Health Care Ethical Case Analysis - Research Paper Example

2nd draft for revision When the Physician Oath Competes with Marriage Vows Case Summary Dr. Salma is a well-known general surgeon at King Faisal Hospital, she had an unknown MRSA infection that accidentally led to the death of 3 of her patients after performing surgeries on them. The incident has been investigated and Dr. Salma has been declared from surgery until she gets treated. Dr. Jack is an anaesthesiologist who works with his wife, Dr. Salma, at the same hospital. After his wife got back to the hospital and was declared for surgery, he started observing his wife’s anxiety of dirt or contamination, thoughts of possibly causing harm to her patients during surgical procedures, fear of making mistakes and the need for order and symmetry in her operation room. Dr. Jack asked his wife to see a psychiatrist and she refused, claiming that everything is under control and nothing is wrong with her. Later that week Dr. Jack assigned himself to be under Dr. Salma’s service in the Operation room as the anaesthesiologist. He observed her obsession of scrubbing, doubting the cleanliness of her staff on service, checking the order of her instruments continuously on the tray, and reciting the procedure to herself many times though it was considered a simple one for her. Although, the procedure was so simple, the patient was considered a high-risk patient for a heart attack, and any prolonged anaesthesia could cause his death. Upon closing the patient, Dr. Salma had to perform a leaking test to make sure that she had patched the patient’s intestine in the right way and there were no leakages or extra sutures needed. This test includes an administration of air through the patient’s gastric intestinal tract while pouring normal saline into the cavity and monitoring the presence of air bubbles. After the test, Dr. Hana, the resident on Dr. Salma’s service said “Great! We are ready to close” But Dr. Salma insisted that she saw some air bubbles, and they have to do more sutures. Dr. Jack told Dr. Salma that the patient couldn’t take the anaesthesia anymore and hi vital were getting low, so he suggested that his wife redo the leakage test while he observed the results to help her calm down her doubts, close the patient and prevent unnecessary procedures. 1) WHAT IS THE ETHICAL DILEMMA? Should Dr. Jack report the OCD behaviors of his wife? 2) WHO WILL BE AFFECTED BY THE DECISION AND WHAT IS AT STAKE FOR THEM? 1. Dr Jack will be affected by the decision, as Dr Salma is his wife and any decision against her will create an emotional stress on her. In this respect, as her husband, it is his responsibility to take proper care of his wife. 2. Dr. Salma will be the person at stake as per the case scenario. She was suffering from OCD behavior and any decision against her with respect to career might lead towards a traumatizing situation. This will further worsen her condition as one of the reasons for the OCD behavior is viewed to be the traumatizing situation. 3. Patients’ well-being will also be at stake, as Dr Salma is a surgeon. As discussed about the patient in the case who was in the verge of dying because of the impact of OCD behavior of Dr Salma, the patients coming for treatment might be impacted by Dr Salma’s OCD behavior 4. The King Faisal Hospital’s good will is at stake, as the actions related to the healthcare staff would create a greater impact in the minds of external society. 3) CONSIDERING THE VARIOUS STAKEHOLDERS, AND KNOWLEDGE OF ETHICAL PRINCIPLES, WHAT ARE THE ETHICALLY RELEVANT FACTORS? 1) The significance of Dr Salma’s goal of recovery or desire for well-being 2) The significance of Dr. Salma’s husband’s concern about the worsening of his wife’s OCD behavior 3) The significance of burdens of health risk on Dr. Salma’s patients from wrong treatment 4) The significance of burdens of adverse impact on Dr. Salma’s patients’ families from wrong treatment 5) The significance of the high probability that effective treatment will enable Dr. Salma to continue to practice medicine and help her to perform the surgeries safely, which might be at stake due to her OCD syndrome 6) The significance of Dr. Salma’s OCD behavior is creating an adverse impact on her professional career and creating risk for the patients under her treatment 7) The significance of Dr. Hana’s maintaining silence and supporting Dr Salma even after knowing that she is doing an unjustified and wrong treatment 8) The significance of Dr. Hana’s responsibility in providing effective treatment to the patient 4) HOW DOES SENSITIVITY TOWARD SOME OF THE ETHICALLY RELEVANT FACTORS COMPETE WITH SENSITIVITY TOWARD OTHERS? With reference to the ethically relevant factors mentioned above, The significance of Dr. Salma’s goal of recovery or desire for well-being (1) Vs. The significance of burdens of health risk on Dr. Salma’s patients from getting the wrong treatment (3). The significance of Dr. Salma’s husband concern that reflects about the worsening of his wife’s OCD behavior with respect to the future decision (2) Vs. The significance of the patients’ risk from getting the wrong treatment (3). The significance of the high probability that effective treatment will enable Dr. Salma to continue practicing of medicines and perform