Exploring Ethical Dilemmas in Healthcare

Introduction:

NMC (2015) has described the ethical dilemmas as the issues that patients and their family members and the health and social care providers face regarding taking the right choice or right decision that will be appropriate to the current situation. Here the study is going to present a case study of an old man facing sever ethical and moral dilemmas regarding his autonomy, competence and consent. Here the study is going to discuss the ethical issues that are faced in the case study by the patient with demonstrating how these dilemmas impact on the overall mental and psychological wellbeing and the quality of life of the patient. This study is going to present different point of views and involvements of different stakeholders regarding managing the dilemmas described in the case study. Additionality, this study will present the ethical conflict that is raised due to the dilemmas in the case study. Then the study will describe how race, religion, gender, ethnicity and age impact the way people will respond to different ethical dilemmas. Finally, the study will present a suitable condition in which it will draw the important points of the entire discussion.

Case study:

Mr C, the 70 years old man suffers from long-term lung disorders and dementia. His 72-year-old wife takes care of him. He suffers from et frequent chest infection due to which he is recommended antibiotics by the doctors. He also frequently is under oxygen support at his home due to the severe lung infection that causes severe breathing difficulties. Recently his chest infection has been deteriorating which is not cured through the antibiotics thereby causing further deterioration of his physical and mental health. Due to this deteriorating health condition, he is unable to eat and drink sufficiently which impact on the health and wellbeing. Providing physiotherapy and intravenous antibiotics in the hospital setting can recover his health condition, but a similar infection can also affect him in the future. At this situation, his wife tries to convince him to go to the hospital as she thinks that hospital treatment can be more relevant as well as organised that can improve this health condition. As Mr C has the traumatic and negative past experiences of the hospital setting in which he faced severe mental distress he is not willing to go to the hospital. In this case study, Mr C faces severe ethical dilemmas regarding his autonomy, competence and consent. Here Mr C experiences moral dilemmas in a different context such as regarding providing consent to undertake the hospital treatment, his own choices of treatment and competence of the care providers in the hospital in meeting his heath needs.

The ethical issues in the case study that the dilemma raises:

NICE (2015) has mentioned that in case of delivery process care providers should follow the ethical aspects that are associated with providing the compassionate holistic care to patients such as respecting patient’s autonomy, taking their informed consent and respects their choices of treatment [NICE, 2015]. Here in the case study the first ethical issues that arise due to the dilemmas faced by Mt C is the protection of his rights and autonomy. Under NHS (2015), the first ethical aspects that the care providers need to implement is protecting as well as the respecting the personal choices, decision and autonomy of patients regarding the types of treatment they need [NHC, 2015]. In the case study, Mr C faces severe ethical dilemmas in the context of his autonomy and rights to take his preferred treatment settings, as his wife is not agreed with his choices of taking the treatment under the home setting. Under NICE (2015) Mr C has the rights to take the types of treatment he thinks would be better for his health and wellbeing and in this context, it is important that care provers, as well as a family member, need to support him to protect this right [NICE, 2015]. On the contrary Grosek et al. (2020) argued that in case of patients with mental and emotional disabilities, care providers face ethical and moral issues in terms of protecting patient’s autonomy and respect patient’s caregivers for treatment. In the case study, as Mr C suffers from dementia and severe ling infection, if care providers along with his wife go with his decision of taking the treatment at the home setting, it can deteriorate his overall physical health even can cause death due to hypoxia or breathlessness. On the other hand, if Mr C is unable to cope up with the hospital environment again like past years, it would also cause further deterioration of his overall mental and physical wellbeing which then interfere with moral and ethical principles of care providers. Th another potential ethical issues that are raised in the case study is the dilemma regarding informed consent from Mr C regarding his hospital admission. Under NMC (2015), while it comes to choose any types of care setting for service users, care providers must take the informed consent from the services users in terms of assuring that the services user has given the full consent regarding undertaking the hospital care [NMC, 2015]. Here in the case study, Mr C faces a severe ethical dilemma regarding whether he should provide his consent to the preference his wife to take the hospital treatment or he must go with his own choice for taking treatment at home setting. As mentioned by Jacobson et al. (2020), informed consent from the patient regarding treatment process is crucial to assure that the patient is aware of the overall treatment process and the care setting that is going to be implemented in his or her case and he or she is agreed with the criteria and condition of the process. Under NICE (2015), care professionals must ensure before starting the treatment process, that patient is intended to take the hospital treatment and no force has been applied on his or her the regarding hospital admission [NICE, 2015]. In this context, the ethical issues are that due to the current health condition of Mr C it is not possible for him to be cured without taking the hospital treatment because at the homes setting it is not possible to have the treatment process, care support and all-times guidance of the physicians and health staff that he desperately needs to be cured of the deteriorating physical health. On the other hand without the consent as well as legal permission of Mr C, his wife cannot provide him with the modern as well as highly organized care that can only be available in the hospital setting, which raises severe ethical issues regarding the informed consent from Mr C for his hospital admission. Another potential ethical dilemma or issue that is raised in the case study is the question on the competence level of the care providers in the hospital in terms of providing the holistic care to Mr C. Under the NMC (2015) code ‘preserving safety’ nursing and health professionals must ensure that they work under their level of competence and professional knowledge in terms of ensuring the high level of safety to patients throughout the care of patients and management of their symptoms [NMC, 2015]. In the case study, the ethical issue is that whether the decision of taking care in the hospital setting is proved to be highly effective for Mr C or his fear of not coping with the hospital environment will come true that will not only interfere with the professional integrity and accountability of care providers but also cause severe mental distress in Mr C. In this context, the ethical issues are concerned with the fact that how much competence, as well as efficient, are the care providers are in the hospital who can improve the overall health condition of Mr C.

