Case study
Hedda is 15 years old individual who has Trisomy 21(Down syndrome). She is a tenant in her own house, which she shares with three other individual and support staff. Hedda can make some decision but will be unable to understand the extent of her injury entirely and is not deemed to have the mental capacity to take more complex decisions about the care she may receive in the accident and emergency department. Sam was taking part in the football match when she sustained the minor injury to her head. A member of the support staff accompanies her to a hospital the scenario raises issues of informed consent and mental capacity.
Overview
The individual with Down syndrome has limited mental or intellectual capacity to make the formed decision. Their social, occupation and verbal domain deteriorate according to severity level. The complex psychological physical and occupational functioning needs consistent supervision. They can learn the necessary self-help skills with the proper guidance may get the primary education to perform specific professional duties in supervision. Besides the self, help skills in a social, occupational, and personal domain for independent life, the patient's needs professional, legal, and ethical supervision to improve the quality of life. Hedda is 15 years old girl has Down syndrome, after getting the injury to a head the staff accompanies her to the hospital.As she cannot make the complicated decision and she has no family guardian with her, therefore the current situation raises the issue of informed consent. Here the question arises if the Sam should be treated first to save her from injuries or the ethical, legal and professional issues should be considered before addressing her. If the clinical psychologist only deal with the psychological development issues of the clients? What is the role of clinical psychologists in the medical suffering (such as injury, severe disease) of their patients? What kind of professional practices a clinical psychologist provides when deals with the injury of the patient. To answer the above question regarding treatment withholding or withdrawing the code of ethics, white paper, theory of autonomy, beneficence, non-munificence and justice need to consider and study thoroughly. T
Theoretical Framework of Professional Practice
In the psychological and medical health care, ethical principals are fundamental to follow and maintain the quality of life for all patients. The professionalism imposes some obligation to Clinical Psychologists and other healthcare staff for enhancing the health care quality. The code of ethics and code of conduct recommend preferring the uniqueness, desire, needs and wants of the patients while giving him/her healthcare facilities. The acceptance of the patient with all the weakness and viral illness are imperative to look after. The easy use of psychological terminology and unconditional positive regards enhances the positive attitude of the patients towards the disorder.
The essential component of professional practices is to control discrimination among patient based on socioeconomic status, race, ethnicity, religion and disabilities etc. the literature is enriched with the evidence that the patient reported many apprehension towards health care due to diversity in language, religion, race and ethnicity. While some other studies indicate that a discriminatory attitude by the professionals towards disabling individual have been studies on a high scale the results of the reviews noted that disable people consider the inadequate people of the society and least preference and acceptance have been given to them. People usually hide their disabled children's and manifest shame while owing them.
In the recent years, many government and non-government institutes are working for the betterment of disabled people. Te aim of those complain or policies is to make them independent in their social, occupational and personal domains of life. The peoples with disability are spending an appropriate self-dependent life with slight supervision. The case of Hedda is one among those, who spend their lives independently in each domain of life. The following aspects highlight those issues that affect the profession. The provision of high-quality care to the patient is a complex phenomenon as the ethical or professionalism hold a vast area. In the case of Hedda, the inform consent is imperative to carry, but the unexpected circumstance and the absence of a parent or guardian make the situation complicated. Furthermore, the cognitive or intellectual slight impairment also made the case worst. The following theories define how to tackle such situation professionally following ethical code and code of conduct.
Autonomy
Autonomy enables the patients the patient has to make health care decisions independently using critical and logical thinking, including wise intention, and action. The decision-making should be free of oppression or persuade. The Clinical psychologist and another healthcare practitioner should inform the patients about all the risk and protective factor of treatment and management plans. The chances of recovery or further loss should also be explained before taking the informed consent. In the current scenario as the patient cannot understand the complex phenomenon, therefore, the guardians or caretaker should singe the informed consent.As mentioned earlier that Hedda has no guardian and not in the state to understand the nature and level of her injury including the diagnosis prognosis, risk and protective factors of the treatment. Therefore, the staff member who lives with Hedda and brings her to the hospital should sign the informed consent and take the responsibility for the consequences of the treatment. The literature suggests many controversial finding in the favour or against the treatment plan. According to a current study, the life of patients is more critical than delays. In case if nobody takes the responsibility of Hedda, the healthcare staff should primarily work for saving the lives of the patient.
Justice
In healthcare, the equality in availing all the treatment benefits and modality according to the need should be considered in high scale. The patience regardless of class, gender, race, ethnicity, disability, language and religion should be treated and benefit equally. Justice usually covers four areas: fair allocation of limited resources, competing rights needs, potential conflicts and obligations with established legislation. Advance technologies create an ethical predicament, as treatment and management facilities are not equally accessible to all people. As the Hedda had the disability, and manifest other characteristics as low socioeconomic status, and no parental support, therefore she may encounter many disadvantages in health care setting. The Psychologists and healthcare practitioners should treat her fairly to make her independent again.
