Legal and Ethical Issues in Healthcare

Legal and Ethical Issues in Healthcare
Healthcare ethics have to do with the wide range of moral decisions that have to be made in medical practice. These are the other considerations that have to be made besides the regular policies and procedures designed for effective medical practice. Of the various aspects of the human body and life, none is as important as health. Technological advancements in the practice of medicine and healthcare, in general, emerge with their sets of moral dilemmas. Many of such issues arise from developments in genetic knowledge and reproductive health (Taylor, 2015).
The relationship between the patient and the healthcare expert, the human subject behavioral research, harvesting and transplanting of human organs, abortion, euthanasia, and allocation of healthcare resources and services are other areas that present moral dilemmas. In the clarification of moral issues in healthcare provision, and consequently, understood, healthcare quality as it is received and practiced should be improved qualitatively (Taylor, 2015).
There is a need to make an ethical decision whenever a healthcare expert meets a situation where there is a competition between values or uncertainty. These dilemmas could arise at personal, professional, organizational, and societal levels. Once a healthcare officer meets such a dilemma, they must take into consideration various influencing factors. These factors include the law, beneficence, autonomy, and nonmaleficence, and juxtapose them with professional, ethical codes of conduct. There are many reasons why there is a growing concern over ethical issues in the practice of medicine and healthcare in general. Such issues as accessibility, quality, the safety of patients, acquisitions and mergers, value-based care, affordability, and financial constraints all converge to make the situation baffling when one has to make hard decisions close to the end of life. The healthcare administrators and executives need to address the wide range of ethical dilemmas that practitioners face in the course of their work today. Such a step should be taken conscious of the need to involve all stakeholders in the process. When there are sounds and systematic process for deciding, it can be an accepted tool to help healthcare executives deal with ethically confusing situations (Yip, Han &Sng, 2016).
Problems of implementing ethical decisions
One challenge that healthcare experts face in implementing ethical decisions is the lack of education on ethical decision making. While medical staff faces dilemmas almost daily, the problem is not helped by the fact that the dilemmas encountered are not documented; neither is there any information giving details of how such dilemmas were overcome. Nurses' ability to handle dilemmas in the course of their profession could be a result of their experience in previous ethical situations at various levels, such as individual, regional, organizational, national, and even at the international level. The encounters at these various levels could present huge challenges in implementing ethical decisions (Webster et al., 2000).
Ethical circumstances in which there is no action could imply that the healthcare worker is aware that there may be a problem, whichever decision is made. An ethical dilemma could result from a nurse being unable to meet her commitments and obligations, ethically. They may be unable to take what they know is the right course of action of simply failed to live up to the expected practice standards. According to Webstar and Baylis (2000), such a situation could be an outcome of a judgment error, inadequate personal resolve to act on required ethical expectations, or some other influences beyond the control of such a nurse(Webster et al., 2000).
Situations of uncertainty about ethics emerge when a healthcare expert is not sure of the ethical requirements or which ones to apply in a given situation. It has been observed that healthcare workers often inherit values. These values, when held personally and as professional beliefs, can stand in the way of implementing standard ethical decisions (Webster et al., 2000).
Ethical Theories
There have been many ethical theories developed over the years to regulate the moral behavior of human beings. The categorical imperative of Kant and general deontological theories are relevant and can be used in any issues relating to healthcare. For instance, if a patient on opioid prescription for a short period, after surgery, were to think of feigning the continued pain experience during the after-surgery visits. He assumes this to obtain a fresh prescription of the same medicine, and abet the addiction to opioid of a friend; then the patient would be trying to view the surgeon only as a means to gain an and end. Any move to make a uniform maxim for an action like that would lead to contradictions. The categorical imperative by Kant would enable one to realize that an action like that should not be taken (Taylor, 2015).
According to virtue theories, if a person exhibits virtuous behavior, it is the foundation of their ethical life. Nevertheless, the theory faces criticisms because it is seen to be devoid of objectivity. The theory also seems to fain in providing the general criteria of what it refers to as good and bad. Furthermore, the theory does not reveal whether the virtuous behavior that a person exhibits is a result of learning or innate. In Casuistry, moral lessons emanate from the analysis of each case on its merit and specifically. Some of these cases may be used as benchmarks for future occurrences. The ethical reasoning premised on Casuistry poses the challenge of exerting excessive pressure to abide by the ethical values of society. Such values may also be unethical too. It also leaves a gap when it comes to its application to general issues such as the allocation of resources. Another theory referred to as Care Ethics focuses on concern and empathy towards those who are vulnerable. It can also be criticized for its subjectivity and lack of general criteria (Reddy &Mythri, 2016).
