Ethical Dilemmas in Healthcare: Balancing Decisions in Critical Care Case Study

Analysis of Ethical Dilemmas in Healthcare: Case Studies on Resource Allocation, Patient Autonomy, and Professional Ethics

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Ethical Dilemmas in Healthcare: Balancing Decisions in Critical Care Case Study

Section 1: Introduction

An ethical dilemma emerges when one is confronted with a circumstance where one should settle on a choice between two ethically clashing decisions. Moral speculations assume a pivotal part in assisting with exploring and resolving such predicaments. These speculations give structures and rules that guide our dynamic interaction, guaranteeing that we think about the moral ramifications of our activities. By understanding moral hypotheses like consequentialism, deontology, and prudence morals, we gain significant viewpoints and devices to investigate and assess the expected results of our decisions. This understanding empowers us to go with additional educated and moral choices, improving the probability of positive results in moral predicaments.

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Case study 1

In Case Study 1, the moral dilemma involves giving Gene or Fred a limited resource—the vacant bed in the critical care unit. The moral conundrum is whether Gene, who tried to live a healthy lifestyle but nonetheless had a heart attack because of his family history, should be given preference over Fred, who practised bad behaviours yet had the same result. The tension arises from attempting to balance genetic propensity with personal responsibility for health. The moral dilemmas in the two scenarios are very different from one another. In Case Study 1, the emphasis is on equitable resource distribution, especially when taking into account the contribution of individual responsibility to health outcomes. It highlights issues with distributive fairness as well as the possible clash between personal preferences and community expectations (Travers, 2018).

Case study 2 :

Case Study 2 on the other hand discusses moral dilemmas including competence, consent, and autonomy. The main question is whether to prioritise Mr. C's overall wellbeing and the possibility of recovering from the current chest infection through hospital intervention or to respect his autonomy by taking into account his past discomfort from hospital admissions and his wife's preference for him to receive the maximum treatment. The moral conundrum is how to choose a course of action that respects liberty and beneficence while taking into account Mr. C's failing health and slim chances for long-term rehabilitation. In Case Study 2, the ethical issues revolve around making decisions for a weak person who has limited autonomy as a result of dementia. The challenge in this situation is striking a balance between the patient's best interests and respect for their autonomy, while also taking their prior experiences, as well as the preferences of their carer, into account (Wolfe, 2021).While the cases differ in their specific ethical issues, there are also some points of agreement. Both cases involve healthcare decisions and the allocation of limited resources. Additionally, they both require careful consideration of the balance between individual autonomy and the well-being of the individuals involved. Both cases highlight the complexity of ethical decision-making in healthcare, where multiple values and principles need to be weighed against each other (Dakin, 2018).

Section 2: (Role of Ethical principles, Professional ethics & Codes of conduct and Legislation and Policy in choice of solution)

Case study 1 :

  • Utilitarian thinking would prioritise the patients' overall health in Case Study 1 and seek to maximise the greatest good for the largest possible number of people. This viewpoint suggests that Gene, who has taken steps to lead a healthy lifestyle, could be given preference in the professional response since his survival and recovery are more likely to benefit society as a whole (Felzmann, 2017). The focus would be on avoiding new health issues and encouraging a healthy populace. Deontological philosophy, on the other hand, would emphasise values and obligations while taking into account each person's rights and obligations. Given that Gene and Fred are both patients in need, the professional answer in this situation may be that they both deserve equal access to healthcare services. Fairness, equality of treatment, and other virtues would be given top priority under deontological ethics (Mandal, 2016).
  • Social justice would emphasise the need for an equitable distribution of the available beds in the critical care unit in Case Study 1. It would emphasise providing Gene and Fred with equal opportunity to obtain the required medical treatment. The impact of genetic predisposition, socioeconomic variables, and structural impediments that may have had an impact on their health outcomes would all be taken into account by a professional response grounded in social justice. It would encourage equitable access to healthcare services and work to reduce health inequities, regardless of personal habits or family history. While Gene's attempts to lead a healthy lifestyle may be appreciated, social justice would promote equitable care and a fair evaluation of the patients' requirements (Ebrahimzadeh, 2019).
  • In Case Study 1, the principle of human rights would emphasize that both Gene and Fred have the right to receive appropriate and timely healthcare. Professionals would recognize their right to life, health, and access to medical treatment without discrimination based on their lifestyle choices. Human rights would require professionals to ensure that the allocation of the available bed in the intensive care unit is based on medical need and not on moral judgments about personal behaviours (WHO, 2019). While Gene's efforts to maintain a healthy lifestyle may be acknowledged, human rights principles would underline the importance of equal treatment and non-discrimination, ensuring that both individuals have a fair opportunity to receive necessary care.
  • In Case Study 1, the UK Mental Capacity legislation and policy may not be directly applicable as Gene and Fred have not been indicated to lack mental capacity. However, if either of them was to lose mental capacity as a result of the heart attack, the legislation and policy would come into play. In such a situation, professionals would be guided by the principles outlined in the Mental Capacity Act 2005, which emphasizes that decisions should be made in the best interests of the individual, taking into account their past and present wishes, feelings, beliefs, and values. Professionals would engage in capacity assessments and consult with appropriate individuals, such as family members or carers, to determine the best course of action for the individual (Wilson, 2017).

