The Subject Of Anorexia Nervosa Health And Social Care Essay
Anorexia nervosa is a life threatening, distressing and often a chronic mental illness, which causes severe weight loss, chronic physical and mental disability such as growth retardation, infertility, osteoporosis, bowel and intestinal disorder, impaired thinking and concentration as well as major disruption in their social, emotional and educational development (Tan, Hope, Stewart & Fitzpatrick, 2006). It is characterised by anxiety and preoccupation with body weight and shape, particularly in eating and weight control. Moreover, this disorder if not treated can cause complications such as bone weakening, decrease in white blood cells that would increase the risk of infection; low potassium level or electrolyte imbalance which may cause dangerous heart rhythms; malnutrition and seizures due to fluid loss from repeated diarrhoea and vomiting (Tan, et al, 2006). Incidentally, those diagnosed are also characterised as patients who frequently refuse to engage with treatment, in spite of the danger to health and life (Tan, et al, 2006).
The rights of an anorexia patient are not different compared to that of a healthy individual. Since the Declaration of Human Rights in 1948, society, and in particular, health care professionals have been influenced into practicing human rights and the preservation of human dignity of the patient (Griffith & Tengnah, 2009). Human rights are essential and inclusive in the society that respects the rule of law, human dignity, equality and freedom (Austalian Human Rights Commission, 2013). It is stated in Articles 1 and 25 of the Universal Declaration of Human Rights, that all human beings are born equal in dignity and rights, particularly in the standard of living such as adequate health and wellbeing of himself and his family (United Nation, 2013). These rights include food, housing, medical care, necessary social services, the right to security in the event of unemployment, sickness and disability. Undoubtedly, all individuals, including people living with a mental disability, such as anorexia patients, have rights and liberty to choose medical intervention according to their needs (WHO, 2013). In addition, as a healthcare professional, the responsibility of upholding the rights and dignity of a patient is necessary (ANMC, 2008).
On the contrary, people with mental illness are exposed to a wide range of human rights violations. Violations often occur in psychiatric institution through inadequate, degrading and harmful care and treatment, as well as unhygienic and inhumane condition (WHO, 2013). They also occur outside the institutional context, with people all over the world experiencing limitation in the exercise of their civil liberties and in the fields of employment, education and housing due to the stigma associated with mental illness (Kreek, 2011). Therefore, the World Health Organisation has developed a resource book for mental health, human rights and legislation, which brings together information on international norms and standards related to the rights of the people with mental disorders (WHO, 2013). The fundamental aim of the mental health legislation is to protect and promote peoples’ rights of autonomy and liberty, as well as to improve their lives and mental well being (WHO, 2013).
Similarly, in Australia, human rights are valued and respect with some protections offered by way of common law and legislations. The Federal Parliament has passed a number of laws relating to the rights of each individual, including the rights of persons living with disabilities and mental illness (Austalian Human Rights Commission, 2013). In particular, according to the Mental Health Act of 2007 (2012), aims to make provisions with respect to care, treatment and control of mentally ill and mentally disordered persons, whilst also protecting their civil rights. Moreover, it also facilitates the involvement of the patient and the persons caring for them in decisions involving care, treatment and control (Mental Health Act, 2012). There are two kinds of patients according to the Mental Health Act (2012), the voluntary patient and the involuntary patient. The involuntary patients are persons who are ordered to be detained against their own will after a mental health inquiry or otherwise by the tribunal. On the other hand, voluntary patients are persons who have willingly admitted themselves in an institution (Mental Health Act, 2012). However, there is a possibility for voluntary patients to be detained against their will, if they are proven mentally incapacitated and/or dangerous to the people around them as well as to themselves by a doctor (Mental Health Act, 2012).
Clearly, the rights of the patient to consent to and refuse are temporarily deferred, even though most anorexia nervosa patients show congruent skills with what is required for a legal capacity test (Silber, 2011). Therefore, as healthcare professional, it is necessary to achieve guardianship order to ensure that patients who refuse receive proper care and treatment. This guardian is a statutory official appointed by the Guardianship Tribunal or the Supreme Court under the Guardianship Act of 1987, to make lifestyle or personal decisions for patients who are incapable of making decision for themselves (Guardianship Tribunal, 2012). Thus, demonstrating to the court that the patient is unable to make decisions is necessary in obtaining guardianship order (Tan, et al, 2006; Mental Health Act 2007, 2012; Guardianship Tribunal, 2012). Furthermore, as a healthcare professional, it is necessary to work with patients and guardians to strengthen the therapeutic relationship in ethical decision making. Hence, this aids nurses to strive for balance between respecting patients’ rights and offering optimal treatment (Matusek & Wright, 2010).
