Rights and Responsibilities in Healthcare - Assignment Example

Rights and Responsibilities – Healthcare Paper For instance, you are caring for two patients, d Gene and Fred respectively, wherein both are suffering from heart disease. Gene has a strong family history of heart disease. He maintains a low-fat diet and regular exercise as preventive measures, yet he still suffered a heart attack at age 44. Another patient, Fred, is not as vigilant as Gene in maintaining a healthy cardiovascular lifestyle. He is a regular fast food diner and does not have an exercise regimen, and suffered a heart attack like Gene, also at age 44. Both require immediate intensive care treatment, but the intensive care unit (ICU) has only one remaining bed for a patient. Assuming that both of them are able to pay and demands the most quality care, and that no two or more patients can occupy a single bed, a quick decision-making must be made, whether to prioritize Gene over Fred or whoever of them had the earlier doctor’s order to be transferred to ICU. What are your thoughts on who should go first to get the remaining ICU bed? Is it justice to prioritize Gene, assuming that he might be more willing to live and has more chance of survival over Fred? Introduction Nursing is faced with various ethical dilemmas in all settings of patient care. There are always situations wherein the nurse must decide based from the ethical principles in nursing care. However, ethical dilemmas happen when two ethically-motivated actions go in conflict with each other (Kelly-Heidenthal, 2003). There are times wherein there seems to be no right or correct decision to make in a situation. Both decisions have risks entailed wherein we have to choose the one with the least consequences. Dilemmas can be good vs. good, bad vs. bad, or good vs. bad, depending on the situation. There are even times when ethics and law may have conflicts with each other (Sullivan and Decker, 2001). There are times when the nurse would rather violate ethical principles than being threatened to face legal consequences (knowing the expensive and time-consuming legal process, including psychological trauma), more commonly in dealing with patients (or a relative or friend) who are influential and/or having enough money to spend on legal proceedings. Although ethics provide a guide on what is right and what is wrong, it does not provide help when ethical dilemmas enter the scene. Description of the Ethical Dilemma In the case presented, both Gene and Fred deserves the best patient treatment, and both of them have the right to occupy that single empty bed in the ICU, yet the situation requires the nurse to prioritize one patient over the other. Prioritizing Gene over Fred violates the patient rights of Fred, and prioritizing Fred violates the patient rights of Gene. Even if a triage principle is applied, both of them are classified as an emergent case, yet one of them must be treated first over the other. There is also a possibility that Fred exerts influence beyond the ethical standards. He may have relatives who are willing to pay more to get ahead, and may be friends with the hospital directors and stakeholders to ask help in prioritizing their patient. Even if we assume that Gene has a more chance of survival, but if the hospital administrators order you to prioritize Fred, are you willing to assume the nurse’s role as a patient advocate of Gene in the threat of your job security, or just allow the administration to prevail and just do as they say? Ethical Issues of the Dilemma There are certain ethical issues governed by the ethical principles that must be taken into consideration on the nurses’ judgment on prioritizing a patient over another. These principles are enumerated by Kelly-Heidenthal (2003). Beneficence. This is determined on what might be the most beneficial outcome in prioritizing a patient from another. For instance, if Fred’s electrocardiograph (ECG) tracing reveals a third degree AV block and ST elevation in leads V1, V2, V3 and V4 (anteroseptal wall myocardial infarction) while Gene shows a second degree AV block Mobitz Type 1 without noticeable ST elevation nor Q wave abnormalities in all limb and precordial leads, it is reasonable to let Fred get ahead over Gene since complete heart blocks present a worse outcome if he is not treated immediately. Nonmaleficence. The decision will be based on deciding the least harm to occur as possible. If Gene suffered an acute heart attack 2 hours ahead of Fred, he must be prioritized over Fred since the prognosis of Gene will be poorer when he was not immediately treated with anti-thrombosis agents, while Fred can still have it while still on the Emergency Department. Not that Fred has the lesser risk of myocardial infarction, but more harm will be done if both Gene and Fred will suffer myocardial infarction. Justice. Perhaps this is the most applicable principle to be applied on this case. Patients must be treated equally, within the limits of the law and the hospital triaging policies. Fred should not be discriminated because of his unhealthy past lifestyles, nor because of his lack of exercise. It is injustice against Fred if Gene was prioritized simply because he was thought of as having a higher chance of survival as he maintains a low-fat diet and regular exercise. If both of them are almost the same disease progression, no one of them should be hastily prioritized over another without considering other factors that warrant a nurse to decide who will go first to the ICU. Fidelity. Though it is