An Ethical Dilemma in Health Care: Stakeholders, Ethical Conflicts, and Resolutions

This article discusses an ethical dilemma in a health care context, focusing on the stakeholders involved, the ethical conflicts they face, and proposing a legally and ethically defensible resolution. It explores the case of Elsie, a patient who experienced a cardiac arrest while being transported to the hospital, leading to a lawsuit against the RAC facility, registered nurses, and paramedics. The article also examines the principles of health care ethics and relevant codes of ethics and professional conduct.

AN ETHICAL DILEMMA

INTRODUCTION
In health care context, professionals and practitioners are required to undertake several
decisions related to life and death of patients; hence they need to consider ethical dilemma in all
areas. In this respect, health care practitioners are also required to underpin clinical practice so
that challenging situations can be appropriately handled.
Elsie is having problems of AMI, bilateral cataracts and hip replacement for around four
years and she had also taken admission to the RAC facility for advanced nursing care. She is
quite satisfied with the services as earlier she spoke to her family as well regarding RAC facility.
In between, she faced severe chest pain which radiated down her shoulder and as a result the care
entity took decision to transport her to the hospital. While transit, she had a cardiac arrest and
even after getting paramedic attempt, she died. Looking towards the case, her family sued the
R.N, the paramedics and RAC facility. The family also determined that the death was brought by
stress of being moved to hospital.
Further, discussion has also been included regarded ethical aspects that needs to be
adhered from case perspective. Moreover, in the study researcher has also mentioned legal and
ethical defensible resolution to the present conflict.
TASK 1
In the below section, detailed information regarding stakeholders have been stated as per
the case of Elsie. Moreover, researcher has also stated ethical dilemma of each of the stakeholder
present in the study.
Determine the stakeholders as per the case scenario
In the present case, different stakeholders are present such as health care practitioners of
RAC, the paramedics, family members of Elsie (patient) and the registered nurses. In the below
mentioned section, different stakeholders are discussed who are affected from this dilemma:
RAC facility: The care home is entitled to treat the patients according to their issues;
therefore in the present case also, RAC facility was accountable to deliver medical services to
Elsie. At the same time, they also faced the major ethical dilemma from Elsie’s family members
regarding her death (Wilson and Wilks, 2013). While giving any of the medical service, RAC
facility could have to discuss the situation with the family members.

Registered nurses: One Friday night, Elsie has severe chest pain and due to irregular
pulse, registered nurses called the ambulance. Since, her condition was severe; thus nurses had
no idea whether they should move her to hospital. This was the major dilemma faced by the
registered nurses in respect of the case.
Family members are important stakeholders in the domain of health and social care.
Hence, the present study is also including the role of family members (Gardner, Ruest, and
Cummings, 2016).
Family members: The family members of Elsie wanted her recovery; but her condition
was too severe. The family members were also unable to comprehend that it was necessary for
the care home to give her medical treatment. Since, they are family, so they are depressed due to
the death which is the major ethical dilemma (Hough and et.al., 2016).
In the current case, paramedics were also involved as they attempted resuscitation but it
went unsuccessful.
The paramedics: The paramedics were doing their duty; however they could have
considered the history of Elsie. This could have helped them to give her better treatment
according to the condition (Hasan and Rashid, 2016). However, the paramedics are also in fault
as Elsie pleaded to leave her when she had chest pain; but considering the pain paramedics found
that it would not be appropriate to leave her in such condition. They performed whatever was
necessary for Elsie and this represents that they are bothered about their moral responsibilities.
As per the question, it is clear that stakeholders should become aware about the condition
of all the patients so that to them in best possible manner. Thus, the section has clearly stated that
ethical facets needs to be prominently considered at the time of dealing with different patients.
TASK 2
Differentiate the ethical and legal conflicts from following perspectives
THE DIGNITY AND RIGHTS OF ALL STAKEHOLDERS IN THIS CASE
Apparently, interest of all the stakeholders can be prevented in the organization when the
entity is able to involve all the people in prominent manner. In the present case, all the
stakeholders possess different rights and responsibilities as they are carrying out their duties in

