Six-Step Process of Ethical Decision Making in Arriving at a Caring Process - Research Paper Example

? Six-Step Process of Ethical Decision Making in Arriving at a Caring Process [Supervisor Six-Step Processof Ethical Decision Making in Arriving at a Caring Process: An Introduction The companies to deal with certain disagreements and uncertainties concerning opposing values perform ethical decision-making in the health care environment. The managers engaged with such decision-making process must take into account ethical values with full compliance to the professional and organizational standards and codes. There are lots of factors that impact the rising concerns in healthcare companies which relate to ethical matters that make the decision making quite complex. Healthcare managers have to deal with rising number of complex ethical predicaments in organizations. Independently they are unable to take ethical decisions in the absence of well-documented and communicated organizational decision-making outline. It is, therefore, important for the healthcare organizations to design, develop, and implement necessary policies, procedures and guidelines to help their staff in arriving at ethical decision-making in their routines. With these mechanisms and frameworks, the organizations are able to effective take sound ethical decisions regarding their companies. This report as such delves briefly into ethical decision making as carried out by various companies with special emphasis on 6-step ethical decision making process as outlined by Purtillo and Doherty (2009) in health care environment. Step 1: Gather Relevant Information The first step in ethical decision-making process is the explicit, relevant data of the ethical issues that generally occurs as a result of insufficient information or evidence, and disagreements concerning the facts. Hence, this step facilitates many disagreements and assists in initiating a successful procedure. It should start by inquiring about the ethical issue that has been in hand (Purtillo & Doherty, 2009). Medical Indications Issues: The patient’s health care problem, its diagnosis and prognosis. Its criticalness, continuance, emergency and reversibility. The objectives of treatment and intervention for patients’. The chances of success for the patients’ population. The plans in view of therapeutic collapse for the patients’ population. The advantages of the treatments and its optimization. The dangers of the treatments and interventions and ways of minimizing these risks (Purtillo & Doherty, 2009). Patient Preferences Issues: The patients’ preferences re-treatment and interventions. The patients’ evaluation of quality of life with and without treatments and interventions. The patient's approval whether voluntary or involuntary. Whether patients are children, have their abilities to accept been identified. Whether patients expressed their wishes in writing, verbally etc. Whether patients are reluctant or incapable to deal with treatments and interventions, if so, the reasons. Whether patients’ decision to choose being appreciated considering ethics and law (Purtillo & Doherty, 2009). Evidence issues: The standards of practice. The availability of type of data to inform decisions. The research outcomes and studies are available to notify decisions (Purtillo & Doherty, 2009). Contextual Features Issues: Families affecting decisions regarding the treatments and interventions. Religious and cultural factors. The existence of health providers and administrator prejudices that might impact decisions concerning quality of life. The involvement of clinical researches and teaching. The existence of relevant legislations. The existence of confidentiality matters and its limitations. The financial implications concerning the decision making. Whether organizational rules concerns the decision making. Whether there exists conflict of interest on the part of the health care providers or within institutions. The targets, goals, principles, and strategic directions of the healthcare companies (Purtillo & Doherty, 2009). Personal Issues: The personal emotions, approaches, values and inclinations concerning the matters. Impact on individual professionals’ role, their response to act professionally and difficulties to rectify. Dealing with expectations that do not correspond with professional role or are beyond the scope (Purtillo & Doherty, 2009). Conditions 1. Empowerment The Strategies should be to reduce power disparities and maximize the prospects for taking part be applied in the beginning and integrated all over the process. These strategies should manifest through the conditions of “empowerment” and, be conditional on the type of the environments that might comprise of communal participations, supporting conflicting outlooks and pluralistic views, democratic voting processes, secret voting, sufficient preparation time, and capacity building (Gibson et al., 2005). 2. Publicity The requirement of “publicity” should be noticeable at each step of the process. This requirement necessitates and maintains open ways of discussion between concerned parties and clearness regarding the procedure. Step 2: Identify the Type of Ethical Problem There are many types of considerations that should be taken into hand in the studies of ethical dilemmas in healthcare settings. Normally, some crucial rules and principles can be applied to study ethical issues in healthcare, namely, autonomy, beneficence, veracity, justice etc. Autonomy is defined as the right to self-rule, freedom, and autonomy. Autonomy in the healthcare care environment entails the therapists’ keenness to fulfill patients’ requirements to arrive at decisions regarding themselves, in case the providers do not agree with the patient’s decisions. The therapists would intervene only when they believed the people do not have enough data or capability to comprehend, or they are forced to do so. The therapists have no obligations and responsibilities to help people to perform inept decisions. Justice implies that the commitment to be impartial to each and everyone. All people, irrespective of race, gender, marital position, diagnoses, socio-economic position and religious beliefs have the right to be dealt justly. The concept of justice in health care settings at times implies equal accessibility of health care to everyone. However, as regards other rights, there could be restraints that could be imposed upon justice when justices encroaches the rights of others. Beneficence implies that health care providers should do well to patients in their