Dilemmas in Medical Professional Codes - Essay Example

?Dilemmas in Medical Professional s: An Ethical Case Review Introduction In every profession, there exist a variety of professional principles that serve as standard parameters in ensuring the quality regulation of offered goods or services to the public consumers, including the standardized practice in medical field. In a broader perspective, professional codes in medical practice dates back to early civilization periods, where Hippocrates of Greece posits that health practitioners must “act so as to benefit the patient(s) and keep (them) from harm according to the physician’s abilities and judgment” (Veatch, 2000, p. 1). In this principle, it takes into account the standardized benchmarks that must be maintained in order to secure the health welfare of patients seeking medical attention. The code basically establishes the kind of relationship shared by patients and their health providers, where the former group is considered inferior compared to superiority exhibited by medically-educated practitioners. Hence, there is a one-sided dependence in such type of association. In current times, there is a shift in the focus of health care from solely treatment provisions to health care promotion and education--there is an integrated transfer of power from health providers to consumers. Where once the medical practitioners hold the sole control on the direction of their clients’ overall care, recent developments account for a more shared responsibility between the two parties involved in health care. Bearing the illustrated changes in mind, there is a general assumption that concepts in medical ethical conduct is not absolute in every situation, including the core ethical principles that govern the medical practice. The paper conducts a case evaluation related to the requested act of withholding the full disclosure medical information by a patient towards biologic relatives, and ethical principles regulating the practitioners’ actions in the performance of such duty. Specifically, this seeks to clarify contradictions in professional limitations of practitioners and extent to which patients can exercise their ethical rights against the moral code of conduct maintained by health providers. Ethical Dilemma: A Case Point Case 1 Mrs M has been having some strange symptoms which have been diagnosed as early symptoms of multiple sclerosis. She realizes she could be unaffected by the disease for some time and so has asked her GP not to tell anyone, even her family. Mr M and their three children are also the GP's patients. The GP is torn by Mrs M's decision because she feels it would be better if the family knew now rather than finding out later. Mrs M wants to keep this secret because "I don't want them to start treating me differently. I want to look after my family for as long as I can before they start looking after me." Ethics is a complex concept that encompasses more than the networking tenets of what is morally right and wrong. Medical ethics, as identified by Flight (2004), is a definitive set of values that guide the practice of medical practitioners, incorporating a variety of ethical theories to provide basis for conflict resolutions and updates on practical health issues in clinical and community health settings. Basic in almost all types of professional ethics is the presentation of the four core approaches in ethical performance: “autonomy (freedom to choose), nonmaleficence (do no harm), beneficence (do what is good), justice” (Ashcroft, et al., 2007, p. 4). In one way or another, these principles interact with one another to influence the procedures by which the medical practitioners perform their duties in work environment. In account with the case presented above, a couple of values seemed to be in conflict during the adherence of professional code in ethics. As listed above, autonomy is the exercise of the liberty to choose. In clinical settings, patients are given options to choose among the treatment alternatives available to them. In application, Mrs. M had reserved her right to keep her medical information private, as indicated in an autonomous client. However, an ethical dilemma surfaces during the progression of the condition, where the physician is fully aware of the progressive neurological deterioration accompanying such disease--requiring the familial support prior to worsening condition of the said patient (Campagnolo & Vollmer, 2010). The General Physician can follow the request of the patient, but in the process, subsequent management of such conditions can be hampered by the lack of significant support by relatives. Medical practitioners have the moral and legal obligation to ensure that no harm will fall on their patients, and that they should prudently act in accordance with the professional intention of doing what is good, as indicated in the fortitude of nonmaleficence and beneficence--in this order. Basing from these ideals, the said General Physician in the case study can potentially violate the discussed principles as a professional to protect the patient should she continue to respect the rights of the patient; disregarding her own ethical responsibility as professional. In more specific term, the