Beneficence
Beneficence refers to those medical and psychological services that only carried out to benefit the patient. The ethics of beneficence require the psychologists, physicians, psychiatrist and trained staff member with adequate knowledge, training and skill to enhance the quality of life of the patients. The patient with a disadvantaged background should be treated fairly to prefer humanity rather than materialism and Sam should be provided best services to heal her injury. All the policies, action, intervention and management plan would be design for the betterment of the patient. According to beneficence theory, the patient-centred approaches should be implemented to fulfil the needs, desire and wants of the patients.
Non-maleficence
Prevention of harm is fundamental in the contemporary health care system. The treatment or management plan comprised of an advanced instrument for the assessment, diagnosis, prognosis and the treatment of illnesses. Literature suggests that due to lack of practice and inadequate knowledge and skill harms the patients. The doctors and other healthcare staff strive for avoiding harm associated with treatment plans. The Hedda current condition may turn to adverse if treated by unskilled and inadequate knowledge. The responsibility for any damage or life loss would be addressing critically with the legal constitution implementation. The patient would not get any physical, emotional, psychological harm after and before the treatment. The only skilled professional would use the advanced instrument and treatment medication; juniors would not be allowed to do any experiment with the lives of the patients.
Legal Issues
The legislation and white paper arena have been conquered in 2015/2016 on National Health Insurance (NHI). This White Paper sets forth the Government's commitment to enhancing the life chances and quality of disabled people. The UNCRPD consider disability as an evolving construct rat her than focusing on defining it. Disability might be asses through social norms when a person manifests impairments in a physical, intellectual, psychosocial, sensory or neurological domain.
Due to this impairment, the individual distinguish or excluded from taking social, cultural, economic and political advantage or even prohibited from availing of human rights. Discrimination based on disability encompasses all types of unfair indirect or direct discrimination, including the accusation of reasonable accommodation. Trusted psychologist and doctor are providing their best services to save their patient from life-threatening diseases and disorders. The Hedda injury, disability and treatment have been associated with controversial findings in the literature. Some studies white paper and parliamentary legislation indicate that informed consent is not imperative for disable children but the timely and accurate treatment should be the first preference of nurses and healthcare professionals.
In contrast, the other studies indicate that the before legal formalities are fundamental before the implementation of treatments. Here the question arises if the ethics allow the legal ceremonies of human life? Should the paperwork give priority or the human life? Again the literature is enriched with controversial data, e.g. the supporter study of legal or paperwork suggests that the informed consent, confidentiality and equality comes under the ethics and to follow all these ethical considerations are as imperative as human lives. In the case of an accident, the legal or paperwork is essential to prohibit the situation in the future scenario. Sometimes the patient admitted to the hospital with severe injuries caused by any purposeful or planed accident, in such cases to promote justice the legal work is essential.
Sometimes due to the carelessness of the doctor, psychologists nurse or other healthcare professional the patient has to suffer a lot regarding death loss. Therefore, to control the likelihood of undesirable results, it is imperative to take informed consent. The legal aspect of health care reduced the chances of mishaps. On the other hand, some controversial studies indicate that health and life savings are more important than legal work. At the spot, the life should be entertained with the quick treatment plan. The case of Hedda was not as worst, as she had the minor injury and the staff member of Sam signed the informed consent. She was entertained by the immediate health care treatment plan.
The legislation and white paper elaborated many amendments in the policies of health care delivery to improve the quality of life. The psychologists, doctor, nurses and other healthcare staff plays a significant role in promoting the quality of health for all the people following the code of ethics and code of conduct. In the recent studies, the disability and quality of life had been a topic of discussion of the researchers, psychologist and sociologist. As the social, occupation, personal, and emotional functioning deteriorate in intellectual disability. Therefore, the collaborative work of psychologist, sociologist, and neurologist bring about a significant revolution regarding assessment, diagnosis, prognosis and management plans of intellectual disabilities.
The government and non-government policies have raised the standard of disabled people. Now in the current civilisation, many psychological intervention centres are working for the betterment of disabled people. Many people with disability are spending independent life successfully after taking vocational training. The nurses provide their medical services to their patient with impairment and refer them to some vocational training to spend their lives independently. Studies indicate that positive relationships have been investigating the high self-esteem of people with intellectual disability and independent live standards.
All those people with disability who were spending independent lives were found to have high self-esteem and positive attitude towards life. Researchers are focusing on the intellectual disability or down syndrome patients to improve their social, personal and occupational skills. A few policies are working on enhancing the educational, cognitive and critical thinking skills by implementing the intervention or lesson plan in their inclusive education. These are also a part of healthcare services to polish all the deficits of the patients of capable him/her to spend a productive life. The legal policies have achieved many milestones for improving the physical, mental and emotional health of the patients by implementing numerous strategies. In future improvement would be expected with the advancement in life.