Medical Ethics

Ethics is a word commonly associated with medicine, especially the negative adjective form - unethical. A lot of things are unethical. Providing opportunity for abortion and not proving this opportunity. Not informing your patient about upcoming procedures. Most aspects related to medical ethics are regulated by law. Where I live (don't bother asking, trying to keep up the illusion of privacy;)), there is a specific law protecting the staff and patients of psychiatric hospitals. The dementia-care part of the nursing home I work at is also considered a psychiatric hospital, so we have to abide by those laws. I did not receive any information about the law yet (which is crazy, but that's another story), but I did learn a bit about it. When we install a motion sensor to increase the patient's safety (because of an increased risk of falling, for example), we have to fill out a form, signed by a physician. This is because it limits the patient's freedom. No problem so far.

Another rule is: never ever lock a door unless on doctor's orders. Again, because the limitation of freedom. Here's where it gets interesting, from an ethical perspective. One evening I was independently running my 'home', as we call it. About ten 'homes' have access to the same hallway, which is password-protected to prevent the patients from going outdoors (by the way, it's also where this happened). Conclusion: the hallway is safe. Still, it is inconvenient, because your patients are not together and can wander through that part of the nursing home. That's why some staff members elect to close the door so everyone is contained, which is easier as they know where everyone is. An illegal action, which is also unethical.

Up to that time, I learned to think about rules in a practical sense, because it was clear that I couldn't work there if I followed all rules. Not that it's a bad nursing home, but coworkers don't like when you say that you can't watch the patient drink their med solution because technically, it's not allowed. But overstepping both legal and ethical boundaries, no way. That day, a particular co-worker asked me to lock the door because "I couldn't work like that, right?". That's what is so scary about overstepping boundaries: when are you sacrificing your patient's well-being for your own comfort?

I think there should be stricter enforcement of rules and laws. I practically have no choice but break some rules, but it is much clearer if no one ever has to. Because sometimes unethical decisions are made based on work load or social pressure. But there is still responsibility. So, politely but without hesitation, I said no. No, I will not compomise my patient's freedom for my own good. Will I make the same decision in five years, or will I get tired of searching everywhere and just lock that door? I don't know. I hope not.