Ethical Aspect of a Healthcare Industry

Healthcare professionals are faced with ethical dilemmas quite often as they treat patients with various illnesses. It is necessary for the healthcare managers to understand the potential ethical issues and how to address them appropriately (Aitamaa, Leino-Kilpi, Puukka & Suhonen, 2010). Most of the situations and scenarios that have ethical dilemmas have no clear options or solutions and require the health care professionals to apply the code of ethics based on their analysis of a particular situation. The research paper provides an analysis of a case scenario that has an ethical dilemma and helps to determine how a healthcare manager can use the ACHE Code of Ethics and other professional code of ethics in determining the appropriate response. The importance of ethics in healthcare is also discussed using the sample case scenario.

Relevant aspects of the case

The Case scenario chosen regards a patient, R.L, who suffered from depression that impaired his decision-making capacity. From the case, it is evident that whenever the chronically-ill patients request to discontinue the life-sustaining treatment, depression can be a reason for their limited ability in making decisions. In summarizing the case, the patient is 80 years of age and lives with his wife in a care center. He has had trouble in caring for himself and has difficulty walking and adhering to medications on diabetes, heart disease, and kidney problems. He was diagnosed with depression and was found to lose interest in the things he used to enjoy. He was later hospitalized for heart attack since his heart was damaged to the extent that it could not pump adequate blood to maintain the normal functioning of the kidneys. He had to undergo renal dialysis to keep him alive and involved inserting needles into the artery and vein to connect to a machine for three hours three times every week. In the second treatment, he requested that the dialysis be stopped for him to die (Lee, 1997).

Ethical concerns

The case scenario presents an ethical dilemma since it is challenging to follow the patient’s requests considering that he has depression that could be influencing the course of the decision. It is clear that depression might have influenced the ability of the patient in making the decision that his life be stopped. Many patients with serious illnesses suffer from impaired judgment despite them having the power of autonomy. Medical practitioners are required to respect patient’s autonomy and allow them to make decisions as long as they give their consent (Aitamaa, Leino-Kilpi, Puukka & Suhonen, 2010). However, the patients require consulting with the family members in the instances where their decision-making processes are affected by other factors. For this patient, he has been suffering from various chronic conditions and taking different types of medication alongside undergoing painful medical procedures. As such, there is a high possibility that the condition rendered him to suffer from depression which affected his ability to make informed decisions.

When patients agree to refuse or take certain medical treatment, they ought to make the decision through a process of informed consent. The physician discloses the information regarding the medical condition, treatment options, likely complications, and the expected outcomes. The patient must give informed consent and be willing to act voluntarily as well as have the capacity to make the decision (Edmonson, 2010). As such, it is necessary that the patient understands the information, the effects of the treatment, and the personal values in life. In an ethical perspective, informed consent should have a basis on the principles of autonomy and beneficence. However, regarding the patient’s case scenario, the two aspects are conflicted. The prognosis of the patient condition is not clear, and the physician has limited knowledge as to whether the dialysis surpasses the negative effects to the patient.

For a normal case, the decision of either continuing with the dialysis or stopping it should be made by the patient. However, there is a possibility that the patient’s ability to make an autonomous decision is affected by the depressed condition. For patients with depression, their ability to think appropriately and positively is affected. Depressed people encounter challenges in concentration and are troubled by the feelings of guilt and hopelessness. In most instances, they are pre-occupied with death and even consider suicide as an option.

The ethical dilemma in the case arose because continuing with the dialysis would be a denial of a right of the patient to refuse treatment which another patient without depression would request. On the other hand, giving in to the patients’ demands would be negligence of due care since the patient may be acting under the influence of depression.

Applying the ACHE Code of Ethics

Health care professionals and leaders ought to apply the principles of the ACHE code of ethics in considering whether the decision made by the patient is logical, consistent, and conforms with other choices and values in life. Eventually, the patient’s wish was granted, and the dialysis was taken off upon which he died six days later upon consultation with the family members. The code of ethics has the standards of ethical behavior that govern personal behavior. The overall objective of health care management profession is to maintain and enhance the quality of life, dignity, and well-being (Jonsen, Siegler & Winslade, 2015). The professionals are also required to have an accessible and efficient health care system and should act in ways that demonstrate their trust, confidence, and respect to the general public. In the ethical dilemma presented, the healthcare leader ought to consider the ethical principles of justice, autonomy, beneficence, and fairness which are crucial in decision making.

The proper response by a health care leader regarding the case scenario should be informed by the professional code of ethical standards which require that the quality and dignity of life is protected. The fact that the patient does not want to continue with the particular form of treatment is not adequate in giving in to his/her demands. In such circumstances, it is necessary to evaluate the impact of the action taken as well as the prevailing conditions that may influence the decision. The patient did not have a clear prognosis on his kidney, and a heart condition and hence would be difficult to weigh out the most beneficial decision to make. Also, the patient has close family members who were hesitant to do what the patient requested. It would be necessary to allow the treatment process to continue until the family members and the patient is contented that no further improvement would be observed. In the case scenario, the patient does not listen to any suggestions from both the family and the physician which is a likely indication that he was influenced by depression. Thus, it was unethical to follow the patient’s request even though it was respect for his autonomy.

References

Aitamaa, E., Leino-Kilpi, H., Puukka, P., & Suhonen, R. (2010). Ethical problems in nursing management: the role of codes of ethics. Nursing Ethics, 17(4), 469-482

Edmonson, C. (2010). Moral courage and the nurse leader: Online Journal of Issues in Nursing, 15(3)

Jonsen, A. R., Siegler, M., & Winslade, W. J. (2015). Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, 8E. McGraw-Hill Professional

Lee M (1997) The Case of the Depressed Patient: Santa Clara University,

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