Develop a solution to a specific ethical dilemma faced by a health care professional by applying ethical principles. Describe the issues and a possible solution in a 3-5 page paper.
Introduction
Whether you are a nurse, a public health professional, a health care administrator, or in another role in the health care field, you must base your decisions on a set of ethical principles and values. Your decisions must be fair, equitable, and defensible. Each discipline has established a professional code of ethics to guide ethical behavior. In this assessment, you will practice working through an ethical dilemma as described in a case study. Your practice will help you develop a method for formulating ethical decisions.
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Main ContentEthical Case StudiesConsider the ethical dilemma the health care professional is faced with in the selected case study. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior).Note: The case study may not supply all of the information you may need for the assignment. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any speculations that you make.Incident 2: Emergency Department Repeat Admissions — A Question of Resource UseMatt Losinski finished reading an article that provided grim details of a study of the overuse of emergency services in hospitals in central Texas. He smiled that sardonic half smile that meant there was a strong possibility that County General Hospital (CGH) might have the same problem. As chief executive office (CEO), Losinski always saw the problems of other hospitals as potential problems at CGH, a 300–bed, acute care hospital in a mixed urban and suburban service area in the south central United States. CGH was established as a county–owned hospital; however, 10 years ago the county wanted to get out of the hospital business and the assets were donated to a not–for–profit hospital system. The new owner has continued a strong public service orientation, even though CGH no longer receives the tax subsidy it did when it was county owned; it must look to itself for fiscal health.The study data showed that nine residents of a central Texas community had been seen in emergency departments (EDs) a total of 2,678 times over 6 years. One resident had been seen in an ED 100 times each year for the past 4 years. Given that an ED visit can cost $1,000 or more, the nine residents had consumed $2.7 million in resources. These high users of ED services were middle age, spoke English, and were split between male and female. To Losinski, the problem seemed like a manifestation of Wilfredo Pareto’s classic 80/20 rule.Losinski forwarded the article on a priority basis to Mary Scott, his chief financial officer (CFO), and asked her to see him after she read it. Scott stopped by Losinski’s office late the next day and began the conversation by asking him why he thought the article was a priority. Scott reminded Losinski that Medicaid paid 75% of costs for eligible ED users and that the cross subsidy from privately insured and self–pay ED admissions covered most of the unpaid additional costs. Losinski had a good working relationship with Scott, but he was a bit annoyed by her rather indifferent response.Losinksi wanted details on use of the ED at CGH. He asked the administrative resident, Aniysha Patel, to gather data to identify use rates for persons repeatedly admitted to the ED. The findings that Patel gave to Losinski two weeks later were not as extreme as those reported from central Texas; however, they did show that a few persons were repeatedly admitted to the ED and accounted for hundreds of visits in the past year. The clinical details were not immediately available, but a superficial review of the admitting diagnoses suggested that most admissions involved persons with minor, nonspecific medical problems—persons commonly known as the “worried well.” Although Scott was correct that Medicaid covered the majority of costs, the fact remained that over $200,000 each year was not reimbursed to CGH. Were that money available, it could go directly to the bottom line and could be used for enhancements to health initiatives for the community. In addition, repeated admissions to the ED contributed to crowding, treatment delays, and general dissatisfaction for other patients.Losinski presented the data to his executive committee, which includes all vice presidents, the director of development, and the elected president of the medical staff. The responses ran the gamut from “So what?” to “Wow, this is worse than I imagined.” Losinski was bemused by the disparity of views. He had thought there would have been an almost immediate consensus that this was a problem needing a solution. The financial margins for CGH were already very thin, and the future for higher reimbursement was not bright. A concern echoed by several at the meeting was the requirement of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) that all persons who present at an ED that receives federal reimbursement for services must be treated and stabilized.Losinski asked his senior management team for recommendations to address the problem of ED overuse.Incident 9: The Missing Needle ProtectorE. L. Straight is director of clinical services at Hopewell Hospital. As in many hospitals, a few physicians provide care that is acceptable, but not of very high quality; they tend to make more mistakes than the others and have a higher incidence of patients going “sour.” Since Straight took the position 2 years ago, new programs have been developed and things seem to be getting better in terms of quality.Dr. Cutrite has practiced at Hopewell for longer than anyone can remember. Although once a brilliant general surgeon, he has slipped physically and mentally over the years, and Straight is contemplating taking steps to recommend a reduction in his privileges. However, the process is not complete, and Cutrite continues to perform a full range of procedures.The operating room supervisor appeared at Straight’s office one Monday afternoon. “We’ve got a problem,” she said, somewhat nonchalantly, but with a hint of disgust. “ I’m almost sure we left a plastic needle protector from a disposable syringe in a patient’s belly, a Mrs. Jameson. You know, the protectors with the red–pink color. They’d be almost impossible to see if they were in a wound.”