The health care system

The health care system

Part 1

Lucia is a 24-year-old patient who happens to have been involved in a car crash accident and which led to trauma and brain injury. Lucia has been in the MCIU for the last four weeks though she is not brain dead. After several neuro consults and prognosis of a meaningful recovery, the chances are less than 1%. Lucia has not shown any responses while in the MCIU, and thus she is under monitoring and permanent vegetative state.

Lucia’s parents are religious and more of conservatives, and they have so far been attentive on her ailment. After various consultation from their priest and the doctor in charge, the parents decided to terminate the life-supporting system and allow whatever happens to happen. The palliative care specialists and the hospital ethicist are also a part of the team that the parents consulted. On that evening after the consultations were made, a decision was arrived at in which the support care unit was to be withdrawn in the presence of the priest, the parents and other family members.

Given that the palliative caregivers were involved, and death of Lucia is anticipated soon after the support systems are withdrawn, they had involved the Organ Procurement Organization, who were expected to carry out an assessment of donor potential. The OPO arrives and discovers that Lucia’s driving license has a stamp on it at the front and a little heart at the back. She had not signed up for the online state donor registry at any time, and there are no health directives on her file.by the look of things, her driving license shows that she had authorized donation the first-person consent and thus there are to be no records of revocation or refusal of the gift.

Uniform Anatomical Gift Act was recently revised and it staters that, in the absence of an express, contrary indication by the donor, no other person is allowed to make, amend or revoke an anatomical gift of a donors body or part of the donor’s body. Lucia qualifies to be a donor under the hospitals’ Donation after Cardiac Arrest protocol as she is not brain dead and is only under support care. To have a regular donation, several hours of evaluations in which tissue testing, reviewing the medical records of the patient, external communication, and having a medical history interview with the next of kin carried out. Its been an hour ago since the support system was to be terminated and the OPO approaches Lucia’s family to inform them on the donation evaluation that has ramped up the parents request to have the life support system withdrawn.

As per the contractual agreement with the OPO, only their representative is allowed to discuss organ donation with families and not any other person. This explains why the hospital had to buy time and wait for healthcare personnel to arrive from the OPO. When having the discussion with the parents alongside the palliative care physician, she asks the parents if they are a way of Lucia’s wish to have her organs donated and tissues to help others. The parent’s response was that they never had such type of discussion as a family and that they all they needed at the time was to be with their daughter during her last minute. They felt that removing her organs and tissues would not give them the chance to share the last moment with her.

The OPO representatives do not follow the parents back to bedside but goes to talk to the caregiver and informs them of how Lucia’s parents reacted they review with the staff on the hospitals’ policy on DCD and the first-person consent opposition. She cites that the state law says that when a hospital refers a patient at or near death to the OPO, the organization is reliable to conduct any reasonable examination necessary to ensure the patient suitability to the medical examination. At this time, Lucia’s parents come looking for the doctor in charge, wondering why it is taking so long to remove all the life support machines and leave it to God.

Part 2

The health care system has four principles in which the health care workers operate in and has to observe in their line of work. These principles are autonomy, beneficence, non-maleficence and justice. These principles are discussed below with relevance connection to the case listed above.

