Ethical Decision Making: Applying Ethical Principles

Abstract

In health care, ethical and moral dilemmas often arise. Decision making often requires use of moral values and principles of health care ethics such as autonomy, beneficence, nonmaleficence and justice. Administrators also look for guidance from the American College of Healthcare Executives Code of Ethics which can provide a good benchmark when faced with making decisions that are challenging and require a certain finesse.

Overview

As the new director of the Emergency Department at Crosby Hospital, Corey Davidson is tasked with developing a system for appraising physicians that wish to apply/reapply to the hospital for ED and clinical privileges. (Capella University (2018). NHS-FP4000 Exemplar Sample Ethical Case Study) He soon learns that one provider seems to be the target of this focus. Dr. Lacey has been at the hospital from the beginning and is considered an icon. He has treated almost everyone that works there and is revered by many. Those that work directly with him have a different view. They feel he is out of date with current accepted best practices. He won’t use the electronic medical record and often disregards the concerns of the nursing staff. His unwillingness to adhere to accepted guidelines and his own failing health and loss judgment are also of concern. After yet another incident the Director of Nursing, Margaret Truman, meets with Corey to discuss the mounting concern and see what can be done. This incident highlights the current move away from prescribing Lasix for shortness of breath until a definitive diagnosis of congestive heart failure is made. Dr. Lacey had to be persuaded by the nurse to hold off as the patient had a pressure injury and possible sepsis. Margaret feels it is only a matter of time before Dr. Lacey causes harm to a patient. Corey realizes that he just might have to take away privileges for this provider.

Analysis of the Ethical Issues

Corey is new to the hospital and his position as Emergency Department Director. (Capella University (2018). His first major tasking is to develop a system for reappraising providers seeing reappointment to medical staff and clinical privileges. After just a few months on the job, He faces having to take privileges away from a very well known, iconic figure in the hospital. Corey even feels like this person is the hospital’s own version Santa Claus. Policy and guidelines are specific on frontline treatments for patients presenting to the ED with certain symptoms. Dr. Lacey appears to ignore those going instead with so called “old school” methods and possibly misdiagnosing or causing further harm to the patient. Corey is faced with trying to find a solution to this problem. What is right for the patients is one guiding force in this issue. However, there is also an obligation to treat this provider with the respect he deserves given his seniority and position within the hospital and community. We also don’t know from the case study if the reappraisal system has been developed and in use. If we assume that this is not yet in place, should he revoke privileges or wait until he can develop the system. If it is in place, how can it be used to justify revocation. Another thing he must look at was whether harm has been done or could have occurred. Corey must make a decision not based on personal bias but rather the principles that guide his profession as a manager. According to the ACHE, Corey has a duty not only to the patients his emergency department treats but also to the employees that he oversees. He must provide a way of evaluating the care provided and ensure that practices are non-discriminatory of age, health, gender, race as well as religion and sexual orientation. ('ACHE Code of Ethics', 2017)

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Application of an Ethical Decision-Making Model

In reviewing the model, we can see that moral awareness is acknowledging that there is an ethical dilemma. Moral judgment involves looking at all the components and weighing the various actions in order to determine the appropriate action for the situation. Use of these components help lead to ethical behavior. In this instance, the dilemma is how to address the issues with Dr. Lacey in a manner that will be just, beneficial and appropriate. Corey’s moral awareness allows him to recognize that Dr. Lacey is much revered and deserves to be treated with respect while at the same time knowing that patients need to be cared for in keeping with current accepted evidence based practice. How he chooses to handle this situation will depend on personal judgment and past experiences.

Effectiveness of Communication Approaches

Margaret Truman, Director of Nursing, was very directive in her communication with Corey that something needs to be done with Dr. Lacey. However, she did not come to Corey with any type of solution to the problem. While Corey is the “owner” of the problem, in order to be effective in addressing her concerns, Margaret could have also come with a possible solution. She comes off as demanding and almost as if she has something personal against the doctor. This leaves Corey feeling as though he has to do something right away and that it will cast him in an unpopular light. While we don’t know how Corey chooses to proceed, we do know that he will need to communicate with Dr. Lacey in a respectful manner. Communication should be held in person, not via email or telephone. Setting up an appointment to keep disruptions to a minimum would be key.

Resolving the Ethical Dilemma by Applying Ethical Principles

Corey faces the ethical dilemma of how to handle the situation with Dr. Lacey. On one hand, it appears as if Dr. Lacey is both out of touch with current practices and dismissive of the nursing staff. On the other, we don’t know if there is more of a personal conflict/power struggle between him and the director of nursing that may be adding to the situation. Corey must sit down with all parties, get their perspectives and input and come to a decision. If he simply revokes Dr. Lacey’s privileges, he may be perceived as wielding too much power. If he has not established the new system for appraising the providers for reappointment and granting privileges, he may need to consult with the hospital’s ethics committee for suggestions on how best to proceed. Beneficence will guide Corey into acting in the best interest of the patients. Nonmaleficence goes along with “first, do no harm.” And justice will be the hallmark for treating everyone as fairly as possible and coming to the best solution for all involved. If a true power struggle does exist, quality of the argument can best determine a course of action rather than hierarchy of personnel. (Falkenström, Ohlsson, & Höglund, 'Developing Ethical Competence in Healthcare Management.', 2015)

Conclusion

In this case study, Corey has to determine a physician’s competence and whether or not there is a power struggle that is clouding the issue. Corey needs to ensure a just outcome by upholding the ACHE code of ethics and principles of ethics.

References

1. ACHE Code of Ethics. (2017, November 13). Retrieved from https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics
2. Capella University (2018), NHS-FP4000 Exemplar Sample Ethical Case Study. Retrieved from Capella Website: http://media.capella.edu/CourseMedia/NHS-FP4000/ethicalCaseStudies/wrapper.asp
3. Falkenström, E., Ohlsson, J., & Höglund, A. T. (2015, November 30). Developing Ethical Competence in Healthcare Management. Retrieved from https://eric.ed.gov/?id=EJ1088687