Ethical Dilemmas in a Health Care Institution - Case Study Example

ANALYSIS OF AN ETHICAL DILEMMA CASE IN A HEALTH CARE Being an important aspect of the society, most especially in terms of maintaining the health and well-being of the people, the health care institution is necessitated to be a solid and amicable institution which values each and every individual in or out of the four corners of the hospital or any other health institution. This linkage between the members of the staff and the dependents of their professions and services serves as the key factor in maintaining the primary function of a health institution. In the succeeding statements, a situation where the deterioration of the link of values is shown and analyzed as to their outcome, implications and potential risks for both the patient and health care provider. A careful analysis and scrutiny of this case is vital in determining and exhibiting the disadvantages of an institution where an ethical dilemma is most prone. Moreover, this analysis would help foretell the hazards of a dilemma and may help in one way or another, in making everyone concerned realize the risks that a clinical dilemma poses to both the client and the health care provider. INTRODUCTION OF THE CASE The relationship of the patient and the health care provider is a bond which is considered a very vital in a certain health institution. The absence of this bond would indicate the deterioration of the caring, trusting and mutual relationship for both the client and the clinical staff. When this bond breaks, a great risk threatens the advantages that both patient and clinical staff could have gained. These instances, which are very common in the haven of people needing care and health assistance and facilitation, are what we usually call the ethical dilemmas. According to Taylor (2005), ethical dilemmas happen when an effort to adhere to ethical principles results in two conflicting courses of action. In the case at hand, we will be discussing the scenario wherein a wife of a prominent physician of certain hospital was diagnosed with endometrial cancer and was confined at the hospital where his husband is affiliated to. At the outset of the story, the clinical and medical staffs (other doctors, nurses, oncology staffs) were involved in the story since the diagnosis was a big issue to them most especially they know the family and the background of the patient. Though not officially involved in the case stated, there are clinical staffs and even doctors who in one way or another gets himself or herself involved in the situation. However, things get worse when these medical and clinical staffs start debating and arguing on the outcome of the patient. Also, the privacy of the patient has long been invaded since her medical charts were already being viewed by the staffs from different departments and designations in the hospital. Nurses and doctors are everywhere making side-comments and foretelling the supposed death of the patient. Another dilemma that is manifested by the case at hand is that the clinical staff has been making positive expectations to the patient that she can still make it to her daughter’s anticipated wedding and that she can still see her grandchildren through continuous medication. These expectations are unhealthy in a way because it makes the patient expect something which won’t actually happen because of the prognosis of her disease. PROBLEM IDENTIFICATION This first problem which is the access of the clinical staffs to the medical documents of the patient can be clearly understood knowing that the patient is the wife of their colleague. However, there is a great risk for the patient when this behavior goes on. Patients also need privacy whoever he or she is. It is one of the patient’s bill of rights to have a considerate and respectful care which includes the privacy and confidentiality regarding their condition and records (ANA). This is considered an ethical dilemma since the hospital staffs need to make decisions as to whether or not they should involve themselves in the case where their colleague is also involved. “Doctors and staffs… face tough decisions, too” says Hadley (2000). The second problem which arises from the situation is the giving of unrealistic expectations to the patient. These expectations would be harmful and would only make the feeling of the patient worse if these things don’t happen. Another is that the autonomy of the patient is not valued. Autonomy is one of the things which a patient should be entitled to. In this case, only the decision of the husband (the doctor) is followed. Lastly, the problem that this case builds up is that the dialogue about the patient’s outcome and even death is being discussed in places wherein there isn’t any privacy like the nurse’s station and other places wherein people passing around can hear these supposedly crucial discussions. STATEMENT OF STAND ON THE DILEMMA Personally, I uphold the values which are essential so that the relationship between me and my patient would not be tainted. It is necessary to take good care of the rapport which has been built because it is the key determinant in helping the patient and making him or her cope with what is happening to his or her health. Privacy is one important value which I maintain in everything I do with my patient. I see to it that the records and charts I made are kept in strict confidence and that