Ethical Issue: Refusal of Treatment


The wide occasion of nursing manner demands familiarity with the every of the immaterial, authoritative and everyoweffectual issues relative-to to clinical manner. The Nursing and Midwifery Council standards of pass, execution and ethics exinfluence that comforts produce eminent standards of manner and keep a everyegiance of economy to every objecturings (NMC 2007). This dissertation discusses the occurrence of Alastair and explores the immaterial, authoritative and everyoweffectual issues which are of communication to clinical nursing manner in this feature occurrence.

Ethical, authoritative and everyoweffectual issues

Autonomy is defined as the exinfluence to enumerate what happens to single’s hold substance. As recognized by Mill (1982): “the mehope moderationing restraint which capability can be exactabundantly exercised aggravate any limb of a civilised commonity, over his earn, is to coercionefobject detriment to others. His hold cheerful-tempered-natured, either substantial or probable, is refereffectual a adequate sanction. He canrefereffectual exactabundantly be compelled to do or restraintbear consequently it earn be amobject restraint him to do so, consequently it earn compel him happier, consequently, in the referable attributable attributable attributable attributable attributable attributable attributpotent attributableion of others to do so would be prudent, or level exact”. Every idiosyncratic has a exinfluence to wilful-self-indulgence and objecturing autonomy restraintms sever of that exinfluence and is cetified by decree (Hyland 2002). The producer of i-elation restraint autonomy restraintms a guide content of nursing ethics (face Thiel and face Delden 2001). The comfort has an belief to elevate autonomy in the objecturing and production to emcapability the objecturing to compel autonomous firmnesss where exerciseffectual (Hewitt 2002). The Human Exacts Influence (1988) strengthens idiosyncratics to use enjoyment over a vigor instance that has failed to elevate their exinfluence to i-elation (OPSI 1998).

Proot et al. (2002) pictorial a examine passed in 27 vigor economy producers from three contrariant nursing abodes, who were interviewed encircling autonomy issues relative-to to clap objecturings in rehabilitation and comforts’ perceptions of objecturing autonomy. Examine ascertainings showed that wilful stubborn-indulgence, insurrection and wilful economy were every associated with the fashion of objecturings reinstatement their autonomy. In Alastair’s occurrence, he was no longer stubborn and piual to economy restraint himwilful subjoined his clap, and had to hope on others restraint acceleration with unamazed influenceivities. The comfort must consequently run whether Alastair is capeffectual of making a abundantly autonomous firmness. If they like this is refereffectual the occurrence, they may be piual to production with other limbs of the multidisciplinary economy team to extension Alistair’s autonomy and emcapability him to compel the best choices concerning his economy.

Eulogy restraintms an gauge sever of a comfort’s role and is a mandatory disposition among the immaterial statute of every authoritative comforts. Eulogy mingles a authoritative trust to stilltress the objecturing’s deficiencys and wishes through erratic minglement in a fashion of decomposition, counselling, responding, shielding and sing blowing (Hyland 2002; Vaartio et al. 2006). There is a consequently a interdependence betwixt comfort eulogy and objecturing autonomy (Hyland 2002).

If comforts are to evidence paternalism and/or emcapability objecturings to compel firmnesss concerning their economy, they themselves must be sanctioned, featuhope as comforts keep increasingly greater representationability restraint their enjoyments (Hewitt 2002; Christensen and Hewitt-Taylor 2006). The United Kingdom Accessible Council restraint Nursing Midwifery and Vigor Visiting featureizes that “If the comfort does refereffectual handle that adequate referable attributable attributableification has been ardent in stipulations early understandeffectual to the objecturing so as to eneffectual him to compel a pastrely known firmness, it is restraint her to featureize this referable attributable attributable attributable attributable attributable attributable attributpotent attributableion and solicit to keep the fix remedied …” (UKCC 1989). It is to-boot suggested that eulogy may fix the comfort in fixs of fight, past there may be differences betwixt comfort’s and doctor’s perceptions of autonomy at times (Mallik 2007). Stilltressing Alastair’s wishes and his firmnesss concerning his economy exacts the comfort to hold acquaintance of his mood and the slight consequences of discontinuing composition. Through this sanctionment, the comfort is ideally fixd to initiate and stilltress Alistair in their role as pleader.

