Discuss about the Ethical Issues And Principles In Healthcare.
Every patient of every nationality, cast, and creed is entitled to receive the best possible care from all healthcare professionals the patients come across. One can count the term ‘ethics’ as one of the most important branches of healthcare as it deals with the moral conundrums, which generally arises due to the conflict of the healthcare professionals over the arising consequences.
If the ethical issues in medicine were reviewed, one would find two relevant terms, namely ‘Deontology’ and ‘Utilitarianism’, as the competing ethical system. Deontology can be regarded as the probable ethical duty, which one person should do in a particular situation. Utilitarianism can be described as the ethical act of a person, done for the greater good of the society. This approach is regarded as the social approach, then an individualistic approach. Every healthcare professional should maintain the balance of both of the ethical approaches while dealing with the consequences.
This article discusses and analyses these ethical conflicts of the provided case study in the light of the ethical theories. The article also analyses the chosen case study in the light of the relevant professional code of ethics. The article also discusses the possible proposals and intervention of professional practice regarding the chosen case study.
The chosen case study states two of the ethical dilemmas faced by an experienced physiotherapist named Henry, who has been working in this field for 8 years.
The first incident includes one of his patients named Jim (73) who is recovering from knee replacement surgeries. The patient has been adamant about not continuing with his exercising routines and was unable to show any improvement for 3 months. Henry took a decision of discontinuing the treatment of the patient after referring him to the massage therapist (Blumenthal-Barby, & Burroughs, 2012). His practice manager Shelly has pointed out that his approach may be good for that particular patient, but the overall consequence would not be good as it sends a negative message towards the society. This incident clearly shows the deontological approach Henry took in this particular situation. The deontological approach may be good for any particular individual, but it may not change the society for good.
Henry has faced another situation as he made a complaint against an alcoholic surgeon he is working with. The practice manager promised him to have a word with the surgeon about the whole incident. However, the surgeon has been continuing his work in the same condition (Elwyn et al, 2014). Henry chose to complain against the surgeon as he thought about the benefit of the patients. Henry’s approach towards the situation is utilitarian as he thought about the possible consequence of the situation and lodged a complaint to the practice manager for the greater good.
The practice manager is clearly concerned for the name of the facilitation center rather than the well-being of the patients (Furler, & Palmer, 2010). The primary concern of every healthcare facility should be the wellbeing of the patients. The practice manager is not concerned about it. She is clearly breaching the code of ethics, which must be followed by all the healthcare professionals in Australia.
Many healthcare professionals function as deontologists while treating a particular patient as the primary concern of any of the professional is the wellbeing of that particular patient. This method provides the healthcare professionals with enough motivation to do good for the patient. Henry faced a conflict while treating the 73-year-old patient named Jim, as the patient was not showing any signs of recovering and was not following the exercise regime provided by Henry. Henry thought the best approach of treating the patient is to refer him to the massage therapist. In this situation, Henry also thought about the wellbeing of the other patients who needs his assistance. Henry’s approach towards the situation is also Utilitarian as he needed to maximize his utility as the healthcare professional (Dion, 2012).
From the viewpoint of Utilitarian approach, the healthcare professionals make the decision by calculating the number of benefits. This approach sets the morality of the approach and it can be determined as consequentialist. This approach is for the greater good of the society, although it can harm some individuals. The physiotherapist from the case study is facing such an issue in his clinic. He observed that one of the doctors is having an issue with alcohol addiction (Page, 2012). He also observed that the doctor is performing the surgery while intoxicated. Henry understood the graveness of the situation and faced an ethical dilemma as his complaint could be bad for the career of the doctor but if the situation continues, the outcome would not be good for the patients. However, Henry overcame the conflict and raised a concern about the situation for the greater good (Reader, & Gillespie, 2013).
In Australia, the physiotherapists are registered healthcare professionals who possess University degree qualification and they need to follow the APA (Australian Physiotherapy Association) code of conduct while practicing physiotherapy. APA has provided the professional members with nine principles with details guidance (Physiotherapy.asn.au. 2017).
