The ethical principles at risk

The ethical principles at risk

Case

Mr. M is a 72-year-old man who has been under home health after suffering a debilitating stroke that affected his right side. Mr. M was particularly put under home care after he ran out of his Medicare allowable days at a nursing facility. He needed significant assistance to carry out his daily activities and was mostly bound to the wheelchair as he was unable to walk. Mr. M lives with his daughter Stacy who is not quite financially stable and has two children. Mr. M had been responding quite well to the rehabilitation progress during the home health service. Recently, one of Mr. M’s children was involved in an accident. He decided to be travelling to the hospital to see his son every day as he believed that he might not make it from the horrible crash. Recently, Mr. M has been showing symptoms of depression occasioned by his son’s accident. He has also been showing signs of fatigue. Notably, Mr. M has missed several of his appointments with the home health providers.

The ethical principles at risk

As a requirement, Medicare requires that a patient receiving home health should meet specific homebound criteria. The homebound status is such that one may have a normal inability to leave their home and that leaving home would require a considerable effort (Musich et al., 2015). However, in the event that the individual leaves their home they infrequently, they may still be considered homebound. In this case, it evident that Mr. M was homebound based on the physical limitations brought by the stroke. However, upon his son’s accident, he breached the aspect of the infrequent and short durations. Therefore, the ethical confusion, in this case, arose from the inability of the requisites of Medicare to define infrequency and duration. Besides, what would be perceived as a right to healthcare at home and the client’s expectations as well as the moral duty of the health provider and his beliefs to provide treatment were in conflict.

The client’s right for self-determination to decide to get the therapy at home as well as the provider’s autonomy to decide the best place where the client would receive treatment were in question. This compromised his right to autonomy. This is because the patient’s financial resources, family preferences, and insurance resources should not have an explicit role in making decisions of decisions that include the place of treatment and the medical variables of the patient’s health as well as their anticipated care needs. Reporting on the patient’s inability to follow the homebound criteria put the professional obligation to act and speak truthfully interfered with the patient’s autonomy to make their health decisions. This compromised the principle of veracity. Besides, while the health provider felt the sense of duty to care for the client, Mr. M did not seem to satisfy all the criteria for coverage by Medicare. This put the principle of justice at risk. Additionally, fidelity was compromised when there was a need for the provider to uphold the commitments she had for all the parties involved. For instance, she owed commitment to the government by adhering to the Medicare regulations and the patient to offer quality care. She also owed commitment to herself as a moral agent. In regard to beneficence, it is apparent that Mr. M was adamant that he needed occupational therapy at home. It was also evident that he was benefiting from the treatment. However, the principle was put at risk when he flawed the legal and ethical requirements of receiving the service.

Ethical Decision-Making Framework

Models of ethical decision making often provide the mechanisms for critical thinking and to plan for resolution of ethical dilemmas. They are tools that can be applied by healthcare providers to develop the ability to think through a dilemma and arrive at an ethical decision. Models for ethical decision-making often consider ethical values, obligations, and principles. They also advocate the utilization of resources such as clinical data, published evidence, intra-professional and inter-professional consultation. According to Levitt (2014), when two or more ethical principles are in conflict, a theoretical framework gives the structure that would be used in decision-making. The four principles of nursing ethics provide the framework for ethical decision making.

For example, in these cases, there are various ethical principles involved in the dilemma. This case portrays several elements of major ethical theories. However, the main theory that would apply in the decision-making process would be deontology. Deontology is a framework that puts into focus every action and the processes as well as the principles and moral rules involved in the acts (Mandal, Ponambath and Paraji, 2016). It weighs all these aspects against the consequences of the decision. According to deontology, one must act according to the principles of ethics in nursing. This implies that one should act morally based on their duty while basing their actions on the consequences and outcomes.

Since the dilemma also involves a legal issue, it would be prudent to apply the Clinical Ethics and Legal Issues Bait All therapists equally. This framework considers the clinical situation, the ethical questions, legal issues, steps for brainstorming, analysis of the action steps, the process of taking action and evaluating the results. From the analysis, it is apparent that there were no legal violations as yet and as such, no legal actions were warranted (Van Denend and Finlayson, 2017).

For Mr. M, the healthcare provider discussed the situation with the family. The decision reached was that the client should be transferred to an outpatient rehabilitation center and not home-based therapy. It was also decided that the patient’s autonomy would be respected by allowing him to visit his son in the hospital. Besides, the healthcare provider discussed with the patient the available options of receiving medical services under Medicare Part B plan in an outpatient rehabilitation center or other health facilities that qualified for the same purpose. Mr. M found the decision quite feasible and acceptable. Additionally, the course of action taken also ensured that beneficence and non-maleficence were upheld by ensuring that the client received their desired continuity of services in their accepted environment. It is prudent to note that the actions taken by the health provider were informed by their experience, as well as their moral obligations, and the four ethical principles.

Conclusively, healthcare providers face ethical dilemmas regularly during their practice. These dilemmas may require a critical process of analyzing and evaluating alternatives to make the most ethical decisions that are consistent with the four ethical principles of nursing practice. In making these decisions, one must be careful to eliminate the unethical options and get the best alternative that would yield the best results. In Mr. M’s case, the ethical dilemma compromised all the main principles of nursing. In light of this, it was prudent to come up with a framework that considered all the actions and decisions made and weighed them against the consequences, including the legal implications of the case.