Ethical Dilemmas in Healthcare
Every day, health care professionals are compromised with challenges which the healthcare regulators expect them to face rationally and analytically. In the face of ethical dilemmas that are common in healthcare, putting patients’ interests ahead, respecting their choice of treatment, and upholding their rights can be a challenging task. Most of the tasks are usually complex and require professionals to provide care objectively and compassionately, regardless of their personal beliefs. This essay presents a case study of Felicity and the health issues surrounding her pregnancy. The paper will explore the concepts in the systems and synergy model in caring for this patient. The ethical theory linked to the case at hand will also be utilized to explore the role of professionals, their accountability and responsibility in ensuring the best health outcomes of Felicity even with the constraints surrounding her case.
Case scenario
Felicity, a 32 weeks’ pregnant lady, has schizophrenia. She is reluctant to undertake prescribed medication nor start treatment for the unborn. She lives with her mother, who is concerned with her refusal to take medication and contacts the midwife to intervene since she is suspecting she may be in premature labor. The relatives are also concerned with Felicity’s condition and pressure her to seek treatment, which she has been so stubborn to take, even becoming aggressive.
The systems theory and synergy model in patient care
In recent years, the synergistic practice has been adapted to ensure the patient’s and the family’s safety. This model describes nursing care while placing the specific needs of the patient at the core of the model (Swickard S., Swickard, W., Reimer, Lindell & Winkelman, 2014). It is founded on the renewed understanding that the competencies of the nurses and the nature of the care they accord are directly affected by the needs of the family and that of the patients. When this is embraced in caregiving centers, a synergy is produced, and optimal health outcomes can be achieved. In the case of Felicity, her health is affected by various stakeholder; her health, parents and her relatives the interplay of which informs the nursing practice. In this model, the characteristics of individual systems are not separately observed. Rather, the synergy from the interplay of various elements of the system will allow the patient and their families to navigate through the treatment model effectively (Swickard S., Swickard, W., Reimer, Lindell & Winkelman, 2014). In this scenario, the final path of treatment will depend on the parents and evaluation of Felicity’s ability to make her own decisions. This being a complex case, care should be taken not to coerce the Felicity to undertake medication or treatment due to her mental condition or as a result of the pressure inflicted by the family members. Rather, a harmonization of this to create a synergy will ensure that Felicity is accorded treatment according to her needs. In this case, her resiliency is low, unpredictable and her life, as well as that of the unborn, is vulnerable
Ethical theory.
In health care, practitioners are usually engaged in making judgments of what is bad or good, although they might not be aware. These subjective terms, good or bad, are usually the guide lights of the activities by healthcare professionals by offering directional signals (Rodger & Blackshaw, 2017). Ethics proposes a value lens that guides midwives in making sense out of situations that arise when working with different types of women. Being ethical comes from an initial cognition of morals and ethical frameworks existing in every situation. Medical ethics arises from the need to protect vulnerable patients, especially expectant women whose wellbeing depends on the accuracy of decisions made regarding their care (Rodger & Blackshaw, 2017). In the case of Felicity, this concept applies to protect her from undertaking a path of treatment due to the pressures from her parent ad relatives. She is 32 weeks pregnant, and her parents are concerned that she may be in premature labor. On the other hand, she may not be viewing the situation straight or influenced by a possible diagnosis. Either way, the medical practitioners are tasked with recommending a treatment plan to prevent the birth of a premature baby at home.
In this case, the principle of patient autonomy, beneficence, and justice are all in play. Felicity’s decision-making ability is directly related to her capacity. Her ultimate decision not to start a treatment plan and not take medication, although appearing unwise, can be considered as an autonomous move that ought to be respected if her capacity to make such a decision is valid. The health practitioners must, therefore, respect her decision and be careful of the possible coercion by the family members, motivated by their concern for the unborn baby and her. As such, the professional’s role in providing care in this instance is bound by the fact that as a midwife, one is entitled to attend to a woman in childbirth; thus, choosing not to attend to her is not permissible (Lee, 2012). Again, there is the principle of beneficence which tasks the nursing professional with working for the ultimate wellbeing of the patient and lastly justice to them regardless of their characteristics (Lee, 2012). Between the three principles, the principle of autonomy takes dominance over the other two. The nursing manager has to respect Felicity’s choice to or not to start treatment even if failing to poses risks for her and the unborn.
