It is often hard for healthcare workers to understand why a patient would refuse care or treatment that could potentially save their lives. We are trained to treat, heal and care for our patients; when they refuse care or treatment because of religious, cultural or even unknown reasons we often question what’s best for this patient. Should they be forced to accept the treatment? Should we rally their family to help “convince” them? Is it ok to refuse treatment, knowing they will die if they don’t get it? The bottom line is, patients have a right refuse care, treatment and services. They have a right to direct their care and we have to abide by their wishes. There are a variety of laws and theories to help guide our decisions and to protect the rights of patients. I will be discussing the laws and nursing theories on ethics, and why it’s important that every healthcare provider is aware of them.
Ethical theories help us put our own values aside and put the values of others first in determining their plan of care. We use various theories in every aspect of healthcare, whether we realize it or not. For example, the theory of Utilitarianism is based on what is best for the majority of the people (Butts & Rich, 2008). We utilize this theory during times of war and disasters when we have to triage patients based on the resources available.
Deontology is the theory of morality based on rules – a “do unto others” approach of thinking, if you will. We have used this theory in the development of various regulations, including reducing the use of restraints in hospitals and nursing homes. Consequences aside, is this the right thing to do? The focus on this theory is more of the rightness of actions themselves, treating patients humanely (Butts & Rich, 2008).
Virtue ethics assumes that a morally right person will make morally right decisions (Gowdy, 2013). I believe that the Patient Self Determination Act takes this theory into consideration. In this act, a competent person can direct their care regarding end of life decisions. If they chose to refuse a treatment that could potentially extend their life, they have that right to refuse. They can even make these decisions known when they are competent for a time when they may not be competent, for example in the use of Advance Directives (Beauchamp & Childress, 2009).
A theory I find puzzling is Moral Particularism. This theory claims that there are no moral principles and a moral person should not be conceived as a person of principle (Dancy, 2013). The basics of this theory are that there is no perfect answer because there is no perfect person. I believe this theory comes into play when a patient cannot make a competent decision, did not make their wishes known prior to this, and there are opposing views to his or her care, treatment and outcomes by family members who are not identified as having power of attorney. These are the instances when a good Ethics Committee will be utilized and put to the test.
An ethical theory that could have applied to the case of Mrs. Z if she were in her own country is the theory of Ethical Relativism. This theory states that there are no absolute truths in ethics, and what is morally right or wrong varies by person and society norms (Britannica). Since Mrs. Z is in the United States we would provide her the same rights as all of our patients. If she chooses to not disclose her health information to her husband and family we abide by her decision based on the HIPAA Privacy Rule and her right of confidentiality and autonomy.
Patient confidentiality became legislated in 1996 with the passing of the Health Insurance Portability and Accountability Act of 1996, or HIPAA. This rule outlines the circumstances when protected health information (PHI) can be disclosed to outside entities. Healthcare providers must abide by HIPAA rules when handling PHI or they will face