The principle number 6 from the APA code of conduct states that the APA members have to communicate with their colleagues and the relevant people for the betterment of the society and the wider community. In the provided case study, Henry, the physiotherapist, observed that a doctor of his clinic is coming to the clinic so intoxicated that he smells like alcohol. He also observed that the doctor is performing the surgeries to the patients in the same condition (Hall, & Bobinski, 2014). The physiotherapists acted professionally in this case and let the practice manager know of the situation. This action was needed to maintain to achieve the optimum patient outcome. The principle number 6 also states that the APA members should also refer the clients to them who can be effective for the ultimate health outcome of the patients. The physiotherapist referred the patient to the massage therapist as he felt that seeing massage therapists would be better for the patient as the patient is not following his approach (Conway & Gawronski, 2013).
The APA principle 8 states that all the APA members should contribute to the development of the total healthcare service, which would enhance the overall development of the community. The ill-treatment provided by the concerned doctor is degrading the level of care provided by the clinic altogether. The physiotherapist was concerned about the whole situation and therefore asked for the help of the practice manager. However, the practice manager has breached the code of ethics provided by the NMBA code of ethics by not showing any concern about the whole situation (Physiotherapy.asn.au, 2017).
The approach of Human Rights in healthcare is concerned with the fact that everyone in the world has the right to approach the highest attainable standard of health. It means that all of the clinics and healthcare centers must be available and accessible for the patients (Godbold, & Lees, 2013). The clinics and healthcare center is also bound to provide the patients with maximum quality care. The practice manager and the doctor from the case study are not at all concerned with the quality of the healthcare. The doctor is coming to the hospital in the drunken condition almost every day. The doctor is even operating on the patient in the same condition. This condition seriously degraded the quality of healthcare in the particular clinic. The practice manager is also not bothered by the situation, as she did not take any step weeks after the complaint lodged by the physiotherapist (Pauly, Varcoe, & Storch, 2012). The practice manager is not concerned by the situation the physiotherapist is facing with a particular patient. The patient is not following any exercise regime provided by the physiotherapist and not showing any signs of improvement. For the betterment of the patient’s condition, the physiotherapist has referred the patient to the massage therapist. The practice manager is breaching the human rights concern in healthcare, as she is unable to understand the situation.
Every healthcare professional has to swear by the Hippocratic ethics, which dictates “first do no harm, benefit only”. This refers to the principle of non-maleficence. In a clinical setting, the term ‘harm’ can be described as the condition, which deteriorates the condition of the patient (Broad, 2014). Sometimes the clinics and healthcare facility justifies the harm by relating it to the natural law theory. In this chosen case study, the doctor is coming to the hospital intoxicated and even operating on the patient in the same condition. This situation is enough to provide harm to the patients.
The practice manager is also harming the patients by neglecting the graveness of the situation. Every healthcare professional has to ensure that he or she is developing into a person of integrity who ensures the trust provided in him or her by the patients. The practice manager of this case study has not achieved eudaimonia (virtue) in her profession. Neglecting a condition can equally harm the patients (Nesri.org, 2017).
The principle of beneficence suggests that every healthcare professional have to avoid the harm and have to incorporate the act of altruism as the way of avoiding harm. The practice manager lacks the altruistic behavior as she refused to sit with the fellow doctor. It is expected from the practice manager as a healthcare worker. She is breaching the basic morality of the healthcare.
Every healthcare professional is more often unclear about the fact that if the patient possesses the right of autonomy (Mill, Allen, & Morrow, 2016). The healthcare professionals might have to assess that if the patient is competent enough to make decisions, which is best for their behalf. In this case, the patient who has undergone the bilateral knee replacement surgery is not following the directions made by the physiotherapist. However, the physiotherapist is respecting the autonomy of the patient and thus referred him to the massage therapist for his betterment.
