The ethics in healthcare comprises of the beliefs, principles and values that shape the choices regarding the medical care (Monteverde 2014). The health care centrals around deciding the right and wrong things while giving healthcare facilities to the patients. The ethical dilemmas comprise of the need to choose from several morally acceptable or unacceptable options, in such a condition when the selection of one choice prevents the selection of another (Monteverde 2014). The various advances in medicine, rise of economic stress, increase in the self-determination of the patients and the difference in the values of the healthcare workers are some of the major factors in the contribution of frequency of ethical issues in healthcare industry (Pauly Varcoe and Storch 2012). The clinicians and the nurses should be well aware of the various issues of the healthcare and should perceive the difference between right and wrong. The hospitals and other healthcare institutions should have an inherent responsibility in the ensuring that the systems are correctly placed and the staffs display ethical behavior. It is also their duty to take action on any unethical issues in the hospitals and do fair justice to the patients.
The thesis statement of this essay is- “Is it acceptable to cover up a mistake if that mistake can cause potential or actual harm to the patient”. The statement would be discussed by taking into consideration the practical organizational context. The issue would be discussed from ethical standpoint by focusing on the concerned legal or professional factors. The situation will be considered from the viewpoint of various participants such as patients, relatives, nurses, clinicians and other paramedical staffs. The ethical issues would be combined with an ethical framework. There would be implementation of the bioethical principles in understanding the thesis statement. The thesis statement would be explored with the help of different philosophical theories such as utilitarian, deontology and the value based care. The concluding part would include the major ethical points discussed in this essay and imply the way the knowledge gathering would influence the future practice.
The medical treatment comprises of different medical errors which have an adverse effect on the health of the patients (Monteverde 2014). It is possible that the medical errors have been caused unknowingly due to medical negligence or intentionally by the healthcare providers (Pauly Varcoe and Storch 2012). These inaccurate treatments may comprise of incomplete diagnosis of injury or disease or ailment. There has been a large amount of deaths due to negative effects of the medical treatment, which has increased considerably over the past few years.
There are situations when I feel that there is considerable life risk or harm to the patient due to a wrong treatment, however, I am afraid of divulging the same to the patient relatives. I may be afraid of the probable consequences on me and the hospital authorities. I often feel the urge to cover up the mistake for the sake of my own profit and good image, which often put the life of patient at risk.
The reason for choosing this ethical dilemma is that there are an increasing number of cases of medical negligence which often causes actual harm to the patients. There are treatments offered to the patients who are below the acceptable standards of practice and they cause injury, hurt or death to the patients. This essay would try to understand the ethical dilemma from the health practitioner’s perspective.
The medical negligence or medical malpractice is considered as considered as substandard treatment rendered to the patients who can be categorized under the medical error (Oyebode 2013). There have been widespread cases of medical negligence in Singapore. There was an elderly woman in 2007, who was administered around 1000 times the actual dose of the radioactive iodine dose as a result of the negligence of the doctor (Pauly Varcoe and Storch 2012). The consequence of this case was that the woman imbibed thyroid gland disorder, which was later converted into lymphoma (which is a type of blood cancer). The medical negligence cases are usually treated as civil torts or there are sometimes criminal proceedings against the hospital authorities (Pegalis and Bal 2012). There are instances when the medical professionals obtain liability insurances for reducing the costs of the different lawsuits, which is based on medical malpractice. The cases of medical malpractice are common in hospitals, where there is a rush of patients. The medical professionals argue on the fact that due to this huge rush, it may not be possible to pay attention to the minute medical intricacies. This often makes them to hide their mistakes in the course of medical treatment of the patients.
There can be various forms of healthcare errors that are evident in the hospitals. They can be verbal, written, communication errors that compromise the health and safety of the patients (Garrouste-Orgeas et al. 2012). There may be errors in the event disclosure such as communication errors to the patients and late reporting to the patient relatives for a chronic illness (Seys et al. 2013). There can be ethical aspects of the different error-reporting mechanisms. The errors which are harmful for the patients are an indication of numerous problems in the system. There can be unfavorable working conditions for the nurses too.
