Health care is a business, and for those who are in the practice of medicine, and deliver health care; it can be a challenge as "the two can be in conflict at times." As said by Gregg Easterbrook, "an ethic of service is at war with a craving for gain" Therefore, a theory or system of moral values is at times, upstaged by the costly reality of its own implementation. Health care is now being challenged on the proper allocation of resources, bringing to the forefront even more ethical questions.
In the medical profession there are standards that govern the conduct of their members. For those that are employed in hospitals and other health care institutions, it is expected that they live by them. It is written into the Hippocratic oath. And it is meant to be part of who they are.
Everyday in health care decisions are pondered, as lives are held in balance while an ill patient lies between life and its pursuit of care. When does the time come to make the decision to surrender to what may be considered, as life's preordained plan? At this time, we are all in need of professional help and guidance.
Those who have answered the call into the medical profession make ethical decisions everyday. None more often, than those that work in the area of Obstetrics. While giving birth is in itself "ordinary" by nature's design. It can for some turn into a complex medical crisis. Thus challenging the obstetrician's skills. Suddenly, thrust upon the physician is the full responsibility for the outcome. One that, if left alone in nature, would have come to its own conclusion.
How great is this crisis for this mother, and as well for the obstetrician when there are complications during a delivery? The physician is now holding in his hands the responsibility to resuscitate and save this infant. Even though all of his knowledge tells him of likely brain damage, or there may even be obvious abnormalities that are known to be incompatible with life. In these cases. There are those that would ask, would not benign neglect be better ?
It is the obstetrician that will be faulted, regardless of the facts, his decision or the outcome. Often there are lay persons searching for an error, finding fault and pursuing justice in the name of law. And regardless of the validity of their claim. Forging forward for financial gains to supplement an irretrievable loss. Therein lies the reason that so many good obstetricians have left the field of medicine and have gone into research.
This story in health care is played over and over again, as each individual comes into a system that is designed to reverse the normal course of events for the ill or injured patient's body. Or with the need to intervene in the normal degenerative process called aging. Most often the healing arts come to the rescue. Again, and again, it applies the best skills in both small and large ways. Then, all things being equal, the improved quality of life will have been gifted once again. How very blessed we are.
Health care has come far in the management of chronic illness'. Great advances having added quality to lives of patients. For those who have been educated about their illness and treatment,. and are compliant with the best practices in self care. They have been fortunate. Eventually, the time comes when their chronic illness becomes acute, and the options are running out. Do we in health care ever think enough is enough? Or should we be giving more aggressive care? What to do next is the dilemma, the reality that everyone of us must face.
So, when ethical dilemmas arise in health care, how are they best resolved ?
Bernard Lo M.D. UCSF Medical Center, is involved in the research area of clinical medical ethics and advocates shared decision making:
*The patients involvement and shared decision making in their care.
*Encourage the patient to play an active role.
*Elicit the patient's perspective on the illness
*Build a partnership with the patient.
*Keep the patient informed,
*Provide comprehensive information.
*Frame the issues without bias.
*Interpret alternative choices in patient goals.
*Confirm patients understanding of information.
*Protect patients interests.
*Help patient to deliberate.
*Make a recommendation.
*Try to persuade patient.
One might question the use of the word persuade. However, in this case, "Persuasion is a form of social influence. It is the process of guiding people and oneself toward the adoption of an idea, attitude, or action by rational and symbolic { Though not always logical } means. It is a strategy of problem solving relying on "appeals" rather than coercion. According to Aristotle, "Rhetoric is the art of discovering, in a particular case, the available means of persuasion "
In the relationship between a patient and their physician, it is trust that is valued the most. A patient wants and needs some direction. Especially, when the time comes to make decisions regarding end of life care. However, more than anything else, the patient and the family needs to know and feel that they will be cared for even as they draw their last breath. It is the ethically right thing to do. We owe it to one another.
http://www.caregiving.com/2009/08/the-ethics-of-care giving-navigating-the-shades-of-grey/
* Bernard Lo, MD, author of Resolving Ethical Dilemmas : A guide for clinicians.
http://en.wikipedia.org/wiki/Persuade