Everyone, but especially vulnerable people, has the right to be treated fully and wholly as a person. No one person is greater or more deserving than any other. Age, race, gender, religion, sexual orientation, lifestyle, culture, social or economic status, political beliefs, physical or mental disability – it doesn’t matter. Every individual is equally precious and valuable. Your role doesn’t stop with just acting for yourself, in your own practice. The Code of professional conduct says you must ‘promote and protect the interests and dignity of patients …’ . This might mean speaking up for a group of people by challenging protocols or practices. We must respect our patients and make sure others do as well. This could mean challenging the lack of information for a certain group, or that the criteria for a particular service unfairly discriminate against a group.

Respecting individuality means letting people make decisions for themselves. You have an obligation to provide people with information about health and social care and how to access care and support, but you can’t make decisions for people as long as they are competent to make those decisions for themselves. It doesn’t matter if you agree or if you think that they might have a better quality of life if they do what you tell them. Part of being a nurse is recognising that people have the right to live the life they want, as the Code of professional conduct says, ‘within the limits of professional practice, existing legislation, resources and the goals of the therapeutic relationship’.

Respecting people also means having boundaries. You also can’t ever exploit your role as a nurse – you can’t use the fact you are caring for someone to gain at their expense. That gain might be physical, social or economic – no matter how, it’s wrong. Benefiting at a patient’s expense is abuse, because your job is to take care of people, not have them take care of you.

The Code of professional conduct states:

“When obtaining valid consent, you must be sure that it is:

Every person is legally competent unless a ‘suitably qualified practitioner’ decides that they are not. Competence to make a decision can vary depending on what the decision is: someone who is not competent to consent to heart surgery might be competent to decide they don’t want to take a bath. Being legally competent means the person can understand what the treatment is, what the consequences are, and make a conscious choice.

If it’s an emergency and the patient can’t tell you what he or she wants, you are expected to do whatever is necessary to preserve life. You can’t use these circumstances to over-ride what you know the patient would say if he or she was able. Sometimes individuals will have left advice with family or friends, or left a document such as a ‘preferred place of care’ (a document that allows people to express their wishes for end-of-life care) stipulating their wishes. You can look at the patient’s past history: if that person has said ‘no’ several times to a procedure, you should know in your heart that, if you were able to ask, he or she would probably still say ‘No’. Several years ago there was a story in the news about a hospital near my home in America. A patient who had a religious objection to a blood transfusion was in A&E bleeding to death. The patient refused blood, even though he knew this meant he would die. As soon as he became unconscious, a doctor started a transfusion. Technically, this fitted the criteria – it was an emergency and it was to preserve life – but the patient clearly had competently refused.

Consent also applies to people with mental health problems or learning disabilities: these individuals still have the right to refuse and consent to care. If someone is sectioned under the Mental Health Act, or if the Courts have appointed someone designated to make decisions on behalf of the individual, it is expected that people who know the patient would participate in the assessment and care/treatment planning to make certain that the person’s wishes are respected and that care decisions are made in the individual’s best interest.

With children, there are special considerations around competence to consent. Parents can give (or refuse) consent, but the age and ability of the child to understand are taken into consideration. If you are working with children, you need to be aware of the specific protocols and procedures around consent.

The truth is that, under law, no one (except, with certain limitations, a parent or a Court-appointed guardian) automatically has the right to make a decision on behalf of anyone else. You have to be sure as much as it is possible that whatever you do is what the patient would want.

Everything you do – or fail to do – is your responsibility. You can’t blame anyone else – there is no get-out clause that you were ‘only following orders’. As a nurse, you have an obligation always to act in the best interest of the people for whom you care. This could mean telling a colleague or another professional that he or she is wrong. Again, your patients have to trust that everything you do is always in their best interest. It’s your duty to make sure your patients are safe and that their care is appropriate and delivered competently.

You must make sure that your practice, the care you deliver and the environment in which it is delivered are safe, therapeutic and ethical. If you believe a patient to be at risk, because you are concerned that for whatever reason another practitioner might not be fit to practise, you are obliged to speak up. If you are concerned about doing this, contact the NMC, your union/trade organisation or speak to your manager. All organisations have policies in place to guide your actions. Remember: the patient comes first.

When it comes to patients being at risk, you can’t afford to wait: if you are worried that a patient is at risk because of the environment and you can’t fix it yourself, you must report your concerns to someone senior. It must also be in writing. That’s where incident reports come from!

Because you are a nurse 24 hours a day, on or off duty, you have a duty to provide care even when you are not at work. You don’t have to be a paramedic – what you need to do is act reasonably to prevent the person from coming to further harm. If you are a mental health nurse and you arrive at the scene of a traffic accident, all that might be expected of you would be to move the injured person into the recovery position; if you were an experienced A&E nurse, a little more might be expected! The NMC says ‘The care provided would be judged against what could reasonably be expected from someone with your knowledge, skills and abilities when placed in those particular circumstances’. What you can’t do is walk past as if nothing happened. For example:

How many people have since reflected that they thought it was odd that Dr Shipman used so much morphine, and that so many more of his patients died at home in relation to similar-sized practices? People later said they had doubts. Why did no-one to speak out? What was it that kept them silent?

If someone had raised these concerns, there might be quite a few people around today living useful, happy lives. If you think something is not right, reflect on it. If you have nagging doubts, raise your concerns. I am sure that the people who didn’t speak up about their concerns over Dr Shipman have trouble sleeping at night, realising how much they could have done by speaking up. It’s not a lesson to learn in hindsight.