Ethical Dilemma in Healthcare

Introduction

I have chosen case study number 7, in which Mr C, the client, is 70 years old and suffers from dementia and lung disease. His wife is looking after him and she is older than him as well. He has a chest infection and is receiving antibiotics; he requires oxygen at home because of lung disease and his general condition. The chest infection has not responded well to the antibiotics that he is currently taking. Mr C is not eating and is drinking very little. In addition he needs intravenous antibiotics and physiotherapy that may help him to recover from this infection, although he may develop a similar infection again in the near future. He does not want to go back to the hospital again because he has experienced distress in the past and does not cope well with the different environment of the hospital. However, his wife feels that the best option for her husband is to go back to the hospital because they will give him the best treatment. In this case study I will identify the ethical issue of the dilemma that is arising between Mr C, his wife and the health care professionals as to whether he is going back to hospital or staying at home. I will identify the different people who will be involved, and how each of them forms their view and how they will work together to create the best solution for this issue. I will explain why I think they must include the patient in the decision-making process. I will also explain my opinion and what I think is the best for Mr C, with evidence that applies codes of conduct that support my argument and theory from the lesson. The different people might include the patient, carers, doctors, family, front line or health care professional workers, the public, care assistants, and services managers. Lastly, I will consider how codes of conduct relevant to this dilemma are applied with reference to age, religion, gender and disabilities. Overall this case study response will be covering the key areas which I will be exploring in more detail, and the conclusion will make recommendations for the best solution and benefit for the patient, while respecting his wishes.

The issue of this ethical dilemma is whether Mr C is going back to the hospital or staying at home. He has different conditions including lung disease, chest infection and on top of this he has dementia which affects his mental capacity. Mr C prefers to stay at home instead of going to hospital to get the treatment he needs. In addition, I will mention the effects of the chest infection on an elderly client with dementia if left untreated.

Utilitarian moral theories purport to be in favour of maximizing the well-being of all concerned. In utilitarian theory, however, autonomy appears to have its value only in its existence to the greater end of well-being.

My own view of this dilemma: I believe that to give the best treatment for his own benefit to reduce the risk of his lung disease, and chest infliction Mr C must go back to hospital for the medial reason. I believe he will be treated, get better quickly because he will get the recourses and be easily accessed by the health care professional. Mr C complained about the previous experience he had at the hospital and he does not like to be in that environment again.

The view of Mr C: The patient plays a crucial role in the healthcare provision. Bearing in mind that they are the most affected and paining, their preferences in the healthcare are sometimes assumed by medical practitioners (Nortje et al 2018). Mr C in the case above is ailing from long-standing lung disease coupled with dementia and he is equally suffering from chest infections. These conditions indicate the excruciating pain that Mr C is going through. There are two main concerns of Mr C from the above dilemma, his consent and pain management.

Pain management is an intervention that seeks to minimize pains experienced by patients with chronic medical conditions (Nortje et al 2018). From the above case study, Mr C is experiencing frequent chest infections associated with their long standing lung disease. These infections have been managed by antibiotics and recently, his condition didn’t respond well to the antibiotics administered. Although the number of times that Mr C has developed chest infections is not mentioned, it is clear that the patient has frustrations with the continuously taking antibiotics for pain management of his condition. Patients who are continuously under medication, for the same or similar conditions often get frustrated and tend to lose hope of overcoming the complications. This can be evidenced by withdrawing from activities such as going to the hospital, or feeding well

The second aspect manifested from this dilemma is the patient experience in the medication. The experience of the patients when seeking health services at hospitals usually has an impact on their subsequent willingness to visit the health facility for medication (Digby et al 2018). The above dilemma illustrates that Mr C is adamant at going to the hospital for further treatment because his previous encounters in healthcare setting was not positive. Negative patient experience stems from their personal reasons as well as the hospital’s role in development of poor experiences by the patients. (Digby et al 2018) For instance, failure to attend to patients in an appropriate time, rudeness from health professionals, and poor sanitation at the health facility may be contributors to patients’ coping difficulties in the hospital environment and as a result, they may be adamant to visit hospitals. Considering the fact that Mr C requires oxygen because of his lung disease imposes feelings of low esteem on the patient in a different environment from home. Since hospitals are largely crowded, Mr C will likely not blend in well due to constant fears and anxiety of how other people at the hospital perceive his condition, particularly if he has an oxygen cylinder that should accompany him wherever he goes. In such cases, patients often prefer to stay at home where they are comfortable and need not to worry about their image in the public.