not as weightier than the previously-mentioned concepts, this principle must be taken with careful consideration. It is best not to promise either Gene or Fred to have the privilege of getting to the ICU bed first unless a firm decision is already made, with the exception of consequent circumstances wherein one patient’s condition became worse than what is already anticipated in the planning process. Promising a patient to get ahead and not doing so is a violation of fidelity to that less-prioritized patient. Veracity. The nurse must be truthful to her patients at all times should she came up with a decision even if there are ethical dilemmas influencing her. She must know how to explain truthfully to Fred the reasons why he is not prioritized over Gene. She should tell him that the disease progression of another patient necessitates a more immediate treatment so that another patient gets ahead to the ICU. Still, she must assure him that he will receive the best possible care even if he is not yet transferred to the ICU. It will be unethical if she will deceive the patient just to let him agree like, “Sorry Mr. Fred, but there is still problems with the unoccupied bed in the ICU. I’ll just let you know if everything is settled before we transfer you.” Ethical Dilemma in the Eyes of the Beholders Each stakeholder has their own viewpoints, reactions, and influences to the dilemma being faced by the medical staff. How nurses, who are directly in charge with the patient care, see the situation would not be the same for the doctor who is very seldom seeing the patient himself. From medical staff, to patients, to professional and non-professional employees, to board members, to the hospital administrators and trustees, and even to the society, everyone has their own different eyes to it. The primary concern of the patient in seeking professional care is to obtain a cure to his health complaints. He may know and understand why such dilemmas happen, but most oftentimes, he is only concerned for his own health and nothing more. For instance, Gene knows that another patient, Fred, needs immediate assistance based from how he sees the other patient, labored breathing, diaphoretic, pale, unable to speak, etc. but still demands the attention of medical staff to him as he tells them, “Attend to me first. He’ll be dying sooner anyway”. Hedonistic patients do not care about the staff’s ethical dilemmas neither the needs of other patients; he has the right to be attended to as early as possible. Luckily, not all patients are hedonistic, them who understands that the staff is facing an unavoidable ethical dilemma. Even among the medical staff have their differing perspectives to the ethical dilemma. In fact, though it is “wrong” for nurses to use deception in informing patients about their condition, it seems to be not “wrong” if the doctor orders the use of deception to nurses (Short and Adshead, 1996). Conflicts often occur between doctors and nurses when the nurse did not carry out an order she thinks to cause further harm to the patient. The society provides a wide range of options for patients, medical staff, employees, and others, who were victims of various ethical dilemmas. Nurses can seek help to the American Nurses Association whenever they encounter these. On the other hand, those associations will try to mediate and investigate what’s wrong with the situation, and if there is any means of preventing such dilemmas to enter the scene. Various help systems are available to give aid should dilemmas arise. Potential Conflicts and Points of Agreement Persons who are involved in the ethicsal dilemmas are discussed in the previous section. These different people can be in agreement (positive relationship) or conflict (negative relationship) with each other. The patient may be in conflict with the doctor when he is in disagreement with the decision of the doctor to prioritize another patient (nonmalefiscence), but agrees with the nurse who will do something to reserve the available bed for him (fidelity). The nurse’s decision to offer the bed to the patient she deemed to be needing immediate care (principle of justice) would conflict with the medical director’s wish to prioritize his relative to the available bed (fidelity of the director to his relative that he will make things fast while admitted at the hospital). Other Factors It is against the law to discriminate patients in terms of gender, ethnicity, religion, age, sexuality, and others, but the medical staff can prioritize patients who require a more immediate attention based from the principle of triage. Those who are at risk in losing life or limb must be treated first than the patient who is a post-operative case. However, Gene and Fred are of the same gender and age, and other factors but their lifestyles before the heart attack actually happened. Their differences simply lie on diet and exercise, which is not a pre-determinant in choosing which patient to prioritize. It is almost impossible that the two patients are of identical disease progression, so the treatment should go to whoever is more vulnerable than the other. References Kelly-Heidenthal, P. (2003), Nursing leadership and management, Delmar Thompson, Singapore. Short, J. and Adshead, G. (1996), "An ethical dilemma: commentary: disciplinary processes should not be used to solve ethical problems", British Medical Journal, 313 p. 1251. Sullivan, E. and Decker, P. (2001). Effective leadership and management in nursing (5th ed.). Upper Saddie River, NJ: Prentice-Hall. Read More