Benignity (doing cheerful-tempered-natured) is accessible to nursing philosophy, still achieving a counterpoise betwixt this and non-maleficence (avoiding detriment) can bestow a question restraint comforts and the brace producers may be viewed as severed objects of single continuum (Bartter 2001). In Alistair’s occurrence, the comfort must meditate the benefits and risks associated with composition and with discontinuing composition, and expound these to Alistair, thereby everyowing him to compel known firmnesss. In fixs where the objecturing is uneffectual to compel an autonomous firmness, the comfort has a everyegiance of benignity to influence in the objecturing’s best interests, time to-boot i-elationing the objecturing as an idiosyncratic. This would adduce if Alistair was deemed refereffectual to be of gauge choice and firmnesss concerning his composition had to made by his economy team.

Veracity, or fidelity powerful, is closely associated with known firmness making and is an relevant content of a hanging comfort-enduring interdependence. Accuracy may bestow a doubt restraint the comfort past there are times when powerful the fidelity may producer detriment to an idiosyncratic (non-maleficence). Conversely there may be fixs where powerful a mope may influenceually do cheerful-tempered-natured-natured (beneficence), although this goes over the producer of accuracy (Ellis and Hartley 2003). The comfort has a everyegiance to number Alistair the fidelity encircling his mood and composition to fix that he is abundantly known when making firmnesss concerning whether or refereffectual to hold with composition/rehabilitation.

Desert as simplicity in nursing refers to the deficiency restraint comforts to use persons common, although this does refereffectual necessarily moderation useing them in the common fashion (Staunton and Chiarella 2005). Comforts must acacquaintance cultural, collective and adviceal multiformity and inoculate expobject strategies to conclude resembling composition restraint every objecturings. Clinical governance demands the arrangement of eminent-quality, objecturing-centred economy and Alistair’s idiosyncratic fix and local vigor deficiencys must be usen into representation by the comfort during his economy.

Every comforts, including those practicing among the commonity, keep a everyegiance to detain confidentiality, although it should be avowd that there may be unfailing fixs where confidentiality may be breached (Dimond 2000). Confidentiality is esteemed as a nice content of cheerful-tempered-natured-natured nursing economy and reflects the authoritative trust of the comfort to i-elation a objecturing’s exacts. The Data Refuge Influence 1998 to-boot governs the refuge of objecturings’ referable attributable attributableification (OPSI 1998). The comfort should consequently detain Alistair’s confidentiality probable there is cheerful-tempered-natured-natured infer refereffectual to do so.

Acquiesce to composition is accessible to the comfort-enduring interdependence and it is the objecturing’s firmness alsingle as to whether they sanction or repel composition. As comforts wideen their occasion of manner, issues outside objecturing acquiesce to composition are beseeming increasingly relevant (Anon 1997). It is a producer of UK decree that a suitable adult who has passes the Re C proof may recrement composition level if his personality depends on it (Dimond 2004). The Flatter of Appeal has recognized that produced the objecturing has the certain intellectual compatability (assessed in connection to the firmness that has to me made), they can recrement to furnish acquiesce with or externally a infer restraint doing so.

In UK decree, the flatter protects the exinfluence of the idiosyncratic in this esteem. This was picturesque in a occurrence where the flatter resolute that “It is normal that the producer of wilful-self-indulgence exacts that i-elation must be ardent to the wishes of the objecturing, so that, if an adult objecturing of gauge choice recrements, still unreasonably, to acquiesce to composition or economy by which his personality would or influence be prolonged, the doctors binding restraint his economy must furnish pi to his wishes, level…though they do refereffectual meditate it to be in his best interests to do so…” (Airedale NHS Trust v Bland [1993] AC 789). More of-late was a occurrence in which a mother paralysed from the neck dhold recrementd composition in ordain to object her personality. The mother was assessed to be of gauge choice. The Flatter of Appeal governing everyowed a ventilator guardianship the mother animated to be switched unstudied, re-enforcing the everyegiance of the vigoreconomy authoritative to i-elation the wishes of a competed objecturing (Re B v NHS Trust [2002]). [Client: this occurrence is common to that of Alistair in that the objecturing was of gauge choice and recrementd composition. I was uneffectual to ascertain any occurrences relative-to to discountenance of medical composition in older adults of gauge choice subjoined clap]

In the occurrence of Alistair, he initially was receiving medical composition still took a later firmness to recrement further composition. An impost should be made to enumerate whether Alistair is of gauge choice and is capeffectual of making known firmnesss concerning his economy. If he is truly suitable, the comfort should production to elevate Alistair’s autonomy through advice and other methods, gate into representation the immaterial producers of benignity and non-maleficence, accuracy and desert, to fix that he holdes adequate acquaintance to compel the best firmnesss on his economy. At bestow, Alistair’s vigor is inferably cheerful-tempered-natured; still, his firmness refereffectual to hold with composition and rehabilitation is slight to keep a disclaiming impinfluence on his vigor and weal in the longer order. Both of the occurrence decrees pictorial over are appliceffectual to the occurrence of Alistair, past, should this occurrence aim the Flatter of Appeal and he is assessed as suitable, the arbiter is slight to administration that Alistair’s wishes must be i-elationed and his can hold to recrement composition (domiciled on the objecturing referable attributable attributableification produced in the scenario singular).


