Establishing Healthcare Ethics Parameters - Essay Example

1 In the world of medical practice and health care, there are many more practical issues than ordinarily meet the eye. The provision of care facilities involves issues pertaining to the context of legal, ethical and professional domain, that are integral to the well-being of both the patient and the health care provider. This paper shall endeavor to dwell upon certain areas of influence in the same realm, and help establish certain working parameters for professionals. Centuries ago, while the science of medical care was in its technical evolution stage, the prime area of reference was only the provision of health care. However, in today's world, where the scientific world has come of age in its standing vis--vis disease care and prevention, subsidiary issues have emerged that are considered to be of prime importance in the realm of health care. The changes in society and life all around the world have brought about considerable changes in the lifestyles of people. Similarly, the profession of health care has seen its development through the ages, and many additional factors like ethical, legal and professional concerns need to be understood better. The learning outcomes associated with this course are crucially linked to the integral understand of clinical issues and practice. This paper in turn shall go a long way in reestablishing the norms that were to be established by the goals for this course. Understand the domain of every prong individually is of vital importance: As was mentioned earlier, knowledge of legal issues to the cause of clinical practice has now become imperative. Though universal laws for humanitarianism and morality remain constant for humans, yet there are certain legal implications that are different for certain countries and even states within countries. It must be understood by a practitioner, that the legal clauses are not a matter of burden, but actually a facilitating and binding factor that ensures that the provision of health care would be unequivocal and just for all. The current face of health care is largely a product of the advancement made during and after the World Wars. However, despite the magnitude and quality of work that was done at that time, the obvious constraint due to the war was that a systematic procedure for providing health care cannot be established. Much has changed since then, and the corporate face of the organizations in the changing world has brought about a new shape to the domain of clinical practice. With the inception of concepts like quality and the ISO standards, what the world of today has realized, is that documentation, for any system of work, is not only essential, but is a must. Though the importance and significance of the three major issues has been established, yet appropriate working with these concerns in minds is still easier said than done. For a new practitioner, it is extremely important to properly identify with the issues. The ethical and legal concerns are very similar to the medical ones in their dynamics. For one, the first thing that needs to be done with a disease is appropriate identification with respect to the symptoms. Only a sound knowledge of the traits of a disease and its patterns can help identity for the practitioner as to what is to be done with it. Similarly, with legal and ethical concerns, the first step is to identify any anomaly in the normal proceedings that are likely to produce a problematic response. This is probably the most important element of the assignment, which helps the participant in preparation for the future challenges. This is one factor alone that differentiates the follower from the leader. The fact of the matter is, that many people in all professions tend to believe what is taught and practiced in front of them. They do not have the ability, urge and background to question - which is the most important feature in the development of science. Henceforth, the most credible feature of this assignment is that it would help in the preparation of analytical insight of the healthcare providers. It is increasingly important for healthcare professionals to develop their knowledge in health care ethics and law, which are pertinent to their area of clinical practice and the delivery of patient care. This is because the science is medical care has become ever more complex, and in the contemporary world, it not only pertains to the provision of medicines to the needy, but also an all-encompassing care provided in terms of ethical, legal and professional concerns. The understanding of ethical and legal issues helps one to balance and assess the validity of ethical and legal arguments in relation to particular cases. This assignment will present a case study which provides with succinct descriptions and analysis of a range legal, professional, and ethical issues pertaining to the case. The High Court of has adopted standard of care applied to medical professionals, that requires for every registered nurse to have a particular level of skill, knowledge and expertise (Forrester & Griffiths 2005). The patient who can establish he suffered harm as a result of a nurse's failure to meet an appropriate standard of care may bring a negligence claim against the nurse as well as the care facility (Tracey et al, 2005). "Quality of care encompasses the adequacy of the total care that patients receive from health care professionals" (Robert & Simon, 2005, p. 1). This entails that the total health care involves much more than just medicines; ethical and management concerns are vital to his wellbeing. Steven's review article (2005) indicates that nursing actions include knowing the system, verifying drug orders before administration, confirming the patient's identity, independently double-checking calculations, questioning inappropriate orders or dosages, listening and following up on patient concerns, and having thorough familiarity with medication administration devices. Earlier, the focus was primarily on the medical and treatment side of the issues, but now, I have a greater appreciation for the ethical, legal and professional concerns that are integral to the care of every patient. The change in practice will not be of procedures or methods, but of