Ethics One ethical dilemma that arises in health care is with respect to quality improvement techniques (Lynn et al., 2007). While it is accepted that quality improvement activities are an intrinsic part of normal health care operations (Ibid), administrators are obligated to ensure that QI activities are conducted in line with ethical guidelines. An ethical dilemma arises, however, when faced with the opportunity to make a quality improvement based on techniques that seem sound but perhaps lack empirical backing. The dilemma would then feature two pathways. The first is to opt to adopt the quality improvement idea before research has shown conclusively that it is effective, and the second pathway is to not adopt the QI tactic until it has been demonstrated effective. A specific example could be a radical new technique for a challenging condition -- it may not be proven but the situation may be so challenging that the use of a radical, unproven new technique to improve outcomes is considered. The administrator may be faced with a patient and physician seeking approval for a new technique that is unproven but has a chance to deliver better results than known techniques.

This dilemma qualifies under the category of "ethical issues in assuring quality of care." There are ethical considerations with respect to the use of peer review, for example. Should a new innovation be faced with research results that are unclear, or have not been subjected to peer review, there is risk to both the patient and to the health care organization. That said, a new technique might be necessary in order to increase the odds of positive patient...

The health care administrator would need to resolve the ethical issue by whatever means are available.
There are several duties that the health care administrator must take into account in making a decision about a new, relatively unproven, technique for quality improvement. The duty of nonmaleficence is the duty not to inflict harm. In the described situation, this duty is central to the ethical dilemma. The new QI technique is believed to improve patient outcomes, but there is an unknown element if the technique has not been subject to adequate peer review. The technique could cause harm, and the risk of causing harm might not yet be known. Yet, if the technique works then the effect will reduce overall harm. The reverse duty of beneficence is also valid, and it is precisely the unknown aspect of the new QI technique that creates the dilemma between these two duties.

The article points out that the duty for QI lies in the duty of nonmaleficence, where the risk of doing harm is key to resolving the ethical dilemma. QI methods should only be adopted when they are known to represent an improvement, which implies a peer review process and some other institution taking the risk associated with the new technique. I feel that this is probably the best approach for most institutions. They need to safeguard both the patient and the institutions. New techniques to improve quality are risky, because they introduce unknown potential outcomes to the patient care experience. This is usually not acceptable, and may also violate the trust that the patient puts in the health care organization to receive the best…