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Ethical Dilemma Brief INTRODUCTION Health care administrators are confronted with ethical dilemmas and difficult decision making during their work

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Ethical Dilemma Brief

INTRODUCTION

Health care administrators are confronted with ethical dilemmas and difficult decision making during their work. As we have already discovered, there are important interactions between ethical behaviors and legal issues. Health care administrators need to understand the relationships as well as the distinct differences. Health care institutions have ethics committees that play a central role in the protection of patient’s rights, the organization as a whole, and its staff.

INSTRUCTIONS

Imagine you work as a professional health care administrator in a large medical center. You have been asked to present a paper at a professional conference on medical ethics and caregiver-patient encounters. You must write a paper about a significant physician-patient ethical dilemma in a medical setting, defending the decision and conclusions made.

Below is a resource with multiple ethical case studies that involved patients, their families, and members of the interdisciplinary team. Choose one of the scenarios on this site, or select a case of your own choosing from another resource.

• Medical Ethics and Physician-Patient Encounters: Case Studies and Best Practices.

Your paper should be 3–5 pages and should include a title page and references, for a total of 5–7 pages.

STRAYER WRITING STANDARDS

This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course.

GRADING CRITERIA

The grading criteria for this executive summary is as follows. It must include the elements listed below, so be sure to address each point. You may also want to review the performance-level descriptions for each criterion in the scoring guide to see how your work will be assessed:

1. Prepare a brief from the perspective of a lead administrator dealing with an ethical dilemma.
2. Apply ethical and moral theories to a case study involving a patient and caregivers.
3. Outline the ethical concerns and potential outcomes in a selected ethical dilemma.
4. Propose a solution to mitigate the issues raised in a selected ethical dilemma.
5. Defend the solution from an ethical standpoint.
6. Use at least three peer-reviewed articles less than five years old.
7. Provide appropriate in-text citations and reference section.
8. Meet clarity, writing mechanics, and formatting requirements.

