Ethics has been defined as the standards of conduct that show the extent to which human beings are to conduct themselves in different situations (The Markkula Centre for Applied Ethics, 2015). Ethical decision making is critical in organizations for improved employee relationship and performance (Elçi & Alpkan, 2009). Ethical standards are especially critical in healthcare settings because the practitioners in that field continuously interact with patients and have to win the confidence of the patients for them to offer effective healthcare (Lynch, Hart, & Costa, 2014). My friend who is a medical doctor is impaired by the use of alcohol and drugs. This implies that he is likely to make errors during medication thus increasing the risk of danger for the patients. I have to make the most appropriate decision which will be of benefit to the doctor, to the organization, and to the patients. As a health service manager decision-maker, I will use the Markkula Centre for Applied Ethics’ framework to make an appropriate ethical decision. The Markkula Centre for Applied Ethics’ framework consists of five sources of ethical standards that will be used as a guide in making the right ethical decision in the case of my professional doctor friend. These sources included the utilitarian approach, the rights approach, the fairness or justice approach, the common good approach, and the virtue approach.
Under the utilitarian approach, I will ensure that my decision generates the best balance of good over harm to all those who are affected (Edwards, 2009). Impairment due to drug abuse by a medical doctor will affect the patient’s health and the doctors and the organization’s reputation (Dumitrascu, Mannes, Gamble, & Selzer, 2014). There are two major options in deciding on the ethical dilemma; to report the doctor to the regulatory authority or to try to assist him to seek for counselling services to help him overcome his addiction to drugs. As a health service manager, I am responsible for the wellbeing of the doctor, that of the organization and the patient, and therefore I have to make a decision that would produce the most good or the least harm to all the parties. Using the utilitarian approach as a guide, I will choose to help my friend by advising him to seek for psychiatric services. However, I will first inform him of the consequences of his behaviour in case the relevant authority are made aware of it. My decision to go for psychiatric services will benefit the doctor, the patients under his care and the hospital’s reputation. The decision will not lead to the termination of the services offered by the doctor, the withdrawal of his practising license, the risk of misdiagnosis and even in some cases the risk of death on the side of the patients will be reduced. Moreover, the doctor will provide quality healthcare services which will improve the organization’s reputation. Thus, my decision will have provided the best or the least harm to all affected parties.
Based on the rights approach, my decision on the ethical dilemma has to be one that best protects and respects the moral rights of the doctor. Human beings have the right to make choices on the kind of life they would live (Knapp & VandeCreek, 2012). It is the right of the doctor to decide to drink or not to, however, he also has the moral obligation of being mentally stable in order to offer effective healthcare services to patients. But his current state of addiction to drugs deprives him the qualification to provide quality healthcare to patients. As a health service manager decision-maker, I am faced with a critical decision to make on whether to allow the doctor to enjoy his right of decision-making at the expense of the welfare of patients or to report him to the relevant authorities. According to Knapp and VandeCreek (2012) rights also imply duties, more specifically, the duty to respect the rights of others. Patients also have the right to a healthy and safe environment that will cater to their mental and physical wellbeing or health in addition to protection from all forms of danger (Joolaee & Hajibabaee, 2012). Therefore, based on the rights approach, I will report the doctor to the relevant authority so that he can be made aware of his obligation to the patients even as he exercises his right of decision making or the right to live the life he desires.
The fairness or justice approach demands that all people should be treated equally or if unequally, then fairly according to some defensible standard. Patients should be given the quality of service they deserve and even paid for (Cohen & Ezer, 2013). But for the doctor who is addicted to drugs cannot offer quality healthcare due to the impairment of the brain caused by the drugs. The patients should be treated equally, but if not equally, then fairly based on some defensible standard which cannot be drug addiction. Therefore, based on this approach I will have to notify the doctor of the patients’ expectation as well as that of the hospital, and if he cannot meet the expected standard, then the organizational procedures of discipline will have to be followed to ensure that there is fairness both on the patients and on the doctor.
