Assignment: NHSFP4000 Capella University Applying Ethical Principles Paper

Applying Ethical Principles

Ethical principles in healthcare, especially biomedical ethics that include principles of autonomy, beneficence, non-maleficence, and justice, are critical and guide not just decisions but also plans of care that providers implement when offering services to patients. Again, ethical decision-making models and effective communication approaches are also essential for providers to create a rapport with patients and their families. These aspects all help to improve the quality of care delivered and enhance patient safety. Ethical decision-making model in health care requires moral awareness, moral judgment, and ethical conduct (Borhani et al., 2021). The purpose of this paper is to analyze how providers make ethical decisions based on cases that they encounter in healthcare facilities. The paper analyzes ethical decision-making using a case study provided in the textbook.

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Overview of the Case Study

The selected case study is titled “To Vaccinate or Not,” where two parents, Jenna and Chris do not want their five-day-old baby, Ana to be vaccinated. The parents have expressed their decision to raise her as naturally as possible which entails breastfeeding exclusively for six months and not vaccinating the baby. They have bonded with the child and believe that they will not use any conventional approaches like medications and food. For instance, they want her to eat organic foods like pureed fruits and vegetables. The Smiths meet Dr. Angela Kerr, a pediatrician to discuss their concerns and mistrust about vaccinations (Darr, 2017). Dr. Kerr effectively engages them and communicates well by explaining the possible risks and benefits of vaccinations and the need for Ana to have them. Key among the benefits are the prevention of infectious diseases, reduced infant mortality and morbidity, attainment of herd immunity in the population, and a stronger immune system. Furthermore, she clarifies that in some states, vaccination is a requirement before a child joins schools at any age. However, Jenna and Chris are opposed to vaccinations because of the possible harm based on their research evidence linking vaccines to increasing the risk for autism spectrum disorder. However, Dr. Kerr asserts that while there has been increased concern about the issue, vaccines have limited chances of being harmful to infants and all people.

The pediatrician elaborates this by offering research evidence from the federal data through the Vaccine Adverse Event Reporting System (VAERS) under the Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) which encourages people to report such cases. Through these reports, the federal government monitors the safety of these vaccines. Dr. Kerr also emphasizes the attainment of herd immunity which ensures that children get protected because the rest of the population is vaccinated and this reduces exposure to vaccine preventable conditions. However, the couple restate and affirm that their child, Ana, will not be vaccinated. The pediatrician comprehends the ethical dilemma at hand and should use ethical decision-making model to address the controversy about vaccines and the refusal by the parents for their baby to get it.

Analysis of Ethical Issues in the Case Study

The primary issue leading to the ethical dilemma that the provider faces is the parents’ refusal to vaccinate the newborn because of the possible risks outweigh the expected benefits. Ethical dilemmas occur when conflicting moral alternatives happen. In this case, it is either to vaccinate or not. The pediatrician knows that it is her obligation and duty as a healthcare worker to vaccinate children based on her experience (Burgener, 2020). The pediatrician is categorical that vaccines save millions of children. The values that she possesses are so strong that they affect her ethical decision making based on the three components mentioned earlier; moral awareness, ethical behavior, and moral judgment.

Application of Decision-Making Model in the Case Study

The physician’s ethical decision making is ineffective since she cannot deploy moral awareness, moral judgment, and ethical conduct while dealing with her patients. Clients or patients are the decision makers in healthcare, especially when they are competent, and if not, their guardians, parents, or other surrogates decides. The physician needs to apply autonomy as part of the biomedical ethical principles where patients make the ultimate choice based on the information offered. Dr. Kerr requires informed consent from the Smiths to vaccinate the newborn. While she understands the inherent benefits associated with vaccines and means no harm, she cannot dictate to the parents what to do with their child.

Moral awareness entails knowing the presence of an ethical dilemma. In this scenario, the physician considered this being either right or wrong aspect (Burgener, 2020). For instance, she believes that not being vaccinated exposes one and others in the population to pathogens, which is wrong and harmful to people. Moral judgment entails getting a decision by identifying facts and considering questions associated with ethical principles. The moral decision in this case is reflected when Dr. Kerr tries to convince the parents about the positive aspects of vaccination.

The decision is based on her experience and organizational culture as well as provisions within some states that make vaccination mandatory. Ethical behavior entail actions aimed at doing the right thing. In this case, Dr. Kerr’s ethical behavior is influenced by the ethical principles required to resolve the current dilemma. These include autonomy, beneficence, non-maleficence and justice. As such, she must accept that autonomy of the patient to make informed decision and offer informed consent overrides other aspects, including beneficence.