the surgeries safely (5) Vs. The significance of Dr. Salma’s OCD behavior creating an adverse impact on the patients’ health during treatment (6). The significance of Dr. Hana’s maintaining silence and supporting Dr. Salma even after knowing that she is doing an unjustified and wrong treatment (7) Vs. The significance of Dr. Hana’s responsibility in providing effective treatment to the patient (8) 5) WHICH ETHICALLY RELEVANT FACTORS OUGHT TO TAKE PRECEDENCE? WHY? The Significance of Dr. Salma’s Husband Concern That reflects About the Worsening Of His Wife’s OCD Behavior (2) should take precedence. According to the case, Dr. Salma was known to be a general surgeon within the King Faisal Hospital. As observed by her husband Dr. Jack, who was an anesthesiologist in the same hospital, his wife endures the MSRA infection. Due to having such infection, three of her patients accidentally died after performing surgeries on them. For this particular reason, she was declared from surgical operations until she received appropriate treatment with respect to the MSRA. However, after her declaration, she returned to the hospital. In this respect, her husband observed Obsessive-Compulsive Disorder (OCD) behaviors in his wife again. He observed his wife’s anxiety with respect to the dirt, cleanliness and the arrangements of the surgical instruments. In this aspect, he further noticed his wife’s nervousness with respect to the treatment of the patient in the operation theatre. She knew that if the patient is given anesthesia for prolonged period, there are high chances of his death. Even then, she was taking a lengthier process pertaining to complete the operation by keeping the patient anesthetic for a longer period (UK-CBT, “Cognitive Behavioural Psychotherapy and EMDR”). Considering this scenario, Dr. Jack endures an ethical dilemma of either to inform the healthcare management about his wife’s repeated problem or to keep the matter secret. His reveal of the truth might lay a greater adverse impact on his wife’s medical career. This might lead towards worsening the critical condition of his wife. In consideration of the disease of Obsessive Compulsive Disorder, it can be affirmed that this disease is basically an anxiety disorder, which is usually characterized by unwanted and uncontrollable thoughts with repetitive behaviors. In such diseases, the obsessive thoughts along with the compulsive behaviors are excessive and greatly interfere in the daily activities that are performed by the human beings. The various categories of OCD behavior include washers, doubters and checkers among others. As discussed in the case, his wife was infected of Methicillin-resistant Staphylococcus Aureus (MSRA). In this aspect, this particular infection is prominent in the hospitals and the nursing homes pertaining to the patients enduring open wounds. Additionally, Dr Jack observed obsessive anxiety within his wife after she returned back to the hospital. He observed that she faces the anxiety syndrome with respect to contamination, disturbing thoughts of might causing harm to the patients during treatment and making of mistakes during operations among others (Veale, Freeston, Krebs Heyman and Salkovskis 332-343). Taking into concern the operation scenario, it can be affirmed this particular reason was the key reason for Dr. Jack experiencing an ethical dilemma. During the operation procedure, it was considered that providing anesthesia for a prolonged period to the patient might lead to death as the patient suffers with a heart problem. In this regard, after the operation is completed, Dr Salma needs to perform a leakage test to patch up the patients intestine pertaining to corrective measures. After the test being conducted, Dr. Hana declared the effectiveness of the entire procedure but Dr. Salma believed in remaining certain faults in the procedure. This was the result of her OCD behavior, which might have led the patient towards death due to the extension of anesthesia. The ethical dilemma of Dr. Jack was that he was working for the interest of the patients and thus it is his responsibility to inform the health management about his wife’s OCD behavior. In this situation, she will have to face numerous consequences that might lead her to traumatic situations, worsening her condition even more. In accordance with the case scenario, Dr. Jack must inform the management about Dr Salma’s OCD behavior, which might create hazardous situations for the patients in the operation theatre (National Institute for Health and Clinical Excellence “Obsessive-Compulsive Disorder”). In accordance with the case scenario, Dr. Salma is suffering from OCD behavior. This is eventually creating hurdle in conducting operations effectively. Dr. Jack, Salma’s husband is familiar with her OCD syndrome and its negative consequences. Dr. Jack faces the dilemma of whether to inform the healthcare management about her disease or not. The ethical dilemma of Dr. Jack also concerns with the wellbeing of his wife as adverse decisions might worsen the condition of Dr. Salma at large (Mayo Foundation for Medical Education and Research “Obsessive-compulsive disorder (OCD)”). The ethically relevant factors that ought to take precedence with reasons are discussed in the following. The basic facets of