Case study 2 :

  • In Case Study 2, the UK Mental Capacity legislation and policy would be highly relevant as Mr C has dementia, which may affect his decision-making capacity. Professionals would be guided by the Mental Capacity Act 2005 in assessing Mr C's capacity to make decisions regarding his healthcare. If Mr C is deemed to lack capacity, professionals would follow the prescribed process for decision-making, including considering his previously expressed wishes and consulting with his nominated decision-maker, which in this case is likely to be his wife. The legislation and policy would guide professionals to act in Mr C's best interests while respecting his autonomy to the greatest extent possible (Crowm, 2017).
  • In Case Study 2, the principle of human rights would highlight the rights and dignity of Mr C as an individual with dementia and long-standing lung disease. Professionals would recognize his right to autonomy, privacy, and informed consent. They would consider his past distress from hospital admissions and respect his preferences to the extent possible. Human rights principles would guide professionals to involve Mr C and his wife in the decision-making process, ensuring their right to participate in decisions about his healthcare. While human rights would recognize Mr C's autonomy, they would also require professionals to consider his overall well-being, avoiding neglect or harm. Balancing these rights, professionals would seek to provide the necessary care and support, taking into account Mr C's unique circumstances and ensuring his dignity is respected throughout the decision-making process (WHO, 2022).
  • In Case Study 2, social justice would emphasise how crucial it is to address health inequalities and guarantee disadvantaged groups have fair access to healthcare. Given the greater societal disparities, a professional approach based on social justice would take into account Mr. C's unique circumstances, including his age, dementia, and lung illness. It would consider the possible effects of earlier grief and his wife's preferences while attempting to strike a balance between the ideals of autonomy and beneficence. Social justice would encourage all-encompassing healthcare that acknowledges the special requirements and difficulties experienced by those with dementia and aims to offer equal treatment, regardless of their cognitive capacity or prior hospital experiences (Ruger, 2004).
  • In Case Study 2, utilitarian reasoning would take Mr. C's prospects for recuperation and general wellbeing into account. It would consider the advantages and disadvantages of hospital care, taking into consideration his discomfort from prior hospital stays and his wife's preference for receiving the most therapy possible. Even though Mr. C may experience future infections, the professional reaction could bias towards hospitalisation if it is anticipated to significantly improve his current health and improve his quality of life (Patil, 2020). On the other hand, deontological reasoning would value honouring Mr. C's autonomy and taking into account his prior suffering. Mr. C's comfort and wellbeing may be given priority in the professional response, allowing for a more cautious approach that respects his prior encounters and personal preferences, even if it means not pursuing hospital treatment (Theofanidis, 2020).

There are two ethical frameworks that might guide the professional approach to each case study: utilitarian reasoning and deontological thinking. Compare and contrast how these strategies might handle the moral conundrums in each situation.

Comparing the two ethical systems, utilitarian thought places an emphasis on results and social welfare in general, frequently tolerating the compromise of individual rights or preferences if doing so results in a greater good for the majority. On the other hand, deontological thought emphasises upholding personal liberty, rights, and moral obligations even when the results may not always produce the greatest overall benefit.

  • Ideas of social justice would play a significant role in informing professional responses to each case, particularly in terms of equitable access to healthcare resources and the fair distribution of benefits and burdens (RE, 2021). Let's compare and contrast how social justice would inform professional responses to each case study.

While social justice would inform the professional responses in both cases, there are some contrasting elements. In Case Study 1, social justice would focus on equal treatment and fair allocation of resources, acknowledging the influence of genetic factors and systemic issues. In Case Study 2, social justice would emphasize equitable access to healthcare for vulnerable populations, addressing disparities and considering the specific needs of individuals with dementia. Both cases highlight the importance of considering the social determinants of health, promoting equity, and challenging any biases or discrimination that may arise in healthcare decision-making.

  • The principle of human rights can provide a valuable framework for professionals to understand possible responses to each case study, particularly in terms of individual entitlements, dignity, and non-discrimination.

