Professional, Ethical, and Legal Issues in Healthcare - Essay Example

? Professional, Ethical and Legal Issues in Healthcare The crisis of malpractice litigation affects all healthcare professionals. Providers are sued for professional negligence, breach of contract, injury as a result of use of defective products or intentional omissions and acts. As such, healthcare professionals should abide by ethical and legal regulations governing this field of profession to avert such occurrences. This profession requires a stringent oversight because it concerns the lives of people and the vulnerability involved while caring for these people. In this paper, the various theories and principles that govern the daily practice of health care professionals, particularly in nursing will be discussed. From the case of a family whose father had been limited by age to undertake his normal duties while the mother had become sickly, a discussion would be built to determine the conflict in the ethical principles. A nurse who is a friend to the mother of the family suffering from cancer finds herself in a difficult situation in trying to be loyal to the mother, to the two sons in the family and to her profession. Having been a good mother, she chooses not to disclose her medical condition to her sons so as to avoid negatively affecting them psychologically. The ethical dilemma that the nurse finds herself in by not disclosing this information will be put in focus. Introduction There are principles that form the foundation of the ethical codes guiding the professional practice in healthcare. These are the foundations of moral theory in healthcare profession with code of ethics that call for honesty, integrity and responsibility. As such, these ethical codes that have been developed for healthcare professionals provide guidance in their practice. These would normally be created in response to anticipated or actual ethical conflicts (Schweitzer 2010). They are usually difficult to comprehend and only make sense when applied in real life in cases of ethical ambiguity. The contents in these codes vary with the risk involved in a specific profession. For example, in psychology, the code of ethics would define in greater depth the relationship with the client due to the high degree of personal relationship a psychologist would have with the client. On the other hand, there would be minimal interaction between a laboratory technician and a patient; hence the relevant code of ethics would be more on the need for accuracy and reliability in their tests. White defines bioethics as the application of the general principles of ethics in healthcare (2005). Indeed, all the areas in health care, including staff utilization, clients’ direct care and finance allocation are bound by ethics. Ethics would raise a question but would not provide an easy answer. Among the reasons that make ethics important in the modern world include advancement in technology, changing society and more knowledgeable clients. There are three main groups in healthcare affected by ethics, namely; the providers, patient and family. They would normally have different perspectives on how they would like issues handled. This becomes more complicated when bioethics, physician theories and societal stake are considered (Warren 2011). Just like other practitioners in healthcare, nurses uphold each principle in their routine practice. However, there are times when these principles conflict calling for the nurses’ ethical decision making in choosing which of the principles becomes priority to be upheld at that moment. In such cases of ethical dilemma, there is no ‘right’ solution. Fant defines ethical dilemma as a problem that does not have a satisfactory resolution (2012). Thus, different ethical choices on an ethical dilemma could be made, but this does not justify any choice as being ‘wrong’ or ‘right.’ The definition of ethics varies from one nurse to another and would normally be shaped by experience, values and beliefs of an individual nurse. The code of ethics with respect to the American Nurses’ Association does not explicitly describe what is meant by privacy but states that “the nurse safeguards the client's right to privacy by judiciously protecting information of a confidential nature” (Ludwick & Silva 2005). Although legal considerations may affect disclosure of such information, the major concern should be the patient’s privacy and what conflict would result with the disclosure of such information. In this case, the nurse would thus be struggling between the anticipated benefits when such information is shared with the concerned parties and the conflicting ethical issues. Case: When I started working as a nurse, my mentor in the health centre gave me a story of her experience that demonstrated some of the ethical dilemmas I was to expect in the course of my career. Jane told me of a family that lived in Virginia. While the mother in this family was a choreographer, the father was a weekend entertainer. He had been an international star in his youthful days but had limited his engagements due to old age. Being Greek with his English spoken with thick accent, he could only secure work as an entertainer, with majority of his friends being Greek. The mother had been diagnosed with rectal cancer about one and a half years ago. Her gynecologist had missed to diagnose this despite her feeling lymphadenopathy and a mass. But after discovery, this was treated, initially with radiation therapy then later chemotherapy. She got well. After about a year or so, she started complaining of back pains. She was diagnosed with spinal metastases with lymphatic involvement. Three months later, she had spinal fracture resulting from the metastases. On hospitalization, she was found with a liver tumor. The two sons in this family loved music. The elder one was more likeable because of his gentleness and would rarely disagree. The mother lost employment because of her condition but the couple remained in denial. The sons knew that their mother had cancer back and she was going back to hospital for chemotherapy and surgery. She tried hard to fulfill her matriarchal roles but her sons’ grades in school kept deteriorating. She never wanted to tell them of her condition and hated that the community around had discovered her condition and hated it even more that they had pity for her. She only revealed her condition