• Autonomy- in the healthcare system it refers the patients right to retain control over his or her body at any point while in hospital.it is acceptable and allowed that a medical practitioner advises or suggest, but there should be no cases in which the practitioner coerce or persuade the patient into making a choice as it is a violation to the principle. Lucia might not be well and able to make a decision, but her driving licence clearly states her wish. The medical practitioners only wish to inform the parents as they have no idea of what Lucia would have wanted to happen. The OPO representative holds a meeting with Lucia’s doctor and the caregivers as it would be unethical and against the principle to have her arrive at a decision alone without consultation.
• Beneficence principle states that the caregivers must do everything in their power to benefit the patient in each and every situation. All the recommended treatments and procedures must be for the benefit of the patient. Caregivers thus need to have a high level of knowledge and skills and make sure they have received the best training in their line of operation. When Lucia’s caregivers and doctor consulted the OPO, they wanted to have the best out of the process. Having the parents decide what they wanted for their daughter was not enough as she also had her wish. The caregivers did everything to the best of their knowledge and for the interest of Lucia. If they went against her wish and approve the parents want to instantly, then they would have abused this principle.
• Nonmaleficence which is one of the best-known principles and which refers to do no harm. With the healthcare providers, they are expected to make decisions and carry out activities that will give a no harm end goal. Therefore, in their line of duty, medical practitioners must ensure and consider whether their decisions will affect the other people or the society even if it is of benefit to the individual. When the healthcare providers consulted the OPO, they saw it fine to push on the organ and tissue transplant. Having the life support system disconnected will only lead to her death and her will to have her organs help others will not be adhered to.
• Justice; this principle holds that fairness should be upheld in all medical decisions arrived at. Laws and legislations should be upheld when making decisions concerning a patient or any issue at hand. The OPO representative, referred to the states act while talking to Lucia’s parents, and it is ethically correct as they are not the source of the decision. This ensures that no injustice is practised and that decisions are made on a fairground.

Part 3

In the health and medical sector, practitioners are expected to uphold some virtues during their time of operation. These virtues are the guidelines of how they should practice their professionalism and how they are expected to behave and respond to certain issues they might encounter. These virtues are honesty, fairness, kindness, leadership, judgement and teamwork. These virtues are discussed in detail in relation to the case discussed above.

• Honesty is a virtue which needs and guides one into telling the truth even when it would cause an impact. Medical practitioners are to maintain honesty and ensure they tell their patients the truth and only the truth. When the caregivers calculated the survival chances for Lucia, and they realized that she only had a 1% chance to survive they informed the parents right away so they could decide on what action to take next.
• Fairness when treating the patients. Caregivers should ensure that patients are treated well and that they do not experience any mistreatments during their stay at the hospital. Even after Lucia’s parents have chosen to have her life support system turnoff, the physicians and caregivers still checked up on her and treated her like any other patients alive or on life support.
• Kindness is a virtue that allows every medical practitioner to deal favourably with the patient. When it comes to dealing with patients, a normal person will find it is hard, but a medical practitioner who has been trained will do it with a lot of care and full of zeal. Lucia has been in the MICD for the last four weeks, and the caregivers have not tired to take care of her, and they constantly check on her response.
• Leadership is another virtue that is practised in the healthcare environment. There is a need to respect all the protocols and ensure that decisions are made by the right authority. The hospital had no mandate to speak to the parents on their daughters’ will, and they thus had to wait for the OPO representative. Issues on body organs and tissue donations are to be handled by the OPO, and thus the hospital respected that and left the right authority to deal with it.
• The health care practitioners are expected and urged to practice teamwork. The goals set are not a one-man goal, and they thus have to work together and achieve the best. Issues concerning health might be tricky, and thus a lot of consultations need to be done before arriving at a decision. Lucia’s doctor and caregivers had to consult each other before they could arrive at a decision. The OPO was also involved as their contribution was required and would be highly appreciated.

• Judgement – medical practitioners, are not expected or allowed to be judgemental. They are supposed to listen to the patients or the next of kin and advise them where appropriate on what to do. When one is at the hospital, they tend to have a lot of issues, and a state of confusion takes over. And thus, they might not make the right decision. The OPO representative informs Lucia’s parent of her wish, and even when they told her of their decision and walked out of her, she did not misjudge them as she understood what they were going through. The caregivers are positive of the situation, and they do not let fear control them

To have the best care offeredthe caregivers are supposed to establish a good relationship with the patients, and they are next of kin. This gives a good environment to take care of the patients and with the health care ethics and virtues being practised appropriately, the chances of having the best results are high. The doctors, caregivers and the patient’s family are expected to cooperate and give a good environment in which the patient can recover in.