The health care providers are embarrassed or devastated about their mistakes and hence they try to conceal them (Stecker Epstein and Stecker 2013). They also try to defend themselves because a mistake has the capability to damage their medical reputation. They may often try to shift the blame to someone else so that their reputation is protected (Pegalis and Bal 2012). The ethical frameworks come in consideration when there is the occurrence of the healthcare mistakes. It is important to respect the autonomy of the patients. The health providers often feel that they would be benefitted from the cover up of their mistakes, which is not true (Pegalis and Bal 2012). In fact, the converse is true. They might be benefitted from accepting the responsibility of their errors and conveying their apologies to the patient relatives. When the healthcare providers accept their mistakes, then there is a relationship of trust between the patient and the practitioner (Pegalis and Bal 2012). The healthcare institutions have an ethical obligation of admitting their clinical mistakes. The clinical mistakes do not remain hidden and they are ultimately exposed before the patient party (Gallin and Ognibene 2012). These often cause the healthcare institutions to compromise their mission statement and lose the trust of their patients. This causes an adverse relationship between the healthcare entity and the patient. There is a situation equivalent to deception and fidelity does not exist in such relationships.
The bioethical principles should be taken into consideration while pondering over the ethical dilemmas (General Assembly of the World Medical Association 2014). The principles lay high emphasis on the ethical guidelines that must be followed by the healthcare professionals. As opined by Faden et al. (2013), the health care delivery is a sensitive subject which is governed by a set of principles concerning medical ethics. The ethical responsibilities of the healthcare practitioners are dependent on the specific situations and the nature of the decision making (Gallin and Ognibene 2012). The nurses, physicians and other medical providers are legally as well as ethically obliged to report benefits, risks and alternative treatment options to the patients. There are four fundamental ethical principles that are applicable to the healthcare setting (Butts and Rich 2012). They are autonomy, beneficence, justice and nonmaleficence. The autonomy ethical duty is concerned with the fact that the patient has autonomy of intention, thought and action while formulating healthcare decisions (Beauchamp 2016). The decision-making process should be devoid of coaxing and coercion. The patient should be able to make informed consent and hence he should be well informed about the risks or benefits of the different medical treatments. The beneficence is concerned with the procedure that is done with the intent of doing well to the involved patient party (Herring 2014). This ethical parameter demands that the healthcare providers should develop as well as nurture skills/knowledge relevant to their field of practice. They should involve in continually updated training and considering the individual circumstances of the different patients (Gallin and Ognibene 2012). The justice element of the ethical parameter deals with the fact that every patient should be given equal medical treatment irrespective of their religion, caste and creed (Kuhse Schüklenk and Singer 2015). The providers of the healthcare should focus on four factors such as competing need, potential conflicts, rights/obligation and fair distribution of the organizational scarce resources (Beauchamp 2016). However, in some reproductive technologies, there are often ethical dilemmas since the medical treatment is not equally divided to all the sections of the society. The non maleficence duty of the medical practitioner focuses on the fact that the medical procedure should not harm the patient or any immediate member related to the patient (Beauchamp 2016). For example, the infertility specialists often assume that they are not doing harm to their patients. However, due to the fact that the assistive reproductive technologies have less success rates, there can be negative emotional level of the patients. There are other cases where it is difficult for the physicians to apply the “do not harm” principle.
There may be several sources from where the laws against medical institutions are derived. They can be federal, state constitutions, city or town ordinance and others (Herring 2014). There can be two kinds of potential actions that can be undertaken against the healthcare providers. One is the lack of consent and the other is concerned with the violation of the standard of care. A patient who has been injured or harmed during the course of medical treatment can bring a claim against the healthcare providers (Herring 2014). The patient can claim that the health care provider has not followed acceptable qualities of care. The patients expect that they receive optimum care in the medical facility and they expect sufficient judgment abilities of the clinicians in treating them (Di Bartolo and Braun 2017). The clinicians are expected to do the surgeries well and the nurses are supposed to take post-operative care. The standard of care arises from several different sources such as professional leader’s interactions, professional publications, presentations and others (Herring 2014). The litigating parties hire different experts for assisting the courts in the determination of applicable care standard. There are usually three phases of the litigation process regarding medical negligence such as initiation, pre-trial and trial (Mason Laurie and Smith 2013). There are often “out-of-court” settlement options, in which both parties do settle the claims before or during the trial.
