Ethical decisions în healt care

An ethical dilemma is a conflict between two obligations. At times a health care worker may have an obligation to a patient that conflicts with his or her obligation to the employing facility or some other person. Sometimes neither choice can be made without sacrificing the other. This is a dilemma.

An example is in a situation where a pregnant woman is killed from injuries sustained in a car wreck, but the fetus may still be able to sustain life by keeping the mother on life support. The wife had always said she would not want to be kept alive on life support if there was no reasonable expectation of full recovery. Should she be put on life support when her family knew she did not want that and it would be at great expense to the family, and when the woman is already clinically dead?

Prolonging life at the end of the lifecycle also presents ethical dilemmas. Should the child's college fund be spent on the grandparent's surgery bill when there is no reasonable expectation for a full recovery and the quality of life will include minimal functioning in a long term care facility? The people in the middle have an obligation to care for both their child and their parent.

Health Care today has an abundance of ethical dilemmas such as assisted suicide, late term abortion, end of life decisions, and balancing for-profit health care delivery systems with humane and high quality patient care.

It is the society, community and individual that set moral standards that distinguish right from wrong. These standards are influences by the societal norms, philosophy, values and religious beliefs. An individual's personal ethics reflect these moral standards and direct his or her choices and behaviors. Respect for the needs and rights of the patient form the basis of ethical behavior in the health care field.

Each health profession has its own Code of Ethics; however they have some common general ideas. The following is a summary of typical commonalties:

- The goal of health care is to promote optimal health, preserve life and support the transition through death when necessary.

- The patient's religious and cultural beliefs and practices are respected.

- Care is provided regardless of the patient's age, gender, race or type of illness or injury.

- The practitioner performs within the defined scope of practice and avoids unethical or illegal acts.

- Competence is maintained through continuing education.

- The rights of patients are respected and confidentiality is practiced.

- The profession is supported through participation in research and/or membership in professional organizations.

The Code of Ethics for a given profession provides guidelines for ethical decision making. For example the National Association of Social Workers' Code of Ethic specifically identifies that having a sexual relationship with a client is unethical (even if consensual). A therapist from the social work profession who falls in love with a client would risk breaking the Code of Ethics to pursue a romantic relationship. If a therapist were to experience a desire to engage in a romantic relationship with a client, he or she will find clear guidelines for appropriate professional behavior in the Code of Ethics. An ethical decision made by a therapist would be to avoid pursuing a romantic relationship with a client.

Scenarios to Ponder and Discuss (on the Bulletin Board) Identify ethical issues and differentiate them from ethical dilemmas by identifying the conflicting obligations in the dilemmas.

1. A new patient is admitted with more than a thousand dollars packed loosely with his clothes. As you (the nursing assistant) are helping him unpack he tells you to put one of the twenties in your pocket.

2. Mr. B. is dying of cancer. His wife calmly explains to the doctor that she knows he would not want to suffer so much and asks for him to be given a lethal dose of morphine.

3. A baby is born with many deformities and only the brainstem section of the brain that provides for respiration and heartbeat, but no chance of higher thinking processes. The doctors recommend withholding feedings. As a nurse you feel that life should be sustained.

4. A lab technician is preparing to draw blood to measure the arterial blood gas of 23 year old Joseph who is being kept alive by respirator following a motorcycle accident. Joseph's pregnant wife stops the technician and says, "No more needles. Do you think I should allow them to discontinue the respirator?"