Ethical Considerations

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Ethical Considerations


Introduction

Ethics is an important element in maintaining interpersonal relationships and peaceful coexistence between people and their environment. Ethics define how we are supposed to act around one another and are important is all settings that involve interaction between two or more people or between people and the environment. These include at; home, school, work place, hospital and public places.


In recognition of the importance ethics, organizations design formal codes of ethics to act as guide for their employees and all stake holders to that organization. Though codes of ethics rarely exist formally in personal relationships, societies have ways of ensuring that what they term as ethics is adhered to. These are usually incorporated in cultural norms and beliefs.


Ethical considerations are especially very important in healthcare setting. This is because relationships in healthcare setting usually involve very delicate issues and failure to observe these ethics might prove to be very costly. All decisions and actions within a healthcare setting are supposed to be guided by ethics.


Definition

Ethics are standards or frameworks that try to capture the underlying practices and opinions concerning morality (Furler & Palmer, 2010). Morals on the other hand, are generally agreed upon disposition on ways that people should act. Morals describes opinions, decisions and actions through which people express their thinking of what is good and right. Ethics is a search of right kind of moral. Ethics can be divided into two branches; normative and Non Normative (Furler & Palmer, 2010).


Normative ethics is responsible for determining whether actions are right or wrong while non-normative ethics is more concerned on describing people ethical beliefs and ethical terms. Normative ethics can further be divided into ethical theory and applied ethics. Ethical theory refers to any philosophy that attempts to describe how people should conduct themselves. Applied theory on the other hand is a branch of ethics that attempt to apply ethical theories in real life situation.


Normative ethics is mainly defined in term of values, norms and virtues (Furler & Palmer, 2010). Moral values are the standard by which we measures people behaviors.  Moral norms are sets of rules that guides that permit or forbid actions. Norms are usually means for achieving values. Moral virtues on the other hand are traits that make a person good. These are such as honesty, trust worthiness and loyalty among others.


Ethics are strongly based on underlying moral principles. Ethical principle refers to actions that define moral rules (Furler & Palmer, 2010). Ethics can be interpreted differently from different moral principles. The most common moral principles that have been broadly used to describe ethics are utilitarianism (consequentialism) and deontology. Consequentialism defines moral as an action that promotes the best consequences while deontology defines moral as an action that adheres to the moral rule or principles.


Ethical principles should be clear, simple, complete and comprehensive, internally consistent and generally support ordinary judgment. The principles should avoid assertion of opinion and inflexibility as it is supposed to be applied on diverse groups of people and therefore should incorporate as many perspectives of issues as possible. Good ethical principal should also avoid polarization. When developed ethical principles are perceived to be imposing a few people’s opinions on the others it will read to division and therefore polarization of the group.


Ethics in Healthcare Administration

There are four basic ethical principle in healthcare administration; autonomy, beneficence, nonmaleficence and justice (Gillon, 2009). Autonomy refers to the right of every individual to determine his own direction. Modern healthcare delivery has recognized the right of patients to be granted autonomy.


Therefore patients must be given information about their illness, available alternative procedures and effects of each procedure and allow them to make a decision on the best way forward based on the information provided. Before performing a procedure on patient, physicians must ensure that patient understands all about the procedure to enable them make informed decision, a principle referred to as the principle of informed consent. Physicians also have their own right to autonomy.


Beneficence refers to the philosophy of doing what is good and right. Every move and action by a physician is expected to be driven by positive intentions especially if those actions are performed to a patient. This is close to nonmaleficence which refers to duty that requires no harm to be incurred. This means that physicians are not expected to perform any action with the intention of harming the patient.


It is very unethical and against every rule for a physician to perform an act with the intention of harming the patient or putting the patient at risk. All procedures, advices and interventions by a physician should be guided by the principle of beneficence and nonmaleficence. With holding treatment and deliberately administering wrong procedures are examples of violation of beneficence and nonmaleficence.


Justice is the principle of ensuring equality and fairness. Decision by a healthcare administrator should be geared toward bringing equality, just and fairness among all. Universal acceptance of patients is also an important moral ethics. Patients arriving at a hospital facility have a right to be accepted and treated for their ailment (Corsino $ Patthoff, 2006).


There are numerous other ethical issues in healthcare but almost all of them have been derived from the four basic ethical principles described above. These are such as confidentiality and protection of patient’s information, healthcare charges, information access, reliability, honesty and integrity, responsibility, compassion/ empathy, self awareness and healthcare services marketing (Committee of Bioethics, 2007).


 Ethical considerations also exist in healthcare research. These are such as; informed consent, minimal harm to subjects, informed consent before procedures, privacy of information provided by the subject, plagiarism and ethical consideration in reporting research result. Informed consent in research requires that the researcher provides the targeted subjects with adequate information about the research and let them decide whether they would like to participate or not. Those who agree to participate should sign formal consent forms.


Researchers should also conduct risk benefits analysis to evaluate whether the research will pose more risks or benefits to the subjects. Researches that presents great amount of risk to the subjects are not ethical. The researcher should also protect the information provided by the subject; rarely should the researcher mention names of the subject or information that will link the subject to the research.


