Ethical Dilemmas in Health and Social Care: Case Study Analysis

This report delves into the complex ethical dilemmas surrounding assisted suicide within a healthcare context. Using a case study of a 40-year-old woman with Guillain-Barre syndrome, the report explores the ethical issues and dilemmas faced by healthcare professionals, patients, and their families. It examines the perspectives of various stakeholders, including health professionals, practitioners, family members, and youth workers, highlighting potential conflicts and points of agreement in their ethical arguments. The analysis considers the influence of factors such as the value of life, truth-telling, and the role of professional codes of conduct. The report discusses the application of deontological and utilitarian ethical theories, as well as the legal aspects of voluntary euthanasia. The report concludes by evaluating the complexities of end-of-life care and the importance of respecting patient autonomy while navigating the moral and professional responsibilities of healthcare providers. The document is available on Desklib, a platform offering AI-based study tools.

Health And Social Care & Health And
Social Policy

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Discussion of case study.............................................................................................................1
Ethical issues and Dilemma in case............................................................................................2
Different stakeholders involved and individual view over dilemma..........................................3
Potential conflicts and points of agreement in ethical arguments...............................................5
Influence of gender, ethnicity, religion, age, sexuality, etc. on responding to ethical dilemma.6
Code of professional conduct and law over ethical dilemma of the case to arrive at moral
solution........................................................................................................................................7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Ethics is a branch of knowledge which is governed by moral principles and plays a
valuable role in the lives of people. It is important for health care workers to work ethically. The
study will utilise a case study to demonstrate the ethical dilemmas in the work of medical
professionals. This study will begin with a case study. This will be followed by ethical issues in
the chosen case, stakeholders involved in it and their view on dilemma, prospects of conflict and
agreement, influence of gender, ethnicity, religion and other demographic factor on ethical
dilemma. Further, in the later part of report discussion is done over code of professional conduct
and law over ethical dilemma associated in the case.
MAIN BODY
Discussion of case study
The case is about 40-year-old woman, Katherine suffering from Gullian Barres syndrome
which occurs due to digestive and respiratory infection. The patient’s immune system starts to
weaken, the service user experiences tingling and weakness in joints and different parts of the
body. The risk in this situation is shortness of breath and permanent damage to cells which
causes paralyses. According to Kuruppuarachchi, Sundaresan and Thivakaran, (2018), the people
suffering from Gullian Barres syndrome are unable to recover and live full lives.
However, in accordance with the case, Katherine is an intelligent unmarried woman
experiencing painful neurological illness which leaves her paralysed from time to time. She was
paralysed for three years, and before this, it was diagnosed by health professionals that there has
been extreme damage to her nerves and muscles because of which she will never be able to
breathe on her own and also will not able to move without assistance. As per diagnosis and
health professional she now needs ventilator support for breathing. Her health professional
discussed the whole situation with her in gentle way.
Apparently, after a discussion, Katherine asked her doctor to speak to her personally as
she wants to discuss something. In the discussion, Katherine stated that she considered options
given by a doctor, but now she feels like ending her life as she does not want to live any more.
According to her, there is no point living like because she was no longer free to move and
breathe on her own, which means that she just had to lay down in constant pain with no hopes of
1

