Analysis Based on the Principles and Processes of Ethical Practice in Care Provision - Case Study Example

Case Analysis Based on the Principles and Processes of Ethical Practice in Care Provision Case Analysis Based on the Principles and Processes of Ethical Practice in Care Provision Introduction The practice of medicine has undergone significant change to bring to the fore the importance of ethical issues (Hammersley, 2009). Several factors have driven this change: patients are more informed than they used to be, cases of doctors being sued for their professional actions or inaction are on the rise, practitioners need to appreciate the implications of their decisions on patients and their families while striving to fulfil their obligations to patients, society, the profession and the government. Overall, ethics deals with discerning what is good and bad conduct. Medical ethics is concerned with the way doctors handle the moral problems that emerge in the course of providing care to patients. This paper analyzes the hypothetical case of Mrs. S based on the principles and processes of ethical practice. Mrs. S is aged 85. She lives alone as all her three children are abroad, although they take turns to visit her once every six weeks. Her children have tried to get her home carers but he has refused. Recently, Mrs. S was hospitalized for the third time following a fall that caused her serious injuries. While at the lodge, she readily accepted support from carers. When her condition improved, she was moved to Raleigh Lodge, a short-term home for the elderly. Even though her condition has improved significantly, she has declined to return home. In order to “force” her to leave the facility and return to her home, the manager of the lodge has asked her doctor and carer to withdraw care. The two object the manager’s plan but do not know what to do next. Mrs. S’s case is analyzed based on the following principles of ethics: beneficence, non-malfeasance, autonomy, justice, confidentiality, disclosure and informed consent. In addition, three processes of ethical care provision, namely professionalism, managerialism and accountability, are applied to the case. Finally, the author sums up the argument and recommends a way forward in Mrs. Ss case based on the discussion. Discussion Beneficence The principle of beneficence demands only what is best for the patient is promoted (Walsh & Woodthorpe, n.d.). The basis of the judging what is best for the patient is a healthy professional relationship between the doctor and their patient. The patient, the doctor or the patients family may define what is best for the patient. Usually, the decision is a joint one. On many occasions, all the parties to the decision are in agreement, although sometimes they will differ. Beneficence implies that the doctor carefully analyzes the condition of the patient before recommending what is best for them. Sometimes taking no action may be the best alternative. In the case of Mrs. S, the lodge believes that her condition has improved enough for her to return home. Mrs. S is reluctant. She seems more comfortable with the environment at the lodge than her home. The fact that she readily accepts support from carers at the facility implies that she is not opposed to them as such; she just do not want them in her home as her children propose. Non-malfeasance This principle demands that the doctor does no harm to their patient (Walsh & Woodthorpe, n.d.). However, many treatments involve some degree of pain or have side effects. The implication is that the doctor contemplates their decisions such that they will do the least harm to their patients. For instance, before the doctor conclude that their patient has cancer, they must have done due diligence to verify their facts. There is pain involved in treating cancer. Subjecting the patient to the pain unnecessarily because of an erroneous decision is unacceptable. In Mrs. Ss case, the lodge manager believes that there is no harm in Mrs. S returning home: after all, her condition has improved so much that she can do most things by herself. The manager is oblivious of the possibility of the psychological harm they may do to Mrs. S by forcing her out of the facility. The harm could include losing friends she has made at the facility. Mrs. S’s doctor and carer seem aware of this fact so they oppose the manager’s plan. Autonomy Autonomy is the capacity of a person to think and arrive at a decision freely, without undue pressure. For this reason, the physician and the patients family should not impose decisions on the patient(Walsh & Woodthorpe, n.d.). Rather, they should support them by providing them with full information, for instance, so that they can arrive at informed decisions. They should also respect the decision of the adult patient even if they do not agree with it. Problems occur where the decision of the patients conflicts that of other stakeholders. Mrs. S seems to have made up their mind to stay at the lodge. The lodge manager thinks otherwise and is justified; Raleigh Lodge is a short-stay facility with limited capacity. Since Mrs. S’s condition has improved, she should return home so that their space can be allocated to another patient. From the case, however, it is not clear whether Mrs. S had prior information that the lodge was meant for temporary accommodation. Possibly, she was not provided with that information, hence her decision to stay. Justice Resources are almost always limited. For example, there may not be a doctor for every patient. For this reason, priorities need to be set. The