Ethics in Health Care Essay
Ethics in the Healthcare In today’s field of healthcare there are many ethical issues and dilemmas in the medical profession - Ethics in Health Care Essay introduction. While working in a military Medical Treatment Facility (MET) I’ve noticed that some of these problems have been around for quite some time now. In my report will identify the issues and dilemmas I’ve seen while working in the MET. Also, will address two dilemmas that I feel are huge issues. Last, will explain how these certain dilemmas have change the way we work in the MET F and shaped medical ethical principles over time.
The first dilemma have chosen to address is the unsafe provider to patient ratio in which can be unethical in certain clinic settings. This particular issue is a very common ethical dilemma amongst the military provider community, whether the provider staff if from a large hospital setting or from a smaller MET. In the MET when the provider ratio is low in comparison to a higher patient ratio the Odds of insufficient care is increased while the patient’s safety is decreased or otherwise compromised. Furthermore, some patients eave to seek off base providers because the MET can’t provide care.
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Inappropriate staffing of providers is one of the number one concerns amongst Mats all over and when not appropriately staffed the risk of terrible healthcare is unfortunately increased. According to the Joint Commission on Accreditation of Healthcare Organizations (COACH) hospitals/clinics are required to have a code of ethics and have clear standards both on patient rights and organizational ethics. Several ethical principles may be in jeopardy when caring for patients if the staffing of providers is low.
Understaffed providers within the MET F setting may have an influence on beneficiaries; although providers may want to do what’s best for their patients, they may be limited or too overwhelmed to get to every patient or to meet the best interests of each patient under their supervision. They may be forced to treat the patient with the highest medical need or triage their condition. This unethical principle may lead to unfair distributed justice and distribution of medical care would be limited if the providers were spread too thin to be able o deliver a fair amount of care to each of their patients. Http:// search. Prosiest. Com. Explore. Trident. Due:2048/deceive/198098086) The Department of Health and Human Services (HAS) reported that for at least a decade, the united States has experienced worsening workforce shortages in medical professions. Most areas in the Nation face shortages of critical healthcare workers, including primary care physicians, nurses, behavioral health and long-term care workers, as well as public health and human service professionals. Moreover, this problem is anticipated to increase in the owing years.
More than 64 million people currently live in a primary-care health professional shortage area, and others live in smaller areas with health professional shortages. More than half of the counties in the United States have no behavioral health worker at all. With the implementation of the Affordable Care Act and the resulting expansion of health insurance coverage, demand for services Of primary care professionals will increase substantially. (http://www. Has. Gob/secretary/about/goals. HTML) The workforce issues resulting from a shortage in providers is being dressed by HRS.
Through execution of the Affordable Care Act, programs of fund scholarships and loans will be implemented to increase the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists in the medical areas of need. This method should enable more providers to be installed not only into the civilian sectors, but also create careers for providers in the military. With the success of this program better healthcare shall increase all over. The second dilemma have chosen to address is inappropriate tasking.
One example of inappropriate asking would be to have new providers placed in a setting where they are unfamiliar for instance in an emergency room setting. When a new provider is placed in an unfamiliar setting the consequential the provider may lack the experience to address certain issues in that area. Another example of inappropriate tasking would be when a provider becomes over tasked and they start to inappropriately delegate their duties to medical technicians whose developmental ethics have not yet matured to the level of the provider.
Although in this latest situation the delegating provider may believe e/she is morally just the principle ethics of it all would not be beneficial to the patient and an injustice of patient care can result in a malpractice. The providers need to be trained in these areas before being thrown into certain positions. There are differences in the training requirements, goals, and objectives of varied medical services that can reduce the flexibility and knowledge of the medical provider workforce and its ability to serve in different settings. As a result, a need exists for greater standardization in curricula and more clearly defined objectives.
HAS is working with state, local, and tribal governments to develop health workforce training, recruitment, and retention strategies and to expand critical, timely access to care by funding the expansion, construction, and operation of Health Centers throughout the United States. (http://www. Has. Gob/secretary/about/ cocoa. HTML) In conclusion, the two medical service issues I believe to be critical to healthcare are very similar and go hand in hand. In the presence of a struggling clinical staff, an overwhelmed provider may feel the need to legate his/hers duty to other personnel.
If the delegated duties are given to a less qualified individual in good intentions the delegating individual may believe that the ethical realism has been met due to having to choose an option of delegation to serve the common good for all of their tasks. Although this is not a good medical ethics one’s standards may think this is acceptable. However, when acts are passed by federal legislation and more funding for medical scholarships will best serve the interest of all medical organizations involved in long term projections. Reference: A.
Ethics in Health Care Essay
There are no absolute rules and guidelines when dealing with humans in medicine (except for operating procedures and et cetera) since different variables are taken into consideration and some of which are not applicable to the other (McCormick, 1988). However, there are three basic principles that are generally accepted by society concerning religion and ethnicity with regards to health care. These are the principles autonomy, beneficence and justice (Ethical Issues, 2003).