attitude. A greater feeling of responsibility and self-accountability would en sure efficient management and enhanced quality of work. It is clear that where the importance of the academic knowledge in this holy profession cannot be undermined, the most important point is the correct appreciation of a holistic picture, wherein the general well-being of the patient is under consideration, and not just the medical one. Inter-disciplinary and multi-faceted studies in studies always tend to generate a greater sense of insight in an individual. In the profession of medical health care, it is all the more important to consider such facts in the consideration for the benefit of the patient. It is clear that where the importance of the academic knowledge in this holy profession cannot be undermined, the most important point is the correct appreciation of a holistic picture, wherein the general well-being of the patient is under consideration, and not just the medical one. Inter-disciplinary and multi-faceted studies in studies always tend to generate a greater sense of insight in an individual. In the profession of medical health care, it is all the more important to consider such facts in the consideration for the benefit of the patient. 2 Ethical science has always found it difficult to decide, about the extent of the information being provided to the patient. Essentially, if one would put oneself in he shoes of the patient, then one would like to receive every bit of information that is related to the medical condition. However, when one looks at the issue from the perspective of the clinician, then the need can be appreciated of withholding some information from the client, for the latter's benefit. Where does the line of morality and ethics come here, and from where the jurisdiction of science starts, is the focus of this essay. Essentially, telling the truth is considered as a moral obligation in almost all cultures and theologies around the world. It is taken as a compulsory act of beneficence, without which the integrity of the health-care provider is lost, and essentially the entire process of health care suffers an emotional blow. The act of kindness is hence lost, and there surfaces an immense feeling of betrayal and anguish on part of the patient. Conversely, the other side presents an equally convincing argument. For one, many patients around the world do not have the technical expertise to understand and analyze the information provided to them. To add, a patient goes through several ups and downs during the treatment process. Given the circumstances, it is believed that it may well be necessary to withhold some information at times from the patient. Though this may jeopardize the act of beneficence, but it is deemed necessary. After all, the true beneficence lies in the cure of the patient, and if this cannot be actualized at the end of the day, then the health-care process would have drastically failed. "Physicians frequently ignore their patients' wishes when they consider the appropriateness of truth telling. A complete shift from nondisclosure to mandatory disclosure without considering patients' preferences may lead to serious harm to patients who do not want to be told the truth" (Asai, 1995). When one has to lie to a patient, the argument is given that the lie itself is for the benefit of the patient. The fact is perhaps true when viewed objectively. The health care provider possibly knows best when and what is necessary for the patient. It is also, purported that by telling the truth, one would be able to present a scenario that is non-malicious. Lies and withholding of truth have integrally been taken as sinful over the years spanning human civilization. So it would go without saying, that if somebody is telling the truth to the patients, then an act of good is being conducted. "The purpose of truth telling is not simply to enable patients to make informed choices about health care and other aspects of their lives but also to inform them about their situation. Truth telling fosters trust in the medical profession and rests on the respect owed to patients as persons" (Glass, et al, 1997). It is also felt generally, that when people are not told their due share, then their respect is being jeopardized. Regard for a human being requires, that of there is any information that is directly concerned to him/her, than it should be immediately passed on, so that they can be mentally prepared for the same. However, the other school of thought believes that providing all the information would actually be disrespectful for the patient. More so in the case of children, they cannot be entrusted with the information related to them. They simply have not developed the cognitive functions that would allow them to handle the pressures of the information given to them. It is thus believed, that the actual regard would be actualized when the patient finds his cure. Subsequently, if the nurse feels that there is something that the patient would be well off without knowing, then they should not disclose that information. "The best time to discuss life-altering and life-threatening disease is when patients can remember the conversation, understand its significance, and participate in health care decisions" (Chodosh, 2000). The ethical grounds may seem to be coming under contention here, but even still, the stance for the cure of the patient is paramount in the health care profession. For that, ends may well justify means. If somebody is not telling things, then it can well be imagined, they do not trust the mental and emotional abilities of the patient. This in effect is an insult to the person, who is not being allowed to be a party to the issues pertaining to his own life. "The wish to protect dependent relatives conflicted with the wish to be open, makes decisions very difficult. Considerable suffering is caused by poor communication, and much of this is avoidable" (Stedeford, 1981). Subsequently, they may not really be able to handle the intensity of the facts, and may even be misdirected by certain details. Their lack of appreciation of reality may in turn lead them to deal with the situation in an undesirable manner which maybe detrimental to the health-care process. It is also believed that "physicians