Managing High Quality Healthcare - Research Paper Example

Introduction This paper presents researches and studies that focus on the legal right of patients to choose “bloodless medicine” in medical care andsurgeries. An analysis of the legal, ethical, and social issue involve in patient’s right to accept or refuse a recommended course of medical treatment is presented. As embodied in The Patient’s Bill of Rights, “the patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action [1]”. Therefore, a medical practitioner or healthcare facility cannot perform any medical care procedures or treatment plan that requires patient’s informed consent. It is the responsibility of the attending physician to inform the patient of the planned course of medical treatment and procedures for the patient to be guided in making a knowledge-based decision on what to accept or what to refuse. However, in medical cases where critical blood loss posed a serious threat to life, most practitioners generally recommend blood transfusion as the best medical treatment and as the only life saving measure. In times of emergencies where patient is unconscious and a life-saving decision is to be made, it is also the moral and ethical duty of the attending medical practitioner to protect and save the life of the patient. After much thought, a blood transfusion is given to the patient without consent, overriding the will or directive of the patient. Incidents like these, often led to conflicts and court cases between the patient and the attending physician. More than seven million people, known worldwide by their religious affiliation as Jehovah’s Witnesses refuse blood transfusion for religious reasons. Without prejudice to their religious stand, this group expects quality health care through “bloodless medicine”. This paper provides highlight on the following: 1. An overview of the Patient’s Bill of Rights in relation to medical ethics. 2. The reasons behind Jehovah’s Witnesses refusal to accept blood transfusion as a form of treatment. 3. The resulting conflicts between Jehovah’s Witness patients and attending practitioners related to blood transfusion without informed consent. 4. The birth of “bloodless medicine” as a standard of quality health care not only for a religious group but for all patients seeking blood transfusion alternatives. Statement of the Issue Does a patient have the right to refuse blood transfusion even if this is the only way to save life? On the other hand, is a medical practitioner duty bound to administer blood transfusion without the informed consent of the patient? If so, is this within the bounds of sound medical ethics? The “father of medicine”, Hippocrates, laid down the ethical conduct that should govern the practice of medicine. This is known today as the Hippocratic Oath whereby medical students pledged to practice medical ethics in dealing with patients by giving the patient the best medical treatment, by protecting the patient from harm when administering treatment, and by respecting the right of the patient to privacy [3]. In cognizance of the Hippocratic Oath, the American Medical Association in Code of Medical Ethics: Current Opinions with Annotations (Chicago: American Medical Association, 1996) emphasized the ethical behavior that should be observed by medical practitioners: “A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.” It is the ethical duty of a medical practitioner to give the best treatment that would result to the best quality of life and must also respect the patient’s decision to forego treatment. Medical ethics dictate that practitioners should respect patient’s decision to refuse blood transfusion. Such refusal cannot be equated as a waiver of quality healthcare services. And where the patient is unconscious, attending medical practitioners should honor an existing directive and coordinate with a designated health care proxy as mandated further in the Patient’s Bill of Rights: “In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfers to another hospital. The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy [1].” Impact on Quality Healthcare Delivery The following provisions of the Patient’s Bill of Rights mandated the responsibility of medical practitioners to deliver due medical care and to find ways to resolve request for appropriate medical care and services. “The patient has the right to considerate and respectful care. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case.” Quality health care management recognized patient’s right to autonomous healthcare decisions. However tensions in doctor-patient relationship can arise when patients and healthcare professionals disagree on recommended treatment plans or procedures. Everyone deserves quality healthcare without prejudice to race, religion, and nationality. Research Sources In 2005, authors Randy Henderson, Nicolas Jabbour, and Gary Zeger published a study entitled “Legal and Administrative Issues Related to Transfusion-Free Medicine and Surgery”. The article gives insights on the refusal of a group of people to accept blood transfusion for religious reasons and how their adamant refusal gave impetus to the evolution of bloodless medicine. Blood Transfusion and Jehovah’s Witnesses “Jehovah’s Witness” is a Christian religion with more than seven million five hundred thousand members in over two hundred lands (Watchtower Bible and Tract Society of Pennsylvania, 2011). The Witnesses’ belief in the sanctity of blood as the symbol of life and adhered to God’s direction as to the sacred use of blood. They obey the Bible’s command stated in Genesis 9:3-4 Leviticus 17:10 of the Old Testament, and Acts 15:28-29 of the New Testament. These passages are quoted in part below: “Every moving animal that is alive may serve as food for you. As in the case of green vegetation, I do give it all to you. Only flesh with its soul – its blood – you must not eat.”- Genesis 9:3-4 “As for any man of the house of Israel or some alien resident who is residing as an alien in their midst who eats any sort of blood, I shall certainly set my face against the soul that is eating the blood, and I shall indeed cut him off from among his people.”