive has been made. In relation to the scenario, it is crucial that this checklist is considered when making a decision such as NFR, due to Katies Learning disabilities. Mencap (2007) published a report called remainder by indifference which can be found in the appendix of this essay. The report examines cases where families believed that doctors used inappropriate use of Do Not Resuscitate Orders simply because the patient had a learning disability rather than assessing the best interest of the patient resulting in institutional discrimination. The Mental Capacity Act (2005) adds that the health care professional must consult anyone caring for the patient or who is concerned for their welfare and gain their views on the decision (Dimond, 2008).In this scenario Katies mother was addressed and i nformed of the decision and her views were taken into account, despite the disagreement of the boilersuit decision. Katies mums attitude and opinion towards the decision could be biased. She whitethorn genuinely not recognise that an NFR decision would be in the best interests of her daughter. Katies mother has her own values and beliefs that are likely to be factors that can twist her disapproval. The health care professional involved with Katies care will need to reassure Katies mum, show compassion and empathise with her situation. As stated earlier in the essay, the best interests of Katie can be determined via consideration of a checklist of circumstances within Section 4 of the MCA (2005). The benefits of treatmentand the probability of them arising are considered (Griffiths and Tengnah 2008). In this scenario the benefits of resuscitation would be measured. If it was concur that resuscitation would do to a greater extent harm than good then it would be considered that NFR would be in Katies best interests (Re A (mental patient sterilisation) 2001).Due to Katies quality of life, because of her cerebral palsy and epilepsy, it was considered by the health care professionals that it was in the best interest of Katie that she becomes NFR, as the outcome of resuscitation would not rectify her quality of life. It was also agreed that resuscitation would do more harm to Katie than good, due to the probability of resuscitation being unsuccessful. However, Katies mum believes that the health care professionals are depriving her daughter of a right to life as was in the case of Airedale NHS Trust v savourless 1993. The Human Rights Act (1998) is an Act of Parliament produced to protect the rights of individuals. The Act incorporates crowd rights and protocols and is comprised of several articles. Schedule 1 Article 2, the Right to Life is of particular relevance in this scenario. The Article legally entitles every persons individuals right to life to be prot ected by law. It states that an individuals life should not be deprived intentionally. Katies mum believes that the decision of NFR is infringing her daughters human rights.If this is proved to be the situation then the professional could face legal action (Dimond, 2008). In this scenario the health care professionals are acting in Katies best interests and will not face any legal proceedings as long as they can justify their decision. This was illustrated in the cases of subject Health Service Trust A V D and others 2000, NHS Trust A v M 2001 and NHS Trust B V H 2001 indicates that decisions such as NFR, which are found to allow the individual to die with gravitas and be in the best interests of the person, are not legally classed as infringing human rights. It could be implied that the decisions of NFR supports Katies human rights. If it is considered that Katies quality of life would remain poor or that resuscitation could potentially cause her harm and not be in Katies best in terests then it could be implied that resuscitation in the event of Katie experiencing a cardiac arrest could prove a contaminating treatment (Thompson et al, 2006).In this particular scenario Katies mother is accusing the health care professionals of being heedless. The case of (Bolam v Friern Hospital Management delegation 1957)initiated the Bolam test. The Bolam test is used to examine if a health care professional has been negligent. If the health care professional has acted in accordance with an accepted trust which is approved by a recognised professional body then they cannot be thought as negligent. However, it could be disputed that the health care professional could be assumed negligent if they resuscitated Katie since it is not in her best interests as the health care professionals have a legal duty of care to preclude acts or omissions which can potentially victimize the patient (Donogue v Stevenson 1932). If the health care professionals were to resuscitate Katie an d it resulted in her becoming harmed then the health care professionals could be accused of being negligent under the Bolam test. Once a decision such as NFR has been reassert and documented then if Katie was resuscitated in the event of a cardiac arrest then this treatment could been seen as battery and it is unlawful as in the case of (Airedale NHS Trust v Bland 1993).Such as in the case of Bland where the patients recovery was not going to happen due to him being in a ineradicable Vegetative State, then the courts can decide that treatment can be withdrawn and not infringe the human rights of the individual (NHS Trust v M 2001). In this scenario the health care team have decided, that due to Katies ongoing chest infections, the pain that she welcomes from her conditions and her poor quality of life, it would not be in Katies best interests for her to be resuscitated in