It is possible that Gemma’s personal experiences and values have sensitized her so that she is more aware of these comments but as a nurse she is required to provide care in a non-discriminatory even manner and so in this instance her personal beliefs should concur with her professional beliefs.

This can, however, mean that she finds it challenging to provide care for people who express views such as these but her professional values require her to (to do otherwise would be discriminating against them).

The principle of consequentialist ethics appears to be invoked here. However there is no consideration of the possible consequences that may emerge. For example does the CPN consider the issue of trust that may be broken if people think they may be coerced? The principle of autonomy is being violated here. Furthermore the principle of doing no harm (non-maleficence) is also being violated in the way in which Peter’s wishes are being ignored without concern for how he might feel.

Given that a person who experiences depression is likely to suffer from low self-esteem and may even be thinking about suicide, telling that person that he is letting everybody down is not the best way of supporting him. A more appropriate response would be to engage Peter in discussing what he wants to achieve and how he wants to achieve it. If he is unhappy with the anti-depressant what would he be happy to do? A transparent approach would also include Peter being told that any involuntary intervention would only be applied under the circumstances that would meet the criteria for treatment under the Mental Health Act and are not the sole decision of the CPN.

In applying Rowson’s framework the multi-disciplinary team might:

1. Consider whether the Mental Health Act applies in this case. Furthermore the nurse must act in accord with the NMC code.
2. Assuming that Peter does not meet the criteria for treatment under the act next consider the principles that might apply. Consequentialism would ask the nurse to consider fully what the possible outcomes of any action might be. This chimes with beneficence and would require the nurse to attempt to bring about a good outcome. The principle of autonomy would dictate that Peter’s wishes must be adhered to as much as is possible. Non-maleficence requires the nurse to attempt to do no harm.
3. Professional guidelines might suggest that the nurse seek clinical supervision to assist in reflection upon the issues raised. Furthermore the nurse would need to document all decisions and rationales for decisions in Peter’s care plan. The nurse should also reflect on whether any particular decisions are based on the nurse’s own personal preferences rather than Peter’s.
4. Assuming that the nurse has taken into account the issues in 3 it is unlikely that any adjustments to professional guidelines or rules of thumb might be made.
5. If the nurse decides that outcomes relating to Peter’s safety might be compromised by respecting his autonomy then the most pressing concern would be safety. Should this be the case then any involuntary approach must be mediated by consideration of Peter’s wishes as soon as is practicable either from Peter himself or the involvement of an advocate.
6. The breaching of any principle of autonomy would be mediated by involving Peter in what happens next and by helping him to express his wishes for now and in the future.

Having considered 1–6 the nurse could reach a decision.