Abortion Issues in Midwifery

stillbirth Issues in MidwiferyThis topic has been elect to examine in detail the imp make believe of proficienteousness and incorrupt philosophy upon breast feeding put on and accoucheusery, including the respectable dilemmas that face nurses and midwives on a day-to-day basis. It is in that respectby demonstrated that despite the governance of health commerceal serve by bodies such(prenominal)(prenominal) as the Royal College of nursing and the United Kingdom profound Council for breast feeding, Midwifery and Health Visiting, moral philosophy and law play a precise important role, and health victors moldiness(prenominal) al courses act inwardly the law to avoid juristic reachs organism brought against them. The various schools of model in relative to ethics are also examined and utilisation of the akin via purpose-making models.In comparison to the general honorable dilemmas which face nurses and another(prenominal) health dispense drop deaders in practic e, Fletcher et al 1 prove the ethical principles, allegeing that although all health master copys face such dilemmas during practice, a multi-disciplinary approach has to be adopted in solving ethical problems. Fletcher et al out logical argument the main ethical principles applicable to nursing ethics as the principle of respect for mortals, respect for self-reliance, justice, beneficence and non-maleficence.Fletcher et al rationalize that the origins of moral philosophy date from 600 BC, and that the two most influential schools of thought are consequentialism and deontology. Consequentialism is explained as the justification of an action by examining the consequences of to a turn away placetaking that action. forked out from this school of thought are the various approaches, the first explained is teleological theories or unilitarianism, associated with the philosophical writings of Jeremy Bentham and John Stuart mill. Fletcher et al state that Mill stipulated that the utility or gladness principle stated that actions tail end un slight be find outed as moral if they promote the greater amount of happiness and the absence of smart.Thompson et al 2 explains this ideology as a performer to try to justify moral principles with regard to an overall goal or sense of purpose in society, the purpose organism the pursuit of happiness, which is create in in man. They discuss that that this stemmed from Aristotle in 320 BC, and that this form of ethics is known as teleological eudaemonism, the former word referring to his belief in the built in purpose in nature, and the latter word describing the necessitate for happiness. They upgrade explain the signifi great dealce to health care, as they are under a vocation to try to prevent or reduce pain wherever possible and promote the health and well- be of endurings.______________________________________________________________________________1 Ethics, police force and breast feeding (1995) pp 7-172 breast feeding Ethics, pp233-238Thompson et al justify the core by which health professionals commode evaluate what likely consequences of doment whitethorn be including side-effects. As act unilitarianism, although they none that where health professionals gravel to bind into account the wider responsibilities to the longanimous of, the hospital, research or otherwise, wherefore rule utilitarianism is more applicable. They close that this ideology emphasises the achievement of goals that are important to the context of adult male life, and the serviceable application of principles or rules and that experienceation of the consequences of application are important to consider to determine whether a typeicular course is right or wrong.Fletcher et al set out the separate branches from this notion, act and rule utilitarianism. Firstly coitions with act utilitarianism, this is explained as each action is to be considered according to the consequences that turn up from i t, morality determined by examining whether the greatest good came from that act. In relative to rule utilitarianism, this is described as following of the general basic rules be in existence, forbidding murder, theft etc, rather than looking at the consequences that whitethorn ensue from that action, as by following these rules the greatest good must ensue as a earthy result.Fletcher et al also discuss preference utilitarianism, as being the allowance of discretion of individuals in project a certain action and to judge the morality of each with regard to their own judgement rather than following a rule or principle. This is plainly applicable to health practice.The second school of thought explained by Fletcher et al is deontology, explained as the promotion of the importance of compliance with a job when confinement an action, the consequences in that respectof being irrelevant when considering to take such an action. This is explained as stemming from religious justificati on, that the explanation of such duties are the laws sent from divinity, as God shtup be relied upon to distinguish what is right and wrong. Fletcher et al discuss the office to the school of thought by Immanuel Kant, a German philosopher (Ground lam of the Metaphysic of ethics) who stipulated that the basis of morality lay in the categorical imperative, a moral command, set by established moral laws. Following such moral rules is regarded as imperative, regard little of the consequences of an action taken in compliance.Fletcher et al emphasise that the deontological perspective reinforces the need to follow obligations, what ought to be done, and how, in a certain situation. The obligations that befall nurses are described as contractual, as part of the terms and conditions of practice session obligations similar to family ones are seen via the role of carer, though by artificial means created, and moral obligations, such as the obligation to respect longanimous confidential ity, perseverings autonomy, to do good (beneficence) and to do no harm (non-maleficence). Fletcher et al explain that these obligations can conflict in practice situations. The obligations of nursing