Describe about the Counseling Ethics for Liver Transplant Surgery.
Dr. Susan Lim is one of the leading surgeons of Singapore, who is famous for performing the first ever successful liver transplant surgery. However, her popularity decreased after the case of the Brunei family in 2007. She had charged £12million for performing the breast cancer treatment of Queen of Brune’s sister. The fee that has been charged by Dr. Lim is considered to be excessive. The Singapore Medical Council has acquired her for not following the moral code of conduct and dis-respecting the ethical rules of the medical practice. She was also responsible for conducting the treatment for 110 days that lasted from January to June 2007. The longer duration of treatment helped Dr. Lim to raise the cost of the bill. The court of Singapore has issued a penalty of $10,000 and canceled her license of surgeons for the 3 years (Harding, 2016).
This is one of the significant cases, where the physician is responsible for violating the moral code of medical practice. In this report, the moral dilemma that has occurred in the case of Dr. Lim is being discussed in details. The eight step model of ethical decision making is applied to explain the position of Dr. Lim. The moral position of Dr. Lim is also described along with the limitations of each theory.
In the modern world the physicians and surgeons have to face the challenge of providing high quality treatment to the patients and also lower the cost of medical service. Every medical professionals need to practice certain ethical code of conduct that will help them to ensure the safety of the patients. There are times, when the physicians had to higher the cost of treatment in order to provide the best quality treatment to the patients. However, there are times; the physicians raise the cost of treatment by prescribing unnecessary treatment and also recommending excessive medications. This helps them to increase their earnings and make better profit. For providing treatments to the rich and royal family the doctors often face the moral dilemma for providing the best quality treatment. In the case of Dr. Lim, it is her duty to follow the moral code of conduct and ensure that there is no discrimination that is done with the patients that may lower her reputation. However, as she is providing treatment to the Queen of Brunei, who belongs to the royal family, it is her duty to provide the best and advanced quality of treatment.
After the incidence excessive billing charge the international reputation of Dr Lim as a renowned physicians will be compromised and she will also not able to practice in all parts of the world. Many patients will also not be able to seek medical treatment advice from her and she will not be able to make her capable contribution to the field of medical world. She will also lose the trust of her patients. The situation of moral dilemma can be resolved using the theories related to the ethical decision making.
Application of 8-Step Ethical Decision model
The eight steps of ethical decision making is one of the effective techniques that can be applied in order to ensure good ethical decisions are made during the time of ethical dilemma (Iphofen, 2016). Dr. Lim can make effective decisions about the medical treatment using the framework of the ethical decision model.
Step one: Gathering of Facts
The first step for applying the ethical decision model is gathering of the facts related to the incident (Patuzzo & Manganotti, 2014). Dr Lim has to gather the facts about the treatment process and also provide facts like the clinical condition of the queen of Brunei family. With the help of further detail information related to the treatment process Dr. Lim can make need to provide the conclusion about the dilemmatic condition. It is also important to consider the uncertainty of the conditions that related to the treatment provided. The treatment of a disease like the breast cancer is done using the many assumptions. It is important to make sure about the assumptions are also included in the facts that is needed to resolve the ethical dilemma (Navabet al., 2016).
Step two: Definition of the ethical issues
The second step of the model is to provide definition of about the ethical issues. In this case, Dr. Lim has to define the ethical dilemma of the situation that will help to identify the particular crisis of the situation. It is common for physicians to face the moral dilemma during the time providing quality healthcare service. The expense of medical care needs to be reasonable, which will help to maintain the medical rights of the patients (Sobhani et al. 2016). With the help of proper definition of the ethical issue, it is possible to describe the complexity of the situation and also the exact area of conflict. In the case of Dr. Lim, she has faced the area of conflict is due to the excessive bill amount that she has claimed for doing the treatment of the Brune family member. She has also faced multiple area and elements of conflict that includes keeping the patient for several days and prescribing heavy and unnecessary medications. This has resulted in the serve side-effects of her patients, which has caused in the worsening conditions of the patients. This is due to the fact that Dr. Lim’s primary focus to make maximum profit instead of ensuring the safety of the patients. She has also performed heavy diagnostic test on the patient, which had resulted in the worsening condition of the patients. The main ethical issues that is faced by Dr. Lim is due to the heavy billing that is imposed by her and it is essential for her to focus on this major issue instead of focusing on the multiple issues that is faced by her during the treatment.
Step 3: Identify of the affected parties
In the next step it is important for the physicians to focus on the individual and the groups of people, who are affected due to the ethical issue (Elwyn et al., 2012). In the case of Dr. Lim the primary affected group is the member of the Brune family, who got the treatment of breast cancer. With the identification of the primary stakeholders, who got affected due to the ethical dilemma, Dr. Lim can directly approach the group to settle the matter outside the legal court. She may payback the amount directly to her patient group. This will help to save her reputation to all the public and will also help her to not face the criminal proceedings of the court and face legal challenges. She can also seek help for the secondary stakeholders, who got affected due herb action of moral dilemma. This includes the members of the hospital, where she performed the treatment process. It is important for her to realize the affect of the ethical dilemma and the trouble that is faced by the patient due to her unethical actions. This will help her to take intervention steps to provide compensation to the affected groups.