The actions of each individual in a society should contribute to the preservation of life, according to the common good approach. This is based on the interlocking associations between members in a community which are also based on ethical reasoning. Moreover, there should be respect and compassion for everybody. Studies have indicated that nurse-patient relationship is critical in the provision of quality healthcare because patients are likely to provide the appropriate information during diagnosis once they have confidence in the healthcare practitioner (Fakhr-Movahedi, Salsali, Negarandeh, & Rahnavard, 2011). Kourkouta and Papathanasiou (2014) note that good nurse-patient relationship is therapeutic because it assures the patients that the physician is interested in their common good and general welfare. One of the major requirements that are significant to the patient’s wellbeing, is the establishment of a system of laws and healthcare. The doctor in the case scenario is acting contrary to the existing system of laws and policies on the provision of effective healthcare. As a health service manager decision-maker I will have to follow the existing policies and laws to give a warning to the doctor and if there are no changes, then follow disciplinary procedures.
The virtue approach of the Markkula Centre for Applied Ethics’ framework is based on the ideas that all ethical engagements have to be in line with some perfect features that cater for the complete human growth. Such virtues are characters that allow one to act most appropriately with respect to compassion, honesty and self-control. Virtue ethics probes one to ask questions such as “how will I become if I do this or that?” (Nortvedt, Hem, & Skirbekk, 2011). The doctor’s behaviour is contrary to the virtue approach because his behaviour of drug abuse is not consistent with the common ideal virtues such as effective healthcare which affects the full development of humanity (Barry, McGinty, Pescosolido, & Goldman, 2014) . There are two critical decisions to make regarding the case of drug abuse by the doctor. The first option is to talk to the doctor on the essence of having ethical actions that are in agreement with some ideal virtues, the second one is to refer him to a psychiatrist who will diagnose his condition and make recommendations upon which I will act.
Conclusion
The case of my professional friend presents an ethical dilemma that is complex and therefore requires an appropriate approach such as the Markkula Centre for Applied Ethics’ framework to determine the most appropriate ethical decision to make. The five sources of ethical standards that I have used as a guide in making ethical decisions regarding the doctor’s case of drug abuse have yielded different results. Despite the approach taken, it should first recognize that it’s an ethical issue, ascertain the facts, examine the alternative actions, arrive at a decision, try it out, act on the decision and contemplate on the outcomes. Based on the utilitarian approach I will seek psychiatric services because they will benefit the doctor, the patients under his care and the hospital’s reputation. The decision will not lead to the termination of the services offered by the doctor, the withdrawal of his practising license, the risk of misdiagnosis and even in some cases the risk of death on the side of the patients will be reduced. Based on the rights approach, I will report the doctor to the relevant authority so that he can be made aware of his obligation to the patients even as he exercises his right of decision making or the right to live the life he desires. Based on the justice and virtue approach, I will make the decision of notifying the doctor of the expectations of the patient and the hospital and then follow the existing disciplinary procedures to ensure that there is fairness both for the patients and the doctor.
References
Barry, C. L., McGinty, E. E., Pescosolido, B. A., & Goldman, H. H. (2014). Stigma, discrimination, treatment effectiveness, and policy: public views about drug addiction and mental illness. Psychiatric Services, 65(10), 1269-1272.
Cohen, J., & Ezer, T. (2013). Human rights in patient care: a theoretical and practical framework. Health Hum Rights, 15(2), 7-19.
Dumitrascu, C. I., Mannes, P. Z., Gamble, L. J., & Selzer, J. A. (2014). Substance use among physicians and medical students. Med Student Res J, 3(Winter), 26-35.
Edwards, S. D. (2009). Nursing ethics: a principle-based approach (2nd ed.). London, UK: Macmillan International Higher Education. Elçi, M., & Alpkan, L. (2009). The impact of perceived organizational ethical climate on work satisfaction. Journal of Business Ethics, 84(3), 297-311.
Fakhr-Movahedi, A., Salsali, M., Negarandeh, R., & Rahnavard, Z. (2011). Exploring
contextual factors of the nurse-patient relationship: A qualitative study. Koomesh, 23-34. Joolaee, S., & Hajibabaee, F. (2012). Patient rights in Iran: a review article. Nursing ethics, 19(1), 45-57.
Knapp, S. J., & VandeCreek, L. D. (2012). Practical ethics for psychologists: A positive approach (2nd ed.). Washington, DC: American Psychological Association.
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65.
Lynch, S., Hart, B., & Costa, C. M. (2014). Giving voice to values: An undergraduate nursing curriculum project. Collegian, 21(4), 367-373.
Nortvedt, P., Hem, M. H., & Skirbekk, H. (2011). The ethics of care: role obligations and moderate partiality in health care. Nursing Ethics, 18(2), 192-200. The Markkula Centre for Applied Ethics. (2015). A Framework for Ethical Decision Making.Retrieved from https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/
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