Navigating Ethical Dilemmas in Medical Practice

Introduction

In this essay, a case study will be used in the discussion an ethical dilemma and the issues brought about by the dilemma. It will take consideration of the different people involved in the dilemma and how each of them are likely to perceive the problem at hand, as well as explain why they are likely to take particular perspectives. It will also consider the potential conflicts and points of agreement in terms of the ethical arguments that will be provided. Eventually, a conclusion will be provided, that describes the manner in which there can exist conflict between professional conduct and ethical situations which result in a difficult dilemma.

The Persons Act 1861 considers abortion as a criminal offense. However, following a decade of political struggle, in 1967, the Abortion Act was conceived and it set out guidelines and requirements for registered health practitioners in commissioning and providing for the termination of pregnancy (Sheldon, et al., 2018). The Act was deemed necessary at the peak time of sexual revolution and the need for liberalizing legislation. The Acts is also lauded as a prime event in women’s liberation. In the 20th century, it is considered as one of the most farsighted, most humane, and finest legislation pieces to ever been drafted. Critique to the Act laud it as a transgression against the foundation of existence of morality. More than fifty years after its accentuation, the Act is one of the oldest law statutes that govern medical practice in the present day.

According to the General Medical Council (GMP), it has been clarified as Good Medical Practice when doctors remain individually accountable for their medical practice and should be in a position to justify their actions and decisions, by demonstrating that their opinions were (British Medical Association, 2014) formed in good faith . In certain cases, doctors, after carefully considering every variable in an underlying situation, would recommend that a patient acquires a medical abortion. Although, attuning to its criticism as a moral practice, some patients may disagree with doctors.

Case Scenario

At 37 years of age, Mrs K has four children. She has been having irregular periods over the recent days therefore, she decides to acquire consultation from the doctor. All along, she has been using diaphragm as a form of contraception and this was after she halted using birth control pills due to the side effects that they had on herself. Following the doctor’s visit, she learns that she is pregnant. Mrs K does not want to have any more children and she claims that she already has enough children to cope with. Eventually, Mrs K develops serious depression. After considering the circumstances to fall within the Abortion Act of 1967, the doctor refers Mrs K to a clinic. Mrs K does not agree with abortion, and the ethical dilemma which develops here is whether the doctor did the right thing or not to make the reference.

Utilitarianism

This is an ethical approach which is concerned with the promotion of balance between the provision of the greatest level of value or good in the society and minimizing to the lowest possible level the resulting harm. In the case provided above, the doctor considered the situation and assumed that the greatest good would be to refer Mrs K to a clinic for the purpose of abortion. The level of harm in the scenario was that Mrs K would be in deep depression and that she would not be in a good position to raise another child. Already, Mrs K has four children and an extra child, as the doctor must have gauged, would have been extra baggage to her life. Probably the quality of Mrs K’s life would have decline following the birth of another child.

According to the Utilitarianism theory, priority is placed on people’s welfare and the ability to ensure that their pleasure is maximized. The assessment of the ethical outcomes of people’s actions is impractical, although, there are ethical guidelines which can consider the overall results of particular actions (Lawrence, 2017). In addition, the consequentialism principle holds that it would be wrong to defer the truth due to the negative consequences it brings about. Therefore, each isolated case needs to be gauged differently (O’Sullivan, 2009). The overall idea is that when a person’s happiness is promoted, the actions that result in that happiness are correct, so long as, eventually, they also result in removal of pain. The professional codes of conduct standards bear these standards. However, being correct is not all about performing actions which are good and right alone.

The Abortion Act 1967 legalizes abortion from a medical practitioner, who can remain accountable for her decision. The question which rises from this scenario is whether the doctor was right to refer Mrs K to an abortion clinic or not. The doctor is in compromising position because her professional conduct would deem her decision to be correct, but morality would judge her actions as wrong. The major dilemma lies in whether the doctor needs to consider letting Mrs K remain in the agony of deep depression and having to bear a fifth, whom she will not be able to cope with, or let her go through an abortion, which would be perceived as wrong from the lens of morality.

The Ethical Dilemma

According to Harnic, Spross and Hanson (2000), an ethical dilemma involves making a choice between two courses of actions which are both morally acceptable in the event when one choice prevents the selection of the other and the need to make a choice between alternatives which are equally unacceptable.

The Doctor encounters the challenge to choose between events which are mutually exclusive. It remains highly debatable whether the doctor ought to let Mrs K proceed with life in a depressive state and have a fifth child. In addition, it remains highly questionable whether the doctor needs to stick to the Code of Practice by referring Mrs K to an abortion clinic. Consider that, the Code of Ethics for Nurses (NMC, 2014, 2018) makes it clear that “nursing care is directed toward meeting the comprehensive needs of patients and their families across the continuum of care,” in addition, “promoting, advocating for, and striving to protect the health, safety, and the rights of the patient.” Despite the fact that Mrs K is the one who does not agree with abortion, the doctor remains entangled in the dilemma. What remains factual is that the Doctor is responsible for being honest, working according to the policy guidelines and legislation and following the Code of ethics, together with the policy of the medical institution in delivery of medical recommendations and treatment (Lawrence, 2007).

