Applying Ethical Principles PDF

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Applying Ethical Principles

Melissa McCartney Capella University NHS4000: Developing a Health Care Perspective Dr. Sturdivant October 2021

Applying Ethical Principles A career in the medical field can be both rewarding and challenging. Healthcare professionals face numerous dilemmas daily that are full of continuous decision making and critical thinking. There will be coworkers, patients, patients’ families or physicians with a different opinion or answer to the problems faced throughout the workday. In this area of work, many actions and behaviors are considered ethical or non-ethical. Ethics, according to the Merriam-Webster dictionary, is defined as the discipline dealing with what is good and bad and with moral duty and obligation. (Merriam-Webster, 2021) These ethical dilemmas that uprise can be solved with the help of the four ethical principles: Autonomy, beneficence, nonmaleficence and justice.

Overview of the Case Study Matt Losinski is the Chief Executive Officer of County General Hospital in central Texas. His main purpose of the case study was overlooking the statistics from Central Texas regarding the overuse of emergency services, which led him to then review County General Hospital’s statistics as well. Ten years ago, the hospital went from hospital business to a not-for-profit hospital system; meaning the hospital no longer receives tax subsidy as to when it was county owned and now looks to itself for fiscal health. His case study reviews 9 residents from Central Texas, in which these residents visited the emergency department a total of 2, 678 in over a sixyear period. These total visits cost around $,1000 or more each visit; resulting in the 9 residents consumed around $2.7 million dollars in resources. These residents were all middle-aged, spoke English and were split between male and female. After Losinski spoke with Mary Scott, the Chief Financial officer; he found that Medicaid paid 75% of costs for eligible users, although

privately insured and self-pay covered most of the unpaid additional costs. These costs amounted to over $200,000 dollars each year that was not reimbursed back to County General Hospital. Analysis of Ethical Issues in the Case Study In the case study above, Losinski states that repeated emergency room visits contributed to overcrowding, delays in treatments and overall dissatisfaction for other patients seeking emergency room treatment. These repeated admissions were possible due to the Emergency Medical Treatment and Active Labor ACT (EMTALA), which allows all persons regardless of their ability to pay or insurance status, who present to a hospital, in which the hospital receives federal reimbursement for service, to be treated and stabilized. The American College of Emergency Physicians EMTALA facts state that the burden of the unpaid care is expanding, which in return is closing many emergency rooms, decreasing resources for everyone and threatening the ability of emergency departments to care for all patients (American College of Emergency Physicians, 2021) Using the Ethical Decision-Making Model to Analyze the Case Study The ethical-decision making model contains three components – moral awareness, moral judgment and ethical behavior. When faced with an ethical dilemma, these components can be used. In moral awareness, Losinski recognizes the troubles and the ethical dilemmas that exist with repeat emergency room department visits. As healthcare providers, we must have the ability to detect and appreciate the ethical asset of the decision one must make. Hospitals must first recognize the ethical dimension of an issue they face, which in this case is emergency room repeated visits. Once a moral awareness is evident, we can make a moral judgment in deciding what is right and what is wrong. There are multiple variables driving personal judgment; one variable is the individual differences and cognitive bias we all have based on personal history

and experience. A second variable is organizations, in which may be influenced from a group, organizational or cultural perspective. Losinski’s moral judgment guided him to speak to the chief financial officer, and then hospital management regarding his findings of the overuse of the emergency room department resources. Unfortunately, hospital management brought forward that the EMTALA allows patients to be seen regardless of their ability to pay or insurance status. This model leads us to ethical behavior, which is taking the action to do the right thing. Losinski knew that his ethical behavior led him to speak with hospital administration, although the outcome was not at all what he expected. Effectiveness of Communication Approaches in the Case Study Communication plays a crucial role in the healthcare system; Effective communication is listening to what is being said so that the message is understood. In this case study, the lack of effective communication is what is Matt Losinski received multiple times from chief financial officer and the hospital management team. What Losinski thought was an ethical dilemma, Mary Scott believed was nothing that should be priority. When he then presented to the management team, which included vice presidents, the director of development, and the president of the medical staff; he was once again shocked to find that they didn’t believe this was anything to find a solution for. Losinski reached to senior management for recommendations and was left without a resolution. Resolving the Ethical Dilemma by Applying Ethical Principles The four ethical principles come in to play: autonomy, beneficence, nonmaleficence and justice. Autonomy gives the patient the right to control his or her body, allowing them to make their own decisions, regardless of whether the health care provider believes that it is in the patient’s best interest or not. Beneficence means the healthcare professionals must do all they can

do, to benefit each patient in every situation. Nonmaleficence is to “do no harm,” and lastly, the principle of justice is to treat all patients the same, in fairness. In the article by L. Neergaard, “Back again; Repeat visits to emergency room a common problem”, Such issues are addressed regarding the repeated emergency room visits. The article speaks that some hospitals have initiated video calls and establishing primary care physicians for patients that do not have one so they do not have to return to the emergency room for follow up visits. “New research, based on records in six states, suggests patients should be pushy about getting follow-up care so they don’t have to return to crowded emergency departments” (Neergaard, 2015).

Conclusion Health care professionals can apply the four principles of health care ethics to ethical dilemmas, which allow them to analyze and solve. These include advocating the principles of autonomy, beneficence, nonmaleficence and justice – along with the Ethical Decision-Making model.

References

Merriam-Webster. (n.d.). Ethic. In Merriam-Webster.com dictionary. Retrieved October 30, 2021, from https://www.merriam-webster.com/dictionary/ethic

EMTALA Fact Sheet. (n.d.). American College of Emergency Physicians. https://www.acep.org/life-as-a-physician/ethics--legal/emtala/emtala-fact-sheet/

Neergaard, L. (2015, Jun 16). Back again; repeat visits to emergency room a common problem. Prince George Citizen Retrieved from http://library.capella.edu/login?qurl=https%3A %2F%2Fwww.proquest.com%2Fnewspapers%2Fback-again-repeat-visits-emergency-roomcommon%2Fdocview%2F1689192641%2Fse-2%3Faccountid%3D27965...