graham averyGraham Avery is a lecturer at the University of Essex in the School of Health and Human Sciences, having been there for just over thirteen years. Prior to this, he worked for 25 years in an acute hospital setting, and the area with which he was most closely associated was surgical nursing. Graham Avery  was instrumental in introducing a variety of initiatives to the workplace: individualized pre-operative fasting, self-administration of medicines, patient group directions, and a no-fault system of drug error reporting. He also studied Medical Law and Ethics at King’s College London, and has undertaken research into non-medical prescribing.

“Law and Ethics in Nursing and Healthcare: An Introduction”

Here’s what Mr. Avery says about his book “Law and Ethics in Nursing and Healthcare“:

Law and Ethics in Nursing and Healthcare: An Introduction“My book is intended to cover the main areas of healthcare that practitioners are likely to face in practice. Thus, following an introduction to the legal system and ethical concepts, there are chapters on Negligence, Consent, Confidentiality, Resource Allocation, Mental Health, Children, Professional Conduct, and End of Life Decisions.

I have endeavoured to make the content as engaging as possible and have interspersed the narrative with real cases and fictional scenarios to illustrate key points. The book is therefore designed for newcomers to the subject, since my intention was to write in a style that could be easily understood. At the same time, though, I have tried to ensure that it is not too simplistic, for this can cause confusion. I personally find the law and ethics to be fascinating areas of study and my hope is that this enthusiasm has been conveyed to the reader.”

What would you define as 3 biggest ethical issues in healthcare?

The 3 biggest issues in healthcare today are, in my view, the following:

  1. Resource allocation (see Question 4).
  1. End of life decisions. In R (on the application of Nicklinson) v Ministry of Justice [2014], the court upheld the sanctity of life principle and refused permission for Mr. Nicklinson to be allowed to die. However, it is possible to discern growing judicial support for the right to die in certain circumstances. I also sense that there is greater public acceptance of this and that the law is heading for change.
  1. Deprivation of Liberty Safeguards. While I believe that the decision in P v Cheshire West [2014] was the correct one, it is clear that it has enormous practical implications for healthcare practitioners. It is equally clear that the present system is unsustainable and must change.

What has brought you to medicine?

Prior to my nurse training, I had been a hospital porter in a small cottage hospital and this was where I realised that I wanted to help people. I qualified as a nurse in 1981 and have worked in a variety of settings within an acute general hospital. I have been a Staff Nurse, Charge Nurse and Practice Development Nurse before joining the University of Essex as a lecturer in 2003.

Should doctors apply the rules of ethics on all patients universally, or vary the extent to which these rules should be applied upon each individual?

My gut instinct (and innate sense of justice) tells me that all patients should be treated equally and that the same rules should apply to all. Any lessening of this principle may initiate a slippery slope that will ultimately lead to a host of unpleasant consequences. I sense, however, a growing argument to state that people should accept a measure of responsibility for their own health. Therefore, if a person with chronic chest problems continues to smoke, the treatment is likely to be less effective. As such, it is possible to see this as being wasteful of resources, which might be more productively used elsewhere. The counter-argument to this, however, is that lifestyle choices may be due to a variety of uncontrollable factors (e.g. environment, genetics, education, peer pressure, etc.). In short, I suspect that patients may be treated unequally in practice and there may be logical reasons for doing so. However, practitioners should be able and prepared to justify these types of decisions, and the decisions should stand up to logical scrutiny.

What do you see to be the biggest problem of healthcare in 21 century?

I feel that the issue of Resource Allocation is by far the biggest problem that healthcare currently faces. At the same time as public demand and expectations grow, the economic downturn has meant that Government is trying to reduce the costs of the NHS. All of this has increased the pressure on services to a point where scandals such as that in Mid-Staffordshire are almost inevitable. I believe that it is possible for the NHS to work more efficiently, but this would require a cultural change and is clearly not going to happen quickly. Increasing taxation to generate more funds would be extremely unpopular and is unlikely to make a significant difference. My suspicion, therefore, is that some hard decisions will soon have to be made. How much is the NHS prepared (or able) to deliver and how much should patients contribute to care outside of these parameters? Almost inevitably, the answers to these questions will widen health inequalities, but they may help to preserve the NHS in a form that we all recognize.

Like this interview with the author? Don’t hesitate to grab a copy of his book!

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