hcs335_v10_wk5_case_study_recommendation_example

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335 ENTIRE

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Philosophy

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Jan 9, 2024

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Health Care Ethics Recommendation Example This is an example of the responses and recommendation based on a health care ethical concern. The case study is different so that you may perform your own evaluation. Ethics Committee Case Study You are the manager of the medical-surgical unit of a medium-sized hospital in the Mid-Atlantic region of the United States. Today, the ethics committee has an interesting case that is brought by a patient s physician, Dr. Emily Goodheart. Dr. � Goodheart is a well-respected geriatrician in good standing with the hospital system. Her patient is a 74-year-old gentleman who was in otherwise good health until two weeks ago when he tripped while walking and a rusty nail perforated his shoe and lacerated his foot. He continued his walk and rinsed the wound himself at home. Unfortunately, his foot began swell and he sought care three days later. By that time, gangrene was well established as well as blood poisoning from the wound. Despite Mr. Crus previous good health for his age, he quickly deteriorated and is � now unconscious. He needs to have a below the knee amputation to save his life. The reason for the ethics committee meeting is that the nephew claims that his uncle told him that he would not want to live if he ever had to have a leg amputated. Therefore, the nephew wants to allow his uncle to die. Dr. Goodheart objects. Her patient has not left an advance directive to this effect, nor had he mentioned any objection to treatment while he was conscious. To be sure, the possibility of amputation had not yet been discussed with Mr. Crus before he became unconscious, but his chances for a full recovery are excellent. Mr. Crus is a man of great wealth, is a widower, and has no family except for his one nephew, Mr. A. Varice who is Mr. Crus heir. Mr. A. Varice is also present at � the ethics committee meeting. Explain Mr. Crus rights in this case. � Legal rights equal rights justified by legal principles and rules while moral rights equal claims justified by moral principles and rules. Therefore, a right is a justified claim or entitlement, validated by moral principles and rules (Compare & Hart, 1973). Someone who has rights does not need to assert their rights to have them (e.g., young children, comatose patients, patients with intellectual disabilities). Therefore, in this case, Mr. Crus, even though he cannot state his rights due to his comatose state, still has rights. His rights extend to those of any patient within this specific hospital under their patient s bill of rights as well as those covered by state and federal law. More � specifically, he has the right to life, liberty, and the pursuit of happiness. Because he is in the hospital, he has the right to medical care. Identify the major stakeholders in the case. The major stakeholders in this case are Mr. Crus, his nephew, Dr. Goodheart, the hospital organization, the nursing staff, and the attorney for Mr. Crus. Mr. Crus certainly is at the center of the case. His life and well-being are at stake. Did he or did he not say he would rather die than have a leg amputated? We only have � � his nephew s word for this statement. His nephew, his only heir to a large fortune, � is hardly unbiased. If his uncle dies, he inherits a large amount of money. Can we attribute such a negative motive to this man? Could he really have his uncle s � well-being at heart? Dr. Goodheart truly believes that her patient can recover and live an active life after the surgery. She has seen his previous medical records and was impressed with his excellent health before this accident. In her expert medical opinion, there is no medical reason for this man to be left to die needlessly. She thinks that if he, indeed, is upset or depressed after surgery, it is to be expected. Dr. Goodheart believes that with proper mental health counseling Mr. Crus can come to accept his amputee status and go on to have an excellent quality of life. Mr. Crus attorney affirms that Mr. Crus does not have an advance directive to give � guidance in this matter. He admits that under the law, this is not a clear choice because Mr. Crus, although unconscious, is not brain dead and has a chance to wake up and a chance (with surgery) to live. A representative from the nursing staff reports that Mr. Crus has been a pleasure

