The patient had delusional schizophrenia and type 2 diabetes, and her foot had mummified and fallen off. The purpose of this study is to analyze the ethical implications of how a woman diagnosed with paranoid schizophrenia was determined to have the mental ability to consent to amputation. When and whether to conduct an amputation on a schizophrenic patient is a major medical ethical challenge. The article looks at the opposing and supporting arguments in light of the ethical principles of patient autonomy, beneficence, non-harm, and equity when it comes to each person’s right to be happy.
Ethical Principles Involved
Principle 1: Fundamental Freedoms and Fundamental Rights
- All individuals who have or are being treated for a mental illness must be treated with kindness and with regard to the inherent dignity of the human person (Okonkwo et al., 2007).
- All individuals diagnosed with a mental illness, or who are treated as such, have the right to be protected against economic, sexual, and other kinds of exploitation, abuse, and demeaning treatment.
Principle 2: Diagnosis of Mental Illness
- A person’s mental disease must be determined in conformity with globally recognized medical standards.
- Having a political, economic, or social status, or being a member of a culture, race, or religious group should not be used to determine if someone has a mental illness.
Consequences of Reversing the Decision
Reduced Respect for Autonomy
It is both illegal and unethical for physicians to coerce competent individuals into therapy just because they believe it is in their best interests. In this context, “competence” is usually considered to refer to the patient’s ability to comprehend and retain pertinent information about their clinical conditions, to balance or reason about the options presented by such information, and to believe that the information pertains to them. In this situation, the patient’s disease robs them of their autonomy over critical areas of their lives and they may lose their ability to defend themselves (Barstow et al., 2014).
Self-efficacy is a term that relates to a individual’s perception that they are able to perform an act in order to accomplish a goal (Okonkwo et al., 2007). Self-efficacy beliefs affect every aspect of people’s lives including how they think; the life choices they make; their susceptibility to stress and depression; how well they are motivated; the acts they perform; the amount of effort they will expend pursuing a course of action; and their emotional reactions to the course of events (Okonkwo et al., 2007). Additionally, self-efficacy is a significant factor in the effectiveness with which information and skills are acquired and is a great predictor of behavior.
Codes of Ethics
A psychiatrist’s personal value bias may have a significant impact on their conclusion about a patient’s ability. This is unethical; therefore, psychiatrists should attempt to identify instances in which they have a strong moral perspective. According to the Code of Ethics for Nurses, every patient has the right to make medical care choices separate from their care givers (Barstow et al., 2014). Patient autonomy allows care givers to advise their patients without empowering or coercing them to make certain decisions regarding their treatment plan. Health practitioners and family members should not coerce or convince a patient or act on their behalf without permission.
Justice and Equity
This outcome’s arbitrariness would contradict an ethical principle: equality. The decision of a patient’s ability to determine should not be decided only by the psychiatrist performing the evaluation’s moral judgment. A decision based on a psychiatrist’s moral beliefs would be unjustifiable ethically since it would be arbitrary. As a result, the conclusion would be dictated by the consulting psychiatrist’s viewpoint (Dyer, 2014). For instance, imagine two patients who had similar symptoms in every way except that they were treated by two different psychiatrists who had divergent moral ideas. If two psychiatrists based their conclusions about their patients’ mental ability in any way on their own moral opinions, their findings for these two patients may disagree, which would contradict equality (Barstow et al., 2014). In this scenario, if the psychiatrist and surgeon conducted a cognitive examination and determined that the patient had the ability to make medical decisions about her care, the patient should not be denied the opportunity to make medical decisions. Each medical choice must be justified in the eyes of the person who suffers and views their agony as illogical.
Personal Values, Beliefs, and Core Ethical Beliefs
Communicating one’s own values aids in the promotion of one’s nursing conduct, ultimately resulting in improved healthcare results. Individuals choosing to enter the nursing profession must recognize that it is their responsibility to provide care, nurture, and assistance to individuals in their immediate vicinity. Therefore, when medical practitioners recognize that they have great feeling or they are morally biased when evaluating a patient’s mental capacity, or when other involved individuals disagree on the patient’s capacity, they should seek other professional opinions.
Diabetes has a higher risk of lower limb amputation. Amputations are most often performed on people with this disease due to unhealed wounds or ulcers. In such cases, patients have a right to decide whether or not to get amputated. The nursing codes of ethics reveals that patients possess autonomy and self-determination which allows them to agree or refuse any medical treatment. Therefore, if a patient has the capacity to make clear decision regarding their treatment, care givers should respect their autonomy. Ethics is a vital aspect of nursing’s basis. Nurses are involved in sickness prevention, pain relief, and the protection, promotion, and restoration of health in the care of people, families, organizations, and communities.
Barstow, C., Shahan, B., & Roberts, M. (2018). Evaluating medical decision-making capacity in practice. American Family Physician, 98(1), 40-46.
Dyer, C. (2014). Woman with schizophrenia is judged to have mental capacity to decide on amputation.
Okonkwo, O., Griffith, H. R., Belue, K., Lanza, S., Zamrini, E. Y., Harrell, L. E., … & Marson, D. C. (2007). Medical decision-making capacity in patients with mild cognitive impairment. Neurology, 69(15), 1528-1535.