Sighting the best course of treatment for both voluntary and involuntary treatment are rare, hence, it requires a closer examination on ethical principles of autonomy, beneficence, and justice. Firstly, the notions of autonomy are explicit in a number of standard conceptions, such as, liberty, the responsibility for personal behaviour, freedom of action and freedom of choice (Beauchamp, 2007). The principle of autonomy also entitles the right to make informed consent about treatment without coercion and unconscionable influence. However, autonomous decisions are observed to one’s ability to use rational reflection and whether or not one is competent to make a particular decision (Matusek & Wright, 2010). Therefore, the restraining of refusal to treatment is arguably a violation of autonomy. Nevertheless, this is justified on the grounds of accommodating a guardianship order (Guardianship Tribunal, 2012). Furthermore, the condition of being anorexic itself, in spite of a patient’s cognitive capacity, could be represented as a failure to autonomy in terms of loss of capacity to self actualisation and self realisation which are essential in human dignity (Bratton, 2010).
The concept of beneficence entails in doing good by contributing to and promoting overall health and wellbeing. This requires healthcare professionals to work in areas of competence to simulate that patients will benefit from seeking effective health care. However, doing what is right for the patient and promoting wellbeing can conflict with the principle of non-maleficence, such as a potential benefit of a life saving treatment where a patient refuses to receive it. As a healthcare professional, the duty of care is necessary, whether the patient consents to or refuses treatment, most especially if it is a life saving treatment (lecture). The involuntary and voluntary treatment, coercive or not, have only one goal which is to save the life of the patient suffering from anorexia. Healthcare professionals have the responsibility to promote good health and wellbeing of the patient, as well as to stimulate and support the growth of the patient’s self worth, which includes dignity and rights (ANMC, 2008). The principle of justice can be defined as striving for fairness in the distribution of benefits, risk and cost and the issues of justice, which include patient dignity, respect for human rights and to make free from unreasonable and unfair treatment (Matusek & Wright, 2010). It has been identified in anorexia cases that patients are usually clear that they do not want to die (Carney, 2009). Therefore, as a healthcare professional, treatment for patients with anorexia should involve using the least restrictive intervention to ensure patient safety and to promote optimal treatment outcomes (Fedyszyn &Sullivan,2007; Krohn, 2013). In addition, the use of multidisciplinary team approach involving a psychology, psychiatry, dietetics, medicine, social worker and family therapy will make the treatment more effective (RANZCP, 2013).
At the heart of the dilemma healthcare professionals, particularly nurses, are torn between conflicting ethical principles and demands of the patients as well as their loved ones. As a result, nurses will approach the situation using virtues or moral values in decision making, which requires nurses to have a good character and moral values to be able to act as a moral agent that advocates on behalf of the patient in decision making (ANMC, 2008). As stated in the Nursing Code of Ethics (2008), the nursing profession acknowledges the universal human rights and accepts the moral responsibility in safeguarding the dignity and equal worth of everyone. Therefore, nurses respect the worth of each patient by establishing kindness through bare acts of gentleness, care and consideration (Snellman & Gedda, 2012). Furthermore, there is unanimity that care should be the central virtue of nursing (Arries, 2005). Care as a virtue involves an innate attitude or disposition that is based on a deep sense of empathy and responsibility. Thus, embraces thinking right and feeling right, as well as having the right goal in ethical practice that present and provide quality care (Arries, 2005).
In addition to the virtue of care, nurses also hold the virtue of justice. This enables the nurse to have an awareness of and a special concern for the vulnerability of a patient. Therefore, justice can be expressed in a concrete action when the nurse understands the situation and develop the need to act in the patient’s best interest. From this perspective, the virtue of justice is not only a matter of fairness but also a loving justice, which can be associated with the virtue of benevolence (Arries, 2005). Ultimately, these virtues are necessary to establish a positive rapport with the patient. Tan, et al. (2010) suggest that what matters most to the patient is not whether they had restrictions of choice or freedom, but the nature of relationships with health professionals (Tan, Stewart, Fitzpatrick & Hope, 2010).