The decision of their own regarding their treatment (Griffith

The first principle of
Beauchamp and Childress is respect of autonomy, which adherence to respect
individual’s right and choices (Griffith and Tengnah, 2014). In the health care
context, consideration of respect for autonomy focuses on the patient’s right
to make the decision of their own regarding their treatment (Griffith and
Tengnah, 2008). Moreover, Miola (2009) postulates that prior to performing any
invasive procedure obtaining informed consent from the patient is very essential
in order to protect patient autonomy. The author further suggests that informed
consent also safeguards patients’ rights and ensures that they understand the
benefits, risk and alternatives of the procedure in advance.

However, in the case of Margaret
she was not able to make her own decision due to her progression of diseases.
Spike (2017) postulates that the standard process of obtaining consent for
medical intervention is interrupted when an individual lack capacity. But,
Brown and Vaughan (2013) argue that the health professional should implement
the principles of best interest or use Lasting Power of Attorney (LPA) when the
patient lack capacity to make decisions for themselves. Nevertheless, when
Margaret had a capacity she had declared her son as the attorney of LPA for her
health and welfare.

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According to the Mental
Capacity Act (2005, section 9) the person who holds the health and welfare of
the attorney provides the legal authority to a person to make decisions
regarding treatment and consenting to medical procedures on behalf of an
incapacitated person. This emphasises that Margaret son has full legal rights
to decline the treatment. He articulates the nurse that the use of the syringe
drive can deteriorate his mother’s condition. To adherence with the Human Right
Act (1998) that every individual has a right to exercise their freedom in
views, religion and thought. Consequently, the team faces dilemma whether to
proceed with the treatment or not as it was not legal to perform the treatment
without the authorisation of LPA. Griffith (2014) believes that when the
decision is not acted upon patient best interests, the nurse can challenge the
designated decision maker and try to resolve the issue. Thus, the nurse
informed the son about the consequences of refusing treatment can further
deteriorate the patient’s health condition leading to dehydration, depression
and electrolyte imbalance due to excessive vomiting (loss of fluid) (Harris,
2010). To exercise patient choices while making an informed decision, it is
very critical that the nurse should provide honest and accurate information
(NMC, 2015).

Following the second principles
of beneficence which is defined as the obligation to do good and provide care
that benefits the patient (Beauchamp and Childress, 2013). Griffith and Tengnah
(2014) argues that the principle of autonomy can clash with the principle of
beneficence when the patient or their relatives makes a decision that the
health professional believes that will not benefit the patient and conflict can
occur. Ellis and Abbott (2012) postulates conflict as an action of disagreement
between one or more individuals that occur because of different opinion, or


In relevance to Margaret case,
the conflict occurred between health professionals and family member while
making crucial decisions, when Margaret son disagreed with treatment as he was
not sure that the use of the syringe drive would benefit Margaret health
condition. However, the NMC’s code (2015) underpins a professional and moral
obligation to all the registered nurse to provide overall benefits to patient
and should act on patient best interest. In this context, the nurse should be
in a position to act as an advocate for their patient as well as providing
realistic information to the patient and their family (Griffith, 2014). The
role of the nurse as an advocacy involves safety of patient values, expectation
and concerns (Choi, 2015).


In Margaret scenario, the nurse
used effective communication and provided realistic information. The nurse also
informed the son the team decision to use antiemetic drugs via syringe drive
would act in the best interest of Margaret as it helps to promote comfort and
aids to relieve the pain (Foy and Blowers, 2009).  Griffith and Tengnah (2014) postulates that
the nurse has an obligation to provide accurate and clear health information to
the patient and family as part of their duty of care. Similarly, Choi (2015)
supports that effective communication while dealing with the complex situation
can create change in perception and behaviour regarding the treatment. After
the deliberation with team member the son agreed with the treatment and acted
in patient best interest.


Non-maleficence is the third
principle which defined as an obligation to do no harm and to safeguard others
from harm (Griffith and Tengnah, 2014). The principle to do no harm also
comprises the professional standards of care and evidence- based assessment of
risk and benefits (Marquis and Huston, 2009). 
The decision made by a health professional to administer antiemetic
medicine via syringe drive did not harm the current status of Margaret. In
fact, Margaret responded to the treatment and course of care. Her nausea and
urge to vomit was controlled and she was more settled and comfortable.
Anti-emetic medication works as a neurotransmitter-blocking agent and send a
message to the chemoreceptors thus blocking the vomit centre in the brain that transmits
the feeling of nausea (Harris, 2010).

The fourth principle of
Beauchamp and Childress’s is justice, which underlies the obligation to treat
others equally (Griffith and Tengnah, 2014). Justice includes the principles of
treating others with fairness and equality with regardless of their age, sex,
religion, gender, belief and disability (Equality Act, 2010).  In this case scenario, the wish of the son was
contemplated as he holds LPA. Although the son contested the treatment at first,
later he gave his consent when the MDT detailed the benefits of using a syringe
drive for the treatment. Finally, the principle of justice was met as the
decision was done with mutual understanding by applying all the relevant laws.