principle of justice demands that, in the allocation of acre, patients with related conditions be accorded the same care(Walsh & Woodthorpe, n.d.). In allocating the care, every patient in the group must receive their fair share of it. However, the duty of ensuring justice is not the doctor’s alone: the patient too has a role to play. Whatever they ask for must be fair and not a burden to others. In the case of Mrs. S, Raleigh Lodge has limited capacity to accommodate patients. Justice, therefore, demands that as soon as a patient improves, they vacate the facility so some else can benefit. Assuming that Mrs. S is full aware that Raleigh Lodge is a temporary-stay facility with limited capacity, then her insistence on staying there is unfair. Otherwise, she is justified in refusing to leave. Confidentiality Confidentiality is the cornerstone of the doctor-patient interaction, even though it is increasingly threatened by the Information Age(Hammersley, 2009). In order to maintain the trust they have developed with their patient, the doctor must not share with any person or authority the personal information about their patient without the patient’s consent. However, confidentiality is not always absolute and must be informed by the circumstances surrounding the patient. For instance, it may be necessary to override privacy in order to promote public health. Even then, the doctor must always seek to minimize harm to the patient. Even though we are not told in the case, it is possible that Mrs. Ss doctor knows something about their patient that the lodge manager does not. The doctor then feels bound by the principle of confidentiality not to share that information with the manager. Otherwise, it must be well-known to the doctor that Raleigh Lodge can only accommodate patients for a limited period. So they must have a good reason to want to hold Mrs. S longer at the facility. Disclosure At mention, the principle of disclosure seems opposed to that of confidentiality. In reality, it is not. For the patient to make decisions, the doctor must disclose to them all the relevant information (Hammersley, 2009). Such information would include the treatment options available to the patient and their likely outcomes. However, there are instances where the doctor may opt not to disclose certain information. For instance, for instance, the patient may expressly ask the doctor not to tell them certain things, but the doctor must still offer the patient the opportunity to know the truth. The doctor may also withhold information if the patient is incapacitated, in which case they share the information with the family of the patient. Also, in an emergency, there may be no time for the doctor to share information with their patient. Finally, there is the contentious notion of “therapeutic privilege”: the doctor believes that the patient is better off without certain information. Because we are not told any of these conditions applies to the case of Mrs. S, we may assume that all relevant information, including how long they stay at the facility, was disclosed to them at the time they were admitted into Raleigh Lodge. This being the case, Mrs. S must have other reasons for wanting to stay at the lodge longer. Informed Consent Informed consent builds on autonomy and the doctor needs consent before they can provide care(Hammersley, 2009). Informed consent also protects the doctor against the risk of legal action taken against them. Consent may be explicit or implied. The former is usually expressed in writing, typically occurs in hospitals and is given for a specific procedure. Consent may also be given verbally, in which case there will be no evidence. However, a consent is not a contract and the patient can withdraw it at any time. For routine procedures, the patient implies consent by regularly availing themselves at the doctor’s office for check-up. Consent can be "informed" only if the patient is furnished with all the information that pertains to the care they seek. Unfortunately, a consent is not a contract: it binds neither the patient nor the doctor. Consequently, while Mrs. S or one or more of her children may have been explained to how long she could stay at Raleigh Lodge, the manager may not sue her for declining to vacate the facility at the expiry of their occupancy. Professionalism Essentially, professionalism in care provision is desirable: doctors and carers must conduct themselves professionally as they relate to their patients. Unfortunately, for decades, some practitioners saw themselves as the experts who knew it all(Heller , n.d.). They assumed that unlike their patients, they possessed highly specialized knowledge and that knowledge was all they need to provide care. Today, such a view is frowned at. Increasingly, physicians appreciate the role of the patient in the care process beyond the provision of diagnostic information. One does not see professionalism in the conduct of the manager of Raleigh Lodge. Upon learning that Mrs. S is reluctant to leave the facility, they immediately ask her doctor and carer to withdraw care and effectively force her out. We are not told of any measures they took to understand the cause of Mrs. S’s reluctance to return home. Understandably, the manager may not be a trained doctor, in which case they should have consulted the patient’s doctor. Managerialism Managerialism emerged from the aforementioned attitude of the physician as the expert who knew it all (Heller , n.d.). In the 1980s, demand for better quality of care forced care providers forced health care providers to