Analysis of an Ethical Dilemma in Health Care Ethics - Essay Example

25 August [Research Paper Ethics have long been a source for discussion and debate among philosophers, sociologists, and civilians. Everyone seems to know what ethics are, but few can adequately define the term “ethics.” This is due to the multitude of sources that ethics can be derived from, including religious beliefs, societal norms, upbringing and background, and personal experiences. Some businesses and organisations have begun to develop their own codes of ethical behaviour as well. Some of these codes are steadfast regulations—setting the stage for ethical behaviour that must be followed. Other organisations have chosen to implement a set of guidelines—used to help individual employees make a choice when faced with an ethical dilemma. The health care industry is one such organisation that tries to balance individual thought and critical thinking decision-making skills with ethical guidelines set forth via laws, regulations, and company policies. Every person, regardless of his or her chosen career or lifestyle, will eventually be forced to make a decision in an ethical dilemma. This dilemma may be as simple as whether or not to tell a friend that he or she may be getting laid off from work or as difficult as deciding whether or not a person has the sense and capability of making a decision on his or her own regarding healthcare and treatment. Doctors often face scenarios such as these often. Generally, doctors can turn to laws and legal documentation regarding how to proceed with a course of action. For example, if a woman were to go to a hospital with an extreme case of preeclampsia: do the doctors work to save her life and the life of her child, or do they respect the patient’s wishes to be left alone. In this particular scenario, several people are involved in the decision-making process; and several others hold stakes in the results of the decision once made. First, the mother has already been informed that without a caesarean, she will die. Additionally, without allowing the doctors to perform the caesarean, the mother has been informed that her baby will also die. The third group of stakeholders in this scenario is the doctors treating Mrs. M. The Doctors face the difficult decision of forcing Mrs. M to endure a terrifying and difficult procedure, or allowing Mrs. M to make a choice that may kill both herself and her baby. Preeclampsia, sometimes called toxaemia, affects nearly five percent of all pregnancies throughout the world (Cleveland Clinic 2007); this disorder is “one of the leading causes of premature births and the difficulties that can accompany them” (Cleveland Clinic 2007, 2). This is because when a woman acquires preeclampsia her uterus becomes deprived of oxygen due to the low amounts of blood able to flow there. Some doctors believe that this spike in blood pressure is caused by poor nutrition; however to date there has been no specific cause defined. The only known cure for preeclampsia to date is to birth the baby. However, since many cases of preeclampsia become apparent merely half-way through a pregnancy, this may not always prove to be the best or most viable option (Cleveland Clinic 2007). If too early in the pregnancy, some doctors can monitor the baby’s health and attempt to let the baby stay in the womb for a longer period of time to develop more fully before being delivered. However, in this particular scenario, allowing the baby to remain inside the mother’s womb was not an option. The preeclampsia had already placed both the baby and the soon-to-be mother in danger of losing their lives. Allowing the child to remain inside the mother would surely kill both mother and child. A caesarean section is a procedure in which doctors can deliver the mother’s baby “through an incision made on [her] pregnant belly” (BellyBelly 2007, 1). Essentially, rather than allow the baby to finish developing in the womb and be birthed vaginally, doctors believed that the best way to ensure safe delivery would be to cut open the mother’s stomach and deliver the baby early. However, caesareans are not without their own risks (BBC News 2007). Some risks include tearing the womb; this risk could place the baby and the mother both in serious harm without alleviating the first brought on by the preeclampsia. Ethically, the doctors must warn Mrs. M of these risks when explaining all procedures and alternatives. This explanation is part of the process of obtaining informed consent from the patient (Edwards 1999). Obtaining informed consent entails that the patient is made fully aware of every alternative available to him or her, the risks and benefits of each alternative, and the consequences of not choosing a specific alternative (Edwards 1999). In many cases, the patients’ only information regarding his or her condition and possible methods of treatment is through contact with the doctors. There are times when informed consent is impossible to attain. For example, a patient may enter the hospital in an emergency and be unconscious or otherwise incapacitated. Additionally, the patient may be mentally unfit to make such decisions due to impaired judgment or mental disability. In such cases, doctors are to turn to a surrogate decision-maker, such as a spouse or relative, to obtain consent (Edwards 1999). According to the scenario, Mrs. M appears to be of sound mind: meaning that despite her refusal to undergo the surgery, Mrs. M seems fully capable of understanding the consequences of her actions and appears alert and respondent to questions. Additionally, Mrs. M refuses to discuss her reasoning behind the refusal of a caesarean section with the doctors. Presumably, in their attempts to gain informed consent, they explained the possible risks to Mrs. M; therefore it may be possible that Mrs. M has decided that the risks involved with the caesarean do not outweigh the benefits of such a procedure. Or, there could be an underlying, irrational fear based on bias or prejudice of the caesarean procedures. The scenario’s description does not go enough into depth regarding exactly how much Mrs. M knows or understands about the caesarean section surgery or about how much of her knowledge was obtained from the doctors versus being obtained through movies, stories, or television