have a legal obligation to disclose to patients specific information, the scope of which is determined by a court on the basis of a reasonable patient's expectation and the circumstances of the case" (Chafe, 1991). Many of them are regulation changes, which the nurse would understand but the patient would not. The client would therefore unnecessarily feel depressed, while the professional may have an entirely different stance about the situation at hand. Handling information is not something that comes naturally to every patient the patient may take the facts as an adverse reality, and may act in retaliation as well. In the cause of health-care provision, a nurse or a physician may well withhold some information which they consider would be important for the client not to know. "Patients studied want their physicians to be highly professional and expert clinicians and show humaneness and support, but their first priority is for the physician to respect their autonomy" (Rudin, et al, 2004). "Not to speak of the diagnosis may simply alarm the patient, who in many cases will already have some idea of what their symptoms indicate. It leaves patients open to discovering their diagnosis in inappropriate ways or to seeking further information from dubious sources" (Clafferty, 2000). This would be the right thing to do in the eyes of many, as withholding any information would then give the right to the practitioners to withhold anything they please. This would then result into a general feeling of mistrust and lack of belief within the patients at large, because then they would not be able to trust the health-care providers with their lives. "While physicians cannot control all the stated reasons for patients' seeking legal redress, they are able to influence the quality of their relationships with patients. And, as already noted, the foundation for a good patient-physician relationship is communication" (Huntington, 2003). The patient can often be stricken with panic and enter a frantic state. Worse still they can enter the zone of depression, which would be another psycho-somatic condition associated with their primary condition; a gamble that is not worth the take. There are certain familial considerations that are very important for certain communities, Bower believes that "if we see errors being made that might threaten relatives' and friends' wellbeing, how can we be expected to stay silent When I am in my more frequent and more comfortable role as the doctor I always invite my patients to involve their family, medically or otherwise, as fully as they wish" (2000). It can thus be considered important to empower the family of the people, as well as the patients themselves, so that they can get a better understanding of the issues. O'Rourke shares that "the difference is that I now tell patients there is a risk that their potentially curable lung cancer may progress and become incurable while they are on our waiting list. The patients know that I am angry on their behalf, but that is little consolation to either them or me when I have added to their already considerable distress and anxiety by telling them the truth about the waiting list" (2001). Holding onto some specifics would leave some room for the patient, who would have some hope and aspirations to cling onto, especially in palliative care. Often, it may be advisable that in times of challenges, one should look for a third adversary, and start to take the side of the patient. Though this might sound cowardly, yet it generates a feeling of trust within the patient, who then has the opportunity to realize what is most important for the cause of the treatment itself. Deciding what is best for somebody is again a very relative concern. Paternalism therefore further injects issues for nurses and the like, which yet remain to be answered. A patient may be yearning for some information, but the health-care provider may be feeling that it is not the appropriate time to do the needful. "Most difficult is how to tell a child that a parent might die. Little specific work exists to guide clinicians, but Kane has elucidated the developmental stages that children go through in their understanding of the meaning and permanence of death" (Kroll, 1998). Additionally, this can generate self-esteem and ego issues as well for the patient, who may not be expecting the facts as they come to him, this may further make the treatment process complex and intricate, thereby complicating the scenario for the patient. 3 The issue with ethics and medicine is a very interesting one - you have to get wet to take a bath! The patient is probably the most susceptible and vulnerable of the beings created. Physically on the defensive, he has come to the physician to seek for treatment for his ailing health. It's not about a car, which he can buy again, or a job that he can change, or a meal that he can choose; this is health, his life. No compromises on this one. So it's not surprising that health-care professionals are called as saviors. But do all patients get their lives saved in the manner they desire The importance of ancillary health services, including paramedics, nurses, physiotherapists, nutritionists and psychologists cannot be overemphasized in the least. Not long ago, it was even a sin to touch the human body; especially the opposite gender. It was just speculation as to what system exists within the human self. Then was the other extreme of the spectrum wherein excruciating methodologies (which were painful and often fatal) were employed to extract the secrets of physiology. But in contemporary times, medical care is fortunately much more intensified and complex. So much so, that it has to be admitted beyond an iota of doubt the doctor alone cannot sustain the treatment proceedings. It is only with the help of these fellow professionals that the saintly task of curing the ill can be performed. However, being in a multifaceted environment has its own challenging dynamics for the patient. Examples elucidating such experiences shall be narrated hereunder, but with the obvious ethical concern of maintaining the identity of the patient confidential. This again, is one of the issues that comes in the post-rehabilitation phase of effective patient care, that information