But these principles are subject to interpretation and discretion of the health workers. The scope of these principles sometimes overlaps and makes the questions such as “What treatment ought to be done? Who should decide for the treatment to be done? And when should it be done? ” a bit complicated. The most obvious ethical dilemma stated in the given scenario is “who has the final say over whether the patients’ leg is to be amputated or not – the physician, the patients’ relatives, or the patient herself? ”
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The issue concerns three parties who obviously have their own agenda’s, reasons, or ethics that they abide to with regards to their stand on the issue. Taking all these into consideration, it is best to look at the different views of the parties concerned. And these parties are the patient, the relatives, and the physician. The person directly affected by any decision reached by the three parties is the patient. So in normal circumstances it is only logical and ethical for us to say that the patients’ decision has the greatest gravity on the issue.
Adding to that is the fact that every patient is vested with the principle of autonomy which states that “the patient has the right to refuse or choose their treatment” (Medical ethics, 2006) or the “willingness to accept the proposed treatment, if the patient is cognitively capable of doing so” (Ethical Issues, 2003, para. 2). However, our patient, Ms. Alexander is suffering from a degenerative disease which is Alzheimer’s disease. A person suffering from this ailment “have trouble remembering, speaking, learning, making judgments, and planning” (Alzheimer’s Disease, 2006, para. ) and since there is yet no cure to this disease, the patients’ condition will worsen as years pass. Now if autonomy is defined as “a person’s ability to make independent choices” (Alzheimer’s Association. 2006) if he is “cognitively capable of doing so”(Ethical Issues, 2003, para. 2) we can safely conclude that our patients right to autonomy is rendered void due to her incapacity in making sound judgment which will hinder her from making independent choices.
And this is where our question take its roots, who has the final say over whether the patients’ leg is to be amputated or not – the physician, the patients’ relatives, or the patient herself? We have ruled out the patient on reasons stated above, this leaves us with the relatives and the physician. It has been common practice in hospitals that in events where in a patient is in a comatose of left in a vegetative state, that the immediate family can make decisions regarding the welfare of the patient.
However, the condition of the patient hasn’t reached that stage yet, and since there was no immediate family (parents, husband, daughter or son) stated in the scenario, this leaves the relatives less right to make decisions for the patient. And given the fact that the death of the patient can very well leave her relatives with large amount of financial assets, their intentions can be put to question as well. In this case, they refuse to let the physician amputate the leg of Ms. Alexander and accusing the physicians’ motivation as an “experimental medication”. Such statement clearly states their doubt in the physicians’ capabilities. This dilemma can be addressed by seeking the advice from other doctors regarding the patients’ condition, which for some unknown reason, the relatives failed to do. However, just recently, a lot of hospitals have discreetly developed policies stating that doctors, and not family members or relatives, should have the final authority to make these decisions.
And if this is the case, this would be beneficial to the patient since it will cancel out the possibility of hidden agenda’s of her relatives, that is, if there truly is a hidden agenda in their refusal to amputate the leg of the patient other than their doubt on the physicians capabilities. Having cancelled out the two parties, we are left with the last one, and that is the physician. With regards to his patients’ autonomy, he has a duty to respect the choice of the patient, as well as the duty to avoid unnecessary harm to them.
This is where we find that the principles autonomy and of beneficence overlap one another. The physician has a choice as to let the patient be, not amputating her leg that is, or performing his treatment in the defense of beneficence. The later can very well serve the interest of the relatives but it will surely leave the patients ailment unattended and could later on cause complications or death. While the former is a clear manifestation of beneficence and will serve the welfare of the patient, it will also cause conflict with the interest of the relatives.
Given that both have negative implications; this is where the physician is faced to do the lesser evil. Beneficence is “the duty of health care providers to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient” (McCormick, 1988). Hence, if the physician deems it significant and utterly important to amputate the leg of Ms. Alexander, he can do so if and only if he truly believes that the patient is “compromised and cannot act in his/her own best interest at the moment” (McCormick, 1988).
His actions can be a case of justified paternalism where in he feels the need to intervene on the attempt of saving the life of the patient. Cases like these often happen on emergency cases where a physician takes medical action without the consent of the patient in an effort to save his/her life. Let’s take a cardiac arrest as an example; the physician doesn’t need to ask for the patients consent in performing cardiopulmonary resuscitation in order to save the patients life. It is with clear conscience that the physician took the necessary actions for the welfare of the patient.
If he refuses to do so, he can be charged with neglecting of duty. Now the question here is, with regards to the scenario: “Joanna Alexander, a 72 year old with Alzheimer’s Disease and diabetes has gangrene of both feet. Her physician believes that her feet need to be amputated in order to save her life. Ms. Alexander has screamed her wishes that no surgical procedures be performed at any time. Ms. Alexander’s family members side with her and are refusing consent fearing that the surgeon’s motivation for the amputation is research of a valuable post-amputation experimental medication. Ms. Alexander’s death would mean a considerable financial gain for her family members. ” To what extent can a physician exercise the principle of beneficence without undermining the patients’ right to autonomy? III. Conclusion If the physician, with absolute certainty of the patients condition and that amputation is indeed the best shot, can exercise the principle of beneficence if he has, as clearly as possible, explained the realities of the patients condition and why he deems it significant for the welfare of the patient that her leg has to be amputated to the relatives and to the patient as well.
If the physician has the slightest doubt on his assessment of the patient and his proposed treatment, he can advice the relatives to consult other medical advice from other physicians. To put things into perspective, though the two principles overlap at some points, it is up to the physician to weigh as to which principle will benefit the patient the most. In this case, beneficence will serve to the best interest of the patient given that, and I would further stress, that the physician is absolutely certain that the treatment will benefit the patient the most.