Ethical dilemma in health care




Read each scenario describing an ethical dilemma in health care. Select TWO scenarios for which you will write a thorough response to not exceed ONE complete paragraph for each. Responses will vary based on an individual’s cultural upbringing, ideology, and educational knowledge; however you must support your position with appropriate theory and principle. In Clinical Ethics, three clinical ethicists (a philosopher – Jonsen, a physician – Siegler, and a lawyer – Winslade) developed a method to work through difficult cases. The process can be thought of as the ″ethics workup,″ similar to the ″History and Physical″ skills that all medical students use when learning how to ″workup″ a patient′s primary complaints. While this method has deep philosophical roots, clinicians who use this method like the way it parallels the way they think through tough medical cases. Medical Indications – All clinical encounters include a diagnosis, prognosis, and treatment options, and include an assessment of goals of care Patient Preferences – The patient’s preferences and values are central in determining the best and most respectful course of treatment. Quality of Life – The objective of all clinical encounters is to improve, or at least address, quality of life for the patient, as experienced by the patient. Contextual Features – All clinical encounters occur in a wider social context beyond physician and patient, to include family, the law, culture, hospital policy, insurance companies and other financial issues, and so forth. escenarios Scenario 1 At your last office staff meeting, the rising cost of rent and overhead was discussed. One of your partners mentioned that he had been approached by a large pharmacy chain with an offer of space adjacent to their new pharmacy that is only one block from your current offices. The cost per square foot is half of what you are currently paying and there was a suggestion that the rent could be lowered if the volume of presсrіptions from your office were substantial. Although this offer is very tempting, you have reservations about the potential conflict of interest. One of your partners is pushing to explore this option. You are wondering if you could manage the conflict by refusing to engage in any reduction in rent based on presсrіption volume but still take the space at the reduced lease costs. Another partner feels that this arrangement will compromise her autonomy and feels that it will look as if the office is associated with the pharmacy even if it is not. Everyone agrees that the overhead costs need to be reduced. What is the right thing to do? Scenario 2 You are the training director for a residency program. Recently, several residents have come to you reporting that a physician frequently makes disparaging comments to residents and to patients about the work of other physicians. The physician’s latest comment was to a patient in which he said he would not allow a particular physician to treat his pets. Other comments attributed to this physician involved telling the residents that a surgeon is a butcher and a psychiatrist a mindless twit. The residents have attempted to speak to him about this practice to which the physician responded by saying he only speaks the truth, adding that patients and residents have a right to know. The residents report the comments appear to be unwarranted and they seem to be scaring the patients. Is this physician behaving unethically? Should physicians question the work of their colleagues? How should this be done?

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