Ethical Decision Making in Healthcare: A Case Study


Added on  2023-06-03

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Ethical Decision Making in Healthcare: A Case Study_1

Case study
Mr. Robert, an 85-year old African American man with a history of falls and dementia is
presented to the emergency department with a bad fall this time resulting to a kneecap
fracture. . He is accompanied by his two sons to the hospital that needed to foresee his
treatment. Upon admission, Mr. Robert complained of so much pain around his knee joint and
muscles of his right leg and was put on pain relieving medication, acetaminophen while he
waited for the physician to monitor his knee. After a couple of hours, he was assessed and the
physician pointed out that he needed a kneecap removal since it was damaged beyond repair.
During all this period Mr. Robert was already hysterical and demanded to know the findings
from the physician. The physician went ahead and told him the news and he felt that surgery
would send him to an early grave. He felt uncomfortable and confused with all the information
regarding the surgical procedure and everything that needed to be done.
His sons were also called to the hospital and given the news. They were informed of the entire
requirements for the procedure to be carried out. They enquired on the cost required for the
whole procedure which the doctor gave them. The cost was high for them since they had no
health insurance and did not qualify for Medicaid. Looking at the condition Mr. Robert was in
the physician explained to them that an urgent action was required which they agreed. The
physician also enquired on the health history of the patient which they highlighted that he had
a healthy life except for the case that he was becoming forgetful in many things and had few
falls in the last three months. They also had questions for the physician regarding the possibility
of walking normally again after the surgery which he assured them that the chance was higher.
They were later presented with an Informed Consent Form and requested to consent for him
since he wasn’t in a position to do it which they did. The surgery was scheduled for the next day
at 0300hrs.
During that evening after being served a meal, Mr. Robert complained that he needed only
liquids since his tongue pained and couldn’t chew. The nurse in the shift never paid much
attention to know more about the tongue but gave in to his demands. He was also assisted in
carrying out activities of daily living. The next day he underwent blood and urine analysis and x-
ray on both knees prior the surgery. Later he was given general anesthesia by injection and
inhalation and the surgery was successful. At the postoperative recovery area the patient was
closely monitored and it was observed that he never ate well. On assessing his complaints
about the tongue the doctor found a lump on the side. He was diagnosed with oral tongue
cancer. He underwent another surgery to remove the tumor. After regular checkups the doctor
noted that it was advancing towards the back of the tongue and chemotherapy, drugs and
radiation were carried out. The cost was too much to bear already for the family. Mr. Robert
felt that he was a burden already despite being in pain. The doctor continuously sedated him to
Ethical Decision Making in Healthcare: A Case Study_2

relieve pain. Either he proposed to his sons and the physicians that he had lived his life and
needed to rest since all he encountered at that moment was pain and suffering and burden to
the family which to him wasn’t called for.
Question Two
When it comes to ethical thinking and decision-making, moral issues greet health professionals
each day bombarding them with questions on how to approach certain issues concerning their
clients and the general healthcare system (Burkhardt & Nathaniel, 2013). Questions on the right
of the patient, fairness to the diverse patients, morality in view of medical technology and
justice are perplexing to the health professionals when it comes to ethical decision making
(Burkhardt & Nathaniel, 2013). In dealing with ethical issues there is a need to first think
through the issue, ask questions regarding the issue and finally draw on factors to consider
(Chadwick & Gallagher, 2016). In resolving the problem, the first step is analyzing the moral
issue (Burkhardt & Nathaniel, 2013). Getting the facts in this case is that Mr. Robert is in great
pain and overwhelmed by the whole process of continuously seeking medical attention. He is
also worried about the cost burden to his children. He further says that his age was reckoning
enough to warrant him an end of life. The doctor is aware that the cancer treatment is
fastening the death of his client despite the client requesting for a mercy –killing.
To be able to deal with the above issues it is important to determine which actions will be
morally best for the case. It will be best to consider utilitarian approach which suggests that
ethical actions are those that provide the greatest balance of good over evil. The approach
seeks first to identify which courses of action are available to the case. The available actions for
the physician are on continuing to administer terminal sedatives to the patients to relieve pain
together with chemotherapy to prevent the advance of cancer. The patient is also opting for
euthanasia to stop the pain and suffering on him and relieves the cost burden to the family. To
the sons they are left in dilemma on which side to choose, whether to support the doctor to
continue with medication as they incur more cost or be in support of their father to end his life.
The doctor is also faced by the challenge of whether to follow the patient’s autonomy and
assist him to a quick death or ignore the patient’s demands. To resolve the actions we have to
consider who will be affected by each action and what benefits or harm will be encountered in
each action (Burkhardt & Nathaniel, 2013). Mr. Robert is in pain and has a terminal illness and
his option is euthanasia. According to utilitarianism on mercy killing is that the right thing to do
is that which results to greatest amount of happiness to the greatest number of people
involved (Stylianidou, 2013) (Chambers, 2011). Considering this the patient will be relieved
Ethical Decision Making in Healthcare: A Case Study_3

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