Effectiveness of Communication in the Case Study

Effective communication is a core aspect of better and successful relationship and interactions between patients and their healthcare providers. Effective communication entails active listening, open-ended engagement, clarity, precision of the message and written as well as non-verbal aspects (Back et al., 2019). The physician demonstrates the most effective communication as she actively listens to the couple, empathizes with them and understands them. Besides, she effectively explains the importance of vaccination and shows her credibility by evidence from federal agencies like the CDC and FDA on the role of vaccinations in public health and management of diseases. The physician shows the parents these resources and evidence. More importantly, she allows them to make decisions after giving sufficient information to demonstrate the positive aspects of vaccination.

Resolving the Ethical Dilemma

The resolution to the ethical dilemma requires using the biomedical principles that include autonomy, beneficence, justice, and non-maleficence. It is imperative that while the physician makes the case for vaccination for the newborn, the parents have autonomy to make independent choices or decisions. In this case, their decision entails not vaccinating Ana, and Dr. Kerr has no choice but accept. The Smiths are categorical that they have a duty and obligation to protect their child and raise it in the best way without risking its health through possible harm from vaccines (Borhani et al., 2021). The use of vaccines remains a controversial issue and the parents have a right to decline them for their child. Evidence and concerns may be not overwhelming but have the potential to affect decision making and choices that parents make concerning either to vaccinate or not.

Conclusion

Healthcare professional encounter ethical dilemma in their daily work that require them to apply ethical principles to resolve. The case study demonstrates how such dilemmas can be complex and require the application of decision making models and ethical principles. Based on the solution offered, healthcare providers need to understand the critical role of decision making models, effective communication, and adherence to the ethical principles of beneficence, non-maleficence, and justice.

References

Back, A. L., Fromme, E. K., & Meier, D. E. (2019). Training clinicians with communication

skills needed to match medical treatments to patient values. Journal of the American Geriatrics Society, 67(S2), S435-S441. DOI: 10.1111/jgs.15709.

Borhani, F., Abbaszadeh, A., Bahrampour, A., Ameri, G. F., & Aryaeenezhad, A. (2021). Role

of judgment in promoting nurses’ decisions and ethical behavior. Journal of Education and Health Promotion, 10. DOI: 10.4103/jehp.jehp_875_20

Burgener, A. M. (2020). Enhancing communication to improve patient safety and to increase

patient satisfaction. The health care manager, 39(3), 128-132.

DOI: 10.1097/HCM.0000000000000298.

Darr, K. (2017). Cases in health services management (6th ed). Health Professions Press.

Vaccine Adverse Event Reporting System (VAERS). (n.d.). About VAERS.

https://vaers.hhs.gov/index.html

Small, C., & Lew, C. (2021). Mindfulness, moral reasoning and responsibility: Towards virtue in

ethical decision-making. Journal of Business Ethics, 169, 103-117. https://doi.org/10.1007/s10551-019-04272-y

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Incident 2: Emergency Department Repeat Admissions — A Question of Resource Use

Matt Losinski finished reading an article that provided grim details of a study of the overuse of emergency services in hospitals in central Texas. He smiled that sardonic half smile that meant there was a strong possibility that County General Hospital (CGH) might have the same problem. As chief executive office (CEO), Losinski always saw the problems of other hospitals as potential problems at CGH, a 300–bed, acute care hospital in a mixed urban and suburban service area in the south central United States. CGH was established as a county–owned hospital; however, 10 years ago the county wanted to get out of the hospital business and the assets were donated to a not–for–profit hospital system. The new owner has continued a strong public service orientation, even though CGH no longer receives the tax subsidy it did when it was county owned; it must look to itself for fiscal health.

The study data showed that nine residents of a central Texas community had been seen in emergency departments (EDs) a total of 2,678 times over 6 years. One resident had been seen in an ED 100 times each year for the past 4 years. Given that an ED visit can cost $1,000 or more, the nine residents had consumed $2.7 million in resources. These high users of ED services were middle age, spoke English, and were split between male and female. To Losinski, the problem seemed like a manifestation of Wilfredo Pareto’s classic 80/20 rule.

Losinski forwarded the article on a priority basis to Mary Scott, his chief financial officer (CFO), and asked her to see him after she read it. Scott stopped by Losinski’s office late the next day and began the conversation by asking him why he thought the article was a priority. Scott reminded Losinski that Medicaid paid 75% of costs for eligible ED users and that the cross subsidy from privately insured and self–pay ED admissions covered most of the unpaid additional costs. Losinski had a good working relationship with Scott, but he was a bit annoyed by her rather indifferent response.

