Patient-Centred Healthcare

Write a paper of 1000 words to examine an ethical and moral dilemma in relation to a significant ethically related issue occurring in a health and social care environment or other similar work-based environment.

In the provision of healthcare, patient-centred approach has been advocated to be an effective approach towards ensuring quality health is accorded to patients. The patient-centred approach to healthcare emphasizes on an established cordial relationship between the patient and the doctor (Berger 2014). The doctor-patient relationship has been associated with great benefits in so far as healthcare is concerned, which is why many seek healthcare dissertation help to explore these dynamics further. This however equally raises ethical issues.

The proponents of the doctor-patient relationship advocate that the relationship should be cordial and friendly in nature to allow doctors to effectively examine and treat patients while at the same time, patients get to experience the presence and direction of the doctor (Chang et al 2013). The cordial relationship can be described as one where the doctor can constantly be in contact with the patients in order to accord them care.

The doctor-patient relationship is characterized by the doctor listening an understanding the needs of the patients and in return, the patients are accorded tailored care according to their needs (Mendoza et al. 2011). However Wong & Lee (2006) hold that there are limits placed on the doctor-patient relationship. For instance, the doctors are supposed to keep their relationship with the patients absolutely professional. This means that regardless of how close the doctor and the patient become, there should be no instance of intimacy between them. This is the basis of both ethical and moral dilemma in so far as the doctor-patient relationship is concerned.

Informed consent is one of the elements of the doctor-patient relationship. The patient and the doctor ought to have a clear and made up mind to relate to each other in so far as relating, communicating and associating with each other is concerned. An informed relationship means that both the doctor and the patients willingly take actions to build their relationships out of free will and with no coercion (Kaba & Sooriakuman 2007). Thus, regardless of how much the doctor views information such as personal experiences of the patients as crucial to the treatment and recovery of the patient, the patient is at free will to decide on disclosing or withholding the information. The doctor is not supposed to coerce the patients in order to obtain the information they desire and this equally applies to the patient. However, there are situations where the doctors have had to coerce patients to disclose information to perform some acts (Biglu et al. 2017). A good example is sexual harassment instances that patients have had to experience at the hands of their doctors, other medical practitioners and carers while in medical facilities.

Confidentiality is another element of the doctor-patient relationship that has been strongly emphasized. Under confidentiality, information between the doctor and the patient ought to be kept secret and the doctor should not disclose such information to the public (Mendoza et al 2011). However, there are both ethical and moral questions arising from this element. For instance, in an instance where the patient discloses plans to harm someone such as a family member or an enemy, would the doctor still keep the information confidential and fail to act? And if the doctor chooses to act, would they not be breaching the ethical trust and commitment to keep information confidential. This raises both ethical and moral debates.

Professionalism is a crucial element in the patient-client relationship where the doctors are obliged, being the carers, to keep their relationship with the patients as professionally as practically possible. Professionalism requires the doctor to be listening, understanding, and at the same time provide crucial care to the patient (Berger 2014). However, while the conduct of the doctor has been generally professional, or at least strived to be, there are instances of unprofessionalism exhibited by the patient. Examples of actions that erode professionalism of doctors are assault of patients, harassment and intentional misdiagnosis of patients leading to wrong treatment being accorded to patients to manage wrong conditions. Additionally, some medical conditions are traumatic and cases like wrongly diagnosing patients with such conditions as cancer or HIV/AIDS may raise trauma in patients.

Another ethically and morally debatable issue is the romantic relationship between the doctor and the patient. The romantic love relationship between the doctor and the patient is possible and real. Ethically, the doctors are prohibited from establishing a romantic relationship with the patients they are treating and it is recommended, that if such a relationship has to occur, the doctor must have stopped treating the patient (Wong & Lee 2006). However, what if the patient has a long term condition and the doctor in the course of associating with the patient develops feelings to the patient? Definitely, they will likely pursue their feelings. Now, while this may be ethically wrong, the moral standards of the society are rarely against such relationships. Romantic relationships at workplace are also present between medical practitioners working in the same medical facilities (Wong & Lee 2006).