The view of the wife: carers play a crucial role in the progress and recovery of the patients with long term medical conditions such as lung cancer and dementia (Nortje et al 2018). From the above case, it is evident that the wife of Mr C has a huge role to play since managing a patient with deteriorating physical health coupled with mental illness is not easy. Such a patient requires attentive and personalized care that targets the both aspects of health and wellbeing (Griffith and Tengnah 2010). Among the roles of the carers is ensuring that the patient adheres to the medication and takes drugs given to them according to the dosage prescriptions. However, due to the impaired judgement caused by Dementia, Mr C is bound to be stubborn and uncooperative when taking the medicines. It is therefore upon the wife, who is the carer to ensure that Mr C takes the medication prescribed by the doctor (Lunch et Al 2018).

However, besides being the carer, Mr C’s wife is a partner and definitely is concerned at the wellbeing of her husband. This is evidenced by her continued dedication to caring for her husband despite his medical conditions. When Mr C contracted the recent chest complications, she was quick to express her view that her husband seeks medical help in the hospital, since he was not responding to antibiotics. This shows her commitment to the recovery of her husband. In the hospital, due to the dementia condition of the husband, the carer may be involved in making crucial decisions regarding the treatment of the patient. Informed consent is necessary and crucial in the hospitals when medication is being provided to patients. Written and signed consent is usually required before treating patients with chronic medical conditions such as lung disease, dementia, and cardiovascular diseases as well as surgical operations (Lynch et al 2018).

The wife therefore can help by providing informed consent and signing the consent form when required by health professionals in the course of providing treatment to the chest infections of the husband. This is because dementia has the potential of impairing the judgement of the patients and Mr C, although it is not documented to have instances of impaired judgement in the case study above, his wife will still be consulted to make crucial decisions on behalf of Mr C.

Health care professional view

The doctors should speak to the carer or family of the patient, when they are making the decision of treatment for the patient because they know very well. Morally, the person is not only able have a choice but also to be accountable and all the professionals and everyone who involves the decision making of the patient must follow the autonomy ,principles and policies guiding ethical behaviour and practice in provision of healthcare to the patients (Nortje et al 2018) .Deontology autonomy says the health professional must follow the rules in order to provide the best treatment to the patient and not cheat or lie to them. According to the condition of Mr C I believe the best principle to apply is Beneficence because it says all the health care providers must do whatever that can benefit the patient entrusted into them for medication and care. Thus, whatever they recommend must be something good for the patient. To ensure beneficence, medical professionals must develop good quality of skills and knowledge which should guide them in provision of health services to the patients. They must be well trained in the most current and best medical practices, and they must think carefully about their patients’ need since individually, every patient is different from the others and what benefits or works one patient may not benefit another.

If a patient is given treatment without their own decision or agreement, the doctor will be infringing the human respect of the patient (Health and Social care Act 2008). All professional health workers have a duty to respect the capacity of the patient. However, sometimes the doctor may choose a treatment option that is different to the service user's wishes. In this situation, the healthcare professional is making a decision based on what they believe is in the best interests and benefits of the patient. The health professional should explain the reason underlying decision with evidence based on the law around the best interest and benefit of the patient (Nortje et al 2018). I think according to this dilemma Mr C got the mental capacity in order to make his own decision. Yes, he got dementia, but we do not know the level of the dementia and I do not want make assumptions since he might be able to makes his own decision (Mental capacity Act 2005). If he hasn’t got mental capacity his wife can make decision for him.

The care staff are not making decisions about what medication the patient is taking, their duty is to provide support for the patient such as: medication giving, prompting, personal cleaning, feeding. They are taking care of the patient so they will develop trust and knowledge. The care staffs are accountable for their views about what is in the patient’s best interest while making decisions.

Identify potential conflict(s) and points of agreement in terms of ethical arguments?

The conflict in this dilemma is between giving the patient what the health care professionals and his wife consider to be of best benefit for Mr C, and respecting his choice and autonomy. The health care professionals have to go through all the needs and barriers that affect service delivery. The conflict could be lack of effective communication between the health professionals and Mr C and which may lead to poor provision of treatment and failure to clearly explain in a manner understood by the patient and the carer on how to adhere to the treatment plan and care while back at home. I think the health care professionals such as doctors, counsellors and social workers should spend quality time with him since that may help him to accept to go back to hospital because people with dementia keep changing their decision because of the mental health caused by dementia (Smebye et al 2015).

Consider how gender, ethnicity, religion, age, sexuality, disability, and/or other differences you think are relevant, might influence how people respond to the dilemma

The decision can affect the client’s wishes. In this case Mr C is not happy with the decision of taking him to the hospital unless they treat him at home. There could be some challenges of discriminations between the patient and health professionals but in this case Mr C does not have any form of discrimination. When it comes old people in general, they feel they are less valuable compared to young people (The age discrimination act). You must not discriminate against service users, carers or colleagues by allowing your personal views to affect your professional relationships or the care, treatment or other services that you provide. The Equality act (2010) says that the healthcare provider must not discriminate stakeholder because of their such as: age, religion, disabilities in order to give treatment all human being have equal treatment.