to her close friends including a teacher and a nurse. Despite her decision not to tell her sons of her condition, the teacher and the nurse decided to tell the boys of their mother’s prognosis. In fact, they both contacted a counselor to liaise with the counselors in the boys’ school with the hope of providing the necessary support to the boys at the time of their mother’s life and even after. Dilemma The dilemma in this story is whether the nurse had the right to do what she did without telling the parents of the boys. After recovery from the spinal surgery, chemotherapy and adjusting to narcotics, the pain the mother had disappeared. She would therefore socialize with her boys while taking narcotics to control pain. The family thus returned to normalcy. The mother would even drive and the nurse saw this and was also aware of the mother’s impaired decision but kept all these to herself. At that point, family happiness was more important. The question that lingers is whether the boys had the right to know this or that the decision of their mother superseded their rights. Should the boys come first now that they were children and should they be the first consideration? Discussion Ethical theories in nursing are useful in providing a structured approach to reasoning morally. To better understand the ethical issues involved, a nurse should explore various ways of moral reasoning employed when making judgments on the moral value of a course of action. Ethical and moral principles and practices have to be observed by nurses if they are to provide their patients with adequate services. The nurse in this case found herself in a difficult situation with conflicting responsibility to the mother as a patient and friend and to her sons. According to Rainbow (2002), the ethical principle of beneficence should have guided the nurse into doing what is good. This principle makes it clear the obligation to make decisions to benefit others. The researcher further argues that ‘doing good’ makes the practice ethical and could make the solution adopted in a dilemma acceptable. The nurse had the powers to choose what would be ‘good’ depending on the theory that would best support her action. Various ethical theories suggest different meanings to ‘good.’ Woods-Bennett (2005) describes deontological theory as that based on obligation or duty. Also referred to as duty-based theory, it has to give self evidence of duties or obligations which have intrinsic value either of or in themselves and would not need any further justification. Moral actions would normally be evaluated based on their rightness or wrongness as opposed to their goodness or their consequences. This is based on the idea that some principles must be upheld in relating to humans. The action taken would be judged as morally right or wrong based on individual duties, rights and obligations relevant in a particular situation (Beagan & Ells 2007). A nurse is therefore morally and legally obliged to act in the patient’s best interest even when the action does not favor the physician, employer or any other healthcare provider (Ludwick & Silva 2005). Perhaps, the principle of fidelity serves to further the intention of deontology. Fidelity encompasses acting in ways that depict loyalty (Bennett-Woods 2005). This encompasses acting as is expected, being trustworthy and performing the expected duties. This is an obvious guess to ethical dilemma as healthcare professionals would be at odds between their belief and what the patient, family or organization policy would expect from them. On the other hand, the theory of utilitarianism also referred to as teleology measures the moral goodness or badness of an action based on its effect or outcome (Jessri & Fatemitabar 2007). Therefore, an action that would result to most good to the majority of people would be considered as morally correct or good. In addition to these two theories, nurses employ a new theory in their practice referred to as ‘caring’ or relational ethical theories which bring a new perspective to moral reasoning. Here, actions would not be judged based on their consequences or obligation. Instead, the caring and responsibility perspective would be used to determine what is morally correct. This means, morally good acts are those that involve showing care and concern for other people, considering what would be of importance to them. The principle of respect for autonomy states that one’s actions are a result of own deliberation and choice (Woods-Bennett 2005). This basically implies that people should be allowed to reign over themselves and make own decisions applicable to their lives. The reason behind this is that an individual completely understands the type of lifestyle they have chosen. In this case, the mother deserved the right to have her wishes respected and not have her sons told of her prognosis until the time when her death would be eminent. Having been a good mother, she deserved the respect, but the nurse was torn between being a friend and a professional. But it was obvious that the boys could discern what was happening going by their ages. As time passed by, the mother looked pregnant due to her liver enlarging and she spent most of her time in bed. The conflict was now in either respecting the rights of the dying or the rights of the ones to be left behind. The nurse pushed the mother to disclose her condition to the boys as they could be negatively affected if this was to be postponed. At some point, the nurse thought of telling the boys of their mother’s condition without telling them of the eminent death. But the principle of autonomy argues that each person deserves respect, as they have the exact life experiences to understand their emotions, motivations and body more intimately (White 2005). In essence, this furthers the principle of beneficence as an independent person would prefer to control own life experiences so as to tap into the most enjoyable lifestyle. Furthermore, autonomy could be viewed from two perspectives. The first viewpoint would be pertanalistic where the authority would prioritize a dependent’s best interest over wishes. For example, the nurse in this case could convince the mother perhaps and the father of the boys to tell their sons of what awaits their mother to save them future undesirable outcomes. Here, the nurse uses her authority in manipulating the patient to tell her sons of her