Utilitarian procedures are commonly used by healthcare personnel in making ethical decisions in the course of rendering their service. Thus, across all levels of healthcare provision and administration, the decisions are commonly based on the best collective good of the patients (Reddy &Mythri, 2016). An example is where the CDC officials learn of a serious contagious disease and decide to quarantine people within specified geographical areas. They could also direct that all healthcare workers taking care of infected patients must, apart from also quarantine themselves, should also report details about the patients who have been diagnosed with such an ailment. Such decisions have moral and even legal implications. They also trigger moral discussions. In any case, the central reason for making such a decision under the circumstances is for the protection of the health of the majority- the citizens, hence promoting social utility(Reddy &Mythri, 2016).
Since each of the systems discussed above have its limitation, there is a proposal to use the four principles approach by Beauchamp and Childress. They try to moderate amid the Utilitarian and Kantian views. They do so by anchoring their moral reasoning at the middle-level principles that are widely used, such as beneficence, regard for autonomy nonmaleficence, and just treatment for everyone. The framework allows for a flexible application using patient information (Reddy &Mythri, 2016)
Ethical Issues in Healthcare
Healthcare workers understand that patient care, and the avoidance of causing harm is the foundation of ethical practice. Healthcare personnel wishes to pursue the right course of action, but such a right thing isn't always in black and white. Each situation is unique. Indeed, dilemmas arise even where there are, clearly, outlined ethical principles to guide healthcare staff. The role that healthcare administrators play in the quality of care rendered to patients within the institutions they run cannot be overlooked. Situations where a healthcare administrator is forced to make a hard decision commonly arise. Many such situations carry an ethical element. It is imperative, therefore, for healthcare administrators to be prepared through their degree training programs for situations such as these (Morrison, 2011). Healthcare administrators commonly make decisions relating to the allocation of resources. Such a decision will have a direct impact on the quality of healthcare to be given to the patients. One scenario is where such an administrator decides to hire more staff to reduce the nursing workload at the expense of buying equipment. Medical lawsuits and malpractice are mental, physical, and psychological drainers in medical practice. A health administrator may be requested to work with personnel to resolve concerns before they are taken to higher levels of decision making. You are often expected to ensure that the healthcare personnel under your charge always place the patient's needs over other considerations. There are situations where the appropriate action may mean sacking a healthcare worker (Morrison, 2011).
Maintaining the right to autonomy and practice is a critical ethical principle. There is an increased reliance on technology by healthcare workers. Such technology includes but not limited to, healthcare record-keeping, transmission, and sharing (EHRs). Management has a responsibility to ensure that such equipment is aligned to the expected moral and ethical requirements of medical practice, including the Health Insurance Portability and Accountability. However, there are situations where confidentiality needs to be broken. Philip Meredith gives an example of the need to break such confidentiality to prevent potential harm to a patient or anyone else within or outside the hospital premises. There is a need to thoroughly understand these guidelines and analyze the ethical issues that interact, for an administrator to be effective (Morrison, 2011).
Healthcare personnel often engage a wide range of stakeholders, such as vendors who supply services and products. It is essential to focus on such engagement because it will help the healthcare worker to make a decision that is in the interest of their patient and not influenced by forces from outside. Situations that administrators should look out for include situations where a doctor prescribes drugs even if it is not necessary to prescribe such a drug- because there is a promise of personal gain from the sale of such a drug. Healthcare administrators are officials with the education and power to direct the course of medical practice and lift it to the highest standard of care for patients (Morrison, 2011).
On the other hand, even if healthcare workers such as nurses choose that the duty of caring for the patient is essential, they will still confound with hierarchical systems and bureaucracy, which require that they are loyal to subordinates within. In situations where the researcher is incompetent but is of higher administrative authority, the nurse is forced to accord them the loyalty. However, such a scenario will, in turn, conflict with the nurse's loyalty to their patients. Thus, there may be a general feeling among the healthcare worker that the patient is vulnerable because they are exposed to such a situation when the nurse cannot do anything about it. Indeed, such a stance is why a lot of authors claim that nurses can't be the advocates of the subjects of research. A lot of scholars defend the idea that prohibiting nurses from being advocates of subjects emanates from a long-standing history of nursing as a special occupation for women and under the dominance of medicine in bureaucratic setups (Chenet al, 2014).
