Part 1 –Week one
Description of some administrative/ organizations’ challenges managers must consider when looking to solve ethical problems.
Three major ethical dilemmas health care administrative/ organizations managers’ face include conflicts of interest; the professional obligation to provide appropriate medical care in relation to management costs and patient autonomy. Conflicts of interest emerge within the boundaries of financial obligations to co-providers such as pharmacies; medical equipment companies and academic research programs. Real conflicts arise when physicians order equipment/ drugs or encourage patients to engage in certain research practices and hospital administration in the capacity of health care institution manager may have to deny such requests (Darr, 2011).
If the manager/administrator is not an advanced nurse then serious professional criticisms can be filtered to attack the administrator’s integrity to deny such requests. Ethically whatever decisions are ultimately made must be in the best interest of the patients concerned. Here is where the administrator is challenged to uphold integrity of every patient seeking service in that institution in avoiding them from paying for services which were not needed (Hughes, 2012).
Precisely, financial obligations to meet targets and goals within the organizations create budget cuts, which affect the quality of care patients receive. For example, budget cut could mean that an intensive care unit nurse/patient ratio adjustments and measures taken to have patients on life support reduced or removed. These serious ethical issues challenge health care managers’ decision making process daily. Similarly at the center of these decisions are patients who have been tax payers all their lives along with being worthy citizens. Due to health care costs quality of care rendered to them is greatly minimized. Meanwhile patients’ autonomy must be respected regardless of whether physicians, family members or health care institution managers agree (Darr, 2011).
References
Darr, K. (2011). Ethics in Health Services Management. (5th Edition). Baltimore, MD: Health
Professions Press, Inc.
Hughes, J. (2012). 3 common ethical dilemmas health administrators face. University of
Phoenix. Retrieved on December, 10th 2013 from http://www.phoenix.edu/forward/perspectives/2012/03/3-common-ethical-dilemmas-health-administrators-face.html
Part 2 - Week one
Baby boy Doe
Baby boy Doe’s account offered by Darr (2011) interprets the case of a baby boy born in 1982 with downs syndrome. The infant died 6 days after birth due to dehydration. Apart from the downs syndrome abnormality congenital esophageal atresia with tracheoesophageal fistula were also present. These were the conditions leading to the death of the infant. Dr. C. Everett Koop was the surgeon general at the time and he advanced the theory that the infant was denied treatment mainly food and water because the parents refused to allow surgeon for the infant. He further contended that because the child was intellectually incapable of making decisions parents took advantage of the situation allowing ther child to die instead of risking surgery. Many such surgeries were performed by this surgeon before and he was convinced that the child would have survived had the repair been performed (Darr, 2011).
For the surgeon general this was a real ethical dilemma since even though he knew the benefits of surgery for the child autonomy of the parents had to be respected and herein lays the rue dilemma. How could he have superseded the parent’s rights and performed surgery without the legal authorization. The only recourse at that point was moving to the court filing an injunction, which would allow him to perform the surgery to save the child’s life (Moss, 1987).
Consequently, measures were taken to protect infants through passage of the Baby Doe Law mandating states that obtain federal money for child abuse programs establish procedures to report medical neglect. In this case there was not medical neglect. The surgeon general was entangled in ethical and moral dilemmas. There was nothing that could have been done at the time apart from seeking help through the court. This was not pursues. Maybe the infant died too soon for this avenue to be explored (Darr, 1993).
Specifically, this law defines that withholding treatment except an infant is irreversibly comatose whereby at that point in time treatment is useless is a moral/ethical violation. As such, evaluation regarding the quality of life at the time and after surgery must be considered if testament is withheld. Valid reasons must be established before treatment is deliberately withheld. Therefore, the Baby Doe Law or its Amendment is related to aspect of the child abuse law in America passed in 1984 (Darr, 1993).
Rigid guidelines have been set from regarding treatment of disabled children irrespective of their parents’ wishes once the states obtains funding from the federal .It would appear that the surgeon general did not consider nonmaleficience. Therefore, the approach was one of beneficence since the hospital did not pursue any other measures to have surgery performed. The hospital acted in a just way from the perspective of autonomy, but morally unfair to the infant who could not make a decision for himself (Darr, 1993).
References
Darr, K. (2011). Ethics in Health Services Management. (5th Edition). Baltimore, MD: Health
Professions Press, Inc.
Darr, K. (1993).Patient Centered Ethics for Health Service Managers. Journal of Health and
Human Resources Administration, 16(2); 197-216
Moss, K. (1987). The 'Baby Doe' Legislation: Its Rise and Fall. Policy Studies Journal 15 (4), 629–651.
Do you think that the hospital did all that it could in this situation?
Did it act appropriately?
No! I do not think the hospital did all it could.as was mentioned earlier it is my opinion that the administration could have moved to the court to have the matte resolved. Reflecting on measures the hospital authorities could have taken is to use Karen Ann Quinlan’s case. She was not a child, but an adult who could not have made a decision for herself. There was no living will or any form of advanced directives (Quinlan, 2005).
When her parents requested that she be pulled off the ventilator and allowed to die physicians refused to grant their wishes because they felt it was unethical and morally inappropriate and legal battles ensued as her parent took hospital authorities to court. Even though eventually the parent’s desires petitions were granted by the court in my opinion the hospital did their best to preserve a patient’s life. When the ventilator was removed the patient lived some seven years after and nurses as well as doctors did not withhold treatment even though they could have (Quinlan, 2005).
Baby boy Doe was born years after this incident and the same beneficence could have been executed by hospital authorities. The surgeon general was sure that the infant would have survived and still withheld treatment because the parents did not give consent. All that is required of beneficence is that the procedure be conducted intentionally of establishing safety and promoting life/health of patient concerned. It also places healthcare providers in a position of responsibility whereby they must develop and maintain their skills and knowledge, at a practicable level to create no danger to their clients/patients (DeAngelis, 2004). This must be maintained through continuous training updates. Importantly, an evaluation of the individual circumstances pertaining to every patient while striving to act beneficently must be undertaken. There is no certainly that these attempts were carried through to save baby boy Doe’s life (Ross, 2008).
References
DeAngelis, B. ( 2004).Nonmaleficience and beneficence. New York. sage
Ross, W. (2008). The right and the good. Indianapolis: Hackett Pub
Quinlan, J. (2005). My Joy, My Sorrow: Karen Ann's Mother Remembers. Cincinnati, Ohio:
St. Anthony Messenger Press.
