The role that healthcare providers play in promoting the health and well being of citizens cannot be overlooked. They work earnestly to provide the best care services that meet the specific needs of their patients. Thus, they have to assess every case thoroughly to determine the best course of action expected to yield the best results. The four main principles of ethics in healthcare – non-maleficence, justice, beneficence, and autonomy serve as the guidelines that help professionals to make best and ethical decisions (Page, 2012). However, as Murray (2010) advises, some medical situations may still lead to ethical dilemmas, making it difficult for caregivers to determine the most appropriate step to take. This case study involves the application of the principles of ethics to solve a significant ethical problem in Hopewell Hospital.
Overview of the Case
E.L. Straight has been working as the director of clinical services at Hopewell Hospital for the past two years. His tenure has seen the launch of several programs to improve the overall quality of healthcare services in the facility. These efforts have been quite successful, leading to a great improvement in patient satisfaction rates and overall healthcare outcomes. Dr. Cutrite is a general surgeon in the medical facility. An old-timer, he is known for his distinguished services. However, his efficiency has been deteriorating over the years due to a decline in both physical and mental capabilities. Aware of Dr. Cutrite’s declining clinical prowess, Straight has initiated a process to reduce his privileges to prevent potential problems that might arise due to his decreasing efficiency. Meanwhile, Dr. Cutrite continued to perform all his duties as before, including surgical procedures.
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Matters took a sudden turn for the worse one morning, when the operating room supervisor informed Straight about the possibility that they could have left a needle protector in a patient’s (Mrs. Jameson) belly during a recent surgery. The supervisor thought that the needle protector might have been difficult to see if it was in a wound because they are red-pink in color. Although he was not absolutely sure of the connection of the two incidents, he said a discrepancy had been noted in terms of the needle protector when comparing the records of the surgery pack after a week. Straight suggested that they should take the patient back into surgery immediately so that they could check if the protector had really been left inside and remove it if so. They could tell her that they merely intended to check her deep sutures and incision and in this way, she would never know what they were looking for. However, this option seemed impossible because Mrs. Jameson had been discharged a few days ago.
Furthermore, the supervisor said Dr. Cutrite had warned them against informing the patient, saying that the needle cover could not possibly hurt her apart from causing her a little discomfort. When Straight called the chief of surgery for clarification, he said while it would cause occasional discomfort and not lead to life-threatening effects, nothing could be said for sure. The dilemma that Straight faces is to choose between two equally terrible options: calling back Mrs. Jameson and performing the surgery to check or ignoring the issue as suggested by Cutrite. The first option would not only be damaging to Dr. Cutrite’s career in Hopewell but the reputation of Hopewell as well, while opening up a possible lawsuit by the patient and her family. The second option would leave Straight terribly burdened about not doing the right thing as well as risk something happening to the patient as a result of the oversight.
Analysis of the Ethical Issues
The main factor that contributes to Straight’s ethical dilemma is the lack of accountability within the medical team. The persons in charge of counting the surgical pack did not notice the discrepancy in time because that would have resolved the issue before the patient was discharged. It shows laxity on the part of the supervisor. Moreover, it also shows negligence on the part of the medical team because they clearly did not check all the boxes before finalizing the surgery with the patient. The third issue was non-acknowledgment of the mistake as well as any responsibility for the action by Dr. Cutrite. The problem would not have been caused if all of them had been doing their tasks well and taken responsibility for the oversight, which would have been the ethical thing to do.
Using the Ethical Decision-Making Model
The above mentioned ethical problem can be analyzed using the three components of the ethical decision-making model, that is, moral awareness, judgment, and ethical behavior. Moral awareness is the ability to recognize an ethical problem (Trevino & Nelson, 2007). Straight exhibits this moral awareness by the fact that he recognizes the ethical problem in which he feels compelled to take action. Judgment involves deciding the right and wrong action in a certain situation (Trevino & Nelson, 2007). His judgment is reflected when he suggests that the patient should be taken back to surgery if the needle cover had indeed been left behind. If Straight decides to act ethically, he would undertake to resolve the issue, influenced by his judgment and the four principles of healthcare ethics.