care environment. Good care implies that the therapists should understand the patients from a holistic view that incorporates the patient’s beliefs, thoughts, and desires and those of the patients’ households etc. Moreover, beneficence is superior to technical capability. It entails performing in manners that show caring: listening, empathy, supporting, and fostering. Beneficence is the inspiration for caring environment; nevertheless, beneficence can be considered complex as it is complex to find out what precisely is good for a person and that person can make the decisions regarding what is good. Nonmaleficence implies the need for healthcare providers not to harm their patients. It is just opposite to beneficence and it is hard to define each term without mentioning the other. The key principle of nonmaleficence implies health professionals safeguard those people from harm who are unable to take care of themselves. This liability to take care of weak groups from society like children and the elderly, as noted in abuse laws. Veracity implies that health care professionals always tell the truth and should not in any way mislead or deceive patients. Veracity principle is founded on common trust and esteem for human values and dignity. True, without truthfulness, important relationships collapse. Similar to other entitlements and duties, there are limitations to this principle too (Purtillo & Doherty, 2009). Step 3: Use Ethics Theories or Approaches The two major decision-making methods employed in moral philosophy are teleology and deontology. Teleological resolves ethical dilemmas by weighing the excess of good over harms produced by each feasible option for action. The deontological view on the other hand, motivates on rights, responsibilities, and rules of justice (Purtillo & Doherty, 2009). Step 4: The Practical Alternatives The Practical alternatives involve brainstorming and deliberation on wide variety of practical alternatives procedures. However, it is proposed for any particular situation, there should be as a minimum three alternatives. Advantages and disadvantages of each alternative should be analyzed thoroughly. Alternatives complying relevant laws and rules should be understood. They must be in agreement with mission, vision, and principles of organization. The specified rules of decision-making should be applicable to each practical alternative (Purtillo & Doherty, 2009). Step 5: Complete the Action This step motivates on the guidelines. The best ethically validated alternatives outlined above are proposed for implementation. The decisions made through the processes are documented and suggested to concerned people. Following that implementation plans are proposed. Finally, procedures for assessing the decisions are established (Purtillo & Doherty, 2009). Step 6: Evaluate the Process & Outcome Finally, to fulfill all the conditions of enforcement, the decision making process should be evaluated to make sure that all conditions have effectively been met. This evaluation should be performed by concerned people engaged in the decision making process as to make the outcomes less biased (Purtillo & Doherty, 2009). Case Study: The Decision-Making Framework The following case study brings to light decision-making process that can be useful in establishment of ethical options. A healthcare professional was hired to diagnose a man who was 70 years old and living with his wife. He noticed that the patient experienced a myocardial infarction and required a complete diagnosis as well as a suitable program to help the patient return home. While evaluating the patient, he noticed that the patient had some visual problems too. The patient informed the healthcare professional that he drove with his wife to the grocery store each week. The healthcare professional advised the patient not to drive as it could lead to a great risk to his own safety or his wife and others. Step One: The Scenario The health professional got a referral to diagnose and treat a patient with myocardial infarction. The professional found visual problems of the patients whilst evaluating general health conditions. He also noticed that the patient was involved in driving activities which the professional believed was risky for the patients and others in view of his visual problems. The professional was worried the patient might get involved in some road accident if he goes ahead with this decision to drive. He was perplexed if he could be held answerable for he knew the patient should not drive. The ethical issue for the professional was whether or not he should apply the safety concerns. However, by defying the patient’s wishes to drive, the professional believed he had a duty for the safety of the patient as well as for other people on driving on the road. Step Two: The Principles Accountability The professional felt responsible for his actions and was determined to perform in the best interest of the patient. He also believed to comply with the norms of his profession, applying the information, competence and ethical decision expected of a professional healthcare counselor. The healthcare professional felt duty-bound to ensure the safety of the patient and other members of the society. Confidentiality: The professional should give fullest consideration to maintain the patient’s confidentiality. It was ethical misdemeanor to share personal data of the patient without his approval, which the patient had not approved in this situation. Informed Consent: The patient needed to be given satisfactory data to see what the professional healthcare was suggesting and the dangers and options of the plan. Step Three: The Relevant Resources In this case, The Highway Traffic Act can also be considered to have relevance. It was significant for the healthcare profession to act in light of the propositions this Act. The Act requires all professionals related to health care to provide information pertaining to the patient to include his/her name, address and medical condition to the Registrar of Motor Vehicles in order to form an opinion that the patient was at risk to him / her or others while driving motor vehicle. The legislation did not offer the professional with the legislative need to reveal the patient’s data without his approval. It only required from the healthcare professional to report the risks. As well, it was significant to establish if any privacy legislation is in place that can deal with the issue at hand. The privacy legislation supported the patient secrecy. Nevertheless, it also supported the need for patient approval releasing