recovery. Katherine ended the discussion by stating that she has discussed this with her family
and they accepted her wishes to remove the ventilator.
Stakeholder
Value of life where Katherine has no consideration over own life because of discussion
with Doctor. She placed very little value to her life where she gave up to pain when her health
began to fail or to deteriorate. Value of life is classified into three elements that are quality,
quantity and sanctity. The quality elements of value of life justified the decision made by
Katherine because she will not be able to live her life she wants to. Nevertheless, it is the moral
duty of the doctor to consider key stakeholder in discussions with very ill patients because
patient consent is important but discussion about decline in health of individual can be more
panicking and life-threatening (Chisholm and Sheather, 2018).
Ethical issues and Dilemma in case
As per the discussion of case, it can be articulated that the case is of assisted suicide which
is voluntary euthanasia where patients wants to end their life in painless manner. It is an act of
intentional killing with consent of patient and his or family or immediate guardians. The ethical
dilemma of the case discussion of health professional directly to patient about her whole
situation which led to discouragement and disappointment in her. The patient suffering from life
threatening diseases are vulnerable to changes and continuous hospitalisation (Levinson,
Humphrey and Polonsky, 2017). However, the moral duty of doctor is to share details with
patients about only about their recovery because any disappointing sentences can harm their lead
to hazardous mental or physical distress. There are different dilemmas in case of Katherine
where she asked health professional that she wants to end her life. In accordance with discussion
of doctor with Katherine, it can be said that it is important for the health professionals and
practitioners to seek patient consent over his or her health concerns but doctors are not liable to
share very part of health with patient because it can be distressing for patient. Dilemma of
discussion Katherine and Doctor discussion is disagreement of patient over care management
plans and truth telling.
On the other hand, ethical issue raised when Katherine discussed whole situation with
family and not doctor because it is moral and professional responsibility of doctor to discuss
whole situation of patient with family or immediate guardians. Now the dilemma is Katherine is
2

aware about whole situation because of which she wants to end her life. However, as per
deontological ethical theory emphasize on duty and morality of human action (Hansoti and et.al.,
2013).
Theoretical Issues
In accordance with this theory action can be right and wrong but needs to be in favour of
human welfare like action where her discussion with Katherine was to inform and share about
her deteriorating health and where she will have to be on ventilator. In accordance with this
ethical conceptualization, it can be argued that 10 months is long time for making decision and
discussion with family. It is the duty of health professional to share every possible scenario with
patients. However, there are cases of recovery but cannot be assumed because there are some
case of paraplegic which has positive health outcome (Deontological ethics, 2017). Thus, the
concepts and morals duty of deontologist justifies action of health professional but leads to
dilemma of right and wrong.
However, according to utilitarian ethical approach respect for human dignity needs to be
a crucial concern for the people in which it is important for the people to respect choice and right
of people. In accordance with this theory ethical concern in Katherine case is her willingness of
ending life via assisted suicide approach because she is unwilling to continue experience
constant pain where there is no scope of recovery. On the basis of this theory very person has
right to make decision for own self and ethical issues are supported by human rights. The ethical
dilemma in this case is accepting choice of patients of euthanasia or focus on her possible ways
of recovery while she is on ventilator. While issue in this situation is end life care because there
is no scope of further recovery due to excessive damage to her nerves and muscles. The
utilitarian approach focuses legal right of person in certain situation by giving priority to
individual decision (Ethics of euthanasia – introduction, 2014). Voluntary euthanasia is legal
because it supports patient will to have peaceful and dignified death regardless of contrast pain
without any hopes of recovery.
Different stakeholders involved and individual view over dilemma
The dilemma of ending life is a cause of concern for every stakeholder who is related
with the patient’s care. As per Katherine case, this kind of condition can be a situation of big
dilemma for various stakeholders including the patient, her family, Doctors, Health professionals
3

and care providers. They have to see through a proper and suitable management of the care
measures.
Health Professionals
As the health professional, however it is my duty to use and imply the best of my
knowledge to save a life with all my efforts. However, the condition of Katherine is quite critical
and out of hand which indicates that applying any sort of efforts such as offering the patient and
her family false hopes, which is unethical. Thus, in such situation, being a part of her request of
assisted suicide is a big dilemma that will impair me to take proper decision (Lederman, 2018).
As per my views, assisted suicide in such case should be permissible as it will reduce prolong
suffering of the patient and her family to a greater extent.
Health Practitioner
As the health practitioner or care provider of Katherine, supporting her decision of
assisted suicide is a crucial dilemma for me. Look up at her condition and suffering, I believe
that the decision is appropriate as it will help the organisation to look after her care. I believe that
the suffering of Katherine is unbearable for her and her family and as they too, with a heavy
heart has agreed on her decision of assisted suicide, it should be fulfilled. But, on the moral and
humanitarian ground accepting this is a big dilemma.
Family Member
Family members are the key stakeholder in health care organisation because the
individual is related with every positive and negative concerns of patient. As per the situation of
Katherine who willing want to end her life, dilemma for the stakeholders is seeing her dying or
in pain (Shapiro and Stefkovich, 2016). Both are the critical situation which is unacceptable for
family members. However, accepting Katherine wish will give sense of relief from her constant
pain but this will lead to situation where family was unable to save her and assist with recovery
and care options. The dilemma of family members can be argued with utilitarian ethical
approach because it is patient right to make decision oneself on the basis of own condition.
Youth Worker
As per Youth workers, Euthanasia is a way of giving peaceful and painless death to
terminally will patient which is supported by human right and therefore it is important for the
4

