Ethical Principles and Codes of Practice Essay

Ethical principles and codes of practice can provide guidance in day-to-day practice. Analyse Peter’s situation in the case study and come to a conclusion about what would be an appropriate response. This essay will analyse the ethical principles and code of practice in relation to the case study of Peter, a man suffering from Alzheimer’s disease and will suggest a course of action for Peter’s situation based upon the application of these principles and the code. It will do this by examining the term ‘ethics’ and will focus on four ethical principles found to be relative to the kinds of ethical issues and challenges met within health and social care settings, these will be applied to the case study. Peter’s situation is that of a man, who, at the request of his family, unhappily (but apparently necessarily), moved to Parkside Manor, a small residential care home. Of late Peter’s condition of Alzheimer’s disease has advanced and he has become progressively uninhibited. His behaviour has caused the staff to question Peter’s placement at the care home, as some of the other residents are beginning to become troubled and distresse d by his behaviour. Some staff feel that with the number of residents needing attention, Peter’s needs require more time than they have to give. However Peter’s family are resolute in their decision for him to remain at Parkside. ‘Ethics’ are defined as ‘the philosophical study of the moral value of human conduct and of the rules and principles that ought to govern it’ (Collins, 2006, p535). Individual values develop over time through socialisation, upbringing and experiences. These values when viewed on a personal level, guide individual actions. Individuals working in the health and social care setting also hold professional values derived from professional training and ideology. Decisions are made using both personal and professional values and all decisions will have an ethical dimension. Historically health and social care practitioners have been directed by principles and guidance, enabling them to develop what is described as a professional morality. Codes of practice have long been seen as regulations guiding practice, with clear standards of conduct (General Social Care Council, 2010, p 4). These usually include some exclusion’s such as disclosure of information but they mainly describe expected forms of conduct. In areas of health and social care ethical principles are used along with codes of practice to guide and enhance the decision-making process. These principles are related to a sense of doing the right thing or that which is moral and with ideas of what is good and bad practice (K217, Book 4, p28).This idea can be problematic and can be viewed both objectively and subjectively. If viewed from an objective point of view, who should be trusted to know what is the objective truth? If subjective, who is the one whose opinion should be listened to? Questions such as these are often at the core of dilemmas. Professionals working within health and social care environments do not just deal with decisions based upon the right and good. Consideration should also be given to ‘ethical dilemmas’, these are situations when two choices are apparent, both eq ual in morality and ethics (K217, Book4, p29). Pattison and Heller (2001) suggest, ethics and value issues thread their way through normal, daily health care practice, the interpretation of which is open to more than one explanation (K217, Offprints, p131). Although principles guide actions, there is still a need to assess a situation and devise an appropriate response. This assessment and response derive from an individual’s values and training as much as from principles. Ethical principles are important in the field of health and social care. Practitioners need to have the ability to make informed, ethical and justifiable decisions relating to the individuals in their care. This can be difficult when faced with a challenging case. Using a framework to develop a structured way of thinking through a particular ethical situation or challenge can be helpful. The ETHICS framework was developed to assist people working in care settings and offers a structured way of assessing a course of action in order to come to an ethically informed decision. It emphasizes the need to be able to select a course of action based upon guidance, information and established principles, as well as the individual’s beliefs. The framework requires practitioners to firstly, Enquire about the relevant facts of the case, Think about the options that are available to all involved, Hear the views of everyone (including service user, family members and relevant providers), Identify any relevant ethical principles and values which may help to guide the decision–making process, Clarify the meaning and consequences of any key values and finally Select a course of action offering supporting arguments (K217, Book4, p32). When taking into account the case study, four ethical principles will be examined. These are: respect for autonomy, non-malfeasance, beneficence and justice. The principles are seen as the starting points for the development of ethical approaches to care practice, providing a practical set of principles, which rather than offe ring direct answers to ethical dilemmas, set out useful guiding principles for practitioners when faced with controversial decisions (K217, Book 4, p34). In Peter’s situation, Autonomy or self-determination is complex. Respect for Autonomy