Mel's Essay

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Format
1) The length is to be two to four pages; three pages are ideal.
2) Because this paper is a personal reflection, it will be acceptable to use “I” statements.
3) You will be expected to cite resources used in proper APA format.
4) No cover page, running head, or abstract are necessary. However, please include a reference list.
5) Content, clarity, organization, grammar, and punctuation will be considered in the grading.
6) Submit your paper via the drop box that will be found in the contents folder for Week 5.

Objectives
This paper is intended to give you an opportunity to reflect on your previous understanding of medical ethics prior to taking this class and apply some of the ethical theories and principles of medical ethics that you have learned to an actual case study. The ethical analysis required in this paper is patterned after "A Practical Approach to Ethical Decision Making for Health Care Professionals" which is provided in the folder for unit Week 1. You should read that document before you write this paper.

Part 1: Case Description
Briefly describe a case that you have read about, heard about, or personally experienced specific to health care. You may refer to cases in your textbooks for this assignment. (You might look at pages xxi-xxii of Purtilo's text for help.) Please provide the reader with enough background information to understand the core issues. Try to include important elements of the story that were available to you or the health care providers at the time the situation occurred. You may put your case into a narrative format or use bullet points to summarize the key issues. If you write a case narrative, keep it in the past tense so it reads like a short story.

Example: "On Saturday evening John came to the emergency room because of a stomach upset. He was seen immediately and tests were run."

Write simply so that almost anyone with some familiarity of medicine can understand what happened and what was so disturbing about the case. Be careful to use aliases or initials for stakeholders’ names to protect confidentiality. Your case should be approximately 1-2 paragraphs in length. Don’t use up all your space describing the case. Just relate details of the case relevant to the ethical analysis.

Part 2: Past Perspectives
After reviewing the case or situation, describe what your perspectives on this case would have been prior to taking this medical ethics course. Be honest! You will not be graded on whether you would have done “the right ethical thing.”

Part 3: Ethical Analysis (Four Steps)

1) Determine legal and ethical standards applicable to your case.
This is a very important section. Be careful not to overlook obvious laws that had a bearing on your case. You may use your textbooks as references to address the ethical component. Also, do not forget relevant sections from the OT or PT Codes of Ethics. You may also include religious principles if they have a bearing on the case. Do not try to include every possible ethical standard applicable to your case. You are much better off selecting about two to three ethical and legal standards and identify how they apply to your case.

2) Clearly identify the ethical problem.
Address what type of ethical situation you faced (dilemma, ethical distress, or locus-of-authority problem) and which ethical standards, laws, or principles were in conflict. When there is a conflict, at least two ethical or legal standards are working against each other, such as the principles of autonomy vs. beneficence. In most cases, many ethical standards and laws are in conflict. For this assignment, however, simply identify the main conflict.

3) List and briefly describe at least three feasible courses of action one might have taken in your case.

4) Select the most appropriate option and defend it.

You must select one specific option. Use data gathered during the decision-making process to justify your course of action (e.g., data about the case, ethical and legal standards, and also taking into account practical matters).

Part 4: Compare and Contrast
Compare your favored option (given in Step 4 above) with what you may have done or thought prior to taking this class (given in Part 2 – past perspectives).

Explain how the information in this class may have helped you make a better ethical decision.

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Part 1 - Case Description

This case is one that was shared with me by my uncle. He's close friends with an OT in the hospital that he works at, and he told me this story readily when I asked.

Pam, an OT, came into her clinic one day to find several of her colleagues talking amongst themselves about a patient. She soon discovered that there was an issue at hand with a woman from the middle-east who had come in for treatment after suffering a spinal cord injury. After her first appointment, it was discovered that the woman had a serious heart condition that posed potential risks to the process of treating her because of the dizzy spells and risks of heart failure that it posed. And to further the issue, the woman came from a culture where women were not allowed to be told medical diagnoses directly, but rather had to be told by a male member of their family. Her husband, in turn, was currently declining to inform his wife of her condition, because he did not want it to affect her performance as a mother.

Pam, as an OT, was torn. Her colleagues asked whether she thought they should go on and inform the woman about her heart condition or not, but she couldn't immediately think of an answer. It was clear that there were two ethical things strongly combating each other.


Part 2 - Past Perspectives

I would have readily said that the woman needed to be informed of her affliction. After all - the heart condition she was suffering from could pose a risk to her life and hinder an OT's ability to treat her. Understanding a culture is one thing, but denying a woman the path to better health because of it would have seemed unthinkable to me. What cultural norm could have been worth the life of a human being? I probably would have defended that side of the argument tooth and nail. And I probably would have thought I could find good resources for it, too. But that, of course, would have been spoken like a true person who had no idea of the intricate network and puzzle that the world of ethics in the medical field can really be.