provide must be balanced against the rights of the individual as patient roles, as enshrined in The Patients Charter, effective from April 1992.Thompson et al push explain that deontological theories can also be distinguished into act deontology and rule deontology, the former being based upon the ability of an individual to impose their own moral transaction into a situation when considering whether to take a form of action, and the latter being the emphasis upon moral duties and laws taking a universal form. They discuss the gene linkage of this school of thought to religious beliefs, as such rules can be argued as coming directly from God, as in the Ten Commandments. They do not discuss how this school applies to health practice, though it can be seen that this could be applied i n paternalism (see below) when considering a patients autonomy. spectral writers such as J.F. Keenan, from the Catholic perspective 3 explain that in that respect has been a turn to virtue ethics which has rejected the new practice of establishing that morality is governed by human rights language, which is considered the extent to which the principle of autonomy can be exercised. Keenan states that virtue ethicists ask whether in that respect is a character building nature to the proposed course of action and that all moral ratings are content to a three sided question, who are we, who ought we to proceed, and how can we get there? He further explains that virtue ethics considers that actions should be considered in the context of whether they provide affect the type of person they leave become by undertaking that action, rather than asking whether there is a right in a certain way.Fletcher et al discuss the issue of autonomy 4 as a basic principle that health professional s should always fully inform a patient about the diagnosis, forms of word available, and obtain his consent thereto, that is to treat him an an autonomous being. It is discussed that this may show case problems if the patient is noeticly stricken or a minor, therefore it is recognised that there cannot be harsh adherence to this principle, as patients would often not bring the specialist association to enable them to make a well- intercommunicate termination. The dilemma described in this instance is that the principle of autonomy can conflict with the principles of beneficence and non-maleficence.Fletcher et al explain that paternalism may be used quite often by health professionals, namely the belief that they can make a finis in terms of treatment on a patients behalf without considering their wishes or overriding the same. This is exercised in harmony with the principle of beneficence, though it is explained that unremarkably patients are told and their wishes are ta ken into consideration.Fletcher et al 5 distinguish betwixt legal rights and natural rights, the former enforceable via courts, and the latter deriving from natural law, originally thought of as coming from God, plainly in modern terms, has become enshrined in the concept of human rights, which concord also become legal rights via the Universal Declaration of Human Rights 1948, itemising rights including the right to liberty and to life.______________________________________________________________________________3 Catholic health check Quarterly May 1992 Assisted Suicide and the tuberosity Between putting to death and Letting Die J. F. Keenan4 Ethics, rectitude and Nursing (1995) pp 35-565 (ibid) pp139-143Fletcher et al 6 discuss the law governing spontaneous stillbirth, stating that it is a criminal offence under section 58 of the Offences against the Persons Act (OPA) 1861 to unlawfully do all act with intent to procure a miscarriage, which make abortion illegal prior to the enactment of the Abortion Act (AA) 1967. Fletcher et al explain that the Abortion Act 1967 did not repeal this earlier Act, but set out grounds which specified when abortion was legal, as a defence to a charge of criminal abortion.They state that this has been revise by section 37 of the Human Fertilisation and Embryology Act (HFEA) 1990, which specify five dollar bill grounds, including that a pregnancy has to be less than 24 weeks advanced the hazard or threat to the mothers life, mental or corporeal health is too great to allow continuance of pregnancy if there is a substantial risk that the child would be born with abnormalities description it severely handicapped and, a unilateral act by a unsex to avert an immediate risk to the life or health of the mother.Fletcher et al explain the right of nurses to exercise a conscientious objection, for lawsuit to carrying out an abortion, the rights of which are enshrined under section 4 of the AA 1967 and the HFEA 1990, the f ormer being the refusal to enrol in an abortion, the latter a right to refuse to participate in either treatment defined by the Act. This can be utilised where the individual health make upers individualised moral scratch conflicts with such a practice. However, as stated by McHale and shaking, 7 this must be actual participation in treatment, not a mere refusal to type a letter of referral 8.It is explained that such an individual can see him/herself open to a legal action against him for an omission if there is a vocation to act, though in practice this is rarely initiaten as another(prenominal) member of lag could perform the same treatment. Nursing staff may also record their objections to a specific course of treatment prescribed by another health professional on personal moral grounds, which might be affected by their contract of employment when the employers make finalitys with regard to this.Additionally, Ann Young 9 states that the refusal of the health professi onal can be made unless the treatment is incumbent to save life or prevent grave permanent injury to the physical or mental health of the mother. However, she criticises the ambiguity of the word grave as this could constitute notion as well as a serious heart defect.In Selective Reduction and Feticide The Parameters of Abortion 10, David scathe emphasized that there is ambiguity in the use of the term of abortion by medical examination practitioners and lawyers alike. He noted that Glanville Williams definition of abortion 11 states that For legal purposes, abortion means feticide the intentional destruction of the foetus in the uterus or any untimely delivery brought about with the intent to cause the death of the foetus.