The nurses that take part in research have to grapple with a lot of ethical concerns concerning informed consent. In the nursing research realms, nurses may be asked to bear witness that there is both informed and voluntary consent given by the subject of research. It is implied that such nurses should make sure that patients are aware of the risks or inconveniences that result from their being subjects of research. The healthcare workers who spend most of their time with patients can judge these situations better. Nurses must also make sure that the patients understand that they have the right to terminate and withdraw participation at any time during the research. If a nurse is the one seeking consent from the patient, then the patient will feel the obligation to participate. The latter scenario is informed by the fact that the nurse is the patient's carer, who they depend on for their wellbeing in health, or because they want to show gratitude for the care already given (Chenet al, 2014).
Strategies for Reducing Ethical Dilemmas
Making decisions based on ethical considerations can be learned. Such learning can be drawn from the understanding of the principles of ethics, the process of making decisions, the nursing code, and ethical theories. Therefore, all nurses would gain from in-depth knowledge of ethical principles and the process of making decisions. This would boost their skills in deciding. Availing avenues for discussion of ethical dilemmas and making decisions could help mitigate the challenges (Nora et al., 2016).
There is also a need to conduct workshops for addressing ethical matters regularly for nurses. In a lot of the health institutions around, ethical committees only meet to make decisions on research findings. It is important to have groups where nurses can exchange information, share experiences, and ventilate over the encounters they have to deal with. Such groups could assume leadership in creating awareness on ethical matters. There is a need for all nurses across the plane to frequently review their nursing practice and identify situations that called for ethical decisions in their work, and how they overcame such situations. Dialogues could be pursued about these issues to reach a consensus on the course of action in similar happenings in the future. Such a practice could also encourage the documentation of encounters and better situation analysis. The result would be a better-equipped healthcare worker with adequate skills in ethical matters (Nora et al., 2016).
Ethical practice in nursing also calls for acting as advocates for the patients. The issue of quacks should also be addressed to enhance professional standards. Nurses in practice should also be equipped with new knowledge and skills in their practice areas. To promote competent and safe ethical care, there is a need to keep enriching the nursing field with new and relevant research where it can be done (Nora et al., 2016).
Conclusion
To improve the quality of ethics in healthcare, organizations therein require tools they can use to measure the standards of ethical practice. Then, they can tell whether the practice conforms with the expectations of established norms in the organizations. The measures will make it possible to compare the various services in a range of settings over time. Although some instruments have been developed to focus on small aspects of the quality of ethics such as confidentiality, privacy, ethical leadership, consultation, and patient-centered communication, there is still a need for assessment tools that are broad-based to cover the wide spectrum of ethical concerns which arise in healthcare.
References
Chen, Y. Y., Chu, T. S., Kao, Y. H., Tsai, P. R., Huang, T. S., &Ko, W. J. (2014). To evaluate the effectiveness of health care ethics consultation based on the goals of health care ethics consultation: a prospective cohort study with randomization. BMC medical ethics, 15(1), 1.
Morrison, E. E. (2011). Ethics in health administration: a practical approach for decision-makers. Jones & Bartlett Publishers.
Nora, C. R. D., Deodato, S., Vieira, M. M. D. S., &Zoboli, E. L. C. P. (2016). Elements and strategies for ethical decision-making in nursing. Texto&Contexto-Enfermagem, 25(2).
Reddy, M. S., &Mythri, S. V. (2016). Health-care Ethics and the Free Market Value System. Indian journal of psychological medicine, 38(5), 371–375. https://doi.org/10.4103/0253-7176.191387
Taylor, S. C. (2015). Health Care Ethics. Internet Encyclopedia of Philosophy. Retrieved from https://www.iep.utm.edu/h-c-ethi/#H2
Yip, C., Han, N. R., &Sng, B. L. (2016). Legal and ethical issues in research. Indian Journal of anesthesia, 60(9), 684–688. https://doi.org/10.4103/0019-5049.190627
Webster, G., Bayliss, F., Rubin, S., &Zoloth, L. (2000). Moral Residue. Margin of Error: The Ethics of Mistakes in the Practice of Medicine. Hagerstown, MD: University Publishing Group.