Ethical_Issues_Paper

Ethical Issues Paper Vivian Hill HCS/578 October 10, 2011 Dr. Mark Cole Ethical Issues Paper Skilled health care workers are resolving ethical dilemmas every day in their line of duties. An ethical dilemma is a situation that will often involve an obvious conflict between moral essential, in which to obey one would result in disobey another. Using collective data in analyzing an ethical response to the dilemma, the subject matter will discuss an ethical dilemma in a health care setting. Competing loyalties between the organization and patient and providing an ethical response along with different ethical responses is a component of analyzing. Implications to risk management will be considered and an ethical decision-making model will identify a guide for future actions. Ethical Dilemma John Hill is a 65 year-old male who is in the hospital for rhino failure (all vital organs are shutting down/not functioning properly) because of a long battle of kidney malfunction. He has an early stage of dementia, but he is aware of his health condition and has expressed to his wife and doctor, he do not want dialysis. His wife of 45 years of marriage has power of attorney over him. A power of attorney is an, “instrument containing an authorization for one to act as the agent of the principal that terminates at some point in the future either by its terms or by operation of law such as death of the principal or agent” (US Legal, 2011). The ethical dilemma is, as a life or death situation and with the consent of his wife should Mr. Hill start dialysis at once' While debating the solution, the attending staff will give him medication intravenous (IV) to stabilize him. His wife then starts to cry and when the nurse came in to check on him, she ask, what should she do' Competing Loyalties “Nurses can get caught in the middle between patient and physician, patient and family, and the patient and organization policies. Nurses are recurrently put in circumstances of conflict arising from competing loyalties in the workplace” (Lachman, 2006). They must constantly try hard to resolve these differences while protecting the patients best interest, supporting the patient-physician rapport and safeguard their integrity. The health care giver has competing loyalties among the organization and the patient. One of the health care provider’s main loyalties is the duty to do good for the patient and in this case doing no harm. The health care provider also has an obligation to the organization to decrease liability by allowing his wife to make the decision. Ethical Response When a patient is approaching the end of his or her life, decisions is made about the types and extent of health care. Competent persons capable of making health care decisions for them have a legal and ethical right to participate in health care decision making. In this case Mr. Hill’s wife has legal rights to make his end of life treatment decision. According to Wilkie and TNEEL (2003), This right to participate is based on the ethical principle of respect for autonomy: the right of the individual to self-determination, in particular over what happens to one's body. This ethical right is protected by state laws mandating informed consent for medical treatments. The attending physician of the ER has informed Mrs. Hill of her husband’s options. Her ethical response was to honor his decision that was said between him and her, to keep from going to dialysis. With this decision becomes complicated because, the wife had a thought and expressed it to the nurse, whose to say that at the time of discussion he had with his wife, he was in his right state of mind' Different Response Because there was a concern raised by the wife, the nurse and the doctors had a different ethical response. They were taking the deontology approach to ethics. They believe that he or she has the “duty and obligations”. “Nurses’ codes of ethics stress the importance of fulfilling duties that are inherently owed to patients, and the importance of preserving the dignity and autonomy of each individual patient” ( Burkhardt & Nathaniel, 2008). To start Mr. Hill on kidney dialysis would prove to be the best treatment recommended in this life or death situation. Risk Management A risk management main concerned with steer clear of patient injury as a means of reducing financial loss and not as an end. Risk managers have taken on bigger responsibilities, making a difference to their hospitals’ monetary depiction. “Risk managers wear many hats, overseeing patient safety and clinical malpractice; business processes, including workers compensation and business interruption; and financial management, processes and strategies” (Enrado, 2007). In this case, the risk manager had to talk to Mrs. Hill so she could understand the outcome her decision as well as making sure that the doctors and nurses honor her wishes. Future Actions Selecting the right ethical decision-making model to guide future actions, entails foreseeing potential ethical dilemmas, most important, guiding others in ethical choice, and making certain decision becomes module of an organization’s structure and measures. According to Davis & Miller (2007), Autonomy is the principle that addresses the concept of independence. The essence of this principle is allowing an individual the freedom of choice and action. It addresses the responsibility of the counselor to encourage clients, when appropriate, to make their own decisions and to act on their own values. There are two important considerations in encouraging clients to be autonomous. First, helping the client to understand how their decisions and their values may or may not be received within the context of the society in which they live, and how they may impinge on the rights of others. The second consideration is related to the client's ability to make sound and rational decisions. Some patients with mental handicap and children should not be allowed to make competent decisions that could cause injury to themselves and others. Conclusion Whereas ethical dilemmas cannot be resolved, a decision is decided through the collaborative application of systematic processes. The support of decision-making models, along with ethical principles and theories can provide guidance to the health care professional confronted with such an ethical dilemma as described above, and permit for consideration of the rights of all. References: US Legal. (2011). retrieved from, http://definitions.uslegal.com/p/power-of-attorney/ .Lachman, V (2006). Applied ethics in nursing. New York City: Springer Publishing. D.J. Wilkie & TNEEL Investigators (2003) Ethics and Law Enrado, P. (2007) Health Care Finance News, retrieved from http://www.healthcarefinancenews.com/news/hospitals-face-risk-management-head Burkhardt, M.A. & Nathaniel, A.K (2008). Ethics & Issues in Contemporary Nursing (3rded) Clifton Park, NY: Thomas Delmar