______________________________________________________________________________6 (ibid)7 Law and Nursing p 2088 Jannaway v Salford AHA 1988 3 All ER 10799 Legal Problems in Nursing dedicatep 20910 (1988) Sweet Maxwell hold and Contributors David P.T. Price11 Textbook of Criminal Law, (2nd ed., 1983), p.292In the context of non-consensual abortion, Price explains that this can advance where the death of a foetus was caused by an act of non-consensual violence upon a pregnant woman. He argues that this act may not necessarily fall within the definition of a criminal abortion under section 58 OPA 1861, and would rather be treated as an scandalise.He states that in the United States, courts are prepared to precede the abuse of abortion, which is similar to section 58, to non-consensual assaults upon women resulting in foetal death 12 though in this case the man causing foetal death was charged with assault rather than foetal murder.Looking at an American viewpoint, in Bioethics and Medical Ethics 13, doubting Thomas Platt considers that the emphasis on autonomy ignores the deeper metaphysical issue of the degree to which any human act can be regarded as freely chosen. He states that the scientific perspective purely states that human behavior is the result of genetic and environmental factors. He stipulates that it has to be the environment in which a person has been raised which allow determine how a person bequeath respond to a suggestion, for example abortion, and that in less technologically developed cultures, they would respond in a different way to the West.Verena Tschudin 14 explains ethical decision making models in many forms including Jametons model, which requires identification of the problem, gathering of data to identify options and make a decision to act and then assess the consequences thereof Crishams model signly massaging the dilemma, outlining the options, reviewing the criteria, before the act and evaluation thereof and the Nursing process model, which requires assessment, homework, execution and evaluation. The latter involves a series of questions at assessment level, planning identifies whether the ethical problem is a question of teleology or deontology, with a series of questions to follow, death penalty requires consideration of whether one would like to receive the same treatment, and finally evaluation considers whether the act has solved the problem and what was gained, with a series of questions.In relation to the exercise of patient consent, this is described as an exercise of a patients autonomy. The UKCCs guidelines re that the health professional must explain the intended test or procedure to the patient without bias and in as much detail as the patient requires, and that if no questions have been asked then the health professional should assess the amount of tuition the patient requires 15. It is explained that a nurse, as per Clause 1 of the UKCC Code of Professional transport must act in such a way as to promote and safeguard the interests and well-being of patients and clients. This is explained to go so far as stating his/her opinion that there has been insufficient information provided to the patient to render the same fully extrapolateab le to him and enable him to make a fully informed decision 16, which can affect the judgment given by a doctor.______________________________________________________________________________12 Hollis v. Commonwealth 652 S.W. 2d 61 (Ky. 1983)13 Medicine, Metaphysics and Morals Thomas Platt West Chester University14 Ethics in Nursing p 85-9515 Exercising Accountability16 (ibid)It is explained further 17 that the principle of autonomy is enshrined in law as the right to self-determination. Written consent is unremarkably provided before surgery, in a standard form from the Department of Health, which has been amended in 1991.The case law relating to consent stems from the general principle that every adult person of sound mind and body has a right to determine what happens to his body, and that a surgeon who performs an operation without his consent has committed an assault 18. However, this principle is hard qualified is discussed. In the case of informed consent, where the patient i s given insufficient information about the risks of a certain procedure, the patient must sue in negligence rather than in onslaught 19.Even the standard set in negligence is weighted heavily in favour of the health professional, as it has been ruled that a doctor is not guilty of negligence as he has acted in accordance with the accepted practice in that field by other doctors 20. This case was affirmed in Sidaway v Bethlem Royal infirmary 21, and in further subsequent cases such as Blyth v Bloomsbury AHA 22 and Gold v Haringey AHA 23, where the restrictive disclosure policy was supported by general medical opinion. It was highlighted that despite this, Lord Bridge has emphasised in Sidaway 24, that even if a health professional acts in accordance with general practice, the court may still take a decision that there has been non-disclosure of material facts. precise problems are highlighted in the context of where a patient is incapable of providing consent, which is governed by l aw. The case law has established that a health professional must moreover(prenominal) do what is absolutely necessary to save the patients life, which does not include removal of a womb if it has been considered a further pregnancy would jeopardise the patients life 25. Therefore, it is argued that this principle of doing what is necessary to save a life overrides the right to autonomy 26. However, this does not extend to the life of a foetus in risk 27.Regarding accountability, Fletcher et al 28 states that the Code of Professional Conduct stipulates a registered nurse, midwife or health visitor is personally accountable for her practice, even off-duty. This ties in with the professionals legal duty of care, as explained by Tingle Cribb 29, deriving from Donoghue v Stevenson 30, as the need to take reasonable care to avoid acts or omissions that can be reasonably foreseen to injury a person affected by the acts or omissions, which can result in an action for negligence. Tingle Cribb state that the nurse has to weigh up the potential harm and gain ground of the patient at that time, and reach the decision involving the least harm.