Involvement of different stakeholders relating to the dilemmas and how they view the dilemma:

NHS (2015) has described that in a care framework many stakeholders are associated who performed their specific and individual roles in terms of managing the health condition of patients. In the case study, the ethical dilemmas that Mr C face are viewed by different stakeholders in different ways. As mentioned by Menon and Padhy (2020), stakeholders who are involved in managing and dealing with ethical dilemmas of patients are nurses, health and social care providers, doctors, psychotherapist, family members and public. Here the important stakeholders in the case study Mr C's wife, who has opposite views and perspectives towards the ethical dilemmas faced by Mr C. Based on the perspectives of Mr C’s wife presented in the case study it is seen that she views the rights and autonomy of Mr C as a services user as the potential barriers that develops psychological constraints in this mind regarding taking the hospital admissions. NHS (2018) has mentioned that as different stakeholders in a care framework have different psychology and perceptions, they will see a same ethical dilemma in a different angle and will respond to the dilemma differently [NHS, 2018]. In the case study, Mr C’s wife views his dilemma regarding protecting his autonomy and choice for treatment is highly irrelevant to his current deteriorating health condition in which he needs immediate and well-organised treatment process with specialized medicines and effective care regime in the hospital rather than undertaking the poor care process at the home setting. NMC (2015) has mentioned that, although the stakeholders who are involved in providing care and treatment to patients view the ethical dilemmas faced by patients differently, they must ensure that they will provide the better solution to these dilemmas rather than increasing the intensity of the dilemma for the patient [NMC, 2015]. For care providers such as nurses, doctors and health care staffs will view the dilemmas of Mr C regarding his consent to treatment in the hospital setting as the major ethical issue based on which his chances of being cured and health is dependent. Here care providers along with the wife of Mr C always view the dilemmas of Mr C regarding his informed consent regarding the hospital treatment as the source of negative and pessimistic thought that will discourage Mr C to take the highly effective and well-organised care regime in the hospital settings. As mentioned by Haahr et al. (2020), many times the difference of stakeholders’ viewpoint regarding the ethical dilemmas create high-level conflict among the care provider and services users that interfere with the overall care outcomes. In the case study, all stakeholder who is involved in case process of Mr C such as his wife, hospital staffs such as care manager, health and social care staffs, doctors and nurses will disagree and oppose the decision and views of Mr C regarding taking the treatment in a hospital setting based on the views of this stakeholder, Mr C must choose the option of hospital treatment over the treatment in the home-setting because the health condition that he currently has can only be cured in a well-organised and multidimensional care regimes in the hospital.

Discussion on the conflicts that are developed due to the ethical issues in the case study:

Different types of conflicts as well as ethical arguments can arise due to the ethical dilemmas in the case study. One of the potential ethical arguments may arise between Mr C and his wife regarding his informed consent to his hospital admission for receiving effective treatment to get rid of current heat issues. Here the perspectives and visualisation regarding the ethics and moral value for both of them are different as Mr C views his informed consent to hospital treatment as interference to his autonomy and freedom. On the contrary, the wife of Mr C thinks that his informed consent is highly important for providing him with immediate hospital treatment that is the only way to improve his current health condition. Under NICE (2015), ethical arguments or conflict between them the care providers and service users must be managed in such a way that will not hamper the overall care ethics and principles. [NICE, 2015]. In the case study, potential conflict may arise between the care providers and Mr C due to his dilemma regarding the competence of services providers to meet his current health needs. Under NMC (2015), nurses and health professionals must be aware of their professional rights and limitations in terms of ensuring that that they provide their best effort to deliver highly safe and compassionate care to patients [NMC, 2015]. In the case study as Mr C faces a dilemma regarding the competence of care providers as he lacks faith and assurance on the ability as well as efficiently of the care providers to provide him with a safe, positive and supportive care environment which can create the opinion mismatch and ethical conflict between the care provides and the Mr C if he is admitted in the hospital. Additionally, if Mr C is convinced by his wife to take hospital admission, then also there is chances of ethical conflict between Mr C and care providers as he may show lack of cooperation and poor coping skill in the hospital environment that can cause an interruption in overall care delivery process (Peluso et al. 2018). Due to the ethical dilemmas experienced by Mr C regarding his autonomy and rights of choosing his preferred treatment, there may arise potential conflicts between Mr C and his wife. Here the ethical dilemma will arise due to contradictory mode of moral values and principles of Mr C and his wife, in which on the contrary to the perspective of Mr C, his wife believes the dilemmas of Mr C regarding his autonomy and rights pose bars on his chances of taking highly effective and organise treatment process that is only possible in the hospital setting. Therefore, there may arise ethical arguments between them regarding whether Mr C’s autonomy will be protected and respected by providing him care at the home setting or he will be convinced to go for the hospital stay to receive the better treatment.