Losinksi wanted details on use of the ED at CGH. He asked the administrative resident, Aniysha Patel, to gather data to identify use rates for persons repeatedly admitted to the ED. The findings that Patel gave to Losinski two weeks later were not as extreme as those reported from central Texas; however, they did show that a few persons were repeatedly admitted to the ED and accounted for hundreds of visits in the past year. The clinical details were not immediately available, but a superficial review of the admitting diagnoses suggested that most admissions involved persons with minor, nonspecific medical problems—persons commonly known as the “worried well.” Although Scott was correct that Medicaid covered the majority of costs, the fact remained that over $200,000 each year was not reimbursed to CGH. Were that money available, it could go directly to the bottom line and could be used for enhancements to health initiatives for the community. In addition, repeated admissions to the ED contributed to crowding, treatment delays, and general dissatisfaction for other patients.

Losinski presented the data to his executive committee, which includes all vice presidents, the director of development, and the elected president of the medical staff. The responses ran the gamut from “So what?” to “Wow, this is worse than I imagined.” Losinski was bemused by the disparity of views. He had thought there would have been an almost immediate consensus that this was a problem needing a solution. The financial margins for CGH were already very thin, and the future for higher reimbursement was not bright. A concern echoed by several at the meeting was the requirement of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) that all persons who present at an ED that receives federal reimbursement for services must be treated and stabilized.

Losinski asked his senior management team for recommendations to address the problem of ED overuse.

Incident 9: The Missing Needle Protector

1. L. Straight is director of clinical services at Hopewell Hospital. As in many hospitals, a few physicians provide care that is acceptable, but not of very high quality; they tend to make more mistakes than the others and have a higher incidence of patients going “sour.” Since Straight took the position 2 years ago, new programs have been developed and things seem to be getting better in terms of quality.

Dr. Cutrite has practiced at Hopewell for longer than anyone can remember. Although once a brilliant general surgeon, he has slipped physically and mentally over the years, and Straight is contemplating taking steps to recommend a reduction in his privileges. However, the process is not complete, and Cutrite continues to perform a full range of procedures.

The operating room supervisor appeared at Straight’s office one Monday afternoon. “We’ve got a problem,” she said, somewhat nonchalantly, but with a hint of disgust. “ I’m almost sure we left a plastic needle protector from a disposable syringe in a patient’s belly, a Mrs. Jameson. You know, the protectors with the red–pink color. They’d be almost impossible to see if they were in a wound.”

“Where did it come from?” asked Straight.

“I’m not absolutely sure,” answered the supervisor. “All I know is that the syringe was among items in a used surgical pack when we did the count.” She went on to describe the safeguards of counts and records. The discrepancy was noted when records were reconciled at the end of the week. A surgical pack was shown as having a syringe, that was not supposed to be there. When the scrub nurse working with Cutrite was questioned, she remembered that he had used a syringe, but, when it was included in the count at the conclusion of surgery, she didn’t think about the protective sheath, which must have been on it.

“Let’s get Mrs. Jameson back into surgery.” said Straight. “We’ll tell her it’s necessary to check her incision and deep sutures. She’ll never know we’re really looking for the needle cover.”

“Too late,” responded the supervisor, “she went home day before yesterday.”

Oh, oh, thought Straight. Now what to do? “Have you talked to Dr. Cutrite?”

The supervisor nodded affirmatively. “He won’t consider telling Mrs. Jameson there might be a problem and calling her back to the hospital,” she said. “And he warned us not to do anything either,” she added. “Dr. Cutrite claims it cannot possibly hurt her. Except for a little discomfort, she’ll never know it’s there.”

Straight called the chief of surgery and asked s hypothetical question about the consequences of leaving a small plastic cap in a patient’s belly. The chief knew something was amiss but didn’t pursue it. He simply replied there would likely be occasional discomfort, but probably no life–threatening consequences from leaving it in. “Although,” he added, “one never knows.”

Straight liked working at Hopewell Hospital and didn’t relish crossing swords with Cutrite, who, although declining clinically, was politically very powerful. Straight had refrained from fingernail biting for years, but that old habit was suddenly overwhelming.

Vaccinate, or Not?

Jenna and Chris Smith are the proud parents of Ana, a 5–day–old baby girl born without complications at Community Hospital. Since delivery, the parents have bonded well with Ana and express their desire to raise her as naturally as possible. For the Smiths, this means breastfeeding exclusively for the first six months, making their own baby food using pureed organic foods, and not allowing Ana to be vaccinated.

The Smiths are college educated and explain they have researched vaccines and decided the potential harms caused by them far outweigh any benefits. They point to the rise in autism rates as proof of the unforeseen risk of vaccines. Their new pediatrician, Dr. Angela Kerr, listens intently to the Smiths’ description of their research, including online mommy–blogs that detail how vaccines may have caused autism in many children. The Smiths conclude by resolutely stating they’ve decided not to vaccinate Ana, despite the recommendations of the medical community.