data other than in circumstances when there was fear of critical risk or harms. Consequently, the duty to warn involved a decision regarding the nature or degree of probable risks. If there were evident risks or harms, then the legislation necessitates revealing data. Step Four: Information or Clarification The healthcare professional generally compiles and explains data that helps to verify a finding. When the patient was informed after carrying out the assessment of the patient’s condition and symptoms it became important for requesting a diagnostic professional to further process. In such circumstances, the professional was expected to make the patient responsive of the finding and suggest necessary steps such as appointment of another health practitioner. Step Five: Identify the Options When the professional had satisfactory data, he considered various options to deal with the circumstances. Step Six: Choose the Best Option 1) The professional healthcare option was of significant importance for the secrecy and learned decision. Indeed, it helped the professional to respect the patient’s desires. He also respected the patient’s private information and data of his medical state. While taking no step, the healthcare professional would be better placed had there been no risk or harm and the duty to warn. That option might be satisfactory, had not the healthcare professional believed the visual testing outcomes were erratic. The negative side of that option was that the healthcare professional conducted additional testing of the visual problems of the patient who acted poorly. The professional was duty-bound to take the case of this patient to another therapist. 2) The professional might act by warning about the threats to the safety of the patient and others. Accordingly, if forewarned, the professional might be able to authenticate the medical issues that made it risky for the patient to drive the car. The professional should give information to the government or other agencies, with or without patient’s approval. By forewarning the professional might also act within the approval granted to discuss with another member of the healthcare professional or the government agencies. The professional also could convey concern to family members of the patient; nevertheless the patient would not support it, as he would consider it as a breach of his confidentiality. The professional should have to give valid reasons to act against the patient’s wishes and his duty to warn others. This option followed by the professional can be seen as the intermediary act of warning others. Rather than notifying others of his apprehensions regarding patient’s driving, he might decide to make a proposal for further evaluation of the patient’s vision. This would help the patient and would provide him the opportunity to act independently of the proposal. This step might also help to discuss the issue in detail, if the patient continued driving, the professional and others would have time and evidence to prove their cases. Moral Issues in Decision Making in Healthcare Environment: An Analysis The medical professionals generally are confronted with various problems in decision that causes moral dilemmas. Aiken and Catalano (2009) are of the view there should be rules and regulations that hold commands over people, health and safety and welfares and relationships and behavior and the interactions with society. The mainstream medical staff necessitates the best procedures, and the decisions should be made which are morally right and correct. The ethical decisions are influenced by medical practitioners’ beliefs, values, life experience, professional experience and skill (Johnstone, 2006). Nevertheless, it is claimed that in such circumstances a methodical approach, skill and focus should be given to all the issues to realize the optimum solution. In accordance with Little (2001), the problem with ethical decision-making is that there is no general accord on matters being ethical or non-ethical. Beauchamp and Childress (2001) were of the view that validation of ethical decision-making should be endorsed by strong ethical reasoning. There are various moral theories that assess the moral values of actions and help the medical professionals to deal with ethical predicaments (Melia, 2004). The contemporary ethical theories to tackle ethical issues are deontological which states that, irrespective of the consequences, duty is the foundation of all ethical steps (Johnstone, 2008). In contrast, teleology states that, the consequences should be the only source for assessing ethical steps (Rumbold, 2005). The principle of autonomy gives stress to the patient's capability to arrive at independent decisions, while that of beneficence states that, medical practitioners should work for the benefits of their patients (Thompson et al., 2005). Burnard and Chapman (2005) are of the view that assessment of ethical decisions is only possible with moral theoretical bases. Conclusions The ethical decision-making process in the healthcare settings is quite complex and necessitates pros and cons of different ethical viewpoints. It necessitates a framework to assess situations to arrive at conscious decision. The Six-Step Process of Ethical Decision Making process outlined above offers medical professionals to make conscious decisions with accountability and principled practices. References Aiken T. D., & Catalano, J. T. (2009). Legal and ethical issues in health occupations. 2nd Ed. Missouri: Saunders Elsevier. Beauchamp, T., & Childress, J. (2001). Principles of biomedical ethics. 5th Ed. New York: Oxford University Press. Burnard, P., & Chapman, C. (2005). Professional and ethical issues in nursing. 3rd Ed. London: Bailliere Tindall. Johnston, M. G. (2008). Ethics in nursing practice: A guide to ethical decision making. Oxford: Blackwell Publishers. Gibson, R. B., Hassan, S. et al. (2005). Sustainability assessment - criteria and processes. London. UK, Earthscan. Johnstone, M. J. (2006). Bioethics: A nursing perspective. 4thEd. Marrickville NSW: Elsevier Australia. Little, M. (2001). On knowing particularism and moral theory. Hastings Center Report, 31(4), pp. 32-4012. Melia, K.M. (2004). Health care ethics: Lessons from intensive care. London: Sage Publications. Purtillo, R. B., & Doherty, R. F. (2009). Ethical dimensions in health professions (5th Ed.). Rumbold, G. (2005). Ethics in nursing practice. 3rd Ed. London: BailliereTindall. Thompson, I. E. Melia, K. M., & Boyd, K. M. (2005). Nursing ethics. 4th Ed. London: Churchill Livingstone. Read More