The Effectiveness of the Communication Approaches
Effective communication between professionals is of great significance in healthcare settings because it promotes efficiency and leads to better health outcomes (Arnold & Boggs, 2019). In the case study, Straight demonstrates excellent communication skills. For example, he is an active listener throughout the conversation. He listened to the supervisor’s message carefully and quickly grasped the situation. In this way, he was able to respond appropriately to resolve the problem professionally. Another important aspect of the communication approach in the case is empathy. Straight was shocked by the news that a needle protector may have been left in a patient’s belly during surgery and was deeply concerned about the problems it might cause her. Thus, he immediately began thinking of an appropriate way to solve the problem.
The communication approaches that should be used more include active listening, proper tone, and politeness while those that should be avoided include inappropriate tone and improper language. The consequence of using effective approaches during communication is that it enables the involved parties to communicate effectively and understand each other (Fagerlin, Zikmund-Fisher, & Ubel, 2011). Non-effective communication approaches can lead to conflicts, making it difficult to solve issues or work collaboratively due to misunderstandings.
The Effectiveness of the Approach Used
Straight was reluctant to take any action to avoid getting into trouble with Dr. Cutrite, who is very influential in the political domain. The effectiveness of this approach is that it prevented conflict between him and Dr. Cutrite, which would cause tension and negativity in the workplace. Also, the process he had initiated to reduce the doctor’s privileges was still underway. The consequence of using a non-confrontational approach is that it does not hinder workflow and work environment in the hospital and maintains peace. The key lesson that healthcare professionals can learn from this case is the importance of practicing effective communication during their interactions with other professionals.
Application of Ethical Principles to a Possible Solution
The proposed solution would be to inform the patient about the issue and face the possible consequences. Ideally, the patient should be taken back to surgery to verify the existence of the needle protector and its removal. Such an action would prevent discomfort to the patient as well as potential adverse health consequences. This solution is based on the four ethical principles of ethical decision-making in healthcare: non-maleficence, justice, beneficence, and autonomy. Non-maleficence means not harming the patient, justice implies treating patients fairly, beneficence refers to taking actions that benefit the patient, and autonomy means respecting the patient’s values (Page, 2012). Arguably, the proposed solution to the ethical problem would constitute fair treatment (justice) and also not harm the patient (non-maleficence). The action only intends to promote the patient’s health (beneficence) while still respecting her values (autonomy). The only problem would be a possible conflict between Straight and Dr. Cutrite, which could be resolved through effective communication.
Conclusion
Healthcare professionals can apply the four principles of ethics in healthcare to resolve ethical problems. In the case study, Straight has to choose between taking the patient back to surgery, ignoring the issue and live with guilt. However, the application of the four principles of ethics in healthcare in developing a solution to the problem resolves the issue. The suggested solution to the ethical dilemma upholds all four principles.
References
- Arnold, E. C., & Boggs, K. U. (2019). Interpersonal relationships e-book: Professional communication skills for nurses. St. Louis: Elsevier Health Sciences.
- Fagerlin, A., Zikmund-Fisher, B. J., & Ubel, P. A. (2011). Helping patients decide: Ten steps to better risk communication. Journal of the National Cancer Institute, 103(19), 1436–1443. doi: 10.1093/jnci/djr318.
- Murray, J. S. (2010). Moral courage in healthcare: Acting ethically even in the presence of risk. Online Journal of Issues in Nursing, 15(3). doi: 10.3912/OJIN.Vol15No03Man02
- Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision
- making? BMC Medical Ethics, 13, #10. doi: 10.1186/1472-6939-13-10
- Trevino, L. K., Nelson, K. A. (2007). Business ethics: Straight talk about how to do it right. Hoboken, NJ: Wiley.
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