the event of a cardiac arrest. Consequently health professionals are not infringing her right to life and con sequently not legally negligent. All health care professionals have a duty of care to their patients (Dimond, 2008). For this section of the essay the author will focus on how a decision such as NFR can have on a adjudge and discuss the legal implications that may occur. Registered keeps are governed by The Code Standards of conduct, performances and ethical motive for harbours and midwives (NMC, 2008). The formula is not a legal document however, it sets a framework of standards that a hold in must adhere to within their recitation and it enables them to act lawfully. Decisions such as NFR can cause professional issues for a entertain.The nurse is the frontline provider of their patients care (Dimond, 2008). They have the most contact with the patient and their relatives. They oftentimes develop a therapeutic kindred with both. This could cause the nurse to face a dilemma of being criticised by the family and friends of the patient if theydo not commence CPR or even face reproach from their colleges if they did proceed with CPR (Dimond, 2008). The nurse may feel duty-bound to commence CPR due to the relationship they have formed with the patient. However, the nurse must always act lawfully. Due to the nurses role as the care provider, they often have contact with the family members. This may provide difficulties for the nurse if the family, such as Katies mum, disagree with a decision that has been made. Therefore, the nurse may be confront with a possible confrontation from the family or friends of the patient due to their disapproval (Hughes and Baldwin, 2006).The nurse has a responsibility to their patients to provide a high standard of care (NMC, 2008). However, at times they may feel as though they are being prevented from providing this standard when a decision such as NFR is issued and could cause them professional implications. However, it could also be argued that the nurse is fulfilling their role in such a situation as the nurse has a dut y to alleviate the suffering of patients (Rumbold, 2002). The nurse would not be alleviating a patients suffering if they commenced CPR and it had been decided that it was not in the patients best interests. Nurses are accountable for their actions (NMC, 2008). The accountability of not providing CPR to a patient can present the nurse with a professional implication. Therefore, as the essay mentioned earlier, if the decision of NFR is legal then the nurse will not be held professionally accountable for not commencing CPR if their patient experiences a cardiac arrest.All Health care professionals are responsible for maintaining standards set in the code of professional conduct. The NMC (2008) governs nurses to Adhere to the laws of the nation in which you are practicing. This implies that nurses are needed to act lawfully. They are required to follow orders such as NFR regardless of their own values and beliefs. A decision such as NFR creates the question of who has the right to de cide what is in the best interests of a patient. Even though the person making the decision is professionally qualified to do so they may find it tangled in proving that it is in the best interests of a patient without capacity (Runciman et al, 2007). The professional has a duty to act lawfully and be able to protract this when making such an important decision. The attitudes of a nurse can offer professional implications for a decision such as NFR. Attitudes are governed by personal values and beliefs. If the nurse did not agree that it is in thebest interests of the patient to become NFR this could create some difficulties. The nurse may decide to vocalise what they consider is in the best interests of their patient and this could conflict with the NFR decision made by the health care professional resulting in an ethical dilemma (Thompson et al, 2006).According to Schlutz (1998), there is considerable evidence that many nurses experience the feeling of powerlessness when confron ted with an ethical dilemma and fear conflict with other professionals such as consultants and doctors. Due to this they may turn out by instructions regardless of it conflicting with their own professional values and beliefs. This could imply that the nurse involved with Katies care could follow an instruction as NFR despite it being against their own professional opinion. However, the nurse must be accountable for their actions and must indicate a satisfactory reason for their conduct (NMC, 2008) therefore potentially resulting in a professional implication. Rundell (1992) claims that the nursing of a palliative patient and providing them with a dignified closing, uncomplicated or uncompromised by CPR could prove to be more complex than simply intervening and commencing CPR. Therefore not intervening when a patient is suffering a cardiac arrest can result in a professional implication of the NFR decision.The nurse could find it very difficult to watch a patient suffer a cardia c arrest and not be allowed to step in because of an NFR decision made by a health care professional who may not even have had a therapeutic relationship with the patient or their family. Doctors and nurses are professionally responsible to perform beneficently, justifying and respecting the rights of others (Thompson et al, 2006). kindness can be defined as an action taken that will benefit others and prevent and remove harm. Examples of harm are suffering and death (Herbert, 1998). If a health care professional fails to act beneficently it violates social, moral and professional