The Ethical Dilemma: Making the Moral Decision - Essay Example

The Ethical Dilemma: Making the Moral Decision "Never let your sense of morals get in the way of doing what's right". IsaacAsimov Isaac Asimov's uncomplicated quotation illustrates the complexity that we are presented with when we are confronted by an ethical decision. An ethical dilemma can put everything we believe in and value on trial as a test of its worth, and a testimony to our worthiness. What was previously right may suddenly become wrong and what was immoral yesterday may suddenly be the only virtuous decision available. Ethical decisions will often be the most important decisions that a health care worker will make, as they can hold a great risk and can have far reaching implications. Ethical decisions may present themselves that can run the risk of ruining a career or creating a poor patient outcome. These decisions must be made carefully and thoughtfully, and with introspection and deliberation. Making the ethical decision is a process of self-reflection and personal integrity. This paper will define an ethical dilemma and explore the decision making process used to arrive at a decision where all the options have significant consequences. As a health care worker, friends occasionally confront me that need medical care and require a prescription drug. They will occasionally request that I write the prescription without seeing the patient, which is in violation of common medical ethics and sound medical practice. They may additionally ask me to write the prescription for a third party that has insurance in an effort to eliminate the cost of the drug. In addition to violating medical ethics, this also has the legal liability of being against the law. Adding to the ethical dilemma is the reality that they often do not have the money for their expensive medications, and using someone else's insurance may be the only option they have to acquire them. I am also familiar with their case and know the patients, and they perceive the demand to see them in the office as simply 'medical over-kill'. These factors impact my decision making process, as I am empathetic to their financial needs and sympathize with their feelings regarding the office visit. I need to make a decision that will consider my friends and our relationship, their physical and emotional health, as well as my career and personal integrity. There are myriad sides to this dilemma and numerous aspects that need to be evaluated. I need to weigh the importance, and definition, of our friendship and how that might be impacted by my refusal to comply with their requests. I also need to examine the fact that I might be able to significantly help these people by doing a minimum amount of harm. The professional ethical guidelines that I uphold have a high value to me, and violating them reduces my own sense of self-worth. In addition, I could risk losing my license, my practice, my career, and my livelihood. I need to be sure that these risks are real, and not simply defense mechanisms that I am using to deny my friends' requests. These are the factors that need to be weighed into a reasonable and balanced decision that I can live with. The decision making process begins by defining the dilemma and ends with taking action. The process also includes consulting professional guidelines, considering all the options that are available, consulting colleagues, and evaluating the potential outcome of each alternative (Koocher & Keith-Spiegel, 2008, pp. 22-23). Every decision we make has consequences and when making a decision we need to be able to accept and endure the cost of that decision. I believe in the theory of virtue in regards to ethics and believe that our actions should adhere to the principle that "what is ethical is what develops moral virtues in ourselves and our communities" (Velasquez, Andre, Shanks, Meyer & Meyer, 2008). Unlike the utilitarian, I don't compare the potential good against the possible harm and see which outweighs the other. I simply must see if my actions develop my sense of moral virtue. I need to be able to personally justify my decision based on my own integrity. In regards to the insurance fraud, I simply could not violate the law in this situation. The fact that it is illegal has moral relevancy and "if laws are made through a reasonable democratic process they have moral force" (Hope, 2004, p. 66). I would violate the law only if I could justify the action, and was willing to accept the consequences. However, the moral transgression in this case is far too grave to be rationalized by my sense of personal morality. In considering potential insurance fraud, I don't have to consider the consequences of the action, because as a medical professional the action is outside my own sense of morality. My decision making process does not move beyond the outright rejection of that action. If this strains my relationship with my friends, then that is a justified conflict. That is a consequence and another dilemma that I must confront. Writing a prescription for a patient that cannot come to the office is a more difficult decision to make. In this case, I am simply facilitating my friend to bypass the office visit requirement. Once again, I am not evaluating the potential harm; I am only concerned with the virtue of writing the prescription. If I know the patient and am