Of Morals and Ethics

The most immediate of the relevant issues raised by the case “SHHH, Don’t Tell!”, is the number of injuries suffered by the patient Lowell Baxter. Baxter actually incurred multiple injuries in this case study, each of which exerted considerable sway over his ability to live a healthy, productive life. The first was an injury which occurred at work. This injury resulted in Baxter’s inability to work at what was termed a “physically demanding job” (Wolfe et al, 2000). The second injury occurred while the patient was coaching a girls’ soccer game. Although the way the injury on his job happened is not described in the case study, this latter injury occurred when he fell on wet grass. These injuries are noteworthy because they are indicative of the efficacy of the treatment Baxter received once they happened.
Another relevant issue raised by this case is the amount of disclosure of the health care practitioners who are treating Baxter. There are two such practitioners, his doctor Felton Cranz and his physical therapist Ms. Nye. Ms. Nye has full disclosure of both of Baxter’s injuries. She knows the extent of the damage of each as well as how each one took place. Cranz, however, has limited disclosure about the occurrence of Baxter’s injuries. Cranz knows the details about Baxter’s first injury, but is unaware that he even had a second injury. Significantly, Cranz is aware of the extent of the damage of the former injury while he is ignorant of the damage incurred from Baxter’s second injury.
Finally, the third issue relevant to this case is the attitude of Baxter himself. After Baxter incurred the second injury, his attitude substantially changed. Whereas before he was amiable and amenable to the advice of his healthcare practitioners, he became recalcitrant and grumpy instead. He refuses to tell his doctor about his second injury. Moreover, his attitude with Ms. Nye is preventing him from recovering as well as he could. He seems to dislike her advice as a physical therapist, and would prefer to spend his time advising her instead.
An explanation of why those issues raise ethical concerns
There are multiple reasons why the aforementioned issues cause ethical concerns to arise. The number of issues is of utmost importance because the second injury undoes much of the work that the practitioners did to account for the first. Mr. Baxter had practically recovered from the first injury when he fell while coaching his daughter’s soccer team. In doing so he began the recovery process all over again. This time, however, that process is worse because his wounds are worse. Furthermore, the main ethical concern with this issue is that one cannot properly treat a wound if there is a subsequent injury which is causing it. Baxter has made it so that the treatment for his initial wound on his back is being used to address a second injury which is affecting his leg. Ethically, there is a conflict in the treatment he is receiving because of the multiple injuries.
There are obvious ethical concerns related to the nature of disclosure between the two practitioners. Ethically, Ms. Nye is in a professional bind. She is aware that Baxter has had multiple injuries, but the doctor who sent Baxter is not aware of this fact. She knows that Baxter is not receiving the full scope of treatment necessary to adequately address his second injury and its expansion to his leg. Therefore, Ms. Nye is in a situation in which it would behoove her patient for his doctor to know the full extent of his injuries due to the second time he was wounded. However, she is in a situation where it is not necessarily her job to volunteer this information to the patient’s doctor. She could help the patient more by conveying this information to his doctor, but she is not necessarily in a position where she can do so herself.
Baxter’s attitude considerably exacerbates the ethical concerns addressed in this case study. As a patient, it is his responsibility to keep his healthcare practitioners abreast of the latest developments related to his health. Specifically, he is tasked with reporting new injuries or any occurrences which might affect the treatment options those healthcare professionals render. However, he is staunchly against this prospect, which is why his attitude about telling Dr. Cranz is creating an ethical dilemma. Since he does not want to tell his doctor, he also does not want his physical therapist to tell his doctor either. As such, he is truly putting Ms. Nye in an ethical quandary. She is certain that Dr. Cranz’s cognizance of Baxter’s injury would influence the former’s treatment options and positively affect the latter’s care. However, she is in a situation in which she is asked not to do so. Patient confidentiality is one of the primary ethical considerations for those in the healthcare profession. Ms. Nye is expected to observe such the protocols pertaining to patient confidentiality. But, doing so worsens the ability of her patient to achieve his objectives of getting properly healed. Thus, this scenario is her primary ethical concern.
How the ACHE Code of Ethics or a similar professional code of ethics can be used to determine the proper response by a healthcare leader
The ACHE Code of Ethics could positively influence Ms. Nye’s quandary in this case study by presenting a series of mores for her to consider. In fact, it can provide many of the relevant “values and ethical decision-making practices” (Rubens and Wimberley, 2004, p. 10) that are germane to the issues identified in this paper. This ethical code can elucidate the points of interest Ms. Nye or any other healthcare practitioner should be mindful of when attempting to determine how to best help her patient. This code can provide a balance for helping the patient to achieve his objectives and maintaining the privacy of the patient. It serves as a guide for ethical consultation.
References
American College of Healthcare Executives. (2017). About ACHE. www.ache.org Retrieved from https://www.ache.org/abt_ache/committee_function.cfm
Rubens, A.J., Wiberley, E.T. (2004). Contrasting the American College of Healthcvare Executives code of ethics with undergraduate health administration students’ values and ethical decision choices. 82(3), 10-17.