How race, religion, gender, ethnicity and age impact the way people will respond to different ethical dilemmas:

As mentioned by Robert et al. (2020), there are many factors such as race, religion, ethnicity, gender and age that influence the ethical behaviour of people. People belonging to a diverse society, ethnic group and communities have different knowledge, decision, perspectives and moral values that impact their way to view as well as respond to the ethical dilemmas. In the given case study, the dilemmas faced by Mr C would be viewed and dealt differently by the other people in the society with different moral principles, values and perspectives. As mentioned by Rainer et al. (2018), ethnicity, age and race develop diverse ethical behaviour, moral values, reasoning ability and judgemental approaches in people which makes them view one's ethical dilemmas differently. For example, as the wife of Mr C is two years older than him, she has experienced as well as feel the up and downs of life more deeply than Mr C which makes her more practical and realistic towards the life. This is why she views the ethical dilemmas faced by Mr C such as the dilemmas regarding the autonomy, competence and consent as the bad choices or negative vibes would pose barriers o convincing Mr C regarding his hospital admission. As mentioned by Neves et al. (2020), cultural norms, social perspectives, family environment and the situational opportunities provide people with freedom of choices that lead them to choose the wrong decision. While viewing the dilemmas from the perspectives and viewpoint of the other stakeholders which are involved in the case of Mr C such as nurses, carers, health and social care staffs, it can be stated that they will see the dilemma of Mr C regarding his autonomy and consent to the hospital treatment is baseless and wrong perspectives of Mr C that interfere with his health and wellbeing. Based on the moral values, principles and ethical behaviour of the care providers they will favour the decision of taking hospital treatment for Mr C as his current health condition cannot be cured through the mere care regimes at the home setting. In addition to this, the wife and Mr C and the care providers have different ethical principles and the moral decision which is opposite to that of the Mr C, in which they are more intended to provide hospital treatment to Mr C.

Application of relevant laws and codes of conduct in terms of managing the dilemmas and providing moral solutions:

NMC (2015), has mentioned that, while it comes to deal with ethical dilemmas of patients as well as of care providers they must work under their professional boundaries and follow and implement the professional conduct [NMC, 2015]. Here in case of Mr C, all the stakeholders who are involved in his care such as his wife and other care providers must ensure that they must not compromise with the care ethics and Codes of Conducts set by NMC (2015) while managing the ethical dilemmas. Under NICE (2018), before starting the treatment care providers must take the informed consent from the patients which will ensure that patients voluntarily take the decision of undertaking the hospital treatment [NICE, 2018]. Here in the case study of Mr C, his dilemmas regarding his ethical consent can be managed by conducting effective communication with him in which community nurses and health and social care staffs will make him understand about the importance of hospital treatment for his current health condition. Under NMC (2015), while it comes to patient’s autonomy, care providers must respect the decision and choices for treatment of the patients. In the case study, Mr C's dilemma regarding his autonomy can be managed by providing the moral solution in which his wife and the other care provides can provide him with the assurance to respect all his decisions, choices and needs at the hospital setting and provide him with the care environment that he expects from the care providers. Under NMC (2015) codes “preserving safety”, care providers must have a high level of competence and professional abilities that will ensure safe and high-quality care to patients [NMC 2015]. In the case study, nurses and family doctors of Mr C can make him understand about the recent modernisation in the care process, innovative treatment techniques and highly skilled care staffs at the hospital who would provide the best-suited care to Mr C that will improvise his physical and mental health and his quality of life.

Conclusion:

From the above-mentioned discussion, it can be concluded that ethical dilemma is the situation in which people face difficulties in selecting the right decision that will not inter with the moral and ethical values. For different people, group and communities the viewpoint towards a specific dilemma are different. Race, age, gender, ethnicity and religion impact on the decision, moral values and ethical behaviour of people that influence the way they deal with the ethical and moral dilemmas. Moreover, it can be stated that stakeholders such as carers, patients, health and social care staffs, family member and the public need to ensure that the care ethics and codes of conducts care followed as well as implemented throughout the care delivery process while dealing with ethical dilemmas of patients.

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