“Where did it come from?” asked Straight.“I’m not absolutely sure,” answered the supervisor. “All I know is that the syringe was among items in a used surgical pack when we did the count.” She went on to describe the safeguards of counts and records. The discrepancy was noted when records were reconciled at the end of the week. A surgical pack was shown as having a syringe, that was not supposed to be there. When the scrub nurse working with Cutrite was questioned, she remembered that he had used a syringe, but, when it was included in the count at the conclusion of surgery, she didn’t think about the protective sheath, which must have been on it.“Let’s get Mrs. Jameson back into surgery.” said Straight. “We’ll tell her it’s necessary to check her incision and deep sutures. She’ll never know we’re really looking for the needle cover.”“Too late,” responded the supervisor, “she went home day before yesterday.”Oh, oh, thought Straight. Now what to do? “Have you talked to Dr. Cutrite?”The supervisor nodded affirmatively. “He won’t consider telling Mrs. Jameson there might be a problem and calling her back to the hospital,” she said. “And he warned us not to do anything either,” she added. “Dr. Cutrite claims it cannot possibly hurt her. Except for a little discomfort, she’ll never know it’s there.”Straight called the chief of surgery and asked s hypothetical question about the consequences of leaving a small plastic cap in a patient’s belly. The chief knew something was amiss but didn’t pursue it. He simply replied there would likely be occasional discomfort, but probably no life–threatening consequences from leaving it in. “Although,” he added, “one never knows.”Straight liked working at Hopewell Hospital and didn’t relish crossing swords with Cutrite, who, although declining clinically, was politically very powerful. Straight had refrained from fingernail biting for years, but that old habit was suddenly overwhelming.Incident 10: To Vaccinate, or Not?Jenna and Chris Smith are the proud parents of Ana, a 5–day–old baby girl born without complications at Community Hospital. Since delivery, the parents have bonded well with Ana and express their desire to raise her as naturally as possible. For the Smiths, this means breastfeeding exclusively for the first six months, making their own baby food using pureed organic foods, and not allowing Ana to be vaccinated.The Smiths are college educated and explain they have researched vaccines and decided the potential harms caused by them far outweigh any benefits. They point to the rise in autism rates as proof of the unforeseen risk of vaccines. Their new pediatrician, Dr. Angela Kerr, listens intently to the Smiths’ description of their research, including online mommy–blogs that detail how vaccines may have caused autism in many children. The Smiths conclude by resolutely stating they’ve decided not to vaccinate Ana, despite the recommendations of the medical community.Dr. Kerr begins by stating that while vaccines have certainly sparked controversy in recent years, she strongly recommends that Ana become fully vaccinated. Dr. Kerr explains that vaccines have saved the lives of millions of children worldwide and have been largely responsible for decreases in child mortality over the past century. For example, the decreased incidence of infection with the potentially fatal Haemophilus influenzae type b, has resulted from routine immunization against that bacterium. Similarly, epidemics such as the recent outbreak of measles are usually associated with individuals who have not been vaccinated against that pathogen.Dr. Kerr goes on to endorse the general safety of vaccines by informing Ana’s parents that safety profiles of vaccines are updated regularly through data sources such as the federal government’s Vaccine Adverse Event Reporting System (VAERS). The VAERS, a nationwide vaccine safety surveillance program sponsored by the Food and Drug Administration and the Centers for Disease Control and Prevention, is accessible to the public at https://vaers.hhs.gov/index. This system allows transparency for vaccine safety by encouraging the public and healthcare providers to report adverse reactions to vaccines and enables the federal government to monitor their safety. No vaccine has been proven casual for autism spectrum disorder (ASD), or any developmental disorder. On the contrary, many studies have shown that vaccines containing thimerasol, an ingredient once thought to cause autism, do not increase the risk of ASD.Finally, Dr. Kerr reminds the Smiths that some children in the general population have weakened immune systems because of genetic diseases or cancer treatment, for example. It may not be medically feasible to vaccinate such children. Other children are too young to receive certain immunizations. Instead, these children are protected because almost all other children (and adults) have been vaccinated and this decreases their exposure to vaccine–preventable illnesses (VPIs). This epidemiological concept is known as “herd immunity.” As more parents refuse immunization for their healthy children, however, the rate of VPIs will increase. This puts vulnerable children at significant risk of morbidity and mortality. Routine childhood immunization contributes significantly to the health of the general public, both by providing a direct benefit to those who are vaccinated and by protecting others via herd immunity. Dr. Kerr concludes by stating that after considering the risks versus the benefits of immunization, most states require vaccinations before children can attend school. Parents may decide not to vaccinate under specific circumstances, however, which vary by state.Jenna and Chris Smith confirm their understanding of what Dr. Kerr has explained, but restate that they do not want Ana vaccinated at this time. Dr. Kerr is perplexed as to what to do.ReferencesIn Darr, K., In Farnsworth, T. J., & In Myrtle, R. C. (2017). Cases in health services management.