to care for in that he is not demanding. When he slipped into a coma, the nurses have made sure to talk to him and play music for him because they know that there are some studies that have shown that people in comas still hear what is going on around them. The manager of the floor reported that so far, the staffing has been up to par so that Mr. Crus has received excellent care from all specialties. In addition, although he is on Medicare, he has sufficient funds and has been able to have his accountants pay all the bills that Medicare does not pay. Therefore, there is no drain on hospital financial resources because of his admission. Identify the ultimate decisions makers (i.e., medical team, family, etc.). Because the ethics committee will only offer advice, the committee will not be an ultimate decision-maker. The ultimate decision-maker in this case will rest with the next of kin, the nephew. However, because of what is seen as a conflict of interest (his desire to decline surgery, which would kill his uncle and leave him enriched), as well as contradictory advice from the attending physician, Dr. Goodheart and the attorney for Mr. Crus may also be seen as playing a large role as ultimate decision-makers, especially if this goes to court. Describe the ethical theories or principles that pertain to the case. Kant s theory of ethics, known as Deontology, centers on duty. In this case, we see � many people who feel a duty to perform or have a duty of care, thus are using Deontology (MacKinnon & Fiala, 2018). First, the nephew may be acting out of familial duty to uphold his uncle s spoken wish to him. The doctor, who has taken � an oath to protect her patients, feels duty-bound to make sure that Mr. Crus receives the best medical care possible. The nursing staff also have a duty of care in their professional capacity to give the best possible nursing care to their patient. The patient s lawyer has a fiduciary duty to his client. � The principle of beneficence can be applied to the physician in this case. Beneficence states that healthcare practitioners have the duty to promote the � health and welfare of the patient above other considerations, while attending and honoring the patient s personal autonomy. (Edge & Groves, 2006, p.65) Dr. � � Goodheart uses this principle when she advocates to perform an amputation on Mr. Crus to restore him to health. Analyze your role as a health care manager in this ethics committee decision. The role of a health care manager brings the perspective of two cultures in the organization: that of the staff and that of the C-suite. This is because the manager is strategically positioned between these two important parts of the institution. The manager knows the needs of her staff. She also knows the needs of the organization at a deeper level than does the regular staff member. With such knowledge, the manager strides both worlds and can contribute to the ethics committee with valuable information from these varied perspectives. Because the ethics committee offers advice only in a situation, the experience the health care manager has developed with decision-making is valuable. She has experience in areas of providing confidential feedback in a manner that respect the person. As a leader in the hospital, a term serving on the ethics committee allows the health care manager to understand how ethical issues are deeply involved in the workings of the organization. It takes an understanding of ethical theories, principles, and values to gain a greater respect for the role of not only the ethics committee member, but also of a health care professional. To sum it up, the health care manager is present to make sure that respect for persons is always maintained during the meeting.

Based on your review of the case and the fact that the doctor and the nephew are not in agreement, state your recommendation to the committee for next steps. My recommendation, based on what has been presented in this meeting, is that the patient, Mr. Crus, should have the surgery. I believe that there is not enough evidence that he wants to die just because he needs his leg amputated based on what his nephew claims he was told. If Mr. Crus had left an advance directive as to what to do if he were unable to speak for himself, this would be a different matter, but he did not. I am suspicious that the nephew has an ulterior motive because he is the sole heir to his uncle s sizable estate. Although this may not be true, it does � need to be kept in mind when considering the case. If the nephew insists on his protestations about the surgery, then my advice is to seek a court order for the surgery. We would be better to err on the side of life than not. Therefore, my advice is for the surgery to take place.

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References Compare, H. L. & Hart, A. Bentham on Legal Right, in Oxford Essays in � � Jurisprudence, 2nd Series. Ed. A. W. B. Dimpson (Oxford: Oxford University Press, 1973), pp. 171-98. Edge, Raymond S. & Groves, John Randall Ethics of Health Care: A Guide for � Clinical Practice � (3rd ed., p. 65). MacKinnon, B. & Fiala, A. (2018). Natural Law and Human Rights. In Ethics: Theory and Contemporary Issues (9th ed., p. 250). Cenveo PublisherServices. � https://bibliu.com/app/#/view/books/9781337467926/epub/OEBPS/13_9781305958678_Chapt er7.html#page_250

hcs335_v10_wk5_case_study_recommendation_example

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