OCD include the unwanted as well as intrusive thoughts and numerous obsessions. In general, obsession is looked upon as an enjoyable aspect, but in case of OCD, the obsession is the frightening result. In this respect, it can be well ascertained that the compulsion is considered as the repetitive behavior, which lays a greater impact on the daily activities of the OCD sufferer. Furthermore, the OCD symptoms reflect a range of mild impacts to severity. As observed that OCD symptoms affect the people differently, a normal set pattern of thoughts remains similar amidst the patients. In case of Dr. Salma, the thoughts pattern remains the same such as obsession, anxiety, compulsion and the temporary relief. As mentioned in the case, one of the prior reasons or the causes of OCD behavior in Dr. Salma was MSRA (Gov. UK “Obsessive Compulsive Disorder”). With respect to the OCD syndrome, it has been further ascertained that the people feel frustrated for their desire of involving in the repetitive behaviors. Consequently, OCD sufferers mainly experience the intense fear pertaining to something miserable might happen to them. The treatment, which is usually associated with OCD syndrome, is Cognitive Behavior Therapy. In relation to the CBT treatment, it basically involves communicating with the patients (Henkelmann 1-5). In this respect, it can be well ascertained that Dr. Jack is concerned much about his wife’s health. He is in dilemma that, if he informs the management about his wife’s OCD syndrome, she might face uncertain and adverse consequences that will result in affecting her health. Dr. Jack, being the husband of Dr. Salma needs to provide her support for treating effectively the OCD disease. It is quite important for the family members of the patients to endure building greater communication with them. In this respect, it can be well ascertained that treatments related to OCD will not cure the syndrome but will certainly help patients to gain control over their compulsive behavior (Centre for Addiction and Mental Health “Obsessive-Compulsive Disorder: Help for Partners and Families”). On another aspect, being a doctor, it is the responsibility of Dr. Jack to look at the interest of the patients coming for the treatment. It can be affirmed that by supporting his wife, Dr Jack is keeping the well-being of the patients. In-fact, it is ascertained that positive relationship between the patients and the physicians is considered to be the cornerstone within any sort of medical practice. There are numerous general principles that have been designed in the International Code of Medical Ethics pertaining to the healthcare sector. In this respect, it can be further ascertained that medical ethics code is the prior and vital consideration on part of the physicians to maintain the well-being of their patients. Thus, it is the responsibility of Dr. Jack to inform the management about the OCD syndrome of his wife. Apart from this, the responsibility of supportive colleagues also lies in the similar context. This can be explained by taking into concern Dr. Hana’s actions. Even after being confirmed about the patients’ risk with respect to prolonged anesthetic period, she took no heed in reporting Dr. Salma about her unjustified and wrong treatment. In this regard, Dr. Hana remained silent, whereby she denied her responsibility of serving the patients’ interests initially (World Medical Association, Inc “WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects”). In consideration with the case scenario, surgery is the vital field in which Dr. Salma was specialized. In accordance with the medical error, Wrong-Site Surgery (WSS) is common and measures have been undertaken to mitigate the risk occurring in this respect. Considering the case scenario, Dr Salma also faced the anxiety of creating WSS error due to her OCD behavior. Taking into concern the vital aspect of the medical error with regard to wrong treatment, this lays a greater impact on the goodwill of the healthcare units. In this respect, it can be further ascertained that the people greatly depends on the healthcare professionals for their well-being. They looked upon the healthcare units as one of the key elements to endure safety and well-being. Eventually, it is estimated that the popularity and the goodwill of the healthcare units depends on the word-of-mouth. In this particular context, it can be further determine that if Dr. Hana reports to Dr Salma about her unjustified and wrong treatment, it is likely to worsen her condition. Consequently, it can be further determined that if a patient receives wrong treatment and faces health issues, it is likely to affect the popularity of that particular healthcare sector. In recent scenario, the health care units have increased largely. Therefore, to sustain in this extensive competitive market scenario, it becomes more vital for the health care sector to ensure deliverance of proper services to the patients. Consequently, being a service sector, the health care units have certain responsibilities towards the societal safety and well-being (Gross Professor Michael L and Mr Don Carrick 100-315; Mohanna 200-259). 