Ethics and Patient Consent in Nursing and Occupational Therapy

Introduction

Ethics in the nursing and occupational therapy communities is an ongoing concern that is being addressed in a number of different arenas and ways. This paper discusses national and international frameworks that have been created to address, define, and provide ethical behavior guidelines for the healthcare communities, comprising measured and timely responses to ethical issues as they pertain to those communities. Specifically, the paper examines ethical decision-making in healthcare regarding patient consent — how it is presented, used, and documented. Additionally, the paper explores legal and ethical frameworks as defined by a variety of Australian and international healthcare and medical entities.

National and International Ethical Frameworks

A number of organizations have established guidelines for ethical behavior by their members. International and national healthcare organizations, such as the World Health Organization (WHO) and the United Nations (UN), have set forth guidelines that affect how not only their individual members but entire countries behave. As an example, in 1948 the UN created the Universal Declaration of Human Rights, which called on all nations and peoples to reaffirm "their faith in fundamental human rights, in the dignity and worth of the human person and in the equal rights of men and women" (United Nations, 1948). By doing so, it ensured that each person implicitly had the right to consent to actions taken on or on behalf of the individual. By ensuring that every person in the global community participates in an equal manner and on equal footing, a standard is set that allows individuals the opportunity to exercise their right to say no — and, conversely, their right to say yes as well.

Other international organizations, such as the WHO, have provided additional and more specific guidelines regarding how issues in healthcare should be handled, and by whom. The WHO Constitution states that all peoples should benefit from medical, psychological, and related knowledge in order to achieve the fullest attainment of health, and that "informed opinion and active cooperation on the part of the public are of the utmost importance in the improvement of the health of the people" (WHO, 1948, p. 1). In other words, individuals should take an interest in their own lives and gain the knowledge needed to make informed decisions concerning their health and well-being.

The Australian Charter of Healthcare Rights (2014) defines seven specific areas of concern for Australian citizens. Those rights include the right to healthcare, the right to safe and high-quality care, the right to be included in decisions about that care, and the right to privacy and confidentiality. The remaining three rights are the right to be shown respect and dignity, the right to comment on care and have those comments discussed, and the right to be informed about the costs and options of available treatments in a clear and open manner.

The United Nations also developed a document articulating what was expected of the international healthcare community with the introduction of the Convention on the Rights of the Child. According to the United Nations website, the Convention became the most "rapidly and widely ratified international human rights treaty in history" (United Nations, 1989). The Convention created a set of guidelines for treating children as human beings rather than "passive objects of care and charity." Since its creation, the Convention has been instrumental in changing how child and youth patients are viewed by the medical community.

Thomas and Weisstub (2008) discuss the ethics and guidelines from different charters and conventions and conclude that many of the organizations have been quite effective in changing cultures around the world regarding healthcare — in particular, the manner in which children are now viewed and the rights that children are now expected to have.

In 1964, the World Medical Association prepared the Declaration of Helsinki. The Declaration was created to provide guidelines to physicians engaged in biomedical research involving human subjects (WMA, 1964). One of the most significant aspects of the Declaration is the explicitly stated right of the research subject to safeguard his or her own integrity, and the requirement that "every precaution should be taken to respect the privacy of the subject and to minimize the impact of the study on the subject's physical and mental integrity and on the personality of the subject" (p. 1). According to the Declaration, the physician is responsible for ensuring that the subject has the right information to make an informed decision, including the fact that the subject can change his or her mind at any time and for any reason.