Mental health nursing is a complex field of nursing that deals with the nurturing of psychological issues of patients and due to this some of its aspects result to controversies making it an issue of concern in ethics. According to Roberts (2004) these principles of nursing remain to face criticism despite some of them being effective for the care of mentally ill persons. Although this has been the case some of these ethics just trigger more thinking and logic concerning this field as stated by Fulford et al (2002). The issue of paternalism that involves the subordinate care given to the psychological disabled is controversial as according to the mental act it advocates for compulsory admissions of persons under mental care scrutiny and also orders restraining and seclusion for such persons. It also demands for special care to be given to persons with such disorders as according to Roberts (2004). In such a case this means the autonomy of such as person to make crucial decisions concerning ones life is interfered with. Seclusion to various rooms with continued restraining of physical activity with the claims that such persons are health hazards to the society is also of concern as it denies them freedom of association. Another major of the concern in psychiatry is the informed consent on the anomalies of the patient and what treatment measures should be taken (Helene, Kristin and Knut, 2007). In nursing they are also ethical disagreement between the patients and the nurses on the kind of decisions which are crucial in treatment resulting to lack of collaboration in this care, other cases of nurses adhering to the will of the patient leading to effects such as euthanasia and wrong medication which are of ethical concern. This has resulted to the unjustified end of life such patients which are questionable and wanting as according to (Alice, Sandra, Marianne and Linda 2011). There is also a problem of psychotropic medication administration without disclosure to the patient and also disrespect of the authority and the powers that pertain to this kind of ailment nursing.
Why are these ethics a dilemma?
These ethics are a show of concern particularly for persons with this kind of illnesses but at times trespass the people’s dignity for life and taking in consideration some of these patients can not think and reason properly. These ethics requires significant consideration since they relate to the biology and social well being of patients which are important aspects of survival as according to Boyd (2008) who states that these points should be put in consideration. The building of a good relationship between the nurse and the patient is advised since it is an important aspect of respecting each other. It is also believed to foster openness on the problem one has and the kind of treatment one is receiving, this has however overstepped patients rights with the patients being treated with psycho-medication while unaware, undergoing medical care without being informed in the fear of reactions of disbelief and in a bid to empathize with the victims family. This is quite unethical as it may cause the patient to abandon treatment on realization and may also cost the sympathetic nurse a job. On the other hand showing extreme sympathy may make the nurse submit to the patient’s will to keep his information disclosed, this may be a show of respect for the patient but compromise occurs if family members insist on knowing the ailment the patient is suffering from since it is their right to know. This calls for such nurses to retain the confidentiality and privacy of the patients’ information. Practices such as euthanasia which is a show of lack of dignity for life have resulted due to such compromise.
These ethics arise due to the issue of paternalism where the care providers want to be in full control of the patient thus no independence (Helene, Kristin and Knut, 2007). This has been the result of social alienation for such persons, their barring from participating in practices of physical exercise thus a lack of collaborative and less successful treatment. This paternalism is what has resulted to patients undergoing forced medication and their treatment unconsciously to safeguard them from such conflicts. Logically this issue is of concern that though the patients are being deprived off their rights to make decisions they are not in their right mind to make those decisions thus these two factors should be put in consideration. This causes a lack of patient autonomy and also the trespass of professional boundaries.
The code of ethics of psychiatry also stipulate competent and ethical protection of the public thus the reasons for secluding and segregating persons with such illness though it is their right thus it is not justifiable as according to Registered Psychiatric Nurses of Canada (2010). The code of ethics on such treatment also respects the freedom to choose what is right and wrong as wrong as it respects the dignity and inherent worth of human well being thus allows such patients to be in a position to decide what they must do concerning their health or not do hence such considerations must be made. Quality practice and maintenance of well being of patients though controversial must not be overlooked in this case thus the patient should be consulted in decision making concerning his health and the kind of treatment he wants to receive though the nurse should not be submissive enough to loose his authority on how best to nurture psychological patients. This thus calls for the integration of collaborative nursing techniques in taking care of such persons (Registered Psychiatric Nurses of Canada, 2010). These dilemmas are supposed to be taken gravely so that medical practitioners do not break the code of ethics and also that they do not trespass patient rights and liberties since they may cause aftermath effects of stigmatization, deception of the beneficent and also a lack of empowerment and integrity to the ailing patient.