An individual, who wishes to work in the professional healthcare environment, has to learn about the ethical theories to handle the critical situation, which often arises in any healthcare system. If the individual wishes to work in the clinical environment, he or she has to follow the Utilitarian approach as it ensures the betterment of the society and the clinic for the future purpose. However, the professional would also have to practice deontology as concerns with the immediate benefit of the patients. As a healthcare professional, one has to learn to balance both the ethical approaches (LaFollette, 2014).
A healthcare professional will also have to be concerned about the professional code of ethics and have to follow it to ensure that all the patients are getting competent care. The healthcare professionals would have to be familiar with the principles of ethics such as non-maleficence, beneficence, and autonomy to assess the conditions, which is better for the patients (Holmes, 2016). A healthcare professional will have to follow three of the main standards of virtue ethics, which are Eudaimonism, ethics of and the admirable traits, which can be identified easily by everyone. A healthcare professional must achieve eudaimonia to ensure the well-being of the patients as well as the colleagues. A healthcare professional would also have to know and acquire the admirable characteristics, which can be identified easily. The healthcare professional would have to lead him or herself towards the road of being an example to the younger generation who wants to be a future healthcare professional.
Conclusion:
In this article, the conflict and the relationship between the deontological and the Utilitarian approach are discussed according to a case study. The conflict arises with the mismatch between two of the holistic approach to ethics. The article also provides proper insight about the relationship with human rights with healthcare and discusses the ethical principles, which are relevant to the case study such as beneficence, nonmaleficence, and autonomy. The article analyses and provides the healthcare professionals with the proposals to improve the quality of the professional practices.
References:
Blumenthal-Barby, J. S., & Burroughs, H. (2012). Seeking better health care outcomes: the ethics of using the “nudge”. The American Journal of Bioethics, 12(2), 1-10.
Broad, C. D. (2014). Five types of ethical theory (Vol. 2). Routledge.
Conway, P., & Gawronski, B. (2013). Deontological and utilitarian inclinations in moral decision making: a process dissociation approach. Journal of personality and social psychology, 104(2), 216.
Dion, M. (2012). Are ethical theories relevant for ethical leadership?. Leadership & Organization Development Journal, 33(1), 4-24.
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.
Furler, J. S., & Palmer, V. J. (2010). The ethics of everyday practice in primary medical care: responding to social health inequities. Philosophy, ethics, and humanities in medicine, 5(1), 6.
Godbold, R., & Lees, A. (2013). Ethics education for health professionals: a values based approach. Nurse education in practice, 13(6), 553-560.
Hall, M. A., & Bobinski, M. A. (2014). Health care law and ethics. Wolters Kluwer Law & Business.
Holmes, D. (2016). Critical interventions in the ethics of healthcare: Challenging the principle of autonomy in bioethics. Routledge.
LaFollette, H. (Ed.). (2014). Ethics in practice: an anthology. John Wiley & Sons.
Mill, J. E., Allen, M. N., & Morrow, R. A. (2016). Critical theory: Critical methodology to disciplinary foundations in nursing. Canadian Journal of Nursing Research Archive, 33(2).
Nesri.org (2017). Join NESRI in supporting people’s movements for human rights. Retrieved from https://www.nesri.org/programs/what-is-the-human-right-to-health-and-health-care
Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision making?. BMC medical ethics, 13(1), 10.
Pauly, B. M., Varcoe, C., & Storch, J. (2012, March). Framing the issues: moral distress in health care. In Hec Forum 24(1), 1-11. Springer Netherlands.
Physiotherapy.asn.au. (2017). Retrieved from https://www.physiotherapy.asn.au/DocumentsFolder/APAWCM/The%20APA/Governance/Code_of_Conduct_V2013.pdf
Reader, T. W., & Gillespie, A. (2013). Patient neglect in healthcare institutions: a systematic review and conceptual model. BMC health services research, 13(1), 156.
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