the only persons who will see it are those concerned with him or her like the attending physician, chief nurse and the likes. Avoidance of disclosing the cases to other persons is vital because it helps maintain the confidentiality and privacy which is essential to every person. More than that, I also ensure that I value the autonomy of the patient- that he or she is involved in the decision making and planning of treatment. This is important because it helps in acquiring the cooperation of the patient in the course of treatment. Lastly, avoidance of giving unrealistic and unnecessary expectations to the patient is an unacceptable manner, in as much as we want the patients to cheer their spirits up; giving false reassurances would only make them feel worse at the end of the day. ALTERNATIVES FOR SOLVING THE PROBLEM Based on the aforementioned problems, resolving the conflicting courses of action is necessary so as to maintain the dignity and confidentiality of the patient and the professionalism of the health care provider as well. One important law enacted by the US Supreme Court is the right against invasion of privacy as inherent in the US Constitution (Taylor, 2005 and NYS). “The US Congress has passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996” (Taylor, 2005). This law is relevant in the case presented because this law contains restrictions in disclosing the patient’s medical records and condition. According to the HIPAA, the patients have a right to see and copy their health record; update their health record, get the list of disclosures the health institution has made independent of disclosures made for treatment payment and operations purposes; “request a restriction on certain uses or disclosures and lastly, to choose how to receive health information” (Taylor, 2005). Based on this law with final regulation made last 2002, there is a great advantage for the patients because privacy and confidentiality is being protected. Reporting this case to the authorities of the health care institution, ethical committees or agencies or even seeking legal counsel is an ideal course of action. Through this, the problem may be lessened and so will the occurrences of the same conflicts. Another way of solving this problem is to speak up and talk to those who are having these misbehaviors and telling them of the risks and potential problems which may arise if these things continue and that the institution as a whole would be tainted should these things continue. OUTCOME EVALUATION In reporting the case to the HIPAA Committee or other ethical committees and agencies, there would be a big chance that the health institution would view this instance as a way of whistleblowing. There would be a great chance that reporting this to external agencies would cause a big turmoil inside the hospital most especially between the reported professionals and the person who blew the whistle to authorities. Though it would be beneficial to the patient and the patients who would be acquiring the service of the hospital, it would be extremely detrimental to the health care providers. In order to prevent this notion on whistleblowing, it would be better if the case is first reported to the authority in the hospital i.e. the chief officers and the like. Through this, the occurrence of misunderstandings would be lesser and the turmoil would be localized and would not reach and pass over the borders of the institution. As to the second solution presented earlier, through talking to those staffs and professionals who tend to do the damage would also be effective for as long as the approach would be in a calm manner so as not to offend him or her. Explaining to him or her, the importance of confidentiality and privacy of the patient would help him or her realize the things which should ad should not be done. The latter would be a good solution to the problem. It is a good approach but in case that misbehaving still persists, then it is about time to discuss the problem to higher officers as stated in the former solution. CONCLUSION Ethical Dilemmas are very common to health care institutions and it is but a challenge to every health care provider. These instances can never be avoided because it comes out naturally in crucial situations. The best thing we can do as health care providers is to always boil our decisions down to what our patients really need and what advantages they should get out of our service to them. As health care providers, we should also bear in mind that our patients are dependent and are in need of our assistance so whatever happens; it is our primary right to defend them from things which are undesirable for them. Whatever it takes, it is our priority to keep them safe from intrusions. Though it would be a risky situation, it would be very rewarding to the feeling and would add up to the sense of professionalism and ethics which every health care provider must possess. LIST OF REFERENCE: American Nurses Association. (1988). Ethics in Nursing: Position Statements and Guidelines. Kansas City, MO: Author. Hadley, Mark. (2000). Hospital ethical dilemmas vary according to size, importance remains same. Retrieved 18 August 2007 from NYS Governor’s Office. (2003). General Rules for Use and Disclosure Disclosures by Whistleblowers. Retrieved 18 August 2007 from Taylor, Carole. (2005). Fundamentals of Nursing 5th Ed. Lippincott Williams and Wilkins, 94-99. Read More