Theories to explain these ethic dilemmas
Using the utilitarianism theory which according to Basavanthappa (2007) states these controversial decisions should be made based on the best and most favored decision. This to some extent could help decisions concerning psychiatry nursing to be taken to favor the practitioners and the family in question but the opinion of the patient may be neglected. The decision may be favored by majority but however it can be against the norms and ethics of human dignity and would lead to practices such as mercy killing, forced medications and health practices being taken as measures to manage such persons without minding of the consequences so long as they are favored. An alternative theory of deontology has been proposed instead and states that medical decisions concerning such vulnerable persons should be made based on their rightfulness as per the stipulated norms (Basavanthappa, 2007). In this theory propositions on doing what is considered to be morally right whether it is favoring the stakeholders involved or not are suggested. This emphasizes on the issues of patient autonomy to make decisions, justice in consideration of beneficence and nonmaleficence actions to the patient regulating paternalism and also veracity in every decision made. These are as a result of advocacy on the importance of human duties and moral principles to rhyme with those of psychiatry nursing.
In bioethics the moral values in biomedicine are followed thus the ethics of nursing to take care of the patient and raise concern if the condition of the patient becomes wanting such as seclusion and isolation from the society must be adhered to. This is however important so that profound treatment can be taken without taking diplomacies to negotiate for the mode of treatment to be taken (Richard and Bernard, 2004). The virtue ethics theory is similar to deontology but takes in consideration on the moral aspect of caring for the mentally sick other than concentrating on the consequences helping more in the adherence to the law minding other than moral duty as specified by the regulations thus emphasizes on the following of medical provisions. The natural law is also important in decision making and largely depends on the stature that the nature of patient will take whether on treatment or not. Though this is a neutral out look of these ethical dilemmas it exposes risks of the patient harming other in his environment and dyeing due to lack of medical attention (Richard and Bernard, 2004). The use of Kantianism theory that puts more emphasizes on action of medical treatment of mental patients other than the consequences and the outcomes has been used to reach to the decision of treatment has been used severally in this case. Existential theories that propose the natural factors are the one that determines the existence of the patient whether sick of not and does not put emphasizes on treatment metods or the natural outcomes of the treatment (Richard and Bernard, 2004). These theories are determining factors in the medical action to be taken on patient with mental disorders though emphasizes should be paid on minding the patient’s say and also its relation with the moral ethics though the most preferred method is that of deontology that emphasizes on the use of morals and proper virtues in psychiatry nursing. This is because it is mindful of what the patient is going through compared to medical ethics in place.
Dilemmas concerning medical nursing of patients with mental disorders have been on the rise raising concerns on the autonomy of the patients to make sound decisions concerning their health, seclusion due to their surrounding environmental threats and also the problem of lack of full consent on the kind of treatment being administered to them and for what purpose is also of concern. These have been raised as psychiatry nursing dilemmas due to their vulnerability to either affect the ethics of this kind of nursing or ability to overstep the mandate of the patient to make decisions concerning treatment. Most of these dilemmas are brought about due to the adherence of different theories of treatment based on the focus they give much attention to, whether it is the consequence of treatment, the outcome or the purpose of treatment. These include the theories deontology, bioethics and also that of virtues among others. These concerns are raised since they have a negative impact in society, on the image of this kind of nursing and also to the patient and should be addressed and collaborative agreements in treatment should be sort for.
Alice, G., Sandra, M., Marianne, L. and Linda, T.(2011) Clinical ethical conflicts of nurses and physicians. Nursing Ethics, Vol. 18 Issue 1, p9-19
Basavanthappa, B. (2007). Psychiatric Mental Health Nursing pp 187-189 Google books
Boyd, A. ( 2008). Psychiatric nursing: contemporary practice Google books pp47-52
Fulford K. et al (2000). Analytic philosophy, brain science, and the concept of disorder. In Psychiatric Ethics, 3rd edn (eds Bloch, S., Chodoff, P. & Green, S.A.), Oxford University Press, New York Chapter 9, pp. 161–191.
Helene, M., Kristin, H. and Knut, W. 2007. Questionable requirement for consent in observational research in psychiatry. Nursing Ethics, Vol. 14 Issue 1, p41-53
Registered Psychiatric Nurses of Canada (2010) Code of Ethics &Standards of Psychiatric Nursing practice
Roberts, M. 2004. Psychiatric ethics; a critical introduction for mental health nurses. Journal of Psychiatric & Mental Health Nursing, Vol. 11 Issue 5, p583-588,