In Singapore, the medical negligence is measured by the various applications of the Bolam test, according to their jurisdictions (Singaporelaw.sg 2017). This is a specific test which is used for the determination of the standard of care, which is applicable in the medical profession. This test specifies the fact that the physician is not guilty of medical negligence if he or she has acted in according to the accepted practice in that particular field or practice (Singaporelaw.sg 2017). The courts in Singapore have the right to designate a doctor as negligent if he is not able to meet a minimum level of consistency and logic. However, the courts do consider the fact that the opinions of the fellow doctors are important for understanding the trends of medical negligence. It is also important to detect the causation between the negligence of the defendant and the damage of the claimant (Mason Laurie and Smith 2013).
There are four factors that should be satisfied before contributing to the medical malpractice- Duty, Breach of Duty, Damages and Causation. There should be the presence of duty that should be owed by a healthcare practitioner, who is in charge of the treatment of his patients (Barnett and Kelly 2017). The duty exists between the doctor-patient relationship and it is a common example where there are chances of medical negligence. For example, a nurse is responsible for the providing secure working environment the patients, which would prevent them from causing potential harms. The clinician endowed with the duty of care for a patient should have failed to perform the duty, which another medical professional in the identical specialty would have done in similar situation (Barnett and Kelly 2017). For example, the nurse may do a breach of professional duty if she forgets to bring the bed down, which may lead to providing an unsafe environment to the patient. There can be damages
The nurses should work according to the instructions provided by the physicians and hence their duties must be performed correctly (Hynninen Saarnio and Isola 2015). For example, a nurse may wait for the physician instruction to start intubation or start IV for a particular patient depending on the medical condition of the patient. However, if there is unavailability of the physician at a particular point of time and there is serious medical condition of the patient, then the nurse would be in an ethical dilemma about whether to start her corresponding job roles or not. Her professional duties claim that he or she should adhere by the instructions of the doctors but on the other hand, on the humanitarian ground/medical ethics ground, she should take necessary actions from her side in order to save the patient’s life (Hynninen Saarnio and Isola 2015). There can be damages that may occur as a result of the potential breach of duty. If the patient falls accidentally out of the bed and breaks his limbs, then there are potential damages (Hynninen Saarnio and Isola 2015). This may be attributed to poor patient care, lack of safety elements and lack of attendants to the patients (Hynninen Saarnio and Isola 2015). The causation element states that there should be direct effect and because factor related to the injury of the patient (Hynninen Saarnio and Isola 2015). In the court of law, this may be one of the most difficult allegations to prove. The successful suit of medical malpractice will be proven if it satisfies the above four factors.
Medical ethics is considered as one of the sensible branches of the moral philosophy, which is concerned with the various conflicts in medical duties and the related potential outcomes (Hynninen Saarnio and Isola 2015). There are two appropriate theories that are consistent with the ethics of the decision making concerning the clinical outcomes and the cases of medical negligence. These theories contradict each other; however, they do have their own advantages as well as disadvantages. According to Braswell McCarthy and McCarthy (2014), the deontological approach is concerned with the consequences or the outcomes not justifying the methods to achieve it. This theory focuses on the right or wrong actions as opposed to the consequences of the actions (Braswell McCarthy and McCarthy 2014). For example, a clinician who may be treating an arthritis patient has been giving him medications for rheumatic arthritis, despite of the fact that he may be having ankylosing arthritis. There are chances that the clinician has identified the correct medical condition of the patient, however, since he has already commenced the treatment, he may not be able to share his mistake with the patient. He may continue to use the wrong treatment. For example, a doctor witnessed a patient who is dying a painful death, comes out of the room and faces the patient party. When the family approached the doctor for knowing the cause of suffer, then the doctor said that “The patient died in a peaceful manner”. The deontologist theory view states that the doctor is lying, which is fundamentally wrong and the family of the patients should be aware of the actual cause of death. This theory focuses on the fact that the options are wrong as far as medical negligence cases are concerned. This theory is patient centric and it gives more preference to patients. However, it is argued that this kind of theory often creates conflicts of interest in between the “equally” entitled individuals.