familiar with the case, I would merely be doing (outside the system) the identical act that would take place in the office. In essence, I would be taking a different means to accomplish the same end. Kant argues that "the end is always more important than the means", but this does not eliminate the importance of the means (Brown, 2007, p. 73). Ethics is the understanding of the right and wrong in an action that goes beyond the mere compliance of a rule (Brown, 2007, p. 72). The major caveat is that it is against the rules and ethical guidelines. The rule exists to protect patients from being treated by practitioners who never see them or assess their illness. I agree with the rule, and understand the reason for its existence. Even if I don't feel that the rule is perfectly applicable to my situation, I still have a moral respect for it. The decision would be easier if the rule were unjust, or if the patient needed medication in their last dying days and was not otherwise able to obtain it. However, the office visit rule and ethical guideline is a mere inconvenience for my friend and me. Aristotle's theory of virtue contends that rules, "prohibit certain types of action absolutely and such actions are among those which a virtuous man would do or refrain from doing" (MacIntyre, 1984, p. 150). Although my ethics are grounded in virtuous principles, I don't follow rules for the sake of the rules. The rule must be just and have a purpose. In this case it is, and I could not justify writing the prescription without seeing the patient in the office. The inconvenience of the means does not eliminate the morality of the rule. If the rule were to elevate its status to become an obstacle to treatment, I would consider violating it to reach a beneficial end. However, in this case I would look for alternative actions, such as offering my friend a ride or locating a pro-bono doctor. I found that making an ethical decision concerning a dilemma was made easier by first defining what was important to me. This does not mean that I only considered my own self-interest, but rather that I developed a set of priorities for my values. Adhering to professionalism, and ethical guidelines, is more important to me than complying with what I view as a friend's unreasonable request. While this might be seen as blindly following the rules, it is a good starting point to begin the decision making process. The questions then become; Will my action elevate my status as a moral human being Is the course I have chosen the most virtuous one available Are the risks real or imagined During the process, you can choose all the available options and evaluate the potential outcomes. Selecting the option to commit insurance fraud had a very real risk of being uncovered and exposed. Once again, an important part of the decision making process is seeking alternatives. Could the patient get the drug cheaper or have it provided by some program. Researching that avenue is a far better decision than turning in a false insurance claim. Furthermore, at every node in the process I had given myself a number of alternatives. Some decisions are not covered by guidelines and have no good answer. An ethical decision may require us to violate the law, or compromise a patient's treatment. However, you do not have to make a bad decision as long as you have unexplored options, and creativity is a critical component of my decision making process. In conclusion, understanding your own values, and working towards an option that reflects them, simplifies the ethical decision making process. The first part of the process requires that we define the dilemma and fully understand the implications of the problem. While I adhere to the principles of virtue, that must be kept within the context of the dilemma. In the examples presented, I was able to adhere to the professional guidelines, offer alternatives, and satisfy myself that I had treated my friends fairly and justly. In any case, the process is made easier with creative thought that generates more unique alternatives to consider. Ethics are significantly context sensitive and it is a process of deciding what we will do in a specific situation. Ethical dilemmas often present us with a number of bad choices, and we are left to choose among the lesser of the evils. While it is sometimes noted that there is no 'right' or 'wrong' answer, ethics always contains a moral component and some decisions have greater virtue than others. Confronting an ethical dilemma merely a matter of taking an action that we can morally justify to our own sense of personal integrity. References Asimov, I. (2007). Institute for global ethics. Brown, M. (2007). The quest for moral foundations. Washington, DC: Georgetown University Press. Hope, R. (2004). Medical ethics: A very short introduction. Oxford, New York: Oxford University Press. Koocher, G., & Keith-Spiegel, P. (2008). Ethics in psychology and the mental health professions. Oxford, New York: Oxford University Press. MacIntyre, A. (1984). After virtue: A study in moral theory. Notre Dame, IN: University of Notre Dame Press. Velasquez, M., Andre, C., Shanks, T., Meyer, S., & Meyer, M. (2008). Ethical decision making. Approaching Ethics. Retrieved May 27, 2009, from Markkula Center for Applied Ethics/Santa Clara University: http://www.scu.edu/ethics/practicing/decision/approach.html. Read More