Ethical decision-making at an individual level and one’s ethical behavior can be viewed in three primary steps using an ethical decision-making model.First is one’s moral awareness, recognizing the existence of an ethical dilemma. This is the pathway to establishing the need for an ethical decision. This awareness is an individual sensitivity to one’s values and personal morals.Once a personal awareness is evident, we can make a judgment in deciding what is right or wrong. This sounds simple, yet there are a number of variables driving this personal judgment. One variable is the individual differences and cognitive bias we all have based on our personal history and experiences. A second variable is the organization. This variable may be influenced from a group, organizational or cultural perspective. A code of conduct or standards of behavior may also influence our judgment.This model, operating in a dynamic fashion, leads us to our ethical behavior; taking action to do the right thing. Is the right thing the same decision for everyone? Obviously not. We are all influenced my multiple factors in our decision-making.This decision-making model can help us understand the pathway to our ethical decisions.
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Applying Ethical Principles
Learner’s Name
Capella University
NHS4000: Developing a Health Care Perspective
Instructor Name
August, 2020
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Applying Ethical Principles
Health care professionals often face ethical problems during their practice that require
them to use their moral values and principles when making decisions. The four fundamental
principles of health care ethics—autonomy, beneficence, nonmaleficence, and justice—act as
yardsticks for fair and ethical decision-making. These ethical principles are widely accepted in
the field of health care. Medical practitioners and health care administrators often use these
principles to make decisions when faced with complex situations involving patients.
Overview of the Case Study
Betsy is a dedicated pediatric nurse known for the care and concern she shows her
patients. Her neighbor and friend, Alice, lives with her husband and 4-year-old daughter, Shirley.
Alice and her husband are followers of Christian Science, a belief that advocates spiritual healing
and discourages most types of medical intervention. One day, when visiting Alice and Shirley,
Betsy sees Shirley experience what seems like a seizure. The child suddenly becomes
unresponsive and has a brief staring spell, with her eyes rolling upward. The episode lasts for 20
seconds, during which she seems completely unaware of her surroundings. While Shirley is
having the seizure, Alice sits by her side and prays but takes no other action. Betsy is concerned
about the little girl’s condition and probes her friend for details. Alice tells Betsy that Shirley
used to have around 15–20 such episodes a day until a few months ago; this has now reduced to
about 12. Alice attributes the improvement in Shirley’s health to her prayers and faith. However,
this does not help Betsy feel comfortable about Shirley’s condition. She is almost certain that
Shirley has epilepsy, which, if not treated on time, could have profound health implications. At
the very least, she thinks Alice should have Shirley’s symptoms accurately diagnosed.
Understanding the gravity of the situation, Betsy sets up a meeting with Shirley’s parents
and Dr. Campbell, director of the neurology department at her hospital. She treats this meeting as
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an intervention, and both she and Dr. Campbell express their concern for Shirley’s health. They
stress on the fact that the improvement in Shirley’s symptoms does not necessarily mean she will
be cured. They empathize with Alice and her husband’s reluctance on account of their religious
faith but reiterate the importance of getting Shirley’s symptoms diagnosed. To prove their point,
they present studies that describe how seizures can be indicative of illnesses such as epilepsy,
which could negatively affect her cognition and behavior. Shirley’s parents are grateful that
Betsy and Dr. Campbell are concerned about their daughter’s health but remain resolute about
going against their faith. They believe that prayer will cure her. Betsy is faced with an ethical
dilemma of whether she should respect the parents’ religious beliefs and not intervene in the
matter or perform her moral obligation as a health care professional.
Analysis of Ethical Issues in the Case Study
In the case study, the main factor that led to Betsy’s ethical dilemma is Shirley’s parents’
refusal of medical assistance for their daughter owing to their Christian Science beliefs. When
Betsy notices Shirley’s seizures, she thinks it is her duty to make sure Shirley receives medical
attention. As she respects the religious faith and belief of Shirley’s parents, she decides to
explain the risks that seizures could involve. She also includes Dr. Campbell in the conversation
so that he could provide an objective opinion to make them understand the need for medical
intervention. However, Shirley’s parents are certain that prayer will cure her seizures.
Considering that their attitude could result in serious health implication for Shirley, Betsy is
concerned about the little girl receiving appropriate medical attention (Baumrucker, et al., 2017).
Using the Ethical Decision-Making Model to Analyze the Case Study
The three components of the ethical decision-making model—moral awareness, moral
judgment, and ethical behavior—can help analyze the ethical issue outlined in the case study.