shows. If the doctors do suspect that Mrs. M is incapable of making such a difficult decision on her own there are a number of ways they can test this theory and obtain permission to perform the surgery. They may call down a psychiatrist or other mental health specialist to try to evaluate Mrs. M’s mental status. The scenario description does not specify whether or not such an expert has been called to see and evaluate Mrs. M. Additionally, if the doctors chose to evaluate Mrs. M as being unfit to make such a decision herself, they would then need to find an appropriate surrogate decision-maker to give consent for the surgery. Unfortunately, such a surrogate may not be readily available. However, there is no mention of a spouse or other relative available for this scenario who can speak on behalf of Mrs. M. To complicate matters further with this scenario, Mrs. M does not appear to be making the decision solely for herself. She is pregnant. Another source of heated debates and discussions is derived from the question of whether or not the doctors should be working for the well-being of the unborn child or of the mother who has paid for their services (Macklin 1995). Some believe that the unborn child should be granted all the rights and safeties given to the mother. However, others believe that until a child is born, that child is a part of the mother’s body and, therefore, the mother has the right to make decisions regarding the well-being of that body. Unborn children do not have the capabilities of speaking for themselves. Therefore, other people must make decisions regarding their health and well-being without the advantage of being able to find out whether or not these decisions are wanted. In this particular scenario, Mrs. M appears to understand that there is a slight chance her baby would survive the premature birth via caesarean section. However, she also understands that if the baby does survive such obstacles, her baby will undoubtedly be severely impaired. Her own personal values are dictating that allowing the child to stay inside the womb as long as possible to finish developing is the best possible option available to her now; if the child is able to stay and develop inside the womb longer, he or she will have a much better chance of surviving without prolonged impairments. Understandably, Mrs. M is doing what she feels is best for her baby. In contrast to this decision, the doctors believe with certainty that Mrs. M’s preeclampsia is severe enough that the baby will not survive inside the womb any longer. Additionally, they believe that by allowing the baby to remain inside the womb, both Mrs. M and the baby will die; whereas if they were allowed to perform the caesarean section, they have a much stronger possibility of saving the lives of both the mother and the baby. Clearly, the doctors are working to serve the interests of everyone involved. At some point, the doctors will have to make a choice. Once they do make their decision, they will have to abide by that decision and face any consequences. As described in the scenario, neither decision appears to be an easy or correct alternative. However, if the doctors choose to force Mrs. M to have the surgery, they may be facing larger consequences. Forcibly performing surgery on a woman can be considered assault. Regardless of the outcome of the surgery, Mrs. M may feel as though she were forced into submission and, as such, lost her right to make such a decision. In addition to this, the doctors cannot impose their own viewpoints onto their patients (Macklin 1995). In this scenario, the doctors do not like the choice that Mrs. M appears to have made. However, they cannot force her to change her mind; and they must respect that this decision is hers to make. Forcing her to make a certain decision will also undermine the entire purpose of attaining informed consent (Kushner and Thomasma 2001). In addition to ensuring that the patient has all necessary information and resources needed to making such a difficult decision, informed consent serves the purpose of developing a trust between the patient and his or her doctor. In this scenario, if the doctors were to forcibly perform surgery on Mrs. M to deliver her baby via caesarean section without her consent, they would undoubtedly lose not only Mrs. M’s trust but also the trust of several other patients and potential patients. Other doctors, nurses, physicians, and healthcare professionals may also begin to lose their trust in the doctors’ decision-making skills when regarding an ethical dilemma (Kushner and Thomasma 2001). However, as stated previously, many patients do not understand the risks and benefits of various procedures. Therefore, it is understandable when doctors begin questioning whether or not the patient can truly make such a decision for his or her self. This type of scenario is not uncommon; many doctors find themselves struggling with the idea of informed consent and a patient’s right to make a bad decision: I feel that the process of informed consent is not always in the patients best interests…once I inform of the risks of the procedure, they then refuse. Even when I subsequently inform them that the risks of not doing the procedure is far greater, they persist in their refusal. Thus the process of informed consent has caused the patient to act in a manner deleterious to their health. Many patients cannot understand the concept of risk/benefit ratios. I understand that we wish to avoid medical paternalism and promote patient independence…but medical decision making is not the same as a consumer pulling products off a store shelf. Part of what the patient is paying for is our professional judgment…Should medicine and society agree that in certain situations a procedure is so clearly needed that the physician may choose not to inform the patient of the complication rate? For example, an otherwise healthy 60 year old with a normal LV [heart function] who has a 90% [narrowing] left main [coronary artery] (10% mortality/year) who needs CABG [coronary artery bypass graft] (2% mortality at one point in time). Could we skip telling him he may die from the procedure and simply recommend he have it? (Bernstein 2004, 1). Clearly, this example demonstrates that patients do not always have a full or deep understanding about the medical