By emphasising the rights and dignity of the people concerned, the human rights concept is seen to play a significant role in both of the case studies. Human rights would emphasise equitable treatment, non-discrimination, and the access to healthcare, regardless of lifestyle choices, in Case Study 1. Human rights in Case Study 2 would place a strong emphasis on autonomy, privacy, and the right to decision-making while also taking into account the overall health and dignity of the person.

  • The professional reaction to each case study would be significantly influenced by the UK Mental Capacity legislation and policy, especially in circumstances when people may not be able to make their own decisions.

. The UK Mental ability Act and policy would educate professionals on the value of determining a person's mental ability, including the proper parties in decision-making, and acting in the person's best interests when they lack capacity in both case scenarios. It offers a moral and legal framework for situations requiring diminished decision-making capacity that strikes a balance between the values of autonomy and beneficence

Section 3: (Role of Personal & professional values in choice of solution)

Case study 1

  • In Case Study 1, virtue ethics would place a focus on helping healthcare practitioners acquire moral character characteristics. Professionals would respond to the quandary by taking accountability, compassion, and justice into account from a virtue ethics perspective. They could acknowledge Gene's attempts to live a healthy lifestyle and think he is exhibiting virtues like self-control and self-care. This might cause experts to give Gene a higher priority based on his personal qualities and the possibility of long-term progress. Professionals, on the other hand, could think that Fred lacks virtues because of his harmful habits. However, virtue ethics would also advise against making hasty decisions and encourage experts to take into account how societal and genetic variables might affect a person's behaviour and health (Kotzee, 2017). While character and interpersonal connections are emphasised in both virtue ethics and care ethics, there are notable distinctions in how they are used in the two case studies. In Case Study 1, virtue ethics could prompt professionals to prioritise people like Gene who have made an effort to live a healthy lifestyle by taking personal virtues and character qualities into account when allocating
  • In Case Study 1, cultural differences may shape people's responses to the dilemma. Different cultures have varying perspectives on health, responsibility, and the role of genetics. Some cultures may prioritize individual responsibility and place a greater emphasis on personal choices, leading to a potential bias against Fred and his unhealthy lifestyle. Others may view health outcomes as influenced by a combination of individual choices, genetic predisposition, and social factors, leading to a more nuanced approach in evaluating the two individuals. Age, race, and gender can also have an impact on how people respond. Biases resulting from gender stereotypes may be perceived as males being less disciplined in their lifestyle choices and women being more health-conscious. Access to resources and treatment, as well as views of health and wellness, may be influenced by ethnic and cultural origins. There may be age-related biases, where older people are assessed more severely for their health results or seen to have less room for growth. Reactions can also be influenced by religion and spirituality. Some theological perspectives may place a strong emphasis on individual accountability for one's health and see disease as a result of divine will or retribution. Others could emphasise the value of taking care of one's body and practising self-care. Prioritising healthcare resources may be impacted by religious beliefs.

Case study 2

  • Care ethics would place a strong emphasis on the value of connections, empathy, and attention to the needs of those who are more vulnerable in Case Study 2. Professionals would acknowledge the caregiver-wife's perspective and the significance of her connection with Mr. C from the standpoint of care ethics. She would be seen as a crucial someone who is well-acquainted with Mr. C's requirements, preferences, and best interests. Care ethics would compel experts to pay attention to her worries and consider them when making judgements. Professionals would place a higher priority on preserving continuity of care in light of Mr. C.'s past struggles with hospital admissions and his wife's desire for him to have the best care possible. The focus would be on building a compassionate and encouraging atmosphere for Mr. C, honouring his autonomy and dignity, and making sure his overall well-being (Moudatsou, 2020). Care ethics in Case Study 2 focuses more emphasis on the relational component, acknowledging the caregiver's position and giving Mr. C's preferences and well-being top priority within the framework of his relationship (Doukas, 2022).
  • In Case Study 2, reactions might vary based on cultural variations, gender, ethnicity, religion, age, and handicap. Views held by carers, professionals, and members of the general public may be influenced by cultural ideas and practises towards care for the elderly and those suffering from dementia. The view of the wife's function as a caretaker and decision-maker may be influenced by gender norms and expectations. Different ethnic and cultural viewpoints may exist on autonomy, decision-making, and the function of family in healthcare decisions. Religious convictions can also have a big impact since they hold diverse perspectives on family engagement, treatment choices, and end-of-life care. Ageism and age-related prejudices may affect how Mr. C, the elder patient, is seen, perhaps leading to judgements that favour younger people or undervalue the value of older lives. The evaluation of Mr. C's skills and the provision of suitable support and accommodations may be impacted by prejudices connected to his disability.
    While their direct influence may be less obvious in the provided case studies, variables like sexuality and other types of diversity may intersect with the overall reaction to the challenges.
  • Virtue ethics, care ethics, and narrative ethics can all inform the professional response to each case study by focusing on character, relationships, and the individual's story.