There are several positive and negative consequences due to the ethical dilemma like situation. For Dr. Lim the primary negative effects are the loss of the reputation that she had to face. She will also face the risk of losing the fame, which she gained due to her past achievements. It is also important to distinguish the difference between the short and the long term consequences of the ethical dilemma (Heyler, 2016). In order to deal with the short term consequences, for Dr. Lim need to take the advice of legal professionals, which will help her to minimize the immediate effects of the court proceedings. On the other hand to deal with the long term consequence, this includes the compromise of the international reputation, Dr. Lim needs to provide treatment to at lower cost and also focus on the quality of care that is provided to the patients. Due to the act of Lim, the reputation of the Singapore medical care is also compromised and people will lose the faith on seeking better quality healthcare treatment. However, there is good chance that there will be barriers that will be faced by the Lim while making decisions about the ethical dilemmas. Nevertheless, in order to avoid the adverse consequence of the situation Lim needs to overcome the cognitive barriers that are faced by the organization.
Step 5: Identification of the relevant principles, rights and justice issues
By taking the assistance of the legal advisors, Dr. Lim needs to understand the ethical principles, which has been violated due to her action. Hence, thereafter she needs to ensure that the intervention steps taken by her do not cause harm to other groups or individual. Effective decision making process is essential to ensure that the consequences unethical actions can be avoided. She can also use the clinical data of her patient to justify about the high cost of treatment that is provided. She may also explain the necessary medical intervention that was required to provide relief to the patient.
Step 6: Consideration of personal character and integrity
Dr. Lim can also take assistance of her colleague and fellow physicians, who can provide moral support to her. She also needs to seek the support from them, which can help them to enhance the reputation. There are several popular newspapers, which published the incidents and it is the duty of Dr. Lim to provide proper justification of her position and therefore, which will help in the restoration her reputation. She needs to provide justification considering about the patients, who got affected due her unethical practice.
The justifications that are provided by Dr. Lim need to be strong and have sufficient evidence. This will prevent her opposition group to force her in the corner within the case. She also has to provide alternative justification and resolutions about the situation. She also needs to ensure that the parties, who are attached with her duty also do not get affected due to her decisions.
Step 8: Checking of the Gut
Finally, it is crucial that the decisions that are made by Dr. Lim are made according to the judicial guidelines. She needs to have clear idea to ensure that the decisions made do not violate the ethical rules. Having good faith and confidence in the decision making process, will help her to ensure to take effective decision.
The theory of teleology is based on the moral fact that a decision needs to be made so that it protects the right of every individual. The consequence of every decision also needs to be considered. In case of Dr Lim, the decision of prescribing unnecessary medication and keeping the patient in hospital for longer duration was implemented to have greater profit. The patient group on the other hand, had to face adverse consequence by paying extra bills. This theory is based on the concept of hard universalism (Cockerham, 2014).
The main limitation of this theory is that it does not focus on the aim of the situation that give raise an unethical situation. Moreover, it focuses only on the view point of one group and does not consider the opinions and position of the all other groups, who are involved.
The Deontology theory or moral dilemma is based on the principle duty, where the right and the wrong side of a situation are judged based on the duty that is being performed (Brody, 2012). In the situation of Dr Lim, her primary duty was to give the best possible treatment to her patient based on the needs of the patient. However, using the fact that her patient belonged from the rich background she raised the cost of the treatment.
The main limitation of this theory is that people, who follow the guidelines, do not focus on the ethical issues and blindly focus only on the moral duties.
The use of the teleology and deontology theory is appropriate for the case of Dr. Lim as it helps in the matter of dealing with the case of ethical dilemma. As the principles of these theories are related to the case of moral dilemma, which is the main issue in case of Dr Lim, the use of this theory has helped to analyze the situation. It also helps to identify the incidents that has caused the ethical dilemma of the situation.
Conclusion
In order to seek support due to the legal issues that is faced by Dr Lim, she need to use the 8-step ethical decision making model. This will help her in the process of dilemma that is faced by her during after the incidence of overcharging of medical bill. This model will help her to seek medical support and thereby help in the process of getting moral and legal support. She needs to make effective decision in order to restore her reputation. She also needs to minimize the adverse legal effects, which will help her to avoid cancellation of license. Using the theories of moral dilemma, it can be justified that the action Dr Lim, has violated the ethical guidelines of medical practice and she has ignored the needs of the patient and have only focused on individual needs.
Reference
Brody, B. A. (Ed.). (2012). Moral theory and moral judgments in medical ethics (Vol. 32). Springer Science & Business Media.
Cockerham, W.C., 2014. Medical sociology. John Wiley & Sons, Ltd.
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., … & Edwards, A. (2012). Shared decision making: a model for clinical practice. Journal of general internal medicine, 27(10), 1361-1367.
Heyler, S. G., Armenakis, A. A., Walker, A. G., & Collier, D. Y. (2016). A qualitative study investigating the ethical decision making process: A proposed model. The Leadership Quarterly.
Iphofen, R. (2016). Ethical decision making in social research: A practical guide. Springer.
John Harding, (2016). [online] Available at: https://johnharding.com/2011/03/dr-susan-lims-great-singapore-ripoff/ [Accessed 21 Dec. 2016].
Navab, A., Koegel, R., Dowdy, E., & Vernon, T. (2016). Ethical Considerations in the Application of the Scientist–Practitioner Model for Psychologists Conducting Intervention Research. Journal of Contemporary Psychotherapy, 46(2), 79-87.
Patuzzo, S., & Manganotti, P. (2014). Deep brain stimulation in persistent vegetative states: Ethical issues governing decision making. Behavioural neurology, 2014.
Sobhani, S., Ghasemian, A., Farzadfar, F., Mashhadinejad, H., & Hejrani, B. (2016). Ethical Theories Used by Neurosurgery Residents to Make Decisions in Challenging Cases of Medical Ethics. Neuroethics, 9(3), 253-261.
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