General Physician, as a trained medical personnel, can assert her clinical position by way of modern paternalism--where she can act as an authoritative figure who can divert the autonomic decision of the patient with more elaborate information campaigns--at the center is the intent to convince the client the benefits of including the family in the plan of management care. The ultimate dilemma in the case study is the contradicting positions maintained by the patient and the clinical provider, where the former insists on autonomously curtailing her medical information while the latter is obligated to adapt the paternalistic concept in convincing the patient otherwise. Standpoints of Involved Parties As a neurological condition, multiple sclerosis is a medical case that is not communicable in transmission. More specifically, the mode of transfer of the disease to other people is by way of genetic predisposition--where a certain affected gene can be passed from one generation to another within the family branch (Campagnolo & Vollmer, 2010). From this point of view, it is clear that the general public is in no way potentially distressed by the disease condition affecting Mrs. M. With this, four classified groups are identified as definitely involved in the ethical dilemma experienced between Mrs. M. and the physician--as explained further in subsequent discussions. Patients: In every health setting, short and long term care provisions still remain rooted on patients’ conditions upon presenting themselves in either clinical or community health institutions. This being said, since their health dispositions are the primary focus, their medical rights are also to be respected. Through the ethics of autonomy, Mrs. M. is exercising her ability to make informed decisions, despite the contradiction of her general physician on enlisting the support of relatives in initial and subsequent care. Gilbar (2004, p. 203) pointed out that the decisions commonly constructed by autonomous people regarding the disclosure of medical information towards the relatives are dependent on two aspects: “patients’ personal interests...and realization that (they) affect the lives of their relatives.” In the case of Mrs. M., the latter seems to be more applicable as chief source behind exerting the autonomous right to confidentiality. In her desire to spare her family from the taxing emotional and physical duty of caring for Mrs. M., she opted to keep silent, backed-up by the ethical regulation protecting her decisions regarding her health. Medical Personnel: As providers of health care, the medical team, especially the primary physician, are dutifully sworn to protect their patients in all aspects of medical service. Hence, they are professionally accountable on keeping their ethical obligations strictly centered on the patients. With regard with the General Physician handling the case of Mrs. M., the situation calls for extensive scrutiny on the extent of protection the physician must extend. In professional ethics, medical personnel can morally safeguard the right of patients to quality care by exhibiting mutual principles of nonmaleficence and beneficence, where doing what is good for the patient and preventing harm are the front-line defense. In one way, the General Physician is following them by agreeing with Mrs. M. on the disclosure issue. However, the case also showed that the physician wished to include the relatives as supportive figures for the patient. In this instance, the General Physician demonstrated her paternalistic nature to want what the best conditions available for her patient, even if it means including the relatives in such professional intention. Biological Relatives: In societies where family is commonly viewed as the most basic unit in the community, such belief proposes the importance of the said group as an invisible extension to the lives of individual members. As the cliche goes that “No man is an island,” it verifies the point that each individual belonging to a certain family will surely seek the camaraderie and unity solely offered in such tightly-packed groups. As family members are frequently treated as significant extension to a sick member, in the role of caregiver and caring supporters, their presence during the whole course of disease process (as in the case of Mrs. M. with her three children) is an integral element to strengthen the client’s resolve to manage the condition more successfully. In this assumption, the ethical act of beneficence seems applicable, and is done in the intent of fulfilling more than the obligatory value of looking after a family member, but more as part of the familial affection and care offered in each one, even during difficult moments in medical care. Autonomy versus Paternalism When the right of one is infringed by the rights of others, there seems to be a dilemma in such events, as to whose rights shall come out as first priority. In line with this statement, as ethics is an encompassing principle on what is considered morally correct, then, its guiding trait should provide sound resolution. In applicable events, the right of Mrs. M. to expect her autonomous decisions to be respected is in direct contrast of the General Physician’s