Applied Ethics and Law in Healthcare

Applied Ethics and Law in Healthcare

Case

The clinical team has assessed that it is time to withdraw life support and let nature take its course, yet the dying patient’s family insists that the hospital “do everything possible” to keep the patient alive. You have been asked your advice as to whether the team can discontinue active treatment and maintain the comfort of the patient while nature takes its course.

Medical practitioners operate in a very delicate and sensitive sector: dealing with the lives of other people. However, despite the sensitivity of the pharmaceutical industry, physicians are often faced with the case of an ethical dilemma that makes their work even challenging. The condition described in the case above is an example of ethical dilemma.  the care providers consider withholding treatment to allow the patient to die and escape suffering; on the other hand, the family members to the patient are hoping that the physicians can do anything within their precious to keep their kin alive. Withholding or withdrawal of life-sustaining treatment is a challenging activity in the healthcare sector for care providers as well as patients and their families (Kirk, Gomory,  & Cohen (2013). Based on a moral perspective, it is imperative that care providers need to try all possible alternatives that can help sustain the life of a patient, even if the condition of the patient continue to worsen. However, contrary to this, most physicians feel that the safest route is to withhold or withdraw life-sustaining. This is  especially in circumstances where the care providers feel that there is little hope of effectuating a beneficial outcome to the patient (Emerson, & Jayawardhana, 2015; Office of the Legislative Auditor. (2015). In light of the case vignette above, the following paper presents a three-staged ethical analysis of the case. First, the necessary conditions that must be met by all medical treatments before they can be administered are discussed. Second, the tenets of ethical decision-making in light of the Markula Centre Framework are explained. Finally, the clinical decision given the case is discussed.

The two necessary conditions for medical treatment

For any medication to be administered to a patient, they must meet two requirements needed for a healthcare professional to be permitted to proceed and apply the prescribed treatment. First, the prescribed medication must be medically indicated. In other words, the care provider must conclude that in light of the diagnostic results and the prognosis, a particular treatment has potential beneficial outcomes to the patient and shall not, in any way, cause or lead to disproportionate harm on the patient (Welie, & Have, 2015). Secondly, the patient, or for minor patients or those who are incomptent, the proxy decision-maker must be given detailed information about the diagnosis of the conditions and the subsequent findings, the course of treatment (prognosis) chosen for the disease and any would-be side effects associated with the selected mode of therapy (Weisse, 2016). The patient or any person acting as a rightful representative of the patient must then make a consent to the information. Though, in cases of emergency where an incompetent patient is rushed to an emergency room with a life-threatening condition, the approval may be presumed to be implied by the decision to take the patient for the medication (Kadivar et al. 2017). However, it is imperative to note that the patient is treated under the presumed consent in the understanding that the treatment will lead to beneficence and that the presumed permission supersedes the need to explain the method of medication to be administered.

In case one or both of the necessary conditions for medical treatment is (are) not met, a healthcare provider has no moral authority to prove the proposed medication. Therefore, as per the case, the decision by the clinic team to withdraw the life-support treatment from the patient to allow him die against the wishes of the family members, who in this case are the proxy decision-makers who have the authority to make a consent on behalf the patient, qualifies the decision of the clinic team to be an act of negligence. If the patient dies because they have divided to withdraw the life-support treatment, then the family members will have all the rights to file a legal suit for damages based on negligence of duty. Furthermore, since the opinion of the clinician’s conflict with the views of the family members, the decision cannot be taken since the necessary conditions for treatment have not yet been met (Yuen, Reid & Fetters 2017). Therefore, the clinicians have to ethically; according to the principle of beneficence, do anything within their disposal to help the patient recuperate (Holt et al. 2017; (Pooley & Felmlee, 2017)).