procedures offered to them or the risks and benefits involved therein. However, responses to this question were overwhelmingly in favour of maintaining informed consent as a necessary and required procedure (Bernstein 2004). Opinions came from doctors, specialist, and patients alike; regardless if the patient makes a decision that the doctor would agree with or may prove to be deleterious to the patient’s health that decision is ultimately the patient’s to make. The medical field is not like other professions. For example, when a person’s car is not working, he or she will take that car to a mechanic; the mechanic will tell that person what the car needs to be fixed and be able to run again and how much everything will cost. Most people will accept this advice and think little on the matter before paying the mechanic to fix the car. If the car dies again or the mechanic makes a mistake while trying to fix the car, the person will then ask for his or her money back. However, in the medical field, if a doctor makes a mistake, people are not always given the chance to simply ask for their money back. Perhaps this is one reason why so many patients appear to refuse a doctor’s help after turning to the doctor for medical advice. Nonetheless, many people will tend to make choices that appear irrational to doctors (Bernstein 2004) and yet these same choices make complete and total sense to the patients. Whether or not a doctor fully understands the reasoning of a patient’s choice should hold no bearing on that doctor’s integrity, however. Additionally, by forcing their opinion of what they believe should be done onto Mrs. M, these doctors will be abusing the power they hold. “The professionals is in a privileged position and there is a profound power differential between the patient and the doctor. Although current politically correct thinking dictates that the doctor and patient are partners in diagnosis and treatment, in reality the patient is very dependent and vulnerable” (Priory Lodge Education Ltd. 1994-2006, 1). Essentially, although most people would seem to agree that patients and doctors work together to make healthcare decisions, the patients are not always equal in their status when compared to the doctor. Many patients are heavily dependent on their doctors and healthcare professionals; this places doctors in a position of power which, if abused, can lead to several potential problems. Finally, the medical field is not always an exact science. While many people hold immense trust in medical professionals, doctors are human beings. As human beings, they are fallible and prone to mistakes and errors in judgement just as any other human being (Kushner and Thomasma 2001). Although schooling and medical training is extensive, and publications are never ending, there is no way to completely alleviate the possibility of human error in any medical diagnosis or prognosis. Therefore, since no doctor can completely guarantee that he or she will never make a mistake during a procedure or regarding a patient’s diagnosis, the patient must remain involved in his or her medical decision-making. Ethical dilemmas are not known for their ease in solving. Generally, they are complicated issues with potentially severe consequences and a multitude of uneasy answers. In this scenario, Mrs. M has presented such an ethical dilemma to the doctors at her hospital when she appeared for treatment and they diagnosed her with a severe and life-threatening case of preeclampsia. Assuming that no mistakes in the diagnosis have been made, the doctors may find it heart wrenching or irresponsible to be forced to watch both Mrs. M and her unborn child die because of her decision to refuse the caesarean section; however, ethically they must abide by the patient’s decision and respect her wishes. To do otherwise could potentially cause many more problems in their future as well as for the future of their patient and the patient’s baby. The doctor’s, however, do have more than just the two choices presented. They can attempt to have Mrs. M declared mentally incompetent by interviewing family members or having a mental health specialist visit and evaluate her capacity to make this decision. They can also call in other experts, such as social care workers, to come and speak with Mrs. M. Finally, they may attempt to track a previous patient who had to face similar circumstances and ask that patient to speak with Mrs. M about her experience with a caesarean section. These latter two options could potentially pair Mrs. M with a person with whom she can relate and possibly change her mind about the procedure. Additionally, they may review the methods with which they have explained the procedures and the risks to Mrs. M. The scenario does not reveal whether or not Mrs. M truly understood the medical jargon or how the risks were detailed in those explanations. In sum, the doctors in this scenario must respect the wishes of Mrs. M. Although she turned to them for advice, her right is to turn down or ignore that advice if she feels that the information is undesirable. Bibliography BBC News. Caesarean raises womb-tear risk. October 2, 2007. http://news.bbc.co.uk/1/hi/health/7024312.stm (accessed December 22, 2007). BellyBelly. Caesarean Sections - What Actually Happens? 2007. http://www.bellybelly.com.au/articles/birth/caesarean-sections-what-actually-happens (accessed December 16, 2007). Bernstein, Maurice. INFORMED CONSENT. July 19, 2004. http://www-hsc.usc.edu/~mbernste/ethics.informed_consent.html (accessed December 11, 2007). Cleveland Clinic. WebMD: Pregnancy- Preeclampsia and Eclampsia. 2007. http://www.medicinenet.com/pregnancy_preeclampsia_and_eclampsia/article.htm (accessed December 11, 2007). Edwards, Kelly A. Ethics in Medicine: Informed Consent. February 22, 1999. http://depts.washington.edu/bioethx/topics/consent.html (accessed December 22, 2007). Kushner, Thomasine K., and David C. Thomasma. Ward Ethics: Dilemmas for Medical Students and Doctors in Training. Cambridge: Cambridge University Press, 2001. Macklin, R. "Ethics, informed consent, and Assisted Reproduction." Journal of assisted reproduction and genetics 12, no. 8 (September 1995): 484-490. Priory Lodge Education Ltd. Medical Ethics. 1994-2006. http://www.priory.com/ethics.htm#Relationships (accessed December 19, 2007). Read More