Topic: Measurement and Applicability of the bioethical principles in Healthcare Management Practices and Decision-Makings
With the advancements and technological developments in the fields of biological sciences, medicines, healthcare sectors and similar aspects, the need for an ethical framework in the operations has been increasingly felt across the globe. Bioethics primarily deals with the ethical implications of different practices and activities in these fields, especially in the field of healthcare, providing guidance regarding rights and wrongs in different discoveries and their implementations (Ives & Draper, 2009).
There are four building principles of immense importance in the conceptual framework of bioethics, the principles being that of justice, beneficence, autonomy and nonmaleficence. However, with time other principles like that of truthfulness and confidentiality have also been incorporated in the conceptual framework of that of bioethics (ten Have & Gordijn, 2014). Keeping this into consideration, the concerned study proposes to analyse whether these principles can be measured and whether these principles have real life relevance and influence on the decision-making aspects and other activities of healthcare management.
This study may contribute in developing a robust bioethical framework in different healthcare organizations across the globe, by constructing a measuring yardstick for the bioethical principles and by reflection on how these principles influence decision-making in the healthcare industry.
The concerned research proposal tries to incorporate a review of the existing literatures in the aspects of bioethical issues in healthcare management, thereby analysing the gaps which exist in the literary and scholarly evidences in this field. The proposal then identifies the gaps which it intends to fill thereby highlighting the research methods and tools intended to be used for the purpose of the concerned study. An extensive research plan is provided at the end of the proposal followed by the potential research limitations in the concerned topic.
Steinbock, London & Arras (2013), define “Bioethics” as the discipline concerned with basic human rights protection and evaluation of rights and wrongs in developments of various life technologies, healthcare management and medicines.
The significance of bioethics, in the contemporary period, is highlighted in the work of Willmott & Willis (2008), where he emphasizes on the facts that bioethics focus on the humane grounds of developments in healthcare, biological sciences, medicines and so on and also works for developing sense and perception of right and wrong among relevant individuals, especially in the aspects of healthcare provision (Turner, 2009).
The theoretical framework of bioethics can be seen to be inclusive of two ground ethical theories, as highlighted by Fox, Fox & Swazey (2008), the theories being Deontological Ethics (focussing more on normative aspects and rules to judge an action, than on its consequences) and Utilitarian Ethics (judging the rights and wrongs of actions on the basis of their consequences).
Beauchamp (2016), highlights the different principles in the bioethical framework to be as follows:
Autonomy- Respecting the decision-making rights and capabilities of the individuals
Beneficence- Working towards betterment of individuals and minimising their risks
Nonmaleficence- Not harming the individuals and working in such a way that the level of unintended harms is also minimised
Justice- Equally and uniformly distributing risks and returns among individuals such that people in the same position get the same treatments and facilities
Augmenting the above-mentioned four principles, Andorno (2009), adds two more principles of truthfulness (non-manipulation of information) and confidentiality (respecting the dignity and privacy of the individuals and their personal information).
Cherry & Jacob (2016), puts forward the examples of several bioethical dilemmas in the contemporary period to be those of allocation of resources, end-of-life healthcare, eugenics, euthanasia and donation of organs.
Shale (2011), highlights the features of ethical healthcare institutes as those of recognition and appreciation of significance of ethics and ethical concerns, gauging the expectations correctly, consulting in case of ethical dilemmas and resolving ethical issues efficiently, thereby taking ethical organizational decisions.
Little evidences could be found in the literary works regarding the aspects of measuring the different bioethical principles and their implications in real scenarios of activities and decision making of individuals, especially in the domain of healthcare management, which the concerned literature proposes to study and analyse.
The concerned research aims to study the possibilities of measurement of the different principles in bioethics and their importance and influences on the decision-making aspects of healthcare management. The proposed study may help in filling the gap which exist in the present research works, regarding the measurement of weightage of different bioethical principles, thereby helping in building up robust and efficient bioethical frameworks in healthcare organizations.
The research question for the concerned study is as follows:
Can the different principles of bioethics and their implications on decision-making process in healthcare management be quantitative or qualitatively measured?
For the research to be robust, fruitful and contributing, it is of immense importance to design the methodological framework for the study and selecting the tools for the same efficiently.
The concerned research aims to take a descriptive research design, where information will be gathered regarding the aspects of perceptions of relevant individuals regarding the principles of bioethics and the implementation of the same in real-life practices in healthcare management (Meyers, Gamst & Guarino, 2016).
As the concerned research aims to find, analyse and interpret the less discussed domains of measurement of bioethical principles and their influence on the decision-making process of healthcare management, it is necessary to have an exploratory as well as explanatory approach to capture and analyse additional information which are not present in the existing research works. For this purpose, the descriptive research design and approach seems to be the most appropriate one (Hopkins, 2008).