Part 4

There are the morals; the should and should not, that guide the work of the nurses and healthcare in their work. This ethics and values include privacy, confidentiality, veracity and fidelity. These are the rules that guide the work of the nurses and the caregivers, and they contribute to the relationship between the nurses, the doctors and the patients are taken care of in the hospital—the rules are discussed below with relevance to the case described in this piece of work.

• Privacy is the ability for one to keep information on a certain issue and only reveal it when the respondent is ready and mentally prepared to receive the information. Privacy is key in the health line as most of the issues are sensitive and need preparation before they are discussed with the next of kin. However, the information should be communicated to the relevant people on time and s a caregiver one should no stay with sensitive information. The MICD caregivers had to stay with the information and wait for the OPO representative to communicate with Lucia’s parents.
• Having confidence in whatever one does is key, and it leads to success. When one does something and is full of confidence, then the chances of failing are minimal. Health caregivers in hospitals and doctors are expected to have confidence in whatever they do and have the patient believe in them. The patients will only gain confidence when they realize that the doctors and caregivers are confident of the services they are offering. The doctors had taken care of Lucia for the four weeks since the accident occurred. They had given their best until it dawned on them that she might not survive, and that is when they had to think of a second opinion.
• Veracity is telling the truth even when it seems hard to. In some situation, the health caregivers and doctors have some difficulties in telling the truth about a patient. However, their profession has ethics, and thus they have no choice but to practice and tell the truth. Despite knowing that it would create an effect when Lucia’s parents are informed that her chances of survival are 1%, they still had to inform the parents and prepare them for whatever was to happen next.
• Fidelity is the faithfulness that a caregiver has towards a patient and ensure that they keep the promises they make to the patient the caregivers turn out to be the people who are around the patient most of the time and they will thus share most of their experiences to them. With this kind of relationship, there are a lot of promises and wishes that are made by the patient, and thus the caregiver is expected to keep them. Through her driving licence, Lucia had made a wish to have organ and tissues donated. Therefore, the caregiver had to look for a way that this wish can be upheld and fulfilled.

Part 5

Healthcare givers are expected to practice autonomy and thus are expected to be true and inform the patient of any action they are taking. There are some issues that a nurse cannot take the consent of the patient and thus, the principle of autonomy may not qualify. In urgent issues, the nurse or the doctor will take action as soon as possible to solve the situation, and thus the patient will have no consent about it. In the case above, Lucia is not aware of her life state, but the parents represent her. The idea of checking her driving license on the issue of donation. The nurse and the doctor thus take action of consulting the OPO and the parents to be able to arrive at a decision.

Justice allows the use of the law in solving issues and the on the concerns of the life of the patient and the welfare of the next of kin.at some points the law may not be applicable as when following the law, the life of a patient may be at stake and they might not solve the issue. Despite all, there is need to following the law, and in case there is any breach, then it should be stated and for there should be benefits to the patient and the next of kin involved. Justice should be used to serve the human benefit.

Healthcare givers are expected to act right and do no harm. Thus, the principle of non-maleficence should be applied and upheld. T some point this principle is abused, and harm to either the patient or the family of the patient is caused.at this point the healthcare giver or the doctor may be held liable in case the situation could have been solved in another way and cause no harm. This principle though being one of the most upheld, it may act against the healthcare givers in ways explainable and some that cannot be escaped.

Keeping a patient’s information private and not informing them can make one to be answerable. Some information may be sensitive, and there is a need to inform the patient. Having the patient informed of their health and progress is of importance and thus should not be taken lightly.

Part 6

The healthcare providers and doctors are expected to uphold all the principles and the values that they are taken through when undertaking their studies. Knowledge and skills are instilled into them, and this is what they are supposed to apply in their line of work. However, they are not restricted to the knowledge they apply as, at some point, personal and applicable knowledge is required. As a healthcare provider, one is expected to be open-minded, follow the rules and be vigilant in their line of work.