professional code to maintain such right and at the same time, paternally act to the best interest of the patient in question. The boundary in which Mrs. M.’s primary decisions, then, is in conflicting link with the obligation of her physician as a professional. Two main points on the ethical presentation of the case seemed to require deeper academic analysis. On the first account, the question on whether Mrs. M.’s wishes to curtail the medical disclosure from her family is lawfully and ethical binding must first be discussed in detail. Gilbar (2004) insisted that medical practitioners must grant their utmost priority to the patient who had sought their professional attention and service first. In doing so, this proposition signifies that between the patient and their biologic relatives, the initial and subsequent professional loyalty will always belong to the original groups of patients. By this, the physician must recognize where her loyalties lie, and that is to Mrs. M., who had presumably outset her children in asking for the physician’s service first. In a more elaborate argument, the right of Mrs. M. to autonomous privilege as rational patient must be respected, in all aspects of management. This means that her confidential privacy is superior against the ethical principle of nonmaleficence and beneficence that is also accorded to her. Bowman and Spicer (2007) reflects on the equal level of competence of the four principles in ethics, where autonomy prevails among the rest. In which case, despite the best professional intentions of physicians, covertly telling Mrs. M.’s relatives may breach the ethical code on autonomy--crossing the boundary towards traditional paternalism. In secondary view, paternally acting on the behalf of their patients may violate the autonomous confidentiality, but in the presence of legal considerations, questions arise on whether ethical exceptions can be obtained. Traditional paternalism may be deemed unacceptable in today’s society, as this promotes discrimination on the rationality of patients under medical management--where medical staff are said to be in superior positions to decide on what is good for patients (Ashcroft, et al., 2007). Contrarily, modern paternalism posits the act of “careful discussion (with patients) to ensure that (they) understand all the relevant issues”--with regard to patient care management (Bowman & Spicer, 2007, p. 35). In distinction, the latter seems to agree more with the concept of autonomy of free will, while subtly acting on behalf of patients. With this in mind, the physician, after extensively explaining the medical situation with Mrs. M., can paternalistically tell the relatives of her patient’s condition, ethically guided by modern paternalism, nonmaleficence and beneficence. On a more valid ethical ground, the British Medical Association informs that patients are morally compelled to update their relatives on their current medical status, and included the physicians to do so, in the presence of exceptional circumstances--when individual condition poses threat to third parties (Gilbar, 2004; Ashcroft, et al., 2007). In the case of Mrs. M., the defected genes in multiple sclerosis may predispose the relatives, as third parties, to pathological danger; giving the general physician a definite excuse to enact paternalistically--but not to provide physical and emotional support to the patient. The good of most (third parties) has more authority than individual (patient) benefit. Despite the difference in ethical values, the intentions behind the decision of Mrs. M. and the General Physician share a common attribute; both altruistically think they did what is right for others--the former wanted to steer her family from emotionally suffering while the latter sought to alleviate her patient’s upcoming sufferings through enlistment of familial support. Influences Governing Ethical Conflict Upon portraying the full extent to ethical conflicts experienced between Mrs. M. and the General Physician, there are a variety of internal features that greatly influence how each may react to such dilemmas. In the case presentation, there are five distinguished elements affecting the overall reaction towards differing ethical stands: culture, gender, ethnicity, age, and socioeconomic status. First off, the ability of cultural beliefs to dictate how people behave seemed to encompass even the ethical regulations. In a cultural orientation where the worth of the family and its individual members are revered in society, decisions are usually based in respect to familial ties. As exemplified by Numico, et al. (2009), in some parts of the world, community-centered populace reserve the status of isolation for those family members who practice autonomy in individual endeavours--possibly including medical autonomy. In spite of this, Mrs. M. opted to her current course of action rather than be the source of pain for her family. Had her sense of familial duty be stronger, subsequent decisions would have been more positive--avoiding isolation in the long run. In relation to cultural affinity, ethnicity is also another aspect that may cause a significant impact to ethical dilemmas. Together with ethnicity is the encompassing issues on