In both case studies, narrative ethics may be used by taking into account the person's life story and unique experiences. Professionals understand that every individual has a distinct story influenced by their surroundings, values, and connections. Professionals may grasp the viewpoints, hopes, anxieties, and desires of Gene, Fred, and Mr. C through comprehending their tales. This knowledge may help in decision-making, fostering empathy, and creating solutions that fit the person's story and values (Daryazadeh, 2019).

  • People's reactions to the ethical difficulties in each case study can be strongly influenced by cultural variations, gender, race, religion, age, sexual orientation, handicap, and other pertinent factors. Let's investigate the probable effects of these variables and contrast and contrast their impact in each situation.

Section 4: (Discussion & Conclusion)

  • The consequentialist framework would emphasise the significance of maximising total well-being and minimising damage when taking Cases 1 and 2 together. The duty framework would place a higher priority on respecting moral duties and responsibilities to those engaged. The virtue framework would emphasise the growth of moral character characteristics and virtues in decision-making.
  • The ideas from philosophy, such as consequentialism, duty ethics, and virtue ethics, are valuable in decision-making in health and social care practice. They provide ethical frameworks that guide professionals in considering the consequences of actions, ethical obligations, and the development of virtuous qualities. These considerations are necessary in shaping everyday responses and choices to ethical dilemmas encountered in healthcare to ensure ethical and responsible decision-making.
  • Conservatism, the attention to histories and local circumstances, and the Handing Down Lens would likely have an impact on decision-making in the above cases. These perspectives emphasize the importance of preserving and maintaining what has been entrusted to us, taking into account the lessons learned from the past and the unique contexts in which decisions are made. They promote a cautious and responsible approach to decision-making, considering the long-term consequences and the well-being of future generations.
  • The intended consequences of the decision recommended in the case study would be promoting the well-being and best interests of the individuals involved, considering their preferences and values. However, unintended consequences could include potential inequalities, biases, or unintended harm to certain individuals. Based on these consequences, it may be necessary to reassess the decision and consider alternative approaches that address any potential disparities. Recommendations would include continuous evaluation, reflection, and an ongoing commitment to fairness, equity, and person-centred care.

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References

Crowm, 2017. Mental Capacity and Deprivation of Liberty, s.l.: Law Com No 372.

Dakin, H. A., 2018. Decision Making for Healthcare Resource Allocation: Joint v. Separate Decisions on Interacting Interventions. Decision Making for Healthcare Resource Allocation: Joint v. Separate Decisions on Interacting Interventions, 38(4), pp. 476-486.

Daryazadeh, S., 2019. Application of narrative in medical ethics. Journal of Medical Ethics and History of Medicine .

Doukas, D. J., 2022. virtue ethics and care ethics. BMC Medical Education, 131(22).

Ebrahimzadeh, J., 2019. Assessing equity in the distribution of hospital beds: evidence from northern Iran. Proceedings of Singapore Healthcare, 28(4).

Felzmann, H., 2017. Utilitarianism as an Approach to Ethical Decision Making in Health Care, s.l.: University of Galway.

Kotzee, B., 2017. Virtue in Medical Practice: An Exploratory Study. HEC Forum. , 29(1), p. 1–19.

Mandal, J., 2016. Utilitarian and deontological ethics in medicine, s.l.: Jawaharlal Institute of Postgraduate Medical Education & Research.

Moudatsou, M., 2020. The Role of Empathy in Health and Social Care Professionals. Healthcare (Basel), 8(1).

Patil, I., 2020. Reasoning supports utilitarian resolutions to moral dilemmas across diverse measures. Journal of Personality and Social Psychology, 120(2).

RE, 2021. What Are Some Key Examples of Social Justice in Health Care?. [Online]
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Ruger, J. P., 2004. Health and social justice, s.l.: NLM.

Theofanidis, D., 2020. Special Article Ethics and Deontology in Nursing Research: A Discussion Paper, s.l.: Dimitrios Theofanidis.

Travers, J., 2018. What Is Resource Equity?: A working paper that explores the dimensions of resource equity that support academic excellence, s.l.: ERS.

WHO, 2019. The Right to Health , s.l.: WHO.

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Wilson, S., 2017. Mental capacity legislation in the UK: systematic review of the experiences of adults lacking capacity and their carers. BJPsych Bull. , 41(5), p. 260–266..

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