The domain of venturing of the concerned research being primarily that of healthcare management, the concerned research aims to select a population of healthcare providers in Australia (consisting of physicians, nurses and management personnel of different reputed healthcare organizations) in the country. From the population the research aims to select a sample of 100 respondents with the method of random sampling, in order to avoid any bias or unintentional errors in selection of the sample for the concerned study.
Using a random sampling method for the purpose of selection of respondents from the above discussed population can help in forming a pool of respondents with different job roles, priorities and activities in the domain of healthcare provision and management. This will in turn rule out the bias of inclining and depending on only the perceptions and views of one type of service providers (Christensen et al., 2011).
Given that the concerned research tries to analyse the possibilities of measurement of the principles of bioethics and their influence on the decision-making aspects of healthcare management, the proposed sample would be the most appropriate one. This is because the sample is expected to have the different care providers in the supply side of the healthcare industry, who are expected to face the different ethical dilemmas in their everyday operations and take decisions.
The study intends to focus on primary data collected from the selected sample of care providers in the healthcare industry of Australia (including a mix of physicians, nurses, managers of healthcare organizations and similar personnel), instead of secondary data, in order to maintain the authenticity and unbiasedness of the concerned research and also to add to the existing researches by finding new information. This is expected to contribute positively to the quality of the research (Walliman, 2017).
The study proposes to use a mixed method in the data collection process, by collection both quantitative as well as qualitative data from the selected sample:
For the purpose of quantitative data collection, the study aims to conduct interviews with the selected 100 respondents with the help of pre-constructed survey questionnaires. The questionnaires are intended to be comprised on close-ended questions with options given for the respondents to choose from (Neuman, 2013).
Different scenarios of possible ethical dilemmas in the aspects of healthcare management will be provided to the respondents as case studies and the importance which they impose on the different bioethical principles, in the aspects of decision-making in such hypothetical scenarios will be studied:
Independent variables- Six principles of bioethics, namely, justice, beneficence, nonmaleficence, autonomy, truthfulness and confidentiality
Dependent variables- Decision making aspects like that of allocation of resources to patients, selection of care provision, decision regarding whether or not to provide care, trade-offs between risks and returns, dilemma between individual welfare and societal welfare and others
The Analytical Hierarchy Process will be applied as one of the most efficient and pragmatic tools in this aspect, in order to analyse the relative preferences of the selected respondents for the six principles in different situations of ethical dilemma in healthcare management (Saaty & Vargas, 2012). This is, in turn, expected to help in analysing the relative importance which the individuals put on the different principles of bioethics, thereby helping in ranking them in terms of their priority and influence on the decision-making process of the individuals in the aspects of healthcare management.
The quantitative data, being entirely cardinal in nature, does not have the scope to take into account the ordinal or abstract aspects which can have considerable influence on the level of importance which an individual imposes on different bioethical principles in the aspects of healthcare management (Lewis, 2015). Keeping this into consideration, the research also intends to collect qualitative data in the form of focussed group -discussions with 20 of the respondents randomly selected from the 100-sample size. With the help of open-ended questions and debates, the research intends to identify the variations and changes in the perceptions of the individuals, regarding the importance of different bioethical principles in their decision-making process in the field of healthcare management, dividing them on the basis of their designations and job roles.
Given the fact that the principles are mostly ordinal and abstract, conducting a mixed method study will be the most appropriate one for the concerned research as it will help in incorporating both the general perceptions and rankings of principles according to their applicability and influence on the decision-making aspects as well as the differences in perceptions arising out of the differences which the individuals have in terms of the nature of service which they provide, their job roles and the types of problems and ethical dilemma which the encounter in their job (Lewis, 2015).
The quantitative data collected is proposed to be organised and analysed with the help of the statistical software SPSS. Statistical tests of correlation and regression will be conducted to examine the relation between the different dependent and independent variables and the level of significance of the same. Paired sample t-tests will also be conducted to compare the importance of different bioethical principles pairwise, based on the perceptions of the selected respondents.
An inductive approach is proposed to be taken to analyse and interpret the qualitative data, so as to arrive to new conclusions and assertions with the help of the data collected, analysed and interpreted. The research proposes to conduct a thematic analysis of the qualitative data collected (Silverman, 2016).