6) WHAT ACTION(S) OUGHT TO BE TAKEN TO RESPOND APPROPRIATELY TO THE MORE SIGNIFICANT ETHICALLY RELEVANT FACTORS? a) General Recommendation With reference to the case study, Dr. Jack is in dilemma of whether to inform the healthcare management about his wife’s OCD behavior. He observed his wife’s behavior very closely and the associated risks for patients by assisting her in the operation theatre. According to the medical code of ethics, it is the sole responsibility of the medical professionals to ensure patients’ safety along with care as the topmost priority apart from anything else. In the context of health care, the Hippocratic Oath is usually taken by the medical professionals and the physicians to practice the medical treatment honestly and dedicatedly. Considering all these factors, it can be recommended that Dr. Jack must inform the management about his wife’s OCD behavior. In this context, the management can opt for various alternatives to mitigate the ethical issue or dilemma effectively. If Dr. Jack is keeping silent taking into concern his wife’s career and worsening of the conditions, ethically he will be wrong. On viewing this particular case scenario, the health management can transfer Dr. Salma from the operation theater (OT) to another medical department, which will not be as critical as OT and will able to monitor her OCD behaviors in a periodical basis (Bouchet-Saulnier 700-800). . b) Infringement In relation to the case scenario, it was the prior responsibility of Dr.Hana to safeguard the interests of the patient at first instance. According to the Hippocratic Oath of the physicians, it is their prior responsibility to take care of the patients’ interests at first instance, which breached by Dr. Hana in the operation theatre. Justifiably, she remained silent even after knowing the complications that the patient might suffer due to Dr. Salma’s OCD behaviour. c) Justification/Weighing of Factors With reference to the provided case scenario, the ethically relevant factors can be apparently noted to be health benefit and safety of the patients among others. As mentioned above, it is the responsibility of the medical professionals to give priority towards the deliverance of quality as well as proper patient care. As observed, according to the International Code of Medical Ethics, it is the duty of a physician to maintain all the time an accelerated standard of professional conduct. Apart from this, it is also the duty of the physicians not to indulge in any profit motive aspect. It is further considered that the medical professionals must deal with the patients honestly. These factors direct towards the justification for considering the patients safety as the priority (Harris 300-360; OCD-UK “Understanding Obsessive-Compulsive Disorder (OCD)”). 7) WHAT (IF ANYTHING) CAN STILL BE DONE TO MANIFEST SENSITIVITY TOWARD THE LESS SIGNIFICANT ETHICALLY RELEVANT FACTORS? In accordance with the case scenario provided, it can be viewed that Dr. Salma has entered into the situation of OCD syndrome only after being infected by MSRA while treating the affected patients. In relation to this, it is the responsibility of the healthcare management to provide proper treatment to Dr. Salma. Furthermore, the management authority of the hospital can shift her to other medical departments that are less complex and critical as compared to the department of OT. This will certainly help the healthcare management of the hospital to maintain its goodwill in the society without suspending Dr. Salma. This plan might create a positive impact on Salma’s mind and help her to recover in a speedy manner (State Government of Victoria “Obsessive Compulsive Disorder”; NIH “What is Obsessive-Compulsive Disorder (OCD)”). Works Cited Bouchet-Saulnier Françoise. The Practical Guide to Humanitarian Law. United States: Rowman & Littlefield Publishers, 2013. Print. “Obsessive-Compulsive Disorder: Help for Partners and Families.” Centre for Addiction and Mental Health. 2012. Web. 07 April. 2014. “Obsessive Compulsive Disorder.” Gov.UK. 2012. Web. 07 April. 2014. Gross Professor Michael L, and Don Carrick. Military Medical Ethics for the 21st Century. United Kingdom: Ashgate Publishing, 2013. Print. Henkelmann Katharina. “Case Study of Severe OCD.” Academia, 2014: 1-5. Print. “Obsessive-compulsive disorder (OCD).” Mayo Foundation for Medical Education and Research. 2014. Web. 07 April. 2014. Harris Dean M. Ethics in Health Services and Policy: A Global Approach. United States: John Wiley & Sons, 2011. Print. Mohanna Kay. Teaching Made Easy: A Manual for Health Professionals. United States: Radcliffe Publishing, 2013. Print. “Obsessive-Compulsive Disorder.” National Institute for Health and Clinical Excellence. 2005. Web. 07 April. 2014. “What is Obsessive-Compulsive Disorder (OCD)?” NIH. 2012. Web. 07 April. 2014. “Understanding Obsessive-Compulsive Disorder (OCD).” OCD-UK. n.d. Web. 07 April. 2014. “Obsessive Compulsive Disorder.” State Government of Victoria. 2014. Web. 07 April. 2014. “Cognitive Behavioral Psychotherapy and EMDR.” UK-CBT. n.d. Web. 07 April. 2014. Veale, David., Mark Freeston, Georgina Krebs, Isobel Heyman and Paul Salkovskis. “Risk Assessment And Management In Obsessive–Compulsive Disorder.” Advances In Psychiatric Treatment (2011): 332–343. Print. “WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects.” World Medical Association, Inc. 2014. Web. 07 April. 2014. Read More