As opined by Broad (2014), the utilitarian theory of ethics concentrates on the correct as well as incorrect outcomes, which forms the basis of the moral judgements concerning action. In the above example, the reply of the clinician was justified as this false statement would ease the burden of the patient family at the time of distress. This theory can be regarded as society centric. In the utilitarian approach, the clinician’s decisions are based on the greatest benefit that is obtained for more number of individuals (Broad 2014). This theory believes that the morally correct act would be the one which would deliver good outcome. It concentrates on the fact that if there is an important moral goal, then any method of achieving it would be acceptable (Broad 2014). There is a common belief that the end goal determines the way of achieving them. The utilitarian bioethics is concentrated on the fact that the medical decisions should be based on the total productive value of the persons and their possible chances of survival (Bright Winn and Kanov 2014). For example, in case of terminally ill patients living on ventilation (having minimal chances of survival), it may be justifiable to free up the medical resources by stopping the treatment since it would be economical. The theories of the utilitarian benefits focus on the fact that if the terminally ill patients are deliberately made to die, then it would mean greater medical prospects for other patients and hence increasing their chances of survival (Broad 2014). The clinicians may try to cover up the case of critically ill patients and tell the patient relatives that they had faced a natural death. This would make them believe their fate and would also do benefit to the society as they would get access to hospital beds and medical treatment (Broad 2014). One of the main disadvantages of this kind of theory concerned with the fact that the physicians would be inclined to kill patients and give relevant justifications.
As opined by Bright Winn and Kanov (2014), the theory of virtue ethics is concerned with the moral characters or the different virtues of the individual. The Nursing and the Midwifery Council (NMC) has laid down certain guidelines for good character and good health of the individuals (Newton Taylor and Crighton 2016). If the clinician or the paramedical staff has good moral character, then they would not cover up their own mistakes. They would admit their medical negligence in front of the patient parties. It gives more flexible as well as creative solutions in the complex human world.
The value based care is essentially a new technique in which the value system are powerful determinants concerning the decisions related to health (Sarwar et al. 2015). The impacts of the value based care are often underestimated. This theory states that the decisions of the individuals are governed by values and facts. However, when there is sharing of the values their presence may go unnoticed. When there is no apparent conflict, the values are often unnoticed. In case of medical negligence cases, the clinicians (with good values) may be inclined to inform the patient regarding any faults. However, there would be some physicians, who would not be eager to share the details to the patient or their relatives by stating that it would act in the best interest of the patient. This theory often throws light on the fact that it is often desirable to implement different values than the universal set of values.
Conclusion
This essay discusses about the different perspectives of a particular clinical situation. The paper is successful in finding an answer to the thesis statement which stated that whether it is acceptable to hide the clinical mistake that have the potential to cause harm to patient. The medical negligence situation in current medical history is being studied in detail along with examples from real life. The various forms of human errors such as verbal, written and communication errors are discussed. The situation of the healthcare providers is elaborated in detail where they are more inclined to falsify the information that are being provided. The bioethical principles are being discussed, which focuses on the four fundamental principles such as autonomy, beneficence, justice and nonmaleficence. The next section deals with the various legal aspects of the medical negligence. There is the application of Bolam test and there is detailed description of the different types of litigations as well settlements. The factors that contribute to the occurrence of medical malpractice are described. These factors are duty, breach of duty, damages and causation. The thesis statement is analyzed from the perspective of both nurses and physicians. The relevant theories are discussed such as deontological approach, which is concerned with the consequences or the outcomes not justifying the methods to achieve it. On the other hand, the utilitarian theory of ethics concentrates the moral judgements concerning action. The theory of virtue ethics and value based care are also discussed. This study would help in the future as it is known how to react and ponder over such situations of medical negligence. The ethical behavior that must be displayed in such situation was well illustrated in this paper, which would help me in my future endeavors.
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