Markkula Centre Framework for Ethical Decision Making

Ethics refers to generally accepted behavior that demonstrates the degree of humane a person based on the actions and decisions that they make in light of the quagmire they are engulfed into. The ethical standards are thus professional yardsticks that are used to assess the extent of morality or immorality of actions taken by employees in the course of discharging their duties (American Association of Critical Care Nurses 2015). The ethical standards are derived from five different sources with different concerns. The pragmatic approach, for instance, asserts that all human actions should cause no harm to either party involved in a struggle. Under this lens, ethical decision-making should, therefore, be centered on good corporate work that ensures that both parties feel a sense of satisfaction with the decision made. The other approach is the Rights approach. Under this school of thought, and ethical act/decision is one that shows reverence and allegiance to the moral rights of others. It is enshrined on the dignity of humanity and thus abhors any act that belittles the fundamental rights of others. In light of the rights approach to ethical decision making, the actions taken should obey all the fundamental rights of an individual as enshrined in the Bill of Rights, including the right to make personal choices (Minority and Community Health 2018). Moreover, it also puts on the shoulders of decision-makers the onus to respect and obey the rights and opportunities of others.

The other source of ethical standards is the fairness/justice approach.  Under this school of thought, there is a need for fair and equal treatment for all. In other words, it states that all similar people should be subjected to same means of treatment. Under this lens, human beings are expected to treat others in a way that they would appreciate when treated by others.  Under the common right approach, ethical action should be virtuous. It must be in line with the ideals of virtues that are upheld by society and supported by professional ethos in the context of the work environment (Morrison, & Furlong, 2016; Gerst-Emerson, & Jayawardhana, 2015).

Additionally, the universal right approach stresses the need to take care of the welfare of others as a way of championing for a just society in which everyone is happy and satisfied with the system. Lastly, the virtue approach stresses the need to realign all actions to virtues that are approved by society as morally correct. According to the virtue approach, any decision or action that falls below the standards of moral values of an organization are considered to be unethical. It advocates for honesty, transparency, fidelity integrity, among others (Nair, & Peate 2015).

When faced with an ethical dilemma, then the sources of ethical standards form the basis upon which analysis of the case(s) is done. Sobriety is imperative and highly critical for making a moral decision. As provided by the Markkula center framework for ethical decision making, one must recognize the ethical issue in question. This recognition should bring into perspective two things: the effect of the decision proposed on either party or the impact of the subject beyond the corridors of justice. In light of the vignette case, the decision by the clinicians to withhold life-support treatment would cause agony and pain to the family members, thus making it a wrong choice (Pfeifer Quill &  Periyakoil 2016).

Further, the decision to take the life of an individual is a serious offense that can call for treason. It is not only unlawful but also immoral and inconsistent with any moral, societal view. Another critical element in the framework that supports ethical decision making is getting the facts right. For instance, in the case, there is a need to understand the condition of the patient and the reasons why the clinicians would feel that his health cannot be recuperated. Further, there is a need to develop an understanding of the views of both parties (the clinicians and the family members). This would help the hospital manager to have a fair look of the matter with the opinions of both parties on the table. Once the views of both parties are understood, then the management can weigh options to come up with a more fair deal that would satisfy both parties.

Clinical decision making

Under the Constitution, all human beings have the right to life, which cannot be shortened by anybody. The bill of rights and the Universal Declaration of Human Rights declared that all human beings have specific fundamental freedoms that cannot be curtailed. Supported by the various sources of ethical standards, the decision by the clinicians to withhold the life-support treatment to a patient who is in dire need for health is against the moral principle of beneficence and, therefore, unjustified. The law demands that care providers should do all that is within their disposal to help a patient improve.

Further, the act would also breach the duty of care that the patients expect from the care providers. By failing to obey the opinion of the family members who are the de facto, the guardians would be tantamount to breaching the principle of autonomy (Stewart & Brown, 2015). Besides, the trepidations associated with the withdrawal of medication are far too many as compared to continuing to offer alternative support services (Gedge, Giacomini & Cook  2016). Therefore, from an ethical point of view, continued provision of care is more justified over the proposal to withhold the treatment.

Pfeifer, M, Quill T. E, Periyakoil V. J (2016). “Physicians provide high-intensity end-of-life care for patients, but “no-code” for themselves.” Medical Ethics     Advisor. 30 (10)

Pooley, R. A., & Felmlee, J. A.  (2017). Mr. Safety: Requirements and Practical Aspects.                           Oxford University Press