Ethical Dilemma Case Study Analysis
Ethical dilemmas are common in the field of medical practice brought about by the issues arising from different aspects of practice. These dilemmas happen when one gets faced with two right decisions and finds it challenging as to which one of the two to choose(American Nurses Association, 2011). This paper seeks to provide a demonstration of the principles of ethics in when one gets faced with conflict in choosing between two right options, identify the stakeholders and their perspectives regarding the dilemma, the resolution option and the rationale behind the option, the implementation plan and the consideration of methods of evaluation, and a discussion of the potential impact of moral distress on the decision-makers.
Bad Blood Ethical Dilemma
Right versus Right
The dilemma that has been presented in the scenario, in this case, is a right versus right dilemma because of the reasons below. Closing the department of emergency in the hospital as stipulated is right because it would help the organization save costs and avoid losing money, which could possibly result in the closure of the healthcare organization(Westrick, 2014). However, it is also right that choosing not to close the department of emergency would benefit the organization as most admissions happen to come through it and it will also save the members of the community the time they will have to travel for almost an hour to get to another hospital when an emergency arises within that time. Both options are right, with one being for the organization and another for the welfare of the community.
Ethical Principles in Conflict
The principles of ethics are essential in helping the CEO making decisions that are logical and also understanding the consequences of the decision she makes concerning the matter. The principles of ethics that arise in this case include the principle of justice whereby the CEO will be faced with a dilemma of making a decision that is just when both options are right(American Nurses Association, 2011). Another principle of ethics in a conflict that gets brought out is the principle of beneficence where the CEO will be faced with the conflict where he is required to do good for others, in this case, a conflict arises because choosing one option would hurt those affected by the other.
Dilemma Stakeholders
There are several stakeholders that are affected by the dilemma in this case and hold different perspectives with regard to the dilemma. The first stakeholders are the management of the organization who believe that closing the department of emergency during the said hours would help the organization save more and avoid closure. The patients and community members are also stakeholders, whose perspective will be that closing the emergency ED will be an infringement of their right to receive care (Agency for Healthcare Research and Quality, 1998). It will be challenging for them because diving for fifty minutes could be a long time to help a patient that needs urgent care. While the perspective of the CFO is that the closure of the organization during the said hours will save the organization a lot of costs, the effect on the community will be significant in the event of emergencies as driving for a long distance to seek care could endanger the life of the patient. While every stakeholder caught up in a dilemma has a perspective they know is right, the right decision of each of them when implemented has a negative effect on the other stakeholder. They are all important, which makes the CEOs process of making the decision challenging.
Options for Resolution
There are several options that present themselves in soling the ethical dilemma presented in the case scenario above. The CEO makes the decision on an ethical basis, and the options available for resolving the dilemma are as follows.
Option One
The first option the CEO has is to allow the closure of the department for the hours that have been suggested in the report by the CFO. The ethical basis for this particular decision is that to ensure that the organization stays open and keeps providing healthcare services to the community, it is necessary for the proposal by the CFO to be implemented until the organization gains stability for the department of emergency to start operating around the clock again.
Option Two
The second option the CEO has is to not allow the closure of the department of emergency during the hours stipulated by in the report by the CFO. The department of emergency should remain open because emergency situations can be life-threatening, and driving for almost an hour could fail to save a patient that needs urgent attention. The ethical basis for his decision is that closing the emergency department will be hindrance the community’s right to access care at all times(Agency for Healthcare Research and Quality, 1998). This would be a major risk to the organization as its continuance of operations with low finances could lead to further losses and potential bankruptcy.
Option Three
The third option the CEO has is to keep the emergency department open and find another means of saving costs for the organization. For example, the organization could implement a program for educating the patients on how to manage certain conditions while at home to help reduce return visits to the emergency department. The reduction in return visits will help the organization save costs and time that would be spent attending to patients whose conditions can be managed in the home environment. The ethical basis of this decision will be to allow the continuance of the provision of care in the emergency department while at the same time-saving costs for the organization to ensure that it stays operational.
Option Selected with Rationale
The option that the CEO found to be most effective in solving the ethical dilemma of the three options that have presented is the third option which is about letting the department of emergency stay open but implement a solution that would help in reducing the return visits to the department of emergency to minimize the cases of emergency to be addressed thus saving the organization time and costs of care provision. The rationale behind this option is that none of the stakeholders involved in the dilemma will be affected negatively(Baker, 1997). All the stakeholders stand to benefit from this option in that the quality of care will be improved for the patients. The nurses will find it easier to carry out their duties due to the reduced workload, and the organization’s financial position will be improved with the costs saved from the reduction in emergency department visits brought About by the education program. This option will solve the dilemma as the decision the CEO arrives at is one that benefits all the parties involved, and it gets made without bias.
Option Selected Implementation Plan
The plan for the implementation of the education program, as presented in the third option, will be as follows. The organization will implement ways through which the nurses will be able to engage in educating patients on self-management after they get discharged from the hospital to help reduce emergency department return visits. While treating the patients, the nurses can also engage in equipping the patients with understanding, knowledge, and preparedness for self- management of their conditions, especially those that are long term(American Nurses Association, 2015). The education of patients can also be implemented by the use of interventions that would provide patients with access to information. The use of the current technologies can help in ensuring that information about their specific conditions and how to manage them gets easily accessed by patients. The organization will also implement the electronic medical record-keeping to enhance access to patient data(Cable News Network (CNN), 2010). Educating patients on how to access and use the electronic medical records systems will improve their access to their medical history information for them to understand how to self-manage their conditions and to know when to and when to not go to the emergency department.
Moral Distress Considerations
In making a decision concerning the moral dilemma, the decision-makers are likely to experience moral distress that arises from the challenge in determining what the right option is(Gray, B.H., & Herbert, 2006). Moral distress can have several potential impacts, including the fact that the decision-makers can end up feeling powerless about the decisions they have made that get associated with depreciation in their sense of well-being. They end up feeling frustrated, angry, and guilty about their view on what is ethically proper in the ethical dilemma they are faced with. They end up feeling guilty about choosing a decision that affected the other parties negatively.
Conclusion
The ethical dilemma, in this case, is brought out in the fact that the CEO is faced with two decisions, both of which are right. The decision is with regard to whether or not to allow the closure of the department of emergency for the purpose of saving costs of care for the organization. She has to make a decision on how to ethically solve the dilemma. This dilemma is potentially brought about by the increase in the visits to the department of emergency in the hospital brought about by the lack of knowledge ion self-management. This is because most of the ER visits are return visits by patients who have healthcare issues that can be solved without necessarily going back to the hospital. Patient education is a significant step in minimizing the chances of such an ethical dilemma arising in the future.
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