______________________________________________________________________________17 (Fletcher et al ibid)18 Schloendorff v Society of New York 191419 Chatterson v Gerson 198120 Bolam v Friern Hospital Management Committee 195721 198522 198523 198824 (ibid)25 Devi v West Midlands AHA26 Re T27 Re F (in utero) 198828 (ibid) pp104-12929 Nursing Law and Ethics p 13-1930 1932The professional standards are maintained by the UKCC in the Code of Professional Conduct, and each nurse or midwife is under that duty, though they argue that this standard is set by the profession itself. In the case of an allegation of a spoil of such a duty, the health professional can be subject to disciplinary action for misconduct. They explain that accountability merely requires a health professional to be able to justify their actions. Fletcher et al conside r that it is important for the professional to have regard to the interests of patients and clients rather than purely the rules of the UKCC. Verena Tschudin 31 states that nurses have both a legal and moral accountability, which arises from patient autonomy.Fletcher et al discuss the dilemmas that may occur in healthcare practice, and where the health professionals moral code is at odds with her duty, The Code of Professional Conduct stipulates that the professional must ensure that no action or omission by that person will be detrimental to the condition of the patient, which can be seen as the principle of non-maleficence. An example is provided that if the incorrect dose of medicine has been administered to a patient, then that health professionals self-interest should not override her duty to disclose the error as this could not be argued to be in the patients best interests.In relation to professional competence, Fletcher et al state that The Code of Professional Conduct stipu lates that a health professional must maintain and improve their professional knowledge and competence. As regards midwives, Fletcher et al state that they requirement is to attend a five-day refresher course, five sanctioned study days every five years or another approved course. There has been an impact in the context of European alliance (EC) legislation, as explained by Bridgit Dimond 32, the activities of a midwife are defined in EC Directive 80/155/EEC Article 4, including providing family planning advice to recognise warning signs of abnormalities necessitating doctor referral.Fletcher et al criticise the limitations of the Post-registration Education and Practice Project in 1990 for newly qualified nurses, and those returning to health care practice after five years, requiring five days study leave every three years and demonstration of professional knowledge and competence. However, since then, Ms Dimond has argued that Project 2000 has sought to integrate nurse clinical t eaching and practice 33.Fletcher et al explain that ethical dilemmas can arise from the instructions provided by a senior member of staff, which does not accord with the health professionals personal or moral beliefs. When making a decision on how to act, that professional will have to consider whether she is acting within the law, according to the Code of Professional Conduct, and also in the best interests of the patient as well as her own beliefs. They discuss the remedies available to patients or clients, which are a complaint to the UKCC which would result in a hearing before the Professional Conduct Committee use of the formal Hospital Complaints Procedure or a complaint to the nurses employer.______________________________________________________________________________31 (ibid) p 11632 Legal Aspects of Nursing pp 444-45733 (ibid) p 270In conclusion, in the context of conscientious objections, it has been suggested that there should be ward-based abortions carried out only 3 4 in special units by professionals who have taken up such jobs as they do not have moral or ethical objections to abortion. Verena Tscudin 35 states that here is however, always a conflict surrounded by a nurse or midwifes duty to keep abreast life rather than destroy it. The culmination of ethical perspectives in decision-making models helper the professional, though she must also always be mindful of her duty to the patient, the Code of Professional Conduct and the law.______________________________________________________________________________34 Ann Young, p 20935 (ibid) p 137BIBLIOGRAPHYBioethics and Medical Ethics Medicine, Metaphysics and Morals Thomas Platt West Chester UniversityCatholic Medical Quarterly May 1992 Assisted Suicide and the Distinction Between Killing and Letting Die J. F. KeenanEthics in Nursing (2nd edition) 1992 (Butterworth/Heinemann) pp 85-95 Verena TschudinEthics, Law and Nursing (1995) Manchester University Press pp 7-17 pp 35-56 pp 139-143 Fletch er et alLegal Aspects of Nursing (2nd edition) 1995 (Prenctice Hall) pp 444-457 Bridgit DimondLegal Problems in Nursing Practice(2nd edition) 1993 (Chapman Hall) p 209 Ann P.YoungLaw and Nursing (2nd edition) 2001 (Butterworth/Heinemann) p 208 McHale and TingleNursing Law and Ethics1995 (Blackwell) pp 13-19 Tingle CribbSelective Reduction and Feticide The Parameters of Abortion ((1988) Sweet Maxwell Limited and Contributors David P.T. PriceNursing Ethics(2nd edition) 1993(Churchill Livingstone), pp233-238 Thompson et al104134Legally Binding Undertaking1. I Rebecca Asghar undertake that in line with my contractual obligations this work is completely and wholly original.2. 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