Ethics scenario analysis and implications

Ethics Scenario

Public health ethics relates to the ethics as it relates to an entire population, in contrast to medical ethics, which relates more to the rights of individuals. Rosenau and Roemer (2013) note that there are often ethical conflicts that emerge when individual rights conflict with the greater good. They highlight the overarching public health principles, that provision of care is regardless of external factors, that there should be equity in the distribution of resources, and that there should be respect for human rights. The case of the burn patient is primarily regarding the human rights dimension.

The human rights dimension results in an ethical dilemma here for a couple of reasons. The first is that the individual in this instance has rights -- or the family members have rights -- and there is question as to whether those rights were respected. The outcome might have been the same for the burn victim, but the rights are embedded in the process, not the outcome. Indeed, the fourth-year resident violated the basic rights of the victim to make his own decisions -- or for his family to make those decisions -- about his life and how it should end. There is an assumption embedded in medical ethics that conduct should be in accordance with certain imperatives, and this Kantian approach to ethics does not allow for the rights of the individual to be disrespected in this manner.

The decision to give the patient a lethal injection does not appear to be rooted in a decision about scarce resources, or about equitable access to health care, and it would only be speculation at this point as to why exactly the resident killed the patient. If there was a rationing issue, the case could be more complex, but it does not appear that rationing was involved, so the issue is simply one of individual rights.

In this situation, the law leaves little room for ethical interpretation. The resident may have felt that he acted in the spirit of not causing harm, in that he was reducing the suffering of the patient, but that is not his decision to make in this instance. There is almost no likelihood that the resident would have had legal sanction to end the patient's life, even if there was universal agreement that the patient is about to die. The patient or the family of the patient has the right to make that decision. Indeed, they may have religious beliefs on the subject, and the resident's actions would not only be against the law, and against the ethical standard of respecting the independence of the patient, but also would be culturally insensitive as well.

Rosenau and Roemer (2013) provide an outline of mechanisms for resolving the dilemma. At this point, the dilemma is whether or not to pursue further investigation into the matter. The law does not provide the opportunity for ethical decision making here -- killing a patient is against the law and there should be an investigation into the circumstances surrounding the death of this patient. Formal mechanisms can be used to help investigate this case, but there is no need for a formal mechanism for resolving the ethical issue. In this case, there is no serious ethical dilemma. An illegal act -- well-meaning or otherwise -- was committed and there needs to be an investigation and if necessary a prosecution. Management needs to address this issue swiftly, ordering an autopsy and brining the resident in for questioning. The matter may also need to be referred to the police, so the legal team for the health care organization will also need to be involved from the outset. The laws guide the ethics here, and while the resident may have felt that there was an ethical dilemma, there was not. The imperative by which the situation needed to be judged was the imperative of the law, and there are few allowances for anything like a unilateral decision by a resident to euthanize a patient. The institution faces no dilemma in ordering an investigation -- this is mandatory by law and by any ethical standard known to the industry.

Part II. End of life decisions are subject to ethical debate within the framework of medical ethics, rather than public health ethics. The rights of the individual are central to this debate. There is cause to investigate the actions of the medical team with respect to this patient. Sprung (2003) notes that there are instances when the line is blurred between withdrawing therapies and shortening of the dying process. What this does not address, however, is the idea of hastening the dying process, which is different than simply taking someone off of life support and offering palliative care.