Dr. Kerr begins by stating that while vaccines have certainly sparked controversy in recent years, she strongly recommends that Ana become fully vaccinated. Dr. Kerr explains that vaccines have saved the lives of millions of children worldwide and have been largely responsible for decreases in child mortality over the past century. For example, the decreased incidence of infection with the potentially fatal Haemophilus influenzae type b, has resulted from routine immunization against that bacterium. Similarly, epidemics such as the recent outbreak of measles are usually associated with individuals who have not been vaccinated against that pathogen.

Dr. Kerr goes on to endorse the general safety of vaccines by informing Ana’s parents that safety profiles of vaccines are updated regularly through data sources such as the federal government’s Vaccine Adverse Event Reporting System (VAERS). The VAERS, a nationwide vaccine safety surveillance program sponsored by the Food and Drug Administration and the Centers for Disease Control and Prevention, is accessible to the public at https://vaers.hhs.gov/index. This system allows transparency for vaccine safety by encouraging the public and healthcare providers to report adverse reactions to vaccines and enables the federal government to monitor their safety. No vaccine has been proven casual for autism spectrum disorder (ASD), or any developmental disorder. On the contrary, many studies have shown that vaccines containing thimerosal, an ingredient once thought to cause autism, do not increase the risk of ASD.

Finally, Dr. Kerr reminds the Smiths that some children in the general population have weakened immune systems because of genetic diseases or cancer treatment, for example. It may not be medically feasible to vaccinate such children. Other children are too young to receive certain immunizations. Instead, these children are protected because almost all other children (and adults) have been vaccinated and this decreases their exposure to vaccine–preventable illnesses (VPIs). This epidemiological concept is known as “herd immunity.” As more parents refuse immunization for their healthy children, however, the rate of VPIs will increase. This puts vulnerable children at significant risk of morbidity and mortality. Routine childhood immunization contributes significantly to the health of the general public, both by providing a direct benefit to those who are vaccinated and by protecting others via herd immunity. Dr. Kerr concludes by stating that after considering the risks versus the benefits of immunization, most states require vaccinations before children can attend school. Parents may decide not to vaccinate under specific circumstances, however, which vary by state.

Jenna and Chris Smith confirm their understanding of what Dr. Kerr has explained, but restate that they do not want Ana vaccinated at this time. Dr. Kerr is perplexed as to what to do.

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Applying Ethical Principles Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Summarize the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case.	Does not summarize the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case.	Identifies the facts of the case study using peer-reviewed journal articles as evidence to support analysis of the case.	Summarizes the facts of a case study using peer-reviewed journal articles as evidence to support analysis of the case.	Assesses the facts of the case study using peer-reviewed journal articles as evidence to support analysis of the case, including reasons why the chosen articles support the analysis.
Discuss the effectiveness of the communication approaches present in a case study.	Does not discuss the effectiveness of the communication approaches present in a case study.	Describes the communication approaches present in a case study.	Discusses the effectiveness of the communication approaches present in a case study.	Discusses the effectiveness of the communication approaches present in a case study, explaining which approaches should be used more and which should be avoided.
Discuss the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model.	Does not discuss the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model.	Describes the approach used by the professional in the case study as it relates to the ethical decision-making model.	Discusses the effectiveness of the approach used by the professional in a case study as it relates to the three components of the ethical decision-making model.	Discusses the effectiveness of the approach used by the professional in the case study as it relates to the ethical decision-making model, including consequences of using effective and noneffective approaches.
Apply ethical principles to a possible solution to the proposed problem or issue from a case study.	Does not identify ethical principles related to the possible solution to the proposed problem or issue from the case study.	Identifies ethical principles related to the possible solution to the proposed problem or issue from the case study.	Applies ethical principles to a possible solution to the proposed problem or issue from a case study.	Applies ethical principles to a possible solution to the proposed problem or issue from the case study, explaining why the proposed solution is based in ethical principles.
Produce text with minimal grammatical, usage, spelling, and mechanical errors.	Produces text with significant grammatical, usage, spelling, and mechanical errors, making text difficult to follow.	Produces text with some grammatical, usage, spelling, and mechanical errors, making text difficult to follow at times.	Produces text with minimal grammatical, usage, spelling, and mechanical errors.	Produces text free of grammatical, usage, spelling, and mechanical errors.
Integrate into text appropriate use of scholarly sources, evidence, and citation style.	Does not integrate into text appropriate use of scholarly sources, evidence, and citation style.	Integrates into text mostly appropriate use of scholarly sources, evidence, and citation style, but there are lapses in style use.	Integrates into text appropriate use of scholarly sources, evidence, and citation style.	Integrates into text appropriate use of scholarly sources, evidence, and citation style without errors and uses current reference sources.