age and socioeconomic status on the matter of making a sound medical decision on health. In a research study, between Mexican-American and European-American samples, the latter demonstrates more positive attitude towards issues regarding health and autonomy than the former. This may mean that Mexican-American tend to exert autonomy in their health and well-being. Furthermore, between Korean-American and Mexican-American subjects, those with higher ages but lower in economic finances tend to relinquish their claims to decision-making in health management compared to their younger and more financially-dependent counterparts (Blackhall, et al., 1995). The results show that as autonomy is shed off with increasing age and decreasing finances, potentials for agreeing to traditional paternalism in health may proliferate. Lastly, the difference in general perceptions between males and females may also extend towards different priorities when it comes to health decisions. Gilbar (2004, p. 202) expounded that males and females have distinctive views on the importance of confidentiality, where males are more concerned on keeping their health conditions to themselves, safeguarding their privacy even against their families, while females are more apprehensive in protecting their families, as the “needs of others is...(linked) to a woman’s sense of identity.” In general, females consider the people in their environment prior to constructing important decisions, hence, they are also sacrificial in their quest to do so. Similar in Mrs. M.’s current viewpoint, she would rather suffer alone than include her family in her pain. Even the General Physician, as a woman, empathized with the plight of Mrs. M., choosing her role as paternalistic medical figure to help her patient in need. Gender, indeed, can change the way people respond to dilemmas in life, as such in health ethics. Summary and Conclusion Summing the case up, it is quite difficult to determine where the rights of Mrs. M. as a patient ends and where the General Physician’s obligation as medical professional begins; hence, an ethical dilemma is formed. The former has the right to autonomy, where she decided to keep her medical condition from being revealed to her family. However, the General Physician, in honoring such right, would also violate her oath moral duty as medical professional, to protect her clients in all clinical ways possible. Such situation points to the main involvement of three groups in the case, the patient, her biological relatives (children), and the consulting physician. Significantly, the views of the identified groups can be influenced by several factors, from culture, gender, ethnicity, age, and socioeconomic status. Among these, culture and gender is directly applicable in the case of Mrs. M., where the culture of familial sacrifice, and the vulnerability of female gender seemed impact the way Mrs. M. views her current medical status. To an extent, the modern version of paternalism appears to be the only option available to the General Physician, where she can exploit her medical knowledge and communication skills to convince Mrs. M. to renege on her initial decision against disclosure. Different from the traditional one, this type of paternalism is more liberal in nature, where patients are presented with every possible situations before letting them decide on which course of action is basically best for them. All in all, the decision against full disclosure may be in line with the autonomous right, but the progressive medical deterioration of Mrs. M’s sclerotic condition ties the General Physician into a narrowed professional decision--disclose the patient’s condition without her full consent, all in the name of creating a stable supportive system that may break the altruistic intention of Mrs. M. from isolated health martyrdom. Mrs. M.’s right to autonomous confidentiality ends as her health condition is threatened, and this is where the moral obligation of the General Physician starts--to assist the patient through the said neurological case through a stronger network of familial and professional collaboration. References Ashcroft, R.E., Dawson, A. & Draper, H. eds., 2007. Principle of health care ethics. England: John Wiley and Sons. Blackhall, L.J. et al.,1995. Ethnicity and attitudes toward patient autonomy. JAMA, 13 September, 274 (10), pp. 820-25. Bowman, D. & Spicer, J.eds., 2007. Primary care ethics. United Kingdom: Radclife Publishing. Campagnolo, D.I. & Vollmer, T.L., 2010. Multiple sclerosis. emedicine, [Online]. Available at: http://emedicine.medscape.com/article/310965-overview [Accessed 2 Feb. 2011]. Flight, M., 2004. Law, liability, ethics for medical office professionals. 4th ed. Canada: Delmar Learning. Gilbar, R., 2004. Medical confidentiality within the family: The doctors’ duty reconsidered. International Journal of Law, Policy and Family, 12, pp.195-213. Numico, G. et al. 2009. The process of truth disclosure: An assessment of the results of information during the diagnostic phase in patients with cancer. Annals of Oncology, 15 January, 20, pp. 941-45. Veatch, R.M., 2000. Cross cultural perspectives in medical ethics. 2nd ed. London, United Kingdom: Jones Barlett Publishers. Read More