Scenario Based Ethical Dilemma

Question: Discuss about the Scenario Based Ethical Dilemma. Answer: Introduction: Health professionals working in health care setting often encounter ethical dilemma while providing treatment to patients with different illness and health issues. To keep a check on ethical issues arising in health care setting, all health professionals are informed about the code of ethics based on key ethical principles and theories (Doherty Purtilo, 2015). Applications of these ethical values in difficult scenarios helps in solving ethical dilemma in practice and control certain behavior in health care to maintain integrity in health care service (Lillemoen Pedersen, 2013). This essay looks into the scenario of Ms. X, a 42 year old female who has been brought to the hospital in a critical condition and requires emergency surgery following severe motor vehicle accident. It discusses the main ethical issues involved in the scenario and takes a stand on the appropriate application of ethical principles and theories to solve the problem. In the scenario of Ms. X, it has been found that as she is in a critical condition after severe motor vehicle accident, she needs immediate emergency surgery. The tragic news for Ms. X is that her husband child did not survive the accident and she has not been informed about it. However, the ethical dilemma in the situation is that before surgery, patients consent for surgery is important, but Ms. X has refused to sign the consent form unless she is informed about the condition of her loved ones. She is very hysterical and asking repeatedly about them. The clinicians cannot avoid the surgery also because without surgery her chances of survival are grim. Therefore, these scenarios presents the clinician with many ethical dilemmas and decide whether Ms. X should be informed about the death of her husband and child or whether the health professional should give the wrong information to Ms. X to take her consent for surgery. By taking both step, the core principles of ethical practice is denied and thinking on strategies to tackle such situation is important. The key principles of health care ethics are related to that of autonomy, beneficence, non-maleficence, justice and veracity. The principle of non-maleficence relates to the duty of health professionals not to harm or cause injury to patients intentionally (Faden et al., 2013). This means that they need to follow standard of care practice to minimize any risk to patients during the surgery. However, in the case of Ms. X, several condition is arising which might worsen her situation- first is the disclosure of death of her family members to her and the patients refusal for the surgery which might risk her survival chances. In such situation, the clinician needs to decide on strategies to handle the situation in a way that minimizes the pain and suffering of Ms. X. Autonomy is another principle in health care ethics by which health professionals need to respect the autonomy of patients and practice on the basis of informed consent to facilitate physician/ patient interaction (Reach, 2014). Although it is the physicians duty to respect the autonomous choice of patients in treatment, however it is also their duty to prevent patients from any harm in treatment. In the scenario of Ms. X, the main dilemma for the physician is that there is a conflict between principle of autonomy and the principle of beneficence (Kaplan, Cranston, Saver, 2015). According to autonomy principle, the physician should disclose about the Ms. X husbands and childs death to her, but this may also further deteriorate her conditions. However if the physician disclose the news to her, she might deny the surgery totally. In that case, the principle of beneficence will be violated and balancing autonomy and beneficence become challenging (Kaplan, Cranston, Saver, 2015). Under this principle, the main duty of the health care provider is to take positive steps to provide benefit to the patients and eliminate any source of harm (Doherty Purtilo 2015). In this situation, the physician might have to prioritize one principle first based on the urgency of need to prevent any harm to Ms. X. As during illness, a patients usual freedom and judgment is diminished, it is best for the physician to think what is best for her in critical condition. As part of ethical responsibility in health care, physicians also need to demonstrate an element of fairness while making treatment decisions. This may include being aware of current laws and legislation related to treatment choices, equal distribution of resources and making everything available to patients at their prescribed time (Moaddab et al., 2015). A physician may need to practice distributive justice by dividing burdens and benefits on the basis of fairness in each action (Fleurbaey et al., 2013). In the case scenario, Ms X is constantly asking about her family after the motor vehicle accident. The physician cannot perform the surgery without her sign in consent form. In that case, if the physician works to respect the autonomy of patient and reveals the death of her family to Ms. X, she might totally deny the surgery. In that case, forcefully arranging for surgery will also be unethical and delay of surgery will mean low chance of her survival. Here also there is a conflict between autonomy and non-maleficence and the physician has the dilemma to take a fair decision to get better outcome for Ms. X. The deontology theory of ethics is also applicable to the case scenario and according to deontological ethics, the morality of the action is judged based on rules. Through this approach, the physician can decide the rightness and wrongness of each action to make the final decision (Herring, 2014).On the contrary, the consequentialism theory decides the wrongness and rightness of any act based on the consequences of any conduct (Sobhani et al., 2016). The deontology theory is based on moral absolutism and the physician of Ms. X can take her decision based on moral norms and core ethical values in health care practice. From detailed analysis of ethical dilemmas facing the physician of Ms. X, it can be said that the physician needs to take his final decision based on the best interest of patients. In that case, the most ethical course of action for the physician will be to give precedence to the principle of autonomy because without patients consent, the physician cannot proceed with the surgery. The physician needs to carefully disclose the news to patients and calm her emotions to make her accept the reality. In such situation also, the principle of non-maleficence and beneficence can be maintained and physician can slowly make her aware of the risk involved in delay of surgery. After this action, the patient may get prepared for the surgery and the best interest of patient will be preserved. Reference Doherty, R. F., Purtilo, R. B. (2015).Ethical dimensions in the health professions. Elsevier Health Sciences. Faden, R. R., Kass, N. E., Goodman, S. N., Pronovost, P., Tunis, S., Beauchamp, T. L. (2013). An ethics framework for a learning health care system: a departure from traditional research ethics and clinical ethics.Hastings Center Report,43(s1), S16-S27. Fleurbaey, M., Luchini, S., Muller, C., Schokkaert, E. (2013). Equivalent income and fair evaluation of health care.Health Economics,22(6), 711-729. Herring, J. (2014).Medical law and ethics. Oxford University Press, USA. Kaplan, B., Cranston, J., Saver, J. (2015). Balancing Autonomy and Beneficence in Acute Stroke Therapy: Neurologist Attitudes Toward Delaying Thrombolysis in Order to Obtain Informed Consent (P7. 332).Neurology,84(14 Supplement), P7-332. Lillemoen, L., Pedersen, R. (2013). Ethical challenges and how to develop ethics support in primary health care.Nursing ethics,20(1), 96-108. Moaddab, A., McCullough, L. B., Chervenak, F. A., Fox, K. A., Aagaard, K. M., Salmanian, B., ... Shamshirsaz, A. A. (2015). Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization.American journal of obstetrics and gynecology,212(6), 736-739. Reach, G. (2014). Patient autonomy in chronic care: solving a paradox.Patient preference and adherence,8, 15. Sobhani, S., Ghasemian, A., Farzadfar, F., Mashhadinejad, H., Hejrani, B. (2016). Ethical Theories Used by Neurosurgery Residents to Make Decisions in Challenging Cases of Medical Ethics.Neuroethics,9(3), 253-261.