In cases of terminal illness of patients, critical and immediate lifesaving medical decisions are essential hence medical decisions contribute to ethical issues in relationship between a patient and the doctor. A specific patient may have their own wishes about the way they want their lives to end. However, the patient families may find it hard or delay with the decision to end life support for a loved one or even give consent to a life-threatening medical procedure which is their will and at times contradicting the will of the patient. Even when it is obvious that increasingly therapeutic mediations for a dying patient will be pointless, it is difficult to prevent a decided family from demanding that life support for the patient must be proceeded. A few states have futility acts, which approve specialists to overrule the patient's family, yet even in these states’ specialists are required to experience a long procedure before life support can be halted. Not so hard to a family that wills to keep the patient alive when the circumstance is vain appears to be an eruption to the old paternalism. It gives a lot of assurance to the principle of patient autonomy—accepting, obviously, that the family effectively are aware of what the patient would have desired. Numerous specialists would stand firm against the family when treatment is unnecessary, or at least express their opinions and perspective. A 2016 Medscape study found that only 22% of doctors would prescribe life-supporting treatment they believed would be in vain, though 42% would not and 36% said it would rely upon the circumstance. There are approaches to keep away from showdowns with the patient's family about futility. When you talk about a significant therapeutic system with the patient and family, remember a discourse of when life support ought to be halted. And whenever you talk about an adverse patient's chances of survival from the condition, don't leave the family with the feeling that the patient could survive (Ferrell et al, 2001). Offering some unobtrusive expectations can be an effective methodology—for instance, "Perhaps you will see him again tomorrow with the entire family." In such an instance the healthcare practitioners and clinical leaders need to take responsibility and be prepared to handle end-of-life issues and assent for threatening procedures which is medically unethical but again essential as well as problems encountered in dealing with elderly patients who may not be able to make rational decisions on their own.

Arguments against the romantic relationship between the doctor and the patients include the fact that in the case of arguments and heartbreaks, parties may end up hurting each other (Chang et al. 2013). The doctor is the one more likely to end up using their authority to hurt their love partners who in this instance are the patients. Actions such as murder, rape, kidnap, assault are among the possible courses of action either party may take following a break-up. However, not all romantic relationships end-up with the heartbreaks and all those atrocities. There are instances where doctor-client romantic relationships have been successful leading into marriages and happy life. This is the reason why while romantic relationships may be ethically inappropriate, they are morally acceptable and have actually occurred. Patient-centred is, therefore, one of the topics that elucidate debates on the morality and ethicality of the doctor-patient relationship which is the core element for effective treatment and provision of care. The antagonism and support of this relationship is often in equal measure and it can be observed that the partners bear the responsibility for deciding whether their relationship is right and wrong

Ethical behaviour is largely shaped by theories that have been developed to explain the underpinning behaviour. While there is a general agreement that ethics and morality are crucial directors in human behaviour and interactions, there are different theories presenting diverging views of what is defined as ethical (Appiah 2010). Each proponent provides slight differences in explaining the aspects of ethics and morality. Interestingly, the ethical issues justified by the respective theory are relevant and applicable to health and social care.

Consequentialism is one of the main ethical theories. It holds that actions are chosen in order to achieve an end and thus the ends are the determinants of ethical behaviour (Lahdesmaki 2005). For instance, in the practice of healthcare, the fear may be that romantic relationship between doctor and patient may lead to heartbreaks, and pains especially to the patient. This end therefore defines and justifies the decision that ethically and morally, doctors should avoid as much as possible to form romantic relationships with the patient. Thus, forming the relationship is defined as unethical, while refraining from forming such romantic relationships is considered ethical. However, it is important to note that the perception of the ends differs from one person to the other and thus individual definition of the end largely determines their perspectives on ethical behaviour.

Another theory of ethics is ethical egoism. This theory advocates that ethical behaviour is aimed at maximizing the good of the moral agent and it is either psychological or ethical by definition. Psychological theory is descriptive in nature and holds that people behave in pursuit of their self-interest (McDevitt et al. 2007). Ethical egoism, on the other hand, is a normative theory where people ought to behave in pursuit of their self-interest. Self- interest is dynamic and thus, the definition of ethical behaviour is dynamic in relation to the pursuit of self-interest. Applicable to health and social care, doctors pursuing their self-interests may end up causing pain to patients through actions such as assault, and harassment especially sexual.

Utilitarianism is another main theory in explaining ethical behaviour. This theory was championed by Jeremy Bentham and is based on the hedonism calculus principle where decisions are based on pain vs. pleasure (Appiah 2010). In this theory, ethical behaviour is defined by actions that promote pleasure and the greatest net benefit as a whole. For instance, by refraining from engaging in romantic relationship between the doctor and the patient undergoing treatment, the parties would be doing so in pursuit of greatest net benefit which is maintaining a cordial doctor-patient relationship throughout the treatment period. The utilitarian principle has been utilized to even explain moral behaviour and enforcing morality. Social norms, according to this perspective, are constructed to protect the greater benefit of the society which could range from peace, stability, or desirable behaviour (Appiah 2010).

Another theory of ethics is deontology. This theory was championed by Immanuel Kent and holds a view on ethics and morality similar to utilitarianism. In this theory, ethics is defined by behaviour that aims at achieving the highest good. And the highest will is goodwill (Valentine & Fleishman 2008). Therefore, goodwill of the people and society defines individual behaviour which should be synchronized to the goodwill. Furthermore, deontology holds that morally right actions are carried out with a sense of duty. In healthcare practice, the doctor ought to act in a manner that upholds the goodwill, which in this case is recovery and healing of the patients under their care. In so doing, the doctor morally assumes the sense of duty of caring and effectively treating the patients. Ideally, all actions, therefore, should be aimed at achieving this objective and patient-centred care is one of the measures of achieving good will (Valentine & Fleishman 2008).