health care context.
RAC facility had the right to provide medical assistance to Elsie as she was their patient.
Since, they knew the health condition of Elsie; therefore they had the authority to take
decisions for her betterment (Eberholst, Hartley and Olsen, 2016). Moreover, the health care
practitioners involved in her treatment also had the right to participate in decision making
process. Apart from this, while transferring Elsie to the hospital, the paramedics were
accountable to save the life of patient; therefore their attempt of resuscitation should be
considered on higher extent (Antommaria, Sweney and Poss, 2010). However, they were
unaware of the previous situation; hence they could have to contact the associated doctors and
nurses who are handling the case. Family members have the right to know the type of
treatment that is being delivered to any of the members. However, in the case of Elsie, nurses
and doctors both did not inform any of the family members; hence they can be sued for this
misconception (Sparks, Collins, and Kearns, 2016).
Thus, concluding it can be said that all the stakeholders have played different roles in the
present case as per their authorities. Ethical dilemma of all the stakeholders stated in the
subsequent research work.
THE PRINCIPLES AND VIRTUES OF HEALTH CARE ETHICS THAT INFORM PROFESSIONAL
PRACTICE
Different ethical theories exist and can be applied as per the cases which also helps in taking
better decisions about the patients. In the subsequent case of Elsie, several principles and
virtues should be applied and a few are discussed as follows:
Consequentialist ethics holds the view that correct moral response is always related to the
outcome and act (Lublin and Reingold, 2001). Relating it to the case, it can be said that the
practitioners carried out their duties in effective manner; however they failed to save the life of
Elsie. Deontology is another ethical term that is based on duties and rights of individuals and it
also ends in themselves. The main focus is laid on intention of individual rather than
successful outcomes; hence accordingly emphasis is given on rules, obligations and duties. It
requires absolute resolution to the rules and regulations so that all the acts can be ethically
managed (Mallari, Grace, and Joseph, 2016). In the present case, health care entities have
applied all the legal rules and obligations while treating Elsie. In the subsequent case,

principlism and ethical principles are being applied where in focus has been laid on autonomy,
respect and dignity. At the time of admitting the patient in care home, it is essential for the
RAC facility to get consent from the patient as they have the right to be informed about the
type of treatment (Wilson and Wilks, 2013). Further, all the moral obligations and support was
required to be given to Elsie during her severe condition. In this respect, it is evident that
health care practitioners have fulfilled all the obligations and duties which they were
accountable to consider.
Summing up the ethical values, it can be said that while treating the patients; health care
practitioners must consider all the values and dimensions so that to underpin the service
capability.
THE RELEVANT CODES OF ETHICS AND CODES OF PROFESSIONAL CONDUCT
It is essential to consider ethical codes and practices so that professionalism can be involved in
all service dimensions. Thus, the section has been stating all the relevant codes that are
concerned with professionalism in health care sector. Through considering the case scenario
the relevant of codes of ethics and codes of professional conduct include following-
The foremost code of ethics and professional conduct for Residential Nurses is related with
promoting the safety of their patients (Badia and et.al., 2016). According with the case
scenario, patient had experience the heart attack while taking to the hospital. Therefore, to
avoid the situation of death the relevant code of ethics and professional conduct must ensure
promoting proper health and safety. Along with this another relevant codes of ethics and codes
of professional conduct must engage in providing care and medical treatment in the
responsible and accountable manner to the patients (Minwalla, 2015). Furthermore, the codes
of professionalism also include nurses should hold up a practical environment that is
contributory to the provision that are related with performing the ethical health care activities.
Along with this, another code of professional also include promoting and abide the ethical and
moral practices and maintain public trust among profession of nursing.
Thus, summing up it can be articulated that professional codes were being used in the study as
a part of health care requisite. This can be observed when all the practitioners delivered
services to Elsie in different ways.

