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Ethical Response to a Dilemma in the Clinic
Introduction
It is not easy to meet the interests of both the patients and the clinicians because of the difference of medical knowledge in both parties. This article focuses on a case where clinicians failed to attend to the patient by looking at their interests first.
The ethical dilemma
I was the nurse on duty when my attention was drawn to a patient who was in need of immediate attention. He was a 60 year old male, a diabetic suffering from chronic myocardial infarction and had a positive family history of hypertension. The patient had been admitted two weeks early and was on antihypertensive drugs. He had been tested for his cardiac markers and they were found to be elevated. The ECG and chest radiograph had shown that the myocardial infarction was worsening. The patient clearly required the attention of his doctor. I also noticed that was having difficulty in breathing and palpitations.
I called the doctor who was supposed to be on duty but he turned me down claiming that all the doctors were on strike and it could not be ethically wise to act in contrary to what all the doctors had agreed. The doctors were on a strike from that particular day until their salaries could be increased by 20% and their working hours reduced by one hour. The doctor requested me to do all I could in ensuring that the patient is alright. The patient started complaining of chest pain which implied angina pectoris and was wondering why the doctor had not arrived. Left without choice, I gave the patient propranolol to slow the heart rate and put him on oxygen to aid his breathing.
Competing loyalties between the clinician and the patient
In this scenario, it is difficult for the doctor to be on the patients side or on other doctors side. The doctor rightfully should be loyal to other doctors on demanding for their interests and the patient also rightfully needs to be treated and in this case urgently. The doctor should find a way to progress with the strike at the same time safe the patients life. Beneficence is an ethical protocol that is followed by medical professionals and it dictates that they should consider interests of the patient first before even their own. Non-Maleficence is a protocol that that implies that the doctor should not do harm to the patient under all circumstances.
Even if the doctor was to argue that the strike would have long term effect by improving the quality of life of many more patients and also make it easier for the clinicians to work, the doctor still would be answerable for the health status of the patient. American College of Physicians (ACP) has a policy that does not allow mass participation in actions that affect medical care delivery to patients (Snyder & Leffler, 2011). American Medical Association (AMA) policy is totally against strikes by the health care givers. On the other hand the patient needs to be attended to by the doctor. He will finally know that the doctor did not attend to him because he was on strike. This is likely to affect the doctor patient relationship because the patient may not be to trust the doctor anymore, it would even psychologically affect him and make him not to respond well to treatments (AMA, 2011).
My Ethical Response
Leaving a patient unattended is wrong especially to clinicians because they should always aim at improving the health status of their patients. Cases like this should not take place at any hospital be it private or public. It made me sad but I had to do what I could to save the patients life. I pleaded with the doctor and he gave me guidelines over the phone on how I could manage the patient. Most of the other nurses supported the doctors strike because they believed that it had more benefits than risks. They believed that if the strike succeeded it would improve health care delivery because it would reduce their working hours and improve their living conditions. The patients obviously were in disagreement with the nurses and felt betrayed (AMA, 2011).
Implications of risk management
The organizers of the strike were supposed to ensure that severely ill patients and those in ICU had been taken care of before starting the strike. This can save many live especially if the strike is meant to cover a wide geographical region with many hospitals. Though not the best, this is a form of simple risk management. Real risk management should be aimed at avoiding malpractice, reduce accidents and following the law. Risk management would improve the quality of health care, increase the number of patients being treated within a specified period and make the clinicians work easier.
Ethical decision-making model
Clinicians and those responsible for the wellbeing of the clinicians should resort to different methods to demand for their rights. The doctors are the management should not take a rigid stand but aim at a compromise state in reference to their situation to make the negotiation between them a possibility. Doctors should always remember that leaving patients unattended is against the practice of good medicine which each doctor is supposed to engage in. The management also has to ensure that they make it possible for the doctors to engage in the practice of good medicine by creating conditions which are favorable for the same (Sharon, 2008).
References
AMA. (2011). Developing AMA Policies. American Medical Skills. Web.
Sharon, T. (2008). The Risk Management Priority in Hospitals Protecting Financial Integrity. Nutritional Supplements. Web.
Snyder, L & Leffler, J.D. (2011). Ethics Manual. America College of Physicians. Web.
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