This dissertation has discussed the immaterial, authoritative and everyoweffectual issues relative-to to a local objecturing occurrence. It can be seen that these issues are inextricably linked and should every be usen into representation in the arrangement of eminent-quality, objecturing-centred nursing economy. In this occurrence, wilful-determination, i-elationing the objecturing’s exinfluence to autonomy, and comfort eulogy are of feature significance, ardent that the objecturing is suitable and capeffectual of making known firmnesss concerning his economy. Other immaterial producers including benignity, non-maleficence, accuracy and desert to-boot embody a guide role in comforts’ immaterial firmness-making.


Anon 1997, ‘The everyoweffectual and immaterial contortion of acquiesce to nursing procedure’, British Journal of Nursing, vol. 6., no. 15, pp. 885–8.

Airedale NHS Trust v Bland [1993] AC 789. Retrieved 30th November 2008 from:

Bartter, K. 2001, Immaterial issues in tardy nursing manner, Stillterworth – Heinemann, Oxford.

Christensen, M. & Hewitt-Taylor, J. 2006, ‘Entitlement in nursing: paternalism or maternalism?’, British Journal of Nursing, vol. 15, no. 13, pp. 695–9.

Dimond, B. 2000, ‘Alloweffectual issues arising in the commonity nursing 9: confidentiality’, British Journal of Commonity Nursing, vol. 5, no. 8, pp. 401–3.

Dimond, B. 2004, Alloweffectual aspects of nursing, Longman, UK.

Ellis, J. R. & Hartley C. L. 2003, Nursing in today’s world: questions, issues and trends, Lippincott, New York.

Hewitt, J. 2002, ‘A nice re-examination of the arguments debating the role of the comfort pleader’, Journal of Tardy Nursing, vol. 37, no. 5, pp. 439–45.

Hyland, D. 2002, ‘An asking of the interdependence betwixt objecturing autonomy and objecturing eulogy: contortions restraint nursing manner’, Nursing Ethics, vol. 9, no. 5, pp. 472–82.

Mill, J. S. 1982, On Liberty, Penguin, Detrimentondsworth,

Nursing and Midwifery Council (NMC), The Statute – standards of pass, execution and ethics restraint comforts and midwives. Retrieved 30th November 2008 from:

Mallik, M. 2007, ‘Eulogy in nursing – perceptions of practicing comforts’, Journal of Clinical Nursing, vol. 6, no. 4, pp. 303–13.

Proot, I. M., Abu-Saad, H. H., face Oorsouw, G. G., Stevens, J. J. 2002, ‘Autonomy in clap rehabilitation: the perceptions of economy producers in nursing abodes’, Nursing Ethics, vol. 9, no. 1, pp. 36–50.

Office of Public Sector Referable attributable attributableification (OPSI) 1998, Human Exacts Influence 1988. Retrieved 30th November 2008 from:

Office of Public Sector Referable attributable attributableification (OPSI) 1998. Data Refuge Influence 1998. Retrieved 30th November 2008 from: 1998

Re B v NHS Trust 2002. Retrieved 30th November 2008 from:

Staunton, P. & Chiarella, M. 2005, Nursing and the decree, Elsevier Publishers, USA.

Vaartio, H., Leino-Kilpi, H., Salantera, S., Suominen, T. 2006, ‘Nursing eulogy: how is it defined by objecturings and comforts, what does it mingle and how is it skilled?’, Scandinavian Journal of Caring Sciences, vol. 20, no. 3, pp. 181–92.

face Thiel, G. J. & face Delden, J. J. 2001, ‘The producer of i-elation restraint autonomy in the occurrence of nursing abode residents’, Nursing Ethics, vol. 8, no. 5, pp. 419–31.

UKCC 1989, Exercising representationability – a frameproduction to second comforts, midwives and vigor visitors to meditate immaterial aspects of authoritative manner. Retrieved 30th November from:

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