rethink their management processes. Consumer groups questioned the ability of health care providers to regulate themselves. Until then, it had been common for physicians to double as managers. While this trend while widely accepted in private practice, it did not augur well with the public sector. Consequently, many healthcare organizations embarked on restructuring their organizations and separating management from care provision. Many consumer groups welcomed the move. While management and care provision at Raleigh Lodge are separate, the arrangement does not seem to function properly. One gets the picture of an overriding manager who makes a decision and imposes them on physicians and patients without consulting either. This type of behaviour compromises the principles discussed in preceding chapters. For instance, it is unlikely the decision of the manager to force Mrs. S out of the facility is in her best interest. Little wonder the patients doctor and carer oppose the move. Accountability Processes Following the concerns of consumers, that self-regulation of the healthcare sector was compromising the quality of care, regulators felt hard-pressed to put in place accountability processes (Heller , n.d.). These processes stressed audit, inspection and the management of performance. Apparently, these interventions failed to capture an element that is crucial to the quality of care: the ability of the physician to question the decisions of the manager within the organization. The goals of the two are not always compatible; at times, they conflict. The manager is likely to be preoccupied with maximizing profits for the owners of the organization. Sometimes, promoting the interests of the patient, which ought to be the primary goal of the physician, may conflict with the goal of the manager. Though not explicitly, this scenario plays out in the case of Mrs. S. striking a balance between organizational goals and the interests of the patient can be a tall order. Conclusion Several changes have necessitated the need for physicians to take the matter of ethics in care provision more seriously (Hammersley, 2009). These changes include an increasingly well-informed public that is not afraid of suing the doctor for an action or inaction they deem injurious to them. The various principles that govern care provision are designed to ensure that the acts in the best interest of the patient. They also insure the doctor against the risk of litigation. However, not all the principles are readily compatible. Examples are the principles of beneficence and justice. Promoting the best interest of a patient may mean that other patients are denied the limited resources, resulting in injustice. Under these circumstances, the physician must work closely with their patients and their families in order to adhere to the principles to the greatest extent possible given the prevailing circumstances. Besides the principles, there are processes designed to foster ethics in care provision. These include professionalism, managerialism and accountability processes. Professionalism demands that the physician stops viewing oneself as the expert who knows it all and starts to see the patient as a resourceful person who must play an active role in care provision (Heller , n.d.). Managerialism suggests that care provision is more ethical where different people perform the functions of management and care provision. Accountability processes are tools of managerialism. From the above discussion, the separation of functions alone is inadequate. There must be adequate checks in place such that physicians can question the decisions of managers that they deem harmful to the patient. Otherwise, there is the risk of management making decisions that promote organizational goals at the expense of the interests of patients. The case Mrs. S calls for collaboration among the patient, her children, the lodge manager and the patient’s doctor and carer. By working together, they will reach a decision that best suits Mrs. S. the fact that while at Raleigh Lodge she cooperates with and accepts support from caregivers implies that the idea of her children to hire a carer for her is still viable. Fundamentally, she has no problem with carers. Possibly, she simply does not want them in her home. Also, the fact that the patient is reluctant to leave the lodge could imply that they enjoy the company of their fellow old people. If that is the case, the team may consider enrolling Mrs. M in a long-term facility for the aged. Throughout the process, the team should play a facilitative role while they supply the patient with all the facts they require to make the decision rather than try to impose decisions on her. Doing so will be consistent with the principle of autonomy(Walsh & Woodthorpe, n.d.). However, should Mrs. S be difficult, the team must not hesitate to apply "therapeutic privilege" – reach a decision they believe is the best for Mrs. S even if they do not approve of it. Such a decision must be a collective, not individual, one. At the same time, the team must be open to the possibility of Mrs. S remaining at Raleigh Lodge, provided her children can pay for her stay there. References Hammersley, M., 2009. Against the ethicists: on the evils of ethical regulation. International Journal of Social Research Methodology, 12(3), pp. 211-225. Heller , T., n.d. Managing risk. In: Book 4: Exploring critical practice. s.l.:s.n., pp. 71-89. Walsh, M. & Woodthorpe, K., n.d. Ethics in healthand social care. In: Book 4: Exploring critical practice. s.l.:s.n., pp. 29-49. Read More