Formative Assignment
How do ethical principles, legislation, human rights and patient autonomy impact
on clinical practice?
Introduction
According to Dove et al. (2017), clinical practice is influenced by an intricate
relationship between human rights, patient autonomy, legal frameworks, and ethical
principles. This relationship is particularly common in situations that require clinical
decisions made reflecting the nursing aspects of accountability, compassion, and
respect (Lewis, 2020). One of these domains is geriatric care in the context of capacity
assessment and obtaining consent (Biros, 2018). Focusing on these aspects, this paper
reflects on how clinical decision making in geriatric care settings is influenced by these
frameworks- revealing how they affect professional responsibility, patient dignity, and
nursing practice.
The Evaluation
Ethical principles are the ‘professional judgement’ pillars in healthcare as explained by
Nursing and Midwifery Council - NMC (2015). One of these principles is maintaining the
patients’ (older adults) autonomy as also fundamentally emphasized by (NMC, 2018).
But, this population’s autonomy is limited by age-related frailty and cognitive decline
expressed through delirium, dementia, or schizophrenic symptoms (Costa et al., 2024).
Here, nurses are required to consistently balance the population’s autonomy with the
principles of beneficence and non-maleficence to promote their wellbeing, and avoid
harm respectively (NMC, 2015). But nurses must not ignore interventions that ensure
the patients’ safety - to uphold the patients’ autonomy. Further, justice and equal
treatment is emphasized by the NHS England (2022) requiring delivery of equitable
geriatric care without making discriminatory assumptions about the patients’
dependence or incapacity. But the healthcare professionals should apply these
principles collectively without fragmentations in all clinical settings (NICE, 2018).
Ethical decision-making in geriatric care is legally supported in the UK by the Mental
Capacity Act (MCA) 2005 that supports interdisciplinary collaboration and presumption
of capacity; and even provides a structured two-stage capacity assessment test (Leiper,
2024). It specifically outlines that in situations where the patients lack capacity,
healthcare professionals should provide appropriate care that corresponds to their prior
values, beliefs, and wishes (Ruck Keene et al., 2023). The least restrictive option should
be chosen and the decisions should be ethically justified, patient-centred, and evidence-
informed rather than being solely based on the patient’s age, the associated
convenience, or diagnosis (NMC, 2015). These protections are further strengthened by
the Human Rights Act 1998 that upholds different patients’ rights. They include the right
to respect for the patients’ private life and their families –article 8; dignity – (article 3);
and liberty - article 5 (Wadham et al., 2024). They protect the patients from scenarios
like being sedated due to severe confusion or agitation in a mental health setting for
“safety” without ongoing review violates their right to liberty.
Conclusion
Overall, consent and capacity in geriatric care is an important aspect of nursing practice
but to avoid the associated challenges during decision-making, geriatric care by the
nurses should integrate respect for patient autonomy, human rights, legislation guiding
specific practice like MCA for mental health, and ethical principles. When combined,
they ensure that geriatric care delivered in a safe, lawful, compassionate, person-
centred, and equitable approach.
References
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