refers to a commitment to respect the decision-making capability of an autonomous individual. Autonomy is the freedom to act as a person wishes, to be able to make decisions about their own life and not to be controlled by others. The case study points out that Peter ‘unhappily’ left his home, at the request of his family to move into Parkside Manor, indicating that Peter had no control over this situation. This lack of right to choose where he lives, directly impinges on Peter’s ability to be autonomous and make reasoned informed choices. Beauchamp and Childress (2009) identify two areas necessary for autonomy: Liberty or independence from control and Agency, the capacity for deliberate action (K217, Book 4, p39). When applying this principle to Peter’s case, it could be argued that a diagnosis of Alzheimer’s limits his capabilities to make decisions for himself, limiting capacity for intentional action and so reducing Peter’s ability to function as an autonomous individual. The codes of practice for social care workers (2010) state: ‘a social care worker must respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or others’ (General Social Care Council, 2010, p9, 4.2). This causes a conflict of interest between Peter’s rights to act in a manner that he chooses and that of the other residents, who deserve to be able to move freely about the home without the risk of being upset or distressed by Peter’s actions. Staff may wish to take steps to minimise the potential risk of Peter’s behaviour causing mental harm and upset to other residents and by following risk assessment policies could asse ss the potential risks in this situation (General Social Care Council, 2010, p9, 4.2). Identifying harmful behaviour is multifaceted and open to interpretation. The assessment of risk could have serious consequences for Peter perhaps leading to a limiting of his rights and liberty in the interest of protecting others from harm (K217, Book 4, p60). Therefore over protection or unnecessary limitation could be considered an infringement upon Peter’s human rights (K217, Book 4 p65). The case study does not accurately point out if Peter has the mental capability to understand that his actions could be disruptive and upsetting for others. This being the case it may also be appropriate to talk to both Peter and his family about the situation in order to find a solution. As the code of practice maintains, ‘care workers must promote the independence of service users and assist them to understand and exercise their rights’ (General Social Care Council, 2010, p8, 3.1). It is suggested, that in cases where decision making capacity is deemed to be impaired, respect for autonomy may involve the care worker acting appropriately in an in dividual’s ‘best interests’ (K217, Book 4, p40). The difficulty here is that Peter’s best interests cannot be viewed without taking into account the best interests of other residents, care workers and relatives. This shows the limits of the code of practice in taking a narrow â€Å"ethical† view rather than trying to take a wider and more balanced perspective. Beneficence and the promotion of welfare are concerned with the provision of benefits and the balance of these against risk in the care and treatment of service users. It requires that care providers make a positive contribution to help others, not just refrain from acts of harm. It could be argued that in Peter’s case, moving into a residential setting may be seen as ‘doing good’. The theory of beneficence or ‘doing good’ is embedded in health and social care practice. Although, rather than being straightforward in its attempts to solve ethical dilemmas, beneficence can be viewed as being rather vague (K217, Book4, p34). The application of beneficence in Peter’s situation could be seen as a controversial one. The need to ‘do good’ in this situation could be seen to be against Peter’s best interests, as in the case of consent. The case study alludes to the fact that Peter’s family are making decisions on behalf of Peter and that the diagnosis of Alzheimer’s disease means that he is incapable of contributing to decisions around his care and wellbeing. It could therefore be argued that this results in a paternalistic approach to care, whereby the family (who are making decisions on behalf of Peter) may be guided by practitioners views of what is in Peter’s ‘best interests’ and in doing so may neglect the choice and personal responsibility of the individual (K217, Book 4, p36). However paternalism may be viewed as acceptable if it is proved that Peter’s autonomy or decision-making capacity is compromised. In this case it may be advisable to initiate an assessment of Peter’s mental health capacity in order to justify the families’ involvement in the decision-making process. Beauchamp and Childress (2009) claim, the philosophy of non-malfeasance is an obligation to do no harm. Unlike beneficence, which promotes welfare and concentrates upon positively helping others, non-malfeasance focuses upon guiding health and social care practitioners to avoid harm-causing activities, this includes negligence. Having a duty of care for a person or persons in care is an ethical concept, neglect is an absence of ‘due care’ the lack of which would be seen as falling below the standards expected by the law and code of practice. The principle of non-malfeasance can be difficult to apply in practice (K217, Book 4, p37). Peter has not been physically harmed himself, although it could be disputed that his behaviour around Parkside Manor