TASK 3
Propose a legally and ethically defensible resolution to these conflicts
In this section, information has been included regarding conflict raised between family
members of Elsie and the RAC facility (who was entitled for the care service of Elsie).
In the present case conflict has taken place in between family members of Elsie Lee, 88
years old lady and the nurses who were looking after the entire care home. Elsie Lee had
difficulty in mobilising due to severe rheumatoid arthritis as well as short term memory
impairment. She had history of AMI which undertakes removal of bilateral cataracts and a hip
replacement four years ago (Watzak and et.al., 2015). On admission of Elsie at the RAC facility
in the Tuesday afternoon the Nurse recommended that Elsie consider making out an advanced
care directive which represents that she would have done in the event linked with health. Elsie
agreed with this statement and awaited with the assistance of family where she cleared to staff
along with family members that no such kind of aggressive treatment is needed and she did want
to be resuscitated (Henning and et.al., 2016). On Friday night, Elsie developed severe chest pain
and due to this reason healthcare authorities have to call ambulance for moving the lady to
hospital. Elsie was not at all ready for treatment and this acted as kind of stress (Iacono and
Carling‐Jenkins, 2012). At the time when Elsie was transferred to hospital she died and her
family member claimed that main reason behind death was stress of being moved to hospital. So,
this was the entire situation due to which conflict took place.
Thus, it is clear that nurses admitted Elsie to the care home as he had severe pain in chest
and afterwards nurse called for the ambulance. This reflects that care practitioners actively
played their duties.
In this section, rights of the individual is being stated in the realm when the person is
unable to take decisions for own health.
In this case family members of the lady has right to claim against hospital authorities but
on the other hand nurses carried out the duty assigned to them where chest pain of Elsie was
severe and due to this reason transfer of her was must. In case if Elsie has died at care home then
it would be responsibility of care authorities only (Deschamps, 2016). It is well known fact that
when any individual is admitted in hospital for treatment purpose then authorities of hospital

holds power to take major decisions. Same is linked with the present case where nurses who
decided to shift Elsie have not committed any wrong act. In case if care authorities have not
rendered proper treatment to Elsie such as medicine along with other form of necessity items
then it can have adverse impact on her health (Newell and Nelson-Gardell, 2014). Further,
actions were taken by nurses to transfer to hospital was taken in order to avoid unfavourable
situation such as death and this took place during transit to hospital. On the other hand claim of
family members of Elsie is also right where Elsie was not ready to be shifted to hospital and the
reason behind her death was stress of being shifted from one place to another. Elsie was not
ready with the decision being taken by hospital authorities and nurses called ambulance for
assistance (Martin, 2016).
Concluding, it is evident that RAC facility wished to limit their liabilities and this is the
reason, the nurses called the ambulance so that patients can be shifted to the hospital.
In this paragraph, it is identified that consent was not taken by Elsie as she was not in a
situation to take decision for her own. Thus, looking towards the condition registered nurses took
decision on behalf of Elsie.
Therefore, in this condition best possible outcome can be determined through mutual
understanding where both the parties through proper communication can find best possible result
(Harrowing and et.al., 2010). Apart from this, it is possible for family members to file case
against nurses as consent of Elsie was not at all undertaken at the time of taking shifting
decision. Ignorance of her suggestion is also one of the major issue where nurses must have
asked what Elsie is needed as she already communicated that it is not required to shift her to
hospital where hospital authorities not followed. This directly lead to unfavourable outcome such
as death which was totally unfavourable in this situation (Hamric and et.al., 2013). So, the best
possible result can be only determined through mutual settlement where it is possible to grant
compensation to the party who has suffered loss. Moreover, filing case against hospital authority
can also assist in determining solution which both the parties have to accept.
As per the case, RAC facility can make use of The Mental Capacity Act 2005 which
provide a legal framework for acting and making decisions on the behalf of people who lack the
capacity to make decisions for themselves (Modra and Hilton, 2016). The family members have

to comprehend that Elsie was not in a condition to take decision. Thus, as per the conflict RAC
facility can apply Mental Capacity Act 2005.
CONCLUSION
From the above it has been concluded that it is required by the health care professionals
as well as practitioners to support clinical practices so that ethical dilemmas and challenging
situations should be handled in an effective and efficient manner. Therefore, in the report it also
summarizes the involvement of different stakeholders within the case scenario and how they
effectively manage their social control as well as duties in order to overcome situation of
dilemmas. Further, it also summarizes that it is essentially regarded to engage in ethical aspects
that needs to be adhered from case perspective.

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