Respect for Autonomy

Autonomy involves the making of a personal action or decision freely, away from influence or manipulation from other people. A patient is thought to have complete understanding in the case where they can make sound reasoning. In the case study above, it remains clear that Mrs K retains her right to make a health decision without being influenced by the doctor. The autonomy principle holds that the wishes of a patient ought to be granted respect (O’Sullivan, 2009). In addition, the biomedical ethics principle starts with an autonomous conversation. Also, with added significance, Beauchamp & Childress (2001) recommend that the presentation order does not suggest that this principle bears priority over every other principle. The criticism of the respect for autonomy principle has the effect of overriding every other moral consideration. The ground of this argument can be disputed by claiming that autonomy refers to an individual choice being made without any form of manipulation so that the patient can end up making a significant decision with the proper degree of understanding that they have (Beauchamp & Childress, 2001). Mrs K has all the rights to defer abortion and she ought to have been given the freedom to make a decision about what to do now that she is about to have a fifth child and is likely to have deep depression. Also, of concern is that Mrs K possess the right mental capacity which guarantees her competence in making the correct decisions for herself.

Beneficence

This principle holds that ethics is relative to the moral principles and it considers the actions of a person. Its argument is that is a medical practitioner’s action results in the patient’s good, the action or decision is good as it is. Related to this theory is that medical practitioners have the obligation to offer protection to their patients from any kind of harm and keeping them away from situations which would result in their harm. The non-maleficence principle, contrary to beneficence, states that medical practitioners do not have the authorization to bring about harm to a patient (Hodkinson, 2008).

Medical practitioners, in general, are required to promote harmless situations to their patients. Of great significance is that medical professionals always perceive patients as a whole person and provide care to them in consideration of their long-term welfare. The concern of the patient’s ability to do well offers great criticism to the definition of the beneficence principle. There is a great debate concerning the meaning of “doing good for a patient” (American Nurses Association, 2005). For example, there are chances that doing good for a certain patient would result in their death, and the action of doing good for another patient would be letting them go through a difficult and painful process of surgery that would correct a deficiency that they have, thus lengthening and improving the quality of their life. Prior to making an action of beneficence, medical professionals ought to consider the needs and wants of a patient so that they can make their lives better.

The dilemma presented in the case above concerns the well being of Mrs K. The beneficence principle holds that doctors need to make sure that patient safety is highly prioritized so that they can prevent them from getting harmed. This brings the suggestion that there is need for respect for a patient’s right to autonomy and dignity. It is evident in the scenario that the doctor failed to consider beneficence because he or she failed to discuss with Mrs K about the options which are underlying. If Mrs K had had a discussion with the doctor concerning the options available to result in a better life for her, the doctor would not have ended up in a dilemma. By discussing the options, it would be possible to reach a final ground which would eventually minimize Mrs K’s depression and allow her to cope up with a new baby just fine, instead of leading her to go against her moral standings.

Non-Maleficence

This concept, on the contrary, refers to concealing the truth from an individual. The non-maleficence principle related to the case study presented above in the manner that allowing Mrs K to proceed without abortion would have tragic implications on her mental health and the welfare of her family. She already made it clear that she cannot cope with another child because she has four of them at the present time. Therefore, the action of the doctor, by keeping Mrs K away from the truth would prevent her from acquiring harm and enhance her care. The veracity principle puts stress on the need to tell the truth and providing the correct information to a patient. When a doctor follows this principle with high level of strictness, they would have to ignore the feelings and concerns of the patient and the family (Lawrence, 2007).

It needs to be understood that, if the doctor anticipated the psychological trauma of telling Mrs K the reality (due to her four children and mental health) would be higher than the final harm, the doctor would not have referred her to an abortion clinic. In such a scenario, a medical practitioner needs to be intelligent enough to create a balance between the net harm and the net benefit. Thus, doctors, and any other medical practitioners, need to be analytical and reflective when making certain decisions for their patients.

Justice

In every medical decision made, there needs to be at least a certain degree of the element of fairness. This means that fairness needs to be present whether a decision may result in a terminal burden or benefit. New treatments and scarce resources need to be distributed equally, and applicable legislation and laws need to be upheld by every medical practitioner when making decisions (Saint Jospeh's University, 2019).

According to Summers (2018), the knowledge that something is unjust means that it is morally wrong. A medical practitioner needs to consider which facts result in an action which is unjust, rather than being simply regarded as wrong. For example, the doctor in the case presented would consider the facts concerning the patient and the general situation, to identify what would be unjust to her welfare, rather than being simply wrong. Injustice happens when cases of equal weight are not granted similar treatment. The patient’s perspective, as well as that of the doctor bear similar weight, and in the case presented, there is a degree of unfairness because the doctor only considers their perspective of what is best for Mrs K, and eventually she ends up in a moral dilemma when she realizes that she failed to consider Mrs K’s perspective on the course of action of abortion.