For conducting any research fruitfully and appropriately, it is of immense importance to taken into account the fact that the research is conducted in an ethical framework, abiding by the ethical rules and norms prevalent in the concerned arena (Resnik, 2011). Keeping this into consideration, the concerned research aims to abide by the ethical guidelines which are provided by the Government of Australia, in the aspects of carrying out researches in the domain of healthcare industry, as well as the ethical codes which are present and practised in the esteemed university under which the research is proposed to be carried out (Nhmrc.gov.au, 2018).
The primary ethical considerations which the proposed research emphasizes upon are as follows:
The concerned study does not intend to work with vulnerable population. The proposed research intends to seek permission from the ethical board of the university before progressing towards the other research related activities.
Acknowledging the importance of the presence of a systematic approach in carrying out the different research related activities and also the aspects of time constraint, time management and budget constraint, the concerned research proposes to conduct the different research related activities a systematic manner, the tentative plan for the same being provided as follows:
As can be seen from the above Gantt Chart, the research is intended to be carried out in a systematic manner with the different research activities being scheduled tentatively in the manner shown above.
For the purpose of carrying out the research related activities, facilities to access different academic sources will be required. Extensive field study will also be required for the purpose of identifying the potential respondents and interacting with them. Questionnaires are required to be formed and facility for carrying out focussed group discussions will also be needed. Foe the purpose of data analysis, statistical software like MS Excel and SPSS as well as qualitative software like N Vivo will be needed.
The tentative budget for carrying out the different research related activities is as follows:
Subscriptions to academic libraries and databases- 100 AUD
Collection of primary data (quantitative and qualitative)- 600 AUD
Analytical tools and software packages for research- 300 AUD
Publishing of the thesis- 400 AUD
However, these numbers are tentative and are subject to change depending upon the circumstances arising while carrying out the research activity.
The concerned research proposes to study the actual importance of the different bioethical principles in the real healthcare management scenario, as is perceived by the healthcare professionals and also the influence of the same on the aspects of decision-making in this domain. However, the concerned research may have some crucial limitations. The primary limitation of the concerned research is that of constraints regarding time and budget, which limits the sample size as well as domain of research. This in turn has the threat of exclusion of different possibilities, thereby making the research less applicable for the global healthcare management scenario. Due to the small sample size and quantitative analysis, the research can also face the limitation of generalisation to some extent. The research also intends to conduct interviews with the randomly selected sample of care providers. However, there might remain the risks of the respondents not understanding what the researcher expects from them, which in turn may increase the risks of biased or faulty data collection to a certain extent.
References
Andorno, R. (2009). Human dignity and human rights as a common ground for a global bioethics. Journal of Medicine and Philosophy, 34(3), 223-240.
Beauchamp, T. L. (2016). Principlism in Bioethics. In Bioethical Decision Making and Argumentation (pp. 1-16). Springer, Cham.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.
Christensen, L. B., Johnson, B., Turner, L. A., & Christensen, L. B. (2011). Research methods, design, and analysis.
Fox, R. C., Fox, R. C., & Swazey, J. P. (2008). Observing bioethics. Oxford University Press.
Hopkins, W. G. (2008). Quantitative research design.
Ives, J., & Draper, H. (2009). Appropriate methodologies for empirical bioethics: it’s all relative. Bioethics, 23(4), 249-258.
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475.
Meyers, L. S., Gamst, G., & Guarino, A. J. (2016). Applied multivariate research: Design and interpretation. Sage publications.
Neuman, W. L. (2013). Social research methods: Qualitative and quantitative approaches. Pearson education.
Nhmrc.gov.au. (2018). National Statement on Ethical Conduct in Human Research (2007) – Updated 2018 | National Health and Medical Research Council. Retrieved from https://www.nhmrc.gov.au/guidelines/publications/e72
Resnik, D. B. (2011). What is ethics in research & why is it important. National Institute of Environmental Health Sciences, 1-10.
Saaty, T. L., & Vargas, L. G. (2012). Models, Methods, Concepts Applications of the Analytic Hierarchy Process: 175 (International Series in Operations Research Management Science).
Shale, S. (2011). Moral leadership in medicine: Building ethical healthcare organizations. Cambridge University Press.
Silverman, D. (Ed.). (2016). Qualitative research. Sage.
Steinbock, B., London, A. J., & Arras, J. (Eds.). (2013). Ethical issues in modern medicine: Contemporary readings in bioethics. McGraw-Hill.
ten Have, H. A., & Gordijn, B. (2014). Global bioethics. In Handbook of global bioethics (pp. 3-18). Springer, Dordrecht.
Turner, L. (2009). Does bioethics exist?. Journal of Medical Ethics, 35(12), 778-780.
Walliman, N. (2017). Research methods: The basics. Routledge.
Willmott, C., & Willis, D. (2008). The increasing significance of ethics in the bioscience curriculum.
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