Running Head: Ethical Dilemma Brief Assignment #3 - EXAMPLE Ethical Dilemma Brief 1 2 Ethical Dilemma Prepare a brief from the perspective of a lead administrator dealing with an ethical dilemma The HCO was recently sued for claims of delaying a diagnosis of care for a patient treated at one of the HCO’s outpatient healthcare facilities. A 50-year-old male, Mr. X, presented to his family physician (FP) in January 2019 due to having chief complaints of back and flank pain. Urine labs from the appointment showed trace blood, and therefore the FP recommended a urologist follow up. The patient returned in May with symptoms indicating an upper respiratory infection. The patient was diagnosed with a viral infection. During this visit, the FP followed up to see if the patient had seen a Urologist whom he had recommended to the patient in January. The patient stated no, so the FP repeated urine labs, which showed blood in the urine once again. The FP encouraged Mr. X to once again make an appointment with a urologist. The patient insisted he would not due to fear of being catheterized and/or having to do a prostate exam. Facility physician once again recommended going to a urologist and told him the risk of kidney or bladder diseases that could be associated with the blood found in his Urine. Mr. X once again refused to seek further evaluation from our urology clinic and thus the FP documented their conversation in his chart. Mr. X returned to the FP office in February with worsening pain and blood in his urine. After that, he finally agreed to go see a urologist and was ultimately diagnosed with renal cell carcinoma. Mr. X and his wife filed a claim against our FP stating they delayed referral to a urologist and thus delayed the diagnosis of his cancer. We are here to discuss this ethical dilemma we tend to face on a day-to-day basis due to our patients refusing medical treatment. Although it does not always necessarily lead to harm, in this case, Mr. X was diagnosed with cancer and will ultimately die from this. Ethical Dilemma 3 Apply ethical and moral theories to a case study involving a patient and caregivers. Healthcare facilities are faced with decisions regarding ethical and moral theories on a day to day basis that involves patients and caregivers. Patients are given choices for medical treatment based on recommendations of our physician’s advice. This advice from our physicians comes from delivering quality patient care. Physicians undertook many years of medical training to deliver patient care. Torrey states medical treatment can be broken up into four categories: preventive, curative, management, and palliative. The Right to Refuse Treatment: A Model Act specifically states that any competent person has the right to refuse medical treatment. "The Act is designed to promote autonomy and respect for persons, by enhancing the individual's right to accept or reject medical treatments recommended by health care providers (The right to refuse treatment: a model act. (1983).” We have determined that anyone competent has the right to refuse their medical treatment. Under this act, by refusing medical treatment you are choosing what you consider to be the best outcome for yourself, even though ultimately it can have an unplanned or unfavored outcome. There are some exceptions when one has the right to refuse treatment. Those exceptions apply to individuals who are deemed not competent by a provider. Other examples of those that can’t refuse medical treatment are those who may have an altered mental status, children, and those who are a threat to our community (Torres). As we see in this case, Mr. X was never deemed not competent and thus had the right to make his own medical decisions. Our provider offered multiple chances for Mr. X to seek a follow-up appointment with a urologist. Ultimately, Mr. X waited until he was in severe pain and discomfort before following the physician’s advice and at that time was then diagnosed with renal cell carcinoma. Ethical Dilemma 4 Outline the ethical concerns and potential outcomes in a selected ethical dilemma. The ethical concerns we face in this case is if the physician delayed care. If the physician advised the patient, Mr. X, to go seek special evaluation in time this could have prevented his renal cell carcinoma diagnosis. Our concerns to be addressed are: Was Mr. X incompetent to make his own medical decisions? Does Mr. X have the right to refuse his medical treatment? Was our provider delaying care? What constitutes enough notifications or advisements when it comes to medical advising treatment? If our physician did not urge the patient, Mr. X, to see a urologist he would be considered negligent and would have failed to provide adequate medical treatment. Our physician urged Mr. X at his initial visit to see a urologist specialist about his flank pain and blood in his urine and he refused. He refused several more times after repeatedly being told by the physician to go seek help and was educated on the potential negative outcomes from delaying care. Despite all the education, Mr. X still declined until he reached severe pain and blood in his urine. Propose a solution to mitigate the issues raised in a selected ethical dilemma. Due to this being a consistent issue in the health care industry, we must have a solution to protect our physicians' license, our health care facility, and to help protect us from any further lawsuits concerning patient refusal to medical treatments. To solve this issue from happening again we must have our nursing staff, physicians, therapist, and every other healthcare team member on the same page about the importance of educating the patient on the specific benefits, treatments, and risks that are involved if they choose to not follow the treatment guidelines. Our providers must be keen on proper documentation of a patient's refusal of treatment. If the patient is still refusing treatment, our providers must try and understand what the patient's reasoning is for refusing treatment to see if there is a way to work with the patient to get 5 Ethical Dilemma said treatment. If allowed, speak with the patients’ family member(s) and educate on the said treatment and diagnoses to see if they can help convince the patient to continue with said treatment. Hopefully, with enough education and family encouragement, the patient will be encouraged to get treatment. However, if the patient still refuses medical treatment that is advised by our providers, the patient can sign a refusal of treatment form. A refusal of treatment form states the provider educated the patient on the diagnosis and treatment and the patient understands the risk(s) involved with refusing such treatment. Defend the solution from an ethical standpoint. The case was dismissed since the provider had adequately documented the patient's visits showing the recommendations to the patient to see a urologist for further workup of his pain and blood in his urine. We had outside expert physicians review the case and believed the physician had adequately informed the patient about the risk of refusing treatment. I also think that informing the patient several times, and even insisting he would make the referral for the patient is adequate to convince a patient to receive medical treatment. The patient is a competent 50year-old male and thus has the right to make his medical treatment. He chose not to go see a urologist despite being educated on the risk. I urge every healthcare provider to understand the importance of proper documentation and consistent education of our patient population to help prevent any further scenarios in which we have seen today. 6 Ethical Dilemma References: Norcal. “Medical Ethics and Physician-Patient Encounters: Case Studies and Best Practices.” NORCAL Group, www.norcal-group.com/library/medical-ethics-and-physicianpatient-encounters-case-studies-and-best-practices. Kessler D. P. (2011). Evaluating the medical malpractice system and options for reform. The journal of economic perspectives : a journal of the American Economic Association, 25(2), 93–110. https://doi.org/10.1257/jep.25.2.93 The right to refuse treatment: a model act. (1983). American journal of public health, 73(8), 918–921. https://doi.org/10.2105/ajph.73.8.918 “Right to Refuse Treatment.” Vermont Ethics Network, vtethicsnetwork.org/medical-ethics/rightto-refuse-treatment. Torrey, Trisha. “Do You Have the Right to Refuse Medical Treatment?” Verywell Health, Verywell Health, 22 Feb. 2020, www.verywellhealth.com/do-patients-have-the-right-torefuse-treatment-2614982. “When a Patient Refuses Treatment, What Should Doctors Do?” Columbia University Irving Medical Center, 24 May 2018, www.cuimc.columbia.edu/news/when-patient-refusestreatment-what-should-doctors-do Selde, William, MD. “Know When and How Your Patient Can Legally Refuse Care.” JEMS, 2 Sept. 2019, www.jems.com/2015/03/25/know-when-and-how-your-patient-can-legal/.