Furthermore, there exist material reasons for discrimination; whereby the equal share of benefits and burdens is overlooked due to material reason (Summmers, 2018). There are two divergent reasons as to why discrimination would occur; first, because the patient needs it; second, because the patient deserves it. When looking at the case presented. The doctor makes a decision for the patient, which seems discriminative. On analysis it can be taken that the doctor made this discrimination because she believed that the patient needs it rather than deserving it. However, since there lacks a form of discussion between both parties to determine whether Mrs K actually needs or deserves abortion, it can be ultimately be considered that justice was overlooked, which contributes to the ethical dilemma.

Context Analysis

In this section, Beauchamp’s & Childress’ (1991) principles will be used in making the discussion about actions that medical practitioners ought to take when deciding what their patients needs to do. Full knowledge of the process of making decisions by medical professionals is reflected by the four principles of beneficence, justice, non-maleficence, and autonomy. According to Gardiner (2003), every ethical principle needs to influence a person’s course of action. It is possible to take the reasoning that the doctor thought that if Mrs K was to proceed with the pregnancy, she would end up with mental and psychological problems. Therefore, the doctor thought to make a final decision that would protect her from this kind of harm.

Through carefully considering the four principles, conflicting values become evident. For instance, due to the healthy and emotional connections which develop between a medical practitioner and a patient, it would be difficult for a doctor to tell the patient the truth in situations where keeping a secret from the patient would be necessary in protecting her from harm that they are unaware of. To add, medical professionals have the obligation to work under the policies and guidelines as stipulated by the healthcare organization they work under. Doctors are also required to provide patients with every medical information that is pertinent to them, and these include plans of treatment, diagnoses, and the results of their diagnoses, irrespective of whether they are positive or negative. In respect to this knowledge Mrs K’s doctor ought to have followed the codes of ethics so as to uphold the patient’s right to autonomous decision making.

The American Nurses Association (2005) points out that in the nurses’ code of ethics, nurses can provide services while respecting the uniqueness between people and human dignity of the client, without any form of discrimination of the economic and social status, personal phenotypical features and the type of their health problem. Mrs K’s dignity and right to make a choice ought to have been respected by giving her several options that exist beyond abortion alone. This gesture would have illustrated that effort was made to justify the rights of Mrs K, while pacing value to the wishes she would have concerning her situation.

Conclusion

This case study reveals that patients possess every right to dignity and autonomy. In the face of making decisions which are important to their lives, their perspectives and choices ought to be received with a high level of respect, since it will result in their well-being. The revelation of the truth about outcomes of certain medical interventions need to be revealed to patients. Also, when providing treatment interventions to patients, doctors are usually faced with numerous and massive ethical dilemmas. Since medical practitioners are at the forefront of providing care to patients in hospitals, they should remain committed towards providing the correct and accurate information to patients.

Medical practitioners need to uphold the truth at all costs, even though there is some negativity associated with it. Even after delivering negative information to the patients, doctors ought to remain in support of them as well as their families. It would be ideal for a medical practitioner to tell the truth in a sensitive and timely fashion since telling lies would affect the doctor-patient relationship adversely, worse than revealing th truth in a careless fashion. In cases where truthfulness is overlooked in daily communication between medical professionals, the patients and their families, the overall relationship would end up in jeopardy.

Keeping Mrs K informed about the reason for opting for abortion over letting her remain with an extra child would have given her a clear understanding as to why she would have to consider the doctor’s option and let go of her moral belief against the act of abortion. The Abortion Act 1967 has been in place for an average of 50 years, and Mrs K is 34 years, therefore it is understandable that Mrs K may not be in terms or up to date with new policies which are associated with modern medicine and medical professional ethics. The doctor would have taken another course of action, instead of settling for abortion, which placed her in a moral dilemma.

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References

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British Medical Association, 2014. The Law and Ethics of Abortion. BMA Views.

Gardiner, P. (2003). A virtue ethics approach to moral dilemmas in medicine. Journal of Medical Ethics, 29(5), pp.297-302.

Hodkinson, K. (2008). How should a nurse approach truth-telling? A virtue ethics perspective. Nursing Philosophy, 9(4), pp.248-256.

Lawrence, D. (2007). The Four Principles of Biomedical Ethics: A Foundation for Current Bioethical Debate. Journal of Chiropractic Humanities, 14, pp.34-40

Sheldon, S., Davis, G., O'Neill, J. & Parker, C., 2018. The Abortion Act (1967): a biography. Legal Studies, pp. 1-18.

Summmers, J., 2018. Principles of Helathcare Ethics. In: Healthcare Ethics. s.l.:Jones & Bartlett Learning, pp. 47-63.

The American Nurses Association, Inc. (2005) Code of Ethics for Nurses with Interpretive Statements

O’Sullivan, E. (2009). Withholding truth from patients. Nursing Standard, 23(48), pp.35-40.