concerning his/her treatment should not be made public without prior consent. While a health-care provider is offering a service, he should be wary of the ethnic, religious and gender concerns of the patient. Because ultimately, the former has to realize that his final goal is to provide patient care. And if he does not care for the patient, then, in affect, patient care has suffered. Perspectives shall always be different in ethics. The cause of the patient care, however, shall be eternally consistent. Interestingly, in a prolonged treatment module, one can appreciate that the patient ultimately spends less time with the doctor, and more time with the ancillary health-care professionals. Henceforth, it becomes all the more essential for them to realize and identify with the needs of the patient. A very comprehensive yet lucid representation of guidelines for nursing practitioners (NMC code of professional conduct, 2004, p. 3) states precisely guidelines on the same lines: "A registered nurse in caring for patients and clients must: respect the patient or client as an individual, obtain consent before you give any treatment or care, protect confidential information, co-operate with others in the team" This clearly goes on to show the emphasis that is laid upon the teaching and training of nurses from the grass-root level. Worth noting are also the factors of 'confidentiality' and 'co-operating with others in the team'. Though a nurse may be professionally quite capable, but unless the feelings of the patient are appropriately empathized with, provisioning of effective health care may be seriously hampered. Not surprisingly, congruent to this is the stance of physiotherapists. In an equally respected brochure by the 'Chartered Society of Physiotherapists', it is stated: "Physiotherapists agree common goals with the patient, multi-disciplinary team and wider care-givers and family" (Core Standards of Physiotherapy Practice, 2005, p. 33). Mutual co-operation for the one cause of humanitarian patient care is henceforth visible from such representations of the manifestos of the health care bodies. All services have to go hand-in-hand in order to provide for the best sustenance of the patient. And this will only be accomplished if the perspective of the patient is fully understood. As mentioned earlier, with due regards to the confidentiality of the patient, the source of this case study shall not be disclosed. As an instance, lets consider the case of a patient who was a 60 year old ailing woman, who had prior history of complaints in the spine. An unfortunate slip at her door step had resulted in a traumatic fall, which actualized a disk slip at the lower spine accompanied by severe impairment of hip movement. Admitted at once in the intensive care, she survived two surgeries and was sent to the orthopedic ward for weeks of surveillance. Here the challenge began, of the ancillary health services. The doctors had appropriately predetermined a course of treatment, with respective medicines, and only time would give them their feedback. But who was to sustain the wrath and agony of the patient during all this time The easy answer went in search of the nurses and the physiotherapists. Irritable by consequence of age and disease, managing her was by no means an easy task. The nurses had to ensure that she took her medicines and injections at time, and that she was washed up adequately. The physiotherapists, on the other hand, had to make sure that the little movement in the hips could be sustained and built upon in these weeks, so that a progressive road to recovery could be sought. The first two weeks were the most difficult ones. The consultant physiotherapist was on a conference abroad, and the make-shift arrangement was a fresh graduate. Though pure in his intentions, yet he was reasonably raw in his approach. He preferred a separate time with the lady, and used to give her stern instructions about how and how not to move. When the nurse on duty used to come, she of course had no idea of his instructions and used to move the lady in appropriate convenience for usage of the bed pan. This resulted in increased turmoil for the patient, and a silent rift between the two health care parties erupted. However, things changed for the good once the consultant returned. She at once took heed to the matter, and convened a meeting with the head-nurse of the ward. A modus operandi was chalked out, and it was decided that all physiotherapy sessions were to be attended by the nurse on duty. It was further agreed that any significant movement of the patient in other hours would be reported to the physiotherapist immediately. After only the third week, significant progress was witnessed, as the moans of the old lady gradually silenced. She was now much more comfortable with her positioning, and was more receptive to the oral and physical treatment. The confidence level between the patient and the health care providers took a steep rise, and the lady actually started looking forward to the sessions as she thought everybody was there to take care of her. There can be no two opinions about the fact that health care is the basic right of every individual. However, with the ever changing dynamics of the health care facilities, and with the increasing specialty of the health care providers, every day owns up to a new challenge for the patient. What has to be remembered that the patient is the same old human being that has been there over the centuries, and the basics of care and support have never changed over time. All the patient seeks is affection and solace; both of which can be easily provided if all professions unite in the cause towards providing the patient their dire right. It's the bare minimum that should be done and it requires no considerable effort; an inter-professional approach is the only humanistic and professional recipe for effective patient care. References Alfano GJ, Hall LE. The Loeb center for nursing and rehabilitation: a professional approach to nursing practice. Nurs Clin North Am. 1969;4:487-493. Asai, A. 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R 2005, 'Legal Issues in Patient Safety: The Example of Nosocomial Infection', Healthcare Quarterly Special Issue, October, pp 140-145 Read More