could be having a detrimental effect on the wellbeing of the other residents who are beginning to be upset by Peter’s uninhibited behaviour. Section 3 of the codes of practice for social care workers may guide staff in pr omoting the independence of other service users (residents) in assisting them to understand and exercise their rights to autonomy. Also for staff to use the appropriate procedures and protocols in which to keep other service users safe from harm (General Social Care Council, 2010, p8, 3.1). As stated, Peter’s ability to make decisions about his care could be impaired, as in the right to choose where to live (which was made at the request of his family). However, maintaining Peter in his own home, as was his wish, would require extra resources such as daily social care help. If this was unavailable, Peter’s wish to remain in his home could be seen as detrimental to his health and wellbeing as his condition deteriorated and this would not uphold the principle of non- malfeasance. The moral principle of justice according to Beauchamp (2006) is fairness in the distribution of benefit and risk (K217, Book4, p42). It can be viewed as fair, impartial and suitable treatment for the autonomous individual. This suggests that everyone has the right to participate in the decision-making process surrounding the ir own treatment. This clearly is not the case for Peter, as he may no longer be classed as an autonomous service user and may not be able to articulate his needs or desires in respect of his care. In this case the staff may wish to assign a person as an advocate to represent and support (where appropriate) Peter’s views and wishes (General Social Care Council, 2010, p6, 1.2). The case study also identifies the staffs growing concerns about their own abilities to be able to give Peter the care that he requires, with some suggesting that his needs demand more time than they have available. The code of practice sets out clear guidelines for staff in Section 3, stating that any resource or operational difficulties experienced by the care worker is to be brought to the attention of the employer or the appropriate authority (General Social Care Council, 2010, p8, 3.4). Staff working within the care home are under increasing pressure to cope with the demanding behaviour that Peter displays and in this case may feel that they are neglecting the other residents because of Peter’s growing needs. This highlights the problem staff have in distinguishing fairly between those that are seen to need support and those that are not. Discrimination such as this all be it without intention of causing harm, raises questions of inequality. As highlighted, codes of practice and other ethical guidelines are not without their limitations. These limitations are often down to an individual’s freedom of choice and their views of what is right and wrong. Codes of practice deal in respect of that is the ‘norm’ not the ‘usual’ and at this point common sense and a corporate view are necessary. Using the four principles to analyse Peter’s situation is far from simple as the principles themselves are open to individual interpreta tion. The task for those directly involved in Peters care, such as family, professionals and the care workers at Parkside, is to ascertain their legal, professional and ethical positions and balance these against the need to protect and care for other residents and staff within the care setting. This may involve identifying ways to reduce the risk to others and to Peter’s dignity and privacy. As the code of practice states ‘a social care worker must respect and maintain dignity and privacy of service users’ (general Social Care Council, 2010, p6, 1.4). Some of the staff at Parkside have begun to question if the placement is an appropriate one given Peter’s growing needs. Staff at Parkside Manor could begin to examine ways of improving the care and support on offer to both Peter and the other residents by firstly initiating an assessment of Peter’s mental health capacity, in order for staff to better comprehend Peter’s level of understanding and to further meet his needs. This will form part of a support plan that will identify resources necessary to meet his growing requirements. The case study does not adequately highlight if Parkside Manor is equipped to deal with mental health problems such as Alzheimer’s or if the population is that of older residents with general care needs. One solution for the family may be to investigate the possibility of an alternative placement for Peter. Placing Peter in a more suitable setting where the staff are more used to dealing with conditions such as Alzheimer’s disease could enhance quality of care and increase Peter’s quality of life. Bibliography Collins, 2006, Collins Concise English Dictionary. Glasgow, HarperCollins Publishers. Open University (2010) K217, Adult health, social care and wellbeing, Chapter 14, Ethics in health and social care. Milton Keynes,The Open University Open University (2010) K217, Adult health, social care and wellbeing, Offprints, Swimming in a sea of ethics and values. Milton Keynes,The Open University General Social Care Council, 2010, Codes of Practice for social care workers. Available at: http://www.gscc.org.uk/cmsFiles/Registration/Codes%20of%20Practice/CodesofPracticeforSocialCareWorkers.pdf [Accessed 25/02/12] Gillon Raanan, 1994, Medical ethics : four principles plus the attention to scope. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2540719/pdf/bmj00449-0050.pdf [Accessed 09/03/12]