condition for their good. As noted, the drawback in this principle would be in the petranalistic figure not sharing in the same ideals as the dependent one. This denies the patient autonomy leading to decreased beneficence (Purtillo 2005). The second way to view respect for autonomy is referred to as libertarian view. Unlike the former, here, the patient’s wishes would be prioritized over their interests. If this was to be applied in this case, then the mother has full control over her own life and should be satisfied with it as she has the power to choose the path of life which would provide the greatest personal beneficence. Though this could be considered as a more mindful viewpoint, it does not mitigate against the patient making decisions that could be more harmful than beneficial (Munson 2004). This explains why the mother of the boys was allowed to make more harmful decision of not telling her boys of her condition. Non-maleficence obliges one to cause no harm to others (White 2005). Such harm could be spiritual, social, financial, psychological or physiological and would be determined by the beholder (Beauchamp & Childress 2001). Rainbow (2002) describes the principle of least harm as that dealing with situations where neither choices to be made prove beneficial. This principle allows one to do least harm possible and to the fewest people possible. The nurse and the teacher could have be in breach of this principle when they asked a counselor to talk to the boys’ counselor in school and talk to them about their mother’s medical condition. In as much as they were seeking ‘good’ for the boys in line with beneficence, they could possibly cause psychological harm to the mother and the boys alike. But viewing it from non- maleficence perspective, the nurse could have considered causing harm to the fewest people, probably the mother alone and save the harm on the majority others, the two sons. In seeking to observe the principle of non- maleficence, the nurse found herself in breach of yet another principle, veracity. According to White (2005), “veracity means truthfulness (neither lying nor deceiving others).” The nurse knew about the mother’s impaired condition but still left her to drive and take the boys out for fun. She was not honest enough to stop the mother from driving and to explain to the boys what their mother was going through. Researchers point out to many forms of deception including intentional lying, non-disclosure of information and partial disclosure of information (Jessri & Fatemitabar 2007). Bennett-Woods (2005) also adds that use of jargon or a language that does not convey information in an understandable manner amounts to veracity. It has been found out of practice that veracity is not easy to achieve because in as much as telling the truth could be easy, the decision on how much truth to tell is often hard (Munson 2004; Purtillo 2005). The nurse was in breach of veracity because of not disclosing to the boys their mother’s deteriorating medical condition. Perhaps, exceptions to truth-telling could be upheld by non- maleficence when the truth could do greater harm than good. Far from the principles is virtue-based ethics which focuses on moral action as a result of character. Since human character is shaped by natural inclinations, education, culture and a myriad of other factors, their virtues are bound to be different. A moral act should promote the good and be with the intent of doing ‘good.’ This therefore goes beyond the duty and obligation to act in a particular way to a display of proper motive as well (Johnston & Smith 2006). The nurse could therefore disclose the relevant information to the boys and still be protected by virtue-based ethics as acting with the intention of ‘doing good.’ Even as healthcare practitioners struggle to observe these principles and theories governing ethics in their professions, cost remains a significant factor. According to Strite and Stuart, the biggest issues facing health care institutions in the United States are “the rising cost of health and maintaining or improving the quality of the care they deliver” (2005, p.50). Nurses are expected to be cost effective just like any other worker in an organization. Porter, with an objective of defining a competitive healthcare institution, appreciated the value of the delivered healthcare as being core in healthcare (2011). This value would be measured by the outcome in patient’s health per the amount of money spent. The professor further argues that the only goal that would unite the interest of all participants in the system is value. In line with this argument, the nurse was to consider the cost of having to contain the psychological effect that the news of their mother’s condition would have on the boys. This would be compared to how this would change if this was kept in secret until she died. The family could perhaps have to pay for the boys’ post-trauma counseling after the delivery of the news which could even be offered free at school. Alternatively, keeping the information a secret could turn out to be more expensive as the boys would have to undergo longer counseling sessions bearing in mind that they would have double tragedy of not only the news of their mother’s death but also the cause of the death. It would be of paramount important for the nurse to take note of the family’s poor economic status and therefore aim at providing the best possible outcome at the least cost. Hence, the goal here should be better health and not more treatment. Logically, poor health is inherently more expensive than better health. Conclusion Understanding the process of moral reasoning is important to nurses and other healthcare practitioners as it enables them understand the various possible view points. This would include either when the morally right action is not immediately apparent when encountered by ethical issues or when there is conflict among members of a healthcare team or family members on the most appropriate action to take. No matter the action taken, there can never be any conclusive judgment that the right decision has been made in case of an ethical dilemma. It is therefore the duty of the healthcare provider to determine which ethical principles take priority and expedite them. Indeed, the guiding principle should be seeking most ‘good’ for the majority. 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