standards (Beauchamp and Childress, 1989). This principle implies that the health care professional would be acting unskilled by not commencing CPR. However, Casteldine (1993) implies that it is of greater beneficence for the health care professional to acknowledge end of life on certain occasions rather than using CPR, which could potentially cause harm, to prevent death. This implication is seen withi n the scenario.However it is imperative that the staff perform lawfully. Health care professionals are often faced with thedilemma as to whether a certified decision has been made morally and legally accepted. This could result in disputes due to differentiating values and beliefs (Herbert, 1998). The NMC (2008) states that a patient, who does not possess capacity, should be protected. This may cause conflict in role responsibility in an NFR decision, as a health care professional not commencing resuscitation in the event of a cardiac arrest could potentially cause the issue of passive non-voluntary euthanasia. This is a further professional implication that the nurse may experience when a decision such as NFR is initiated. Passive non-voluntary Euthanasia can be defined as when the individual who dies is unable to give their consent and the individuals competent requests concerning euthanasia are not known, such as Katies wishes are not know due to her not having the mental capacit y.In effect it involves not providing or discontinuing treatments that would be relatively successful in preventing the patients death because death is considered to be kind to the patient by the health care professional making the decision. Therefore, this type of euthanasia depends on other factors for its act in causing death, such as Katies underlying pneumonia which if go away untreated could kill her or promote her inability to breathe satisfactorily without oxygen or respiratory assistance. By withdrawing treatment or as in Katies case creating an NFR that would normally be done for a patient with this condition, with the objective of causing the patients death out of compassion could be regarded as passive euthanasia and be see as allowing the patient to die rather than killing them. Again when faced with such a situation the nurse must always abide by the NMC Code (2008) and act lawfully in their practice and they will not be accountable for breaching their professional duties. In conclusion, this essay has contained legion(predicate) reasons why legal implications could arise due to Katies mother disagreeing with the NFR decision.When a health care professional makes a decision such as NFR, it is taken very seriously and as this essay has explained the health care professional has a legal obligation to justify their decision. They are required to follow the appropriate assessments and procedures before making their decision. The health care professional has a duty of care to their patient and they must ensure that they are considering the overall outcome and quality of life if CPR was performed and if it would be in their patients best interests orpotentially cause harm. It is imperative that they discuss all decisions with the immediate family and reassure the family that they are acting in the best interest of the patient (Hawley, 2007). Decisions such as NFR need to be regularly reassessed because a patients condition may improve or they may r egain their capacity to make decisions. There are many legal and professional implications that the health care professional could adjoin due to such a decision. Therefore it is essential that they are certified of the law because they will be accountable for their actions.Ultimately they must be able to prove that they are acting in the best interests of the patient and be able to provide relevant evidence to support this. In this particular scenario, Katies mother was made fully aware of the NFR decision and what it meant if Katie was to have a cardiac arrest. She was involved in the decision making process and consulted regarding her daughters condition. Soon after the health care professional made the NFR decision Katies health deteriorated due to the Pneumonia and subsequently her quality of life was poorer than previously. It was at this point that Katies mum finally accepted the NFR decision and realised that it was in the best interests of her daughter that she should not be resuscitated.As the essay has shown, in the event that Katies mother pursued a clinical negligence claim against the Health Board, on the grounds that she believed the health care professionals in charge of Katies care were neglecting her daughters right to life, the likeliness of a ruling that Katie be for resuscitation in the event of a cardiac arrest would be unlikely due to Katies mental capacity, overall outcome, quality of life and the evidence supporting the health care professionals decision that it would be in Katies best interest.In conclusion, the essay draws on the fact that all health care professionals, when making a decision such as NFR are required by law to assess patients mental capacity, follow a code of practice and always act in the best interest of the patients regardless of the patients families views and a patients disability. In order for this to be achieved, the Bolam Test and Section 4 of the MCA (2005) should be considered. The health care professiona l in this scenario conducted their decision process accordingly, following the correct assessments and legal frameworks, basing their decision on Katies best interests due to her ill health rather than her learning disability. 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