Part 3 - Ethical Analysis

Step 1) The ethical/legal standards I would apply to this case - mainly - are Principles 1 and 3 of the OT Code of Ethics. There are other parts and principles that could apply in ways, as well, but I chose these two because I believed they were the most prevelant to this case.

Principle 1, A) states:

"Provide services in a fair and equitable manner. They shall recognize and appreciate the
cultural components of economics, geography, race, ethnicity, religious and political
factors, marital status, age, sexual orientation, gender identity, and disability of all
recipients of their services."

And Principle 1, C) states:

"Make every effort to advocate for recipients to obtain needed services through available
means."

One part has to do with respecting other cultures and other ethnicities that an OT encounters in the workplace. That would include respecting the fact that, in the culture that this case deals with, women are not told directly by medical professionals what is wrong with them. The other part - C - however, suggests that an OT should do everything in his/her power to make sure that the recipient of the treatment (in other words, the woman in this case) obtains the services they need through whatever means are available to them. Both parts conflict in this case, making the decision a very hard one to make.

Principle 3, A) states:

"Collaborate with recipients, and if they desire, families, significant others, and/or
caregivers in setting goals and priorities throughout the intervention process, including
full disclosure of the nature, risk, and potential outcomes of any interventions."

And Principle 3, C) states:

"Respect the individual’s right to refuse professional services or involvement in research
or educational activities."

Step 2) Again, two parts of a principle that conflict in this case. The first part says that an OT should communicate the nature, risks, and potential outcomes of interventions to the recipient of the treatment. Again, this would be the woman in this case. The second part, however, supports the woman's refusal of professional services, which she inadvertantly agreed to when sticking by the norms of her culture. How do you respect both sides at the same time? An ethical dilemna between these principles is currently at hand in this case. So what could possibly be the solution?

Step 3) After much thinking, I finally settled on three courses of action that I believe might have been applied in this case.

1) Speak with the husband again and strongly advise him again to inform his wife of her condition. Explain to him the true nature of the illness and the fact that it may keep her from effectively acting as a wife and a mother. If he continues to refuse, then respect his wishes based on a respect for the choices of his culture. She does have the right to refuse professional services, which she has indirectly done. She knows the norms of her culture, and knew that coming in for treatment. Therefore, the customs of the culture should be upheld.

2) Uphold Principle 3, A), and tell the woman about her condition. Explain to her that you do understand her cultural traditions, but her life was literally at stake with this illness she has. Explain that you are indeed respecting her culture, but you could not ignore the ability to help her when she so desperately needed it. This does not directly break Principle 1, A), though it does partially go against it. At the cost of the woman's life, however, that part of the principle may be partially compromised.

3) Opt out of participating in this case - if you are given the choice - because you are ethically compromised by it. Explain to your employer that you do not know the best course of action, and perhaps seek advice from a higher source.


Step 4) I would go for option 1. A patient's right to refuse professional services has been an ethical issue for years in the medical field, ever since it was first instated. I do believe that the woman, in this case, was fully aware of her culture's norms pertaining to treatment, and therefore was accepting the fact that her husband had the right to tell her or not tell her about her condition. My gut instinct would have been to tell her about her affliction, because that is her right as a patient, but I also can't argue with a patient's right to choose the terms of their service in this case. Really, it is a very hard decision, but in the end, I believe that I would stick with this conclusion as my answer.


Part 4 - Compare and Contrast

Prior to taking this class, as I stated before, I would have immediately gone with the decision to tell the woman about her heart condition. That would have been my gut instinct, my belief that the medical field knows best, and the thing I would think to be the most fair to the woman herself. In this class, however, we took a much closer look at ethics than I was used to, and I learned to pick up on some of the more subtle implications and rights that I normally wouldn't have seen. In a way I think it taught me some very important problem-solving abilities in this case...and even though I still don't know if my decision is the perfect one - because ethics aren't perfect and I'm only human - but I'm grateful that I've learned a way to go through problems logically and ethically to figure out the best decision. I know that I'll probably face many cases in which ethical problems arise, and I actually do feel more prepared for it now that I've looked at some of the most important ethics that pertain to my field, and also had the chance to try and solve some ethical dilemnas for myself through practice in this course.


Sources:

The OT Code of Ethics (2005).

Purtilo, Ruth. (2005). Ethical dimensions in the health professions (4th ed.). Philadelphia: Elsevier Saunders.

Scott, Ron. (2009). Promoting legal and ethical awareness: A primer for health professionals and patients. St. Louis, MO: Mosby Elsevier.