This case may be subject to multiple bias generating factors. That Felicity has been diagnosed with schizophrenia may be skew the nature of the solution into a coercive stance. There is a high possibility of disregarding her decision as influenced by her condition and not her knowledge of the factors which may influence the evaluation of the problem. Additionally, the information from the parents and relatives may be distorted due to the concern for Felicity. The core of ethics requires health professionals to act on solid facts and not from external sources of information, which may translate into bias in evaluating the condition. Again, perceiving the existing disjoint between Felicity’s location and not attending treatment may also lead to the consideration of denying the midwife attending her in an attempt to coerce her to go to the hospital. This will, however, be against the code of nursing ethics.
Determining the course of action
The premises of this case are complicated by Felicity’s case of schizophrenia, which then attracts multiple biases. Consent must be treated as a voluntary and free from any form of coercion. Health professionals must assess the validity of the decisions made and ensure that the patients are of mental capacity and not unduly influenced (Torres & De Vries, 2009). This would be the initial point of consideration in the case of Felicity, whose family and relatives’ may inflict pressure for her to seek treatment that she is not ready for. The principle of self-determination considers it to be against the law to coerce treatment even if this may result to death provided the person making the decision is of sound mind (Torres & De Vries, 2009). Felicity’s decision, although seemingly irrational, must be upheld. Having certain mental disorders does not justify the presumption of incapacity in decision making. Capacity is a variable that can only be determined by healthcare professionals. Therefore, Felicity needs to be subjected to a capacity test. This can be carried out by health care professionals with adequate knowledge of the failure to reach the same decision a court would reach. This assessment should be recorded to ensure accuracy in representing the conversation and mapping out the best course of action for the treatment plan. The assessment should consider the distorted cognitive functions as well as her profound personal beliefs while considering external influences such as labor pains. Evaluating Felicity along this line would determine whether fatigue and labor interacted with her mental condition and influenced her ability to reason straight. If Felicity is found to be of solid capacity to make decisions, then her choice not to receive treatment though unprofessional should have to be accepted regardless of whether this will affect the life of the unborn. In case she fails to express her capacity, then a decision reflecting her best of interests should be made in conjunction with parents and healthcare professionals. It is, however, worth noting that even with the rights of the unborn being on the question, it does not overrule the refusal of treatment if her capacity is upheld.
Healthcare professionals are usually compromised with ethical dilemmas that they are rarely prepared for, with scant knowledge of the frameworks guiding their actions. Familiarizing and acknowledging the nursing principles is the underlying framework for compassionate practice. The next step on a patient’s health should be determined after evaluating their capacity and allowing them to make decisions that fit them best. At the heart of this system is the systems and synergy model and the ethical theory models, which improves the ultimate outcomes of the patients and their family. The ethical theory, on the other hand, evaluates the ethical principles that have to be put into consideration when deciding on a treatment plan.
References
Lee, L. M. (2012). Public health ethics theory: review and path to convergence. The Journal of Law, Medicine & Ethics, 40(1), 85-98.
Rodger, D., & Blackshaw, B. (2017). An introduction to the ethical theory for healthcare assistants. British Journal of Healthcare Assistants, 11(11), 556-561.
Swickard, S., Swickard, W., Reimer, A., Lindell, D., & Winkelman, C. (2014). Adaptation of the AACN synergy model for patient care to critical care transport. Critical care nurse, 34(1), 16-28.
Torres, J. M., & De Vries, R. G. (2009). Birthing ethics: what mothers, families, childbirth educators, nurses, and physicians should know about the ethics of childbirth. The Journal of perinatal education, 18(1), 12.