Ethics of care is one of the emerging theories in ethics which presents a paradigm shift in the view of ethics and morality. This theory places importance on personal relationships and that ethical actions are guided by virtues which important in personal relations (Lahdesmaki 2005). The moral obligation is to care for the special person. In the case of healthcare, the doctor bears the moral obligation, which is to care for the needs of the individual patient, hence patient-centred care. However, in an instance where the doctor fails to take care of the patient or mistreats them, the doctor would be breaching their moral obligations and consequently acting unethically (Appiah 2010).

In a structured environment such as medical institutions and democratic countries, rules and regulations have been developed to enforce morality and ethics by defining actions that amount to or contravene morality and ethics. The rights theory of ethics explains that every human being has fundamental rights that should be upheld and exercises at will (Vitel & Paolillo 2004). However, these rights are either defined positively or negatively. Positive rights promote free expression and enjoyment of the rights while negative rights are defined to limit the behaviour of people within the documented limits. The rights theory, therefore, provides a punishment that comes with breaching of fundamental human rights. Doctors have been faced with legal battles and even punished due to various medical malpractices that have infringed on the rights of patients due to unethical behaviour.

The last, among the 6 theories of ethics discussed herein is the theory of justice. Justice is a principle of equality and fairness and should be accorded to people at all times. This theory is premised on equity, fairness, and impartiality. Justice is executed in a way that similar people within a similar environment receive similar treatment while differences should be equally accounted for and treatments accorded with respect to the individual (Appiah 2010). The rules should be administered freely and fairly and no person to be held accountable for actions they totally cannot control. In healthcare, it is not uncommon for doctors to face criminal suits filed against them by patients looking for justice, regardless of the claims of the files. Issues have centred on the doctor’s failure to act ethically leading to the alleged injustice and courts have had some doctors convicted while others have been acquitted, depending on the determination of the cases filed against them. In this case, justice is used as a measure of ethics.

Most of the often-observed moral issues related to health or the social sciences are based on ethical principles and theories as seen in the discussed theories. The theory of consequentialism outlining relation of action and end outcome, the theory of egoism which advocates on individuals as agents of good morals based on their self-interests, theory of Utilitarianism which explains ethical behaviour in decision making aspect that decisions are made on basis of pain and pleasure, the theory of deontology which depicts ethics as behaviour to attain the best moral wellbeing and the theory of Justice, that it is a principle of equality and fairness and should be accorded to people at all time.

Looking for further insights on Patient centred care-planning, delivering and auditing the journey? Click here.

References

Appiah KA 2010: The honor code: how moral revolutions happen. W.W. Norton & Company, New York

Biglu MH, Nateq F, Ghojazadeh M, Asgharzadeh A 2017: Communication skills of physicians and patients’ satisfaction. Materia Socio-Medica 29: 192-195.

Berger D 2014. Corruption ruins the doctor-patient relationship in India. BMJ 348:1-2.

Chang CS, Chen SY, Lan YT 2013: Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters. BMC Health Serv Res 13: 22.

Ferrell, B. R., Novy, D., Sullivan, M. D., Banja, J., Dubois, M. Y., Gitlin, M. C., ... & Livovich, J. (2001). Ethical dilemmas in pain management. The Journal of Pain, 2(3), 171-180.

Kaba R, Sooriakumaran P 2007: The evolution of the doctor-patient relationship. International J of surgery; 5:57-65.

Lahdesmaki, M. 2005; When Ethics Matters – Interpreting the Ethical Discourse of Small Nature-Based Entrepreneurs. Journal of Business Ethics, 61: 55-68. Velasquez, M.G.1998. Business Ethics: Concepts and Cases (4th ed). Upper Saddle River. NJ: Prentice-Hall.

Mendoza MD, Smith SG, Mickey M, Hickner JH 2011: The Seventh Element of Quality: The Doctor-Patient relationship. Fam Med 43:83-9.

McDevitt, R., Giapponi, C. and Tromley, C. 2007.A Model of Ethical Decision Making: The Integration of Process and Content. Journal of Business Ethics, 73:219-229.

Valentine, S. and Fleischman, G. 2008. Ethics Programs, Perceived Corporate Social Responsibility, and Job Satisfaction. Journal of Business Ethics, 77: 159-172.

Vitell, S.J. and Paolillo, J.G.P.2004. A Cross-Cultural Study of the Antecedents of the Perceived Role of Ethics and Social Responsibility Business Ethics: A European Review,

Wong SYS, Lee A. 2006: Communication Skills and Doctor-Patient relationship. The Hongkong Medical Diary; 3:7-9