Healthcare Providers and Treatment

¶ … employ the 6-step model described by Wagner and Toren in their article, for evaluating a particular healthcare scenario. Managers are in charge of ensuring and fostering an ethical and secure work atmosphere wherein nurses can deliver quality patient care. It is often stated in the nursing profession that the key duties of managers include taking care of patient needs and upholding their right to be delivered quality healthcare. This 6-step model provides a means to conflict resolution via a model of ethical decision-making. A number of conditions and steps are proposed for examining and solving ethical quandaries.

• Definition of ethical issue;

• Clarification of professional and personal values, regulations and ethical tenets involved;

• Identification of alternative courses of action;

• Selection of a particular course of action;

• Initiation of discussions on unsolved problems;

• Solution generalization to similar problems.

Definition of Ethical Issue

A child, aged six, is diagnosed with meningitis, and the clinic requests her parents' permission to begin treatment. The parents are divorced, with the mother (not a biological parent) enjoying primary custody of the child. Being a follower of Christian Science, she cites religious reasons for deciding against seeking medical treatment for the child. On the other hand, her (biological) father, a resident of another state, is firm on the opinion that the child should be administered necessary treatment. He seeks another doctor's independent consultation.

What is the course of action a healthcare provider must pursue in the face of such a situation, wherein one of the patient's parents opposes the recommended treatment? The healthcare provider bears the child's best interests in mind when recommending the treatment. Is the opposition of treatment recommendation by a parent to be regarded as a 'problem'? Just like a majority of medical ethics issues, the 'problem' will typically be one of perspective. In simple words, the doctor as well as the child's parent (non-biological mother, in this case) has the child's best interest in mind. After recognizing the above fundamental aspect, the healthcare provider must attempt to ascertain the reason for opposition to treatment (Muirhead, 2004).

Clarification of professional and personal values, regulations and ethical tenets involved

Healthcare providers' conduct must honor their responsibility to self, patients, coworkers, and the community. While the guidelines cannot be enforced in court, they are to be taken as behaviors expected of honorable healthcare professionals. The four separate principles listed below are relevant to every provider-patient interaction:

1. Beneficence: Doctors should go all out to improve their patients' health. They must understand that what works for a particular individual might not work for another. In other words, they need to develop an understanding of individual patients' capacity of tolerating pain, suffering and disease, as well as comprehend the effect of their decisions on a given patient's QOL (quality of life).

1. Autonomy: Ultimately, patients have a right over their bodies and health. Treatment acceptance or refusal ultimately rests with them, despite their choice being contradictory to the healthcare provider's professional opinion. In the end, doctors are only responsible for providing requisite information to patients so that they can make informed choices.

1. Non-maleficence: This denotes an extension to the Hippocratic Oath's 'do no harm' doctrine. Healthcare providers must take into account all potential unintentional harm from a treatment course. All treatment decisions should involve frank appraisal of benefits and risks.

1. Justice: A healthcare professional should fairly administer treatment and healthcare resources. Time, the most valuable aspect for healthcare providers, should be allocated ethically (The best practices in medical ethics, n.d).

"Informed consent" forms another aspect of doctor-patient interaction which should be approached in the ethically right manner. Considering time constraints, this may be challenging; nevertheless, physicians are duty-bound to accord patients autonomy when deciding healthcare options. For minors, doctors have identical ethical obligations in regard to informed consent. However, minors cannot, by law, consent to any treatment. Although state laws differ with regard to the particulars, legal guardians or parents have to give their permission (The best practices in medical ethics, n.d). American law considers minors incapable of providing legal healthcare-related consent. Thus, it empowers legal guardians or parents to make these decisions (which are, then, legally binding).

Identification of alternative courses of action

Still, parental power isn't absolute. If a parent's choice can cause considerable harm or make the child seriously vulnerable as compared to another alternative, states can intervene and mandate treatment over the parent's or guardian's objections. The following potential courses of action are identified:

1. If a parent/guardian does not consent to essential medical care aimed at preventing harm, disability or death, state and local child neglect/abuse regulations allow law enforcement authorities to intervene. Negotiating with the parent/guardian and trying to reach consensus with regard to a treatment plan is desirable.

1. In case a guardian disallows provision of transportation or medical attention under critical circumstances (i.e., when the child faces high risk of harm or even a threat to life), notifying law enforcement and enlisting their help in removing the child to temporary protection and custody elsewhere is crucial.

1. Healthcare providers are authorized to offer treatment without parents' or guardians' consent if a child's medical condition presents risks of serious harm or death, and instantaneous treatment can save the child (Sirbaugh & Diekema, 2011)

1. Leaving things, the way they are, continuously assessing the situation, postponing ultimate decision-making

1. Offering expert supervision till things clear out

1. Notifying the health ministry of the child's problem and seeking their help

Selection of a particular course of action

Law enforcement authorities, in this instance, will be asked to intervene in accordance with state and local child neglect and abuse regulation. Negotiating with the parent/guardian and trying to reach consensus with regard to a treatment plan is always desirable.

Initiation of discussions on unsolved problems

Like a majority of medical ethics problems, this issue is one of perspective. Problem resolution typically deals with how it is approached. Trying to understand the patient (the child as well as her family and family dynamics), in addition to addressing specific fundamental ethical principles, can facilitate problem resolution. Firstly, the attending physician must ensure the family knows the treatment is recommended with the child's best interests in mind. At the heart of the medical profession is the code of beneficence (i.e., acting to promote others' welfare). Another basic code is non-maleficence (i.e., ensuring no needless harm is caused to patients). Such simple reassurance by following the aforementioned principles can, hopefully, lead to constructive dialogue and parental agreement to treatment (Sirbaugh & Diekema, 2011).

Solution generalization to similar problems

Via this case, a common ethical dilemma -- the conflict between healthcare providers' non-maleficence and parental autonomy -- was identified. Conflict resolution may take place effectively by approaching individual cases separately. While it is assumed that deference must be given to parents in case of disagreement with regard to a child's treatment, healthcare providers do have a central role to play. The collective ethical quandary encountered by healthcare workers and parents should be settled. The other alternative would be going to court. As mentioned previously, all ethical problems have their own resolution. Concerned parties must take time out and understand one another's perspective comprehensively, as this will lead to emergence of the balance of components needed to settle the given ethical uncertainty (Sirbaugh & Diekema, 2011).