Legal and Ethical Issues in Healthcare Practice

Introduction to Healthcare Ethics

Healthcare ethics concerns the wide range of moral decisions that must be made in medical practice. These are considerations that go beyond the regular policies and procedures designed for effective medical practice. Of the various aspects of human life, none is as important as health. Technological advancements in medicine and healthcare in general emerge with their own sets of moral dilemmas. Many such issues arise from developments in genetic knowledge and reproductive health (Taylor, 2015).

The relationship between the patient and the healthcare expert, human subject behavioral research, the harvesting and transplanting of human organs, abortion, euthanasia, and the allocation of healthcare resources and services are other areas that present moral dilemmas. Through the clarification of moral issues in healthcare provision, the quality of healthcare as it is received and practiced should be improved (Taylor, 2015).

There is a need to make an ethical decision whenever a healthcare expert encounters a situation in which values compete or uncertainty exists. These dilemmas can arise at personal, professional, organizational, and societal levels. Once a healthcare professional faces such a dilemma, they must take various influencing factors into consideration. These factors include the law, beneficence, autonomy, and nonmaleficence, and must be weighed against professional ethical codes of conduct. There are many reasons why concern over ethical issues in the practice of medicine and healthcare is growing. Issues such as accessibility, quality, patient safety, acquisitions and mergers, value-based care, affordability, and financial constraints all converge to complicate hard decisions made close to the end of life. Healthcare administrators and executives need to address the wide range of ethical dilemmas that practitioners face today. Such efforts should be taken with a conscious awareness of the need to involve all stakeholders in the process. When there is a sound and systematic process for making decisions, it can serve as an accepted tool to help healthcare executives navigate ethically confusing situations (Yip, Han, & Sng, 2016).

Problems of Implementing Ethical Decisions

One challenge that healthcare experts face in implementing ethical decisions is a lack of education on ethical decision-making. While medical staff encounters dilemmas almost daily, the problem is compounded by the fact that such dilemmas are rarely documented, and there is little information detailing how they were overcome. A nurse's ability to handle dilemmas in the course of their profession may be shaped by experience in previous ethical situations at various levels — individual, regional, organizational, national, and even international. Encounters at these various levels can present significant challenges in implementing ethical decisions (Webster et al., 2000).

Ethical circumstances in which no action is taken may indicate that the healthcare worker is aware that a problem exists regardless of which decision is made. An ethical dilemma can result from a nurse being unable to meet their commitments and obligations ethically. They may be unable to take what they know is the right course of action, or may simply fail to live up to expected practice standards. According to Webster and Baylis (2000), such a situation can be an outcome of a judgment error, inadequate personal resolve to act on required ethical expectations, or influences beyond the control of the nurse (Webster et al., 2000).

Situations of ethical uncertainty emerge when a healthcare expert is unsure of the ethical requirements or which principles apply to a given situation. It has been observed that healthcare workers often internalize values from their environment. These values, when held personally and as professional beliefs, can interfere with the implementation of standard ethical decisions (Webster et al., 2000).

Ethical Theories in Healthcare

Many ethical theories have been 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 applied to issues relating to healthcare. For instance, consider a patient on a short-term opioid prescription after surgery who considers feigning continued pain during follow-up visits in order to obtain a new prescription and supply an addicted friend. In this scenario, the patient would be treating the surgeon purely as a means to an end. Any attempt to universalize such an action would lead to contradictions. Kant's categorical imperative helps demonstrate why such an action should not be taken (Taylor, 2015).

According to virtue theories, exhibiting virtuous behavior is the foundation of an ethical life. Nevertheless, the theory faces criticism for lacking objectivity. It also seems to fall short in providing general criteria for distinguishing good from bad behavior, and it does not clarify whether virtuous behavior is learned or innate. In Casuistry, moral lessons are drawn from the analysis of each case on its own merits. Some cases may serve as benchmarks for future occurrences. Ethical reasoning premised on Casuistry, however, risks exerting excessive pressure to conform to society's ethical values — values that may themselves be flawed. It also leaves a gap when applied to broad issues such as resource allocation. Another theory, Care Ethics, focuses on concern and empathy toward those who are vulnerable, but it too can be criticized for its subjectivity and lack of general criteria (Reddy & Mythri, 2016).

Utilitarian procedures are commonly used by healthcare personnel when making ethical decisions in the course of service delivery. Across all levels of healthcare provision and administration, decisions are commonly based on the best collective good for patients (Reddy & Mythri, 2016). An example is when CDC officials learn of a serious contagious disease and decide to quarantine people within specified geographical areas. They might also direct that all healthcare workers caring for infected patients must quarantine themselves and report details about diagnosed patients. Such decisions carry moral and legal implications and trigger broader moral discussions. Ultimately, the central reason for making such decisions is to protect the health of the majority — the citizens — thereby promoting social utility (Reddy & Mythri, 2016).

Since each of the systems discussed above has its limitations, there is a proposal to use the four-principles approach by Beauchamp and Childress. This framework attempts to mediate between Utilitarian and Kantian views by anchoring moral reasoning in widely accepted middle-level principles: beneficence, respect for autonomy, nonmaleficence, and just treatment for everyone. The framework allows for flexible application using patient-specific information (Reddy & Mythri, 2016).

Conclusion

To improve the quality of ethics in healthcare, organizations require tools to measure the standards of ethical practice and determine whether practice conforms with established organizational norms. Such measures make it possible to compare services across a range of settings over time. Although some instruments have been developed to address specific aspects of ethical quality — such as confidentiality, privacy, ethical leadership, consultation, and patient-centered communication — there remains a need for broad-based assessment tools that cover the full spectrum of ethical concerns arising in healthcare.

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