According to Hanssen (2019) addressing the moral beliefs of different people of communities or as a whole society can help to avoid disagreement. For instance, one solution is to define the key of importance for people to live good life. In this case when health care professionals, family, close friends, and public group all agreed on one solution whether they treat the patient at home or take him to hospital can be referred to as utilitarianism because they are maximizing the benefits from the health issue of Mr C since improved health will be beneficial to him, his wife and even the healthcare providers (Hanssen and Tran 2019).

Culturally, whether the action is right or wrong depends of the moral norms of society. The same action may morally right to one society and maybe morally wrong to another one. In terms of culture relativism related to treatment, I believe it is relevant to this dilemma because the different colleagues working in a health care are from diverse, background and culture beliefs including the patient (Nortje et Al 2018). The health care professional has understood the moral belief of the patient is very important because the patient believes in the traditional treatment and they do not want get medicating.

Consider how far relevant codes of professional conduct and law, as applied to the dilemma, help with arriving at a moral solution

Equality act cover saying

Equality When two different patients achieve or get the same value and needs although they have different illness it does not matter whether they are wealthy or poor they both have the same value of treatment and accesses available recourses. The health care professional should consider the patient wishes and respect their choice

Health and social care Act (2008) regulation 9

This regulation focused on patient centred care and details the prescribed best practices for providing care to the patient (Griffitth and Tengnah 2010). Patient centred care is a value-based approach to care that demands healthcare providers to tailor their services and provide care according to the needs of the patients. It assumes an individualized approach to care provision (Griffith and Tengnah 2010). The regulation demands that healthcare providers work with individual patients and ensure the patients are well informed of the suggested care or treatment plan and that the provider considers the views of the patients. Decisions from patients and their carers in the course of treatment should be made by people with legal authority to do so under the requirements of the mental capacity Act 2005.

Mental capacity Act 2005

This is legislative Act of the parliament of UK and Wales. It covers legal frameworks governing the decision making on behalf of adults who cannot make decisions for themselves. The mental capacity Act can be relied upon to justify the decision or consent provided by Mr C's wife who is the sole carer of her husband. Upon the establishment of the impact of Dementia on the mental capacity of Mr C by the doctors, his wife can have legal authority to provide informed consent for providing treatment for Mr C. The five key principles of the mental capacity Act 2005 provides legal criteria for the decision making by carers on behalf of the patients. However, the patient should be involved in the decision making process as much as are able to. For instance, much as Mr C has dementia, the Act expresses that he is considered of sound mental capacity capable of making decisions on his own, but when a decision is made on his behalf, the Act emphasizes that such decision should be of the best interest to the patient.

Conclusion

The case of Mr C raises key ethical questions and dilemma that should be addressed. Provision of quality medical treatment and care is a responsibility of medical health practitioners. Patients on the other hand have the authority to make decisions concerning healthcare they are accorded. The above case study elicits different perspectives among the healthcare providers, the patient and the Carer. The core issue of contest is the setting for treatment with doctors and carers opting to admit the patient to the hospital while the patient expresses his reservations against the idea. By and large, quality healthcare is crucial for maintaining the health of the population. In this case, Mr C may still be admitted to the hospital following the consent of his wife, though there are legal and professional codes that regulate the provision of care to patients’ conditions such as that of Mr C

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References

Act, E., 2010. Equality Act 2010. The Equality Act.

Act, M.C., 2005. Mental Capacity Act. London: The Stationery Office.

Digby, R., Lee, S. and Williams, A., 2018. The liminality of the patient with dementia in hospital. Journal of clinical nursing, 27(1-2), pp.e70-e79.

Griffith, R. and Tengnah, C., 2010. The Health and Social Care Act 2008. British journal of community nursing, 15(12), pp.598-602.

Hanssen, I. and Tran, P.T.M., 2019. The influence of individualistic and collectivistic morality on dementia care choices. Nursing ethics, 26(7-8), pp.2047-2057.

Lynch, H.F., Joffe, S. and Feldman, E.A., 2018. Informed consent and the role of the treating physician. New England Journal of Medicine, 378(25), pp.2433-2438.

Nortjé, N., Hoffmann, W.A. and De Jongh, J.C., 2018. Development of Bioethics and Professionalism in the Healthcare Context. In African Perspectives on Ethics for Healthcare Professionals (pp. 11-24). Springer, Cham.

Smebye, K.L., Kirkevold, M. and Engedal, K., 2015. Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study. BMC health services research, 16(1), p.21.

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