- Leviticus 17:10 “The holy spirit and we ourselves have favored adding no further burden to you, except these necessary things, to keep abstaining from . . . blood... ”- Acts 15:28-29 The Bible’s command “not to eat” and “to abstain from blood” is observed by Jehovah’s Witnesses literally and this applies also to blood transfusion. Although JW’s position on blood transfusion is absolute and non-compromising, they still have the right to receive quality medical care (Watchtower Bible and Tract Society of Pennsylvania, 1977). Blood transfusion is traditionally recommended to a patient when hemoglobin level fall below10 g/dl or when the hematocrit level fall below 30%. For their refusal to accept blood transfusion, some physicians and hospitals don’t accept JW patients (Jabbour et al, 2005). Foremost in the mind of physicians is their duty to save life by all medical means. Without patient’s informed consent, some physicians succeeded in administering blood transfusion to their JW patients by seeking court orders. Patients directive in the event that they are unconscious are being trespassed and transfusion, as a life saving measure, is administered without consent. This resulted to conflict between JW patients and their attending physicians. In some cases, JW patients ended up filing lawsuits against medical practitioners to protect and uphold their rights. The stand of Jehovah’s Witnesses prompted medical society to take this as an opportunity to improve medical care and to conduct scientific studies on transfusion alternatives. The Evolution of Bloodless Medicine In 1957, Dr. Denton Colley of the Texas Heart Institute together with his team of cardiovascular surgeons pioneered open-heart surgery without blood transfusion. Dr. Cooley’s team successfully performed 1250 cases of “bloodless” open-heart surgeries and found out that the risk in bloodless operation is “not substantially higher than the others”. Dr. Cooley’s achievement caught the attention of the editor-in-chief of the American Journal of Surgery. In 1995 he referred to Dr. Cooley’s transfusion alternatives and blood conservation techniques as medical care that should be available “to every operation and therefore meaningful to all 17,000 readers of the American Journal of Surgery”. Finally the authors recognized that the success of transfusion-free medicine and surgery program or “bloodless medicine” is also largely dependent on well-established policies and procedures that recognize patient’s rights, in collaboration with scientific and ethical medical practices spearheaded by Dr. Colley’s team. Relevant Instructional, Legal, Ethical, and Social Issues The common question raised in the medical community is how far should the physician go in ‘confirming’ the patient’s choice of non-blood management without it being viewed as ‘badgering’ or coercion and how to make sure that the decision to refuse blood and face all consequence is really a personal and informed decision of the patient (Jabbour et al, p. 21) An open and honest discussion should be conducted prior to medical treatment and before patient’s admission to established a better understanding and to foster ethical relations between the patient and the attending physician without prejudice to the patient’s bill of rights and with due respect to the efforts of the medical community. Analysis of the Research Article According Jabbour et al (2005), historically Jehovah’s Witnesses have been the largest users of bloodless and/or transfusion-free medicine and surgery. Many organizations now have respected the Jehovah’s Witnesses Biblical view on blood and the medical community has also recognized the benefits of using transfusion alternatives in surgeries and medical treatment of blood related medical cases. There is a growing trend on the demand for bloodless medicine as this protects from blood transfusion risks. “It is hoped that bloodless-medicine becomes the standard of care for any medical or surgical patient. One cannot deny that there are many modalities that have been heavily relied upon in the past, even as it relates to the use of blood, that are now considered archaic and unscientific. With ongoing progress in the area of oxygen-carrying products and synthetic clotting factors such as factor VIIA, the future looks brighter in providing a safe and effective alternative to blood transfusions”, Jabbour, et al (2005, p.22) Bloodless medicine through transfusion alternatives provided for quality health care needs not only for a religious group but also for a growing number of patients who prefer non-blood treatment. The publication of the facts and developments in the field of transfusion free medicine has caught the attention of patients who are averse to the risks associated with blood transfusion. Conclusion Life is sacred and every human being has the right to life preservation through the best medical care and treatment. However, the refusal of a recommended treatment does not mean denial of one’s right to preserve life and continue living. The Patient’s Bill of Rights and the Code of Medical Ethics provide a framework that fosters a better understanding and life-friendly relationship between the patient and the medical practitioner as well as the healthcare institution. Through the collaborative effort of the medical society and medical scientists, the dilemma of a religious group are being taken care of, giving impetus to the evolution of non-blood surgery and medical treatment. The right to life is upheld by respecting the patient’s bill of rights. The delivery of needed quality medical service for the protection and preservation of life was made possible by addressing the legal, ethical, and social issues involved in medical practice, and by taking positive actions toward better and safer medical solutions. It is seen that collaborative efforts between the medical practitioners and the cooperation of the patient and their caregivers, open and honest communication, respect for personal views and professional values, and the pursuit to deliver quality medical care preserved the life of those who are challenged by blood related problems. References 1. American Hospital Association, 1992.Patient Bill of Rights, Chicago, Illinois. Catalog No. 157759. Retrieved from http://www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm 2. Legal and Ethical Issues in Medical Practice, Including HIPAA, Chapter 3, pp. 37- 58. Retrieved from http://highered.mcgrawill.com/sites/dl/free/0073520837/588974/SampleChapter03.pdf 3. Watchtower Bible and Tract Society of Pennsylvania, 2011. 2011 Yearbook of Jehovah’s Witnesses, Pennsylvania, USA. 4. Nicolas Jabbour, Transfusion-Free Medicine and Surgery, Blackwell Publishing Ltd., 2005 ISBN: 9781405121590. Introduction by Randy Henderson, Nicolas Jabbour, and Gary Zeger, “Legal and Administrative Issues Related to Transfusion-Free Medicine and Surgery”, 2005 5. Watchtower Bible and Tract Society of Pennsylvania, 1977. Jehovah’s Witnesses and the Question of Blood, Pennsylvania, USA. . Read More