Whereas moral awareness is knowledge of the existence of an ethical dilemma, moral judgment
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involves choosing between the right and wrong actions when posed with such a dilemma. Both
moral awareness and moral judgment lead to ethical behavior. Ethical behavior is taking the right
action to resolve a dilemma. Betsy’s moral awareness is reflected by the fact that she recognizes
the circumstances surrounding Shirley’s condition. Her moral judgment is reflected by her
decision to try to convince Shirley’s parents to get Shirley medical help because she believed
that it was the right thing to do. Betsy’s ethical behavior constitutes the action she takes to
resolve the dilemma. This, in turn, depends on her personal judgment and the four principles of
health care ethics (autonomy, beneficence, nonmaleficence, and justice) she should abide by as a
health care professional.
Effectiveness of Communication Approaches in the Case Study
Listening plays an important role in patient–physician communication. By listening to
Alice, Betsy learns of the frequency of Shirley’s seizures and the reduction in their occurrence.
She also learns that Alice and her husband believe that this reduction is due to their prayers and
faith in Christian Science. Therefore, active listening helps Betsy understand the situation better.
Betsy is aware that if she decides to get medical help for Shirley without the consent of
Shirley’s parents, she would be violating their right to informed consent and overstepping her
boundaries as a health care professional. So, she decides to present them with the information
they need to make an informed decision. She maintains an open communication with Shirley’s
parents while explaining the impact of seizures on their daughter’s health. She stresses the
importance of immediate diagnosis of Shirley’s seizures. Thus, by being respectful of Shirley’s
parents’ emotions and providing them with complete information about the problem, Betsy
communicates the situation to them in an effective manner.
During the discussion with Shirley’s parents, both Betsy and Dr. Campbell are
empathetic toward Alice and her husband’s reluctance to get the necessary medical help for their
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daughter on account of their religious faith. Betsy seems to have involved Dr. Campbell so that
he could share his objective expert opinion based on his experience in dealing with patients who
have similar symptoms. She probably thought that Shirley’s parents would change their decision
if Dr. Campbell reiterated that Shirley could develop severe cognitive problems (such as learning
difficulties and memory deficits) or behavioral problems (such as irritability, anxiety,
hyperactivity, and mood swings) if her seizures are neglected. However, they were unable to
convince Shirley’s parents to get Shirley medically diagnosed.
Although Betsy followed a systematic approach while dealing with the issue at hand, it
seems to have been ineffective as Shirley’s parents continued to stand by their faith in prayer.
However, listening patiently to patients’ problems and showing empathy and genuine care while
communicating with them are some lessons that health care professionals can take back from this
case study.
Resolving the Ethical Dilemma by Applying Ethical Principles
The four ethical principles of autonomy, beneficence, nonmaleficence, and justice are
often employed to resolve ethical dilemmas related to health care. Autonomy refers to accepting
and understanding patients’ values, beneficence refers to acting for the welfare of patients,
nonmaleficence refers to not doing harm to the patient, and justice refers to treating patients
fairly without bias.
The ethical dilemma that Betsy faces in this case involves three of the four basic
principles of medical ethics. In the case study, the ethical dilemma is caused by the conflict
between the principles of autonomy on the one hand and beneficence and nonmaleficence on the
other. Betsy preserves the autonomy of Shirley’s parents by respecting their religious beliefs and
not coercing them to get the girl correctly diagnosed. She further ropes in Dr. Campbell to try to
explain to them the importance of getting an accurate diagnosis.
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Approaching Child Protective Services—a social service agency run by the government
to counsel and support children and their families and promote child welfare—could be
considered by Betsy as an ethical means to resolve the dilemma. As Betsy is obligated to help
Shirley get medical care (beneficence) and prevent any harm that might be caused from ignoring
her seizures (nonmaleficence), she could seek intervention from Child Protective Services.
Although involving Child Protective Services could result in overriding the ethical principle of
autonomy, Betsy might have to take this decision keeping Shirley’s best interests in mind
(Baumrucker et al., 2017).
Conclusion
The four principles of health care ethics can be applied by health care professionals to
analyze and resolve ethical dilemmas. In the case study, Betsy has to decide between respecting
Shirley’s parents’ religious beliefs and performing her moral obligation as a health care
professional by helping Shirley seek medical care. The proposed solution involves upholding the
principles of autonomy, beneficence, and nonmaleficence to resolve Betsy’s ethical dilemma.
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References
Baumrucker, S. J., Easterday, J., Stolick, M., McCall-Burton, M., Adkins, R. W., Winiger, D., &
Cook, C. (2017). Ethics roundtable: Parental autonomy and the minor patient. American
Journal of Hospice & Palliative Medicine, 34(3), 287–292.
http://journals.sagepub.com.library.capella.edu/doi/pdf/10.1177/1049909115608812
Capella University (2018). NHS-FP4000 Exemplar Sample Ethical Case Study. Capella Website:
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