After conducting the research, the researcher also needs to consider how he releases the results. The results should not cause disturbance, anxiety, embarrassment or shock to the subjects that were involved (Achkar and Maklin, 2008). For example, releasing results of a research that was investigating prevalence of a deadly disease in a certain population in careless manner may cause shock and anxiety in that population.


Throughout history there have been reports of violation of healthcare ethics by healthcare professional. Some of these incidents have ended up on sad notes resulting in deaths and litigations afterwards. Gallagher (2009) conducted research that aimed at providing quantitative analysis on various form of ethical violation among Certified Addiction Counselors.


The study having being completed only in Pennsylvania revealed that 46.2% of Certified Addiction Councilors had ethical violation involving dual relationships including sexual relationship with current or former patients while 38. 4 % were involved in exploitation of patients. The figures reported in the study above are shocking by any standards.


This study by Gallagher (2009) also sort to investigate what could be reason that makes healthcare professional to get involved in violation of ethics. Limited knowledge of the code of ethics was cited as one of the reason that made many practitioners to get involved in ethical violations. Other reasons included; limited supervision, isolation where the relationship between patient and physician is very private and failure to understand the importance of ethical guidelines.


Codes of ethics in healthcare are usually implemented by various stakeholders. These include; professional bodies such as Nursing Council, the government though its departments and individual health institutions (Hurdle et al, 2007). Implementation of code of ethics raises the question of compliance. In order to make all concerned parties compliant to these codes of ethics, consequences for failing to comply are usually set.


Violation of healthcare ethics is usually taken to be a serious offense which attracts tough measures against professionals found guilty. This is especially so for the legal and institutional codes of ethics. Many healthcare professional usually find themselves out of their jobs, their licenses cancelled, facing fierce court battle and some are even incarcerated for violation of these ethics.


Ethical dilemma

Ethical dilemma may occur when two ethical principles suggest opposite actions. For example, it is one of the ethical requirements (autonomy) that physician should respects the values of the patients regardless of whether the physicians share the same values or not. When the patient happens to be too young the physician has to adhere to values prescribed by the parents or guardians. A situation might come up where a child may require a medical intervention such as blood transfusion which may be contrary to the parents’ religious values.


It is also an ethical requirement to ensure that the child’s condition is rectified (beneficence). In such a case physician may encounter an ethical dilemma because they are required to decide whether to respect the patient’s parents’ values or to offer an intervention that will save the child’s situation but which is contrary to the patient’s value.


Ethical dilemma that involves respect of human liberty and autonomy and providing an intervention to save a situation are usually common phenomena in healthcare. The recent one was during the outbreak of the influenza virus H1N1. The government was forced to violate the citizen’s liberty and autonomy to decide whether they would like treatment by forcing each individual to be vaccinated in order for the government to safeguard the interest of the general population (Stockowski, 2009).


Moral dilemmas may also occur when the ethical principle governing certain conducts in institutions are inconsistent with the moral principles of the implementing individual. For example, institutional ethical rules and principles may require that a physician respects the values of the patient and provide care whenever requested. A patient may come to a hospital with a request for a procedure such as abortion which may be contrary to the available physician’s moral values.


An ethical dilemma with arise since the physician will have to choose between the individual values and the requirements by the institutions code of conduct. Other healthcare procedures that bring a lot of ethical questions and dilemma include; mercy killing, birth control, human cloning, transgender surgery and cosmetic surgery. Such practices are usually contrary to many physicians moral values and may present an ethical dilemma.


It is also an ethical rule in healthcare setting that medical interventions and procedures be administered by competent personnel. However a dilemma arises in situations where a healthcare facility has less than adequate personnel. Such institutions are usually located in rural areas where it is usually difficult to access healthcare services. 


In such a situation hospital administrator are forced to make a decision between sending patients away because there are no physicians in the specialty or having physician from other specialties perform minor interventions that are outside their areas of competence but which would have minimal negative implications.


A similar dilemma may occur in situation where physicians responsible for a certain procedure are away and a patient has come in, when in a very critical condition. The administration has a choice of having a physician who is present to act outside his areas of competence or put the patient’s life on the line as they wait for the competent physicians.


Ethical dilemmas also surround the contentious topic of performance based healthcare and cost of healthcare (Satin, 2006). The US healthcare system was judged as the most expensive in the world but which has services that do not much the cost. In order to minimize the cost and improve quality a system was introduced that would see hospitals and physicians receive funds based on performance.


This system has elicited various ethical dilemmas. One of them is that, while moral ethics demand that stake holders should implement such a system that would lower cost of healthcare and improve quality, this system is showing signs of improving better healthcare providers while making the ones performing poorly become even more poorer. Therefore the system is being accused of increasing disparities between those with better access to quality healthcare and those with limited access. Thus, the system is said to violate moral ethics of justice.


Lack of standardization is one of the greatest ethical dilemmas that confront the pay for performance system of healthcare (Wharam et al, 2009). Appropriate methods for measuring performance that would ensure equity and at the same time transparency are yet to be developed.


There are also concerns that implementation of performance based healthcare lack evidence of safety and efficacy. Opponent of this system of healthcare argue that the system pose risks to healthcare stakeholders particularly the vulnerable patients.


Another ethical dilemma is that, though the system may motivate the physicians and other practitioners to improve on their performance, it is feared that the system may change the attitude of the physicians and the doctor/ patient relationship (Satin, 2006).. Opponent to this system fear that physicians may start providing healthcare services with the incentive as their primary motivation rather than the need to improve the patient’s conditions (beneficence).


This would be so unethical since physicians are supposed to have the interest of patients at heart. The physicians may also begin to select patients who are able to pay better for services rendered and avoid patient who are not able to do the same (Larriviere & Bernat, 2008). Selective acceptance of patients violates the ethics of universal acceptance and can also be treated as withholding of treatment (Corsino $ Patthoff, 2006). This presents a huge dilemma as to whether the adoption of the performance based healthcare was best way forward for the country’s ailing health sector.


Another ethical dilemma may concern marketing of health services. While some stakeholders advocating for performance based healthcare argue that it would provide competition which would bring cost down, there are ethical concerns as to whether competition is the best way forward for the health industry.


Ethics requires that when marketing health services, one should provide accurate information and should not attempt to induce consumption of services that the clients do not need. However, with the coming of the pay for performance healthcare which in a way seems to commercialize health services we seem to be headed in this direction.


Solving Ethical Dilemma

Whether there are ethical dilemmas or not, healthcare professional must make decisions and continues to provide services. Therefore, effective mechanisms need to be developed for solving ethical dilemma. The first step to solving ethical dilemmas in healthcare is to revisit the four basic principle of healthcare ethics; autonomy, beneficence, nonmaleficence and justice (Gillon, 2009).


If two or more of these principles are conflicting, choose to follow the one that will optimize positive consequences while minimizing negative consequences. It is important for one to try and detach his motifs and personal feeling from the issues (Cristani & Burato, 2009). This will be useful in eliminating preferential reasoning which may bias one’s decision concerning the matter at hand.


However, it should be noted that personal motifs and feeling are different from personal values and code of conduct. While motifs and feeling should be detached, personal values and code of conduct should play a vital role in solving the ethical dilemma.


Conclusion

Ethics are important elements in human lives. They are useful in guiding human conduct which ensures a peaceful coexistence between them and their environment. Ethics are important in every sphere of life; whether at school, work, on the road or in the park. This is no exception in a healthcare setting. Ethics and ethical considerations must exist in the healthcare system if there is to be efficient provision of services.


In order to standardize this ethics general principle have been agreed upon by various healthcare stakeholders and formerly written down as codes of ethics. Though there many other ethical considerations in healthcare 4 basic ethical principles were defined from which all the other considerations are derived from. These include; autonomy, beneficence, nonmaleficence and justice.


However, there are occasion where two or more ethical consideration come into conflicting with each other. This result in a moral dilemma which must be solved by making the best decision concerning which ethical principle should be followed.


Reference

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Committee on Bioethics (2007). Policy Statement. Pediatrics, 120 (4), 895- 896

Corsino B. and Patthoff D. (2006). The Ethical and Practical Aspects of Acceptance and Universal Patients Acceptance. American Dental Education Association, 70 (11), 1198- 1201

Cristani M. & Burato E  (2009). Approximate Solution of Moral Dilemmas in Multiple Agent System. Journal of Knowledge and Information Systems, 18 (2)

Furler J. & Palmer V. (2010). The Ethics of Everyday Practice in Primary Medical Care: Responding to Social Health Inequities. Philosophy, Ethics and Humanities in Medicine, 5 (6)

Gallagher J. (2009). Ethics Violations: A Quantitative Study Comparing Human Services Professions. Counselor, 10 (2), 16-17

Gillon R. (2009). Medical Ethics: Four Principles plus Attention to Scope. BMJ (Clinical Research Edition), 309 (6948), 184- 188

Green W. (2007). Ethics in Mental Healthcare. Academy of Psychosomatic Medicine, 48 (4), 364

Hurdle J. et al (2007). A Code of Professional Ethical Conduct for the American Medical Informatics Association. Journal of the American Medical Informatics Association, 14(4), 391-393

Larriviere G. & Bernat J (2008). Threats to Physicians Autonomy in a Performance- Based Reimbursement System. American Academy of Neurology, 70 (24), 2338- 2342

Mc Donald C. (2011). Clinical Judgment and Deep Value Commitment. A Job, 2 (22), 18

Pattinson S (2006). Medical Law and Ethics. Oxford Journals, 14 (3), 442- 445

Satin D. (2006).The Impact of the Pay for Performance Beyond Quality Markers- A Call for Bioethics Research. University of Minnesota Center for Bioethics, 10 (1), 1-3

Stokowski L. (2009). Ethical Dilemma for Healthcare Professionals: Can WE Avoid Influenza. BMJ), 219 (6948), 148- 154

Wharan J. et al (2009). High Quality and Ethical Pay-for Performance: A Society of General Internal Medicine Policy Analysis. J Gen Intern Med 24 (7),884-889


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