doctors to consider wish of Katherine for ending her life because 10 months is long time for
thinking and coming up to valid inclusion. The dilemma for youth workers in this case will be
moral difference in letting people die and killing patient. Further, conflict occurs when deriving
two situations at same page that is killing someone is morally right or wrong.
Potential conflicts and points of agreement in ethical arguments
Assisted Suicide\Euthanasia is emotionally charged conflict of issue for stakeholders
involved with terminally ill patient. On the basis of legitimate right, it is patient who is suffering
from constant pain to choose way to die i.e. a peaceful death. In contrary, it is argued that
euthanasia is a kind of murder which is done to enable dignified and comfortable death to
terminally ill patient. According to Kangasniemi, Pakkanen and Korhonen, (2015), disclosing
diagnosis information completely to patient can be devastating because he/she may lose the will
to live life and recover from the disease. However, dilemma is truth telling where care providers
and nurses have to decide regarding the challenges of particular situation. Conflicts in ethical
argument occurs due to some crucial concern which are as follows:
 Letting die or killing: According to Brody, 2012, Killing is voluntary action taken by
health profession after seeking consent from all stakeholders in patient care for giving
lethal injection. Whereas keeping service user alive with the help of support system like
in case of Katherine where is on ventilator 24 hours and there is no scope of recovery as
she will be never be able to breathe herself.
 Pain relief and Euthanasia: Raisio and Vartiainen, (2015), Euthanasia is a lethal drug
which is given to patient for relieving pain which causes painless and dignified death.
The drug is given to limited patient who are terminally ill and struggling from life on
palliative care. However, use of this drug is considered as pain reliever but in intentional
killing which is morally considered as murder.
 Mercy killing: As per the views of Rumbold, (2017), Extraordinary medical care is
known as mercy killing where assisted suicide is chosen to relive patient who is suffering
from unbearable pain from prolonged period. The solution is morally and ethically right
because in this patient suggest having dignified and peaceful death. In case of Katherine,
Doctors diagnosed that her muscles and nerves are completely damaged when she was
paralysed for 3 year due to Gullian Barres syndrome. As per health professional it was
clear that she will never be able to breathe own her own and will be on ventilator. Thus,
5

as per psychological factors mercy killing is morally right because it is the situation
where patient suffers from depression, feeling of loss and lack of dignity, burden,
dependent and feeling of dislike.
The discussion derives various points which supports ethical arguments of Katherine case where
according to deontologist approach of ethical theory it was the duty of health professional to
make it clear to patient about her condition where she will never be able to recover and will have
to be on ventilator entire life. Apparently, it is responsibility of doctors and nurses to work
legally and staff truthful to practices and patient where respecting patient autonomy is foremost
concern. In accordance with this it is necessary for care workers to seek patient concern in every
situation and consider individual wish for further treatment and care plan.
Influence of gender, ethnicity, religion, age, sexuality, etc. on responding to ethical dilemma
Demographic factor
Ethical dilemma is influenced by various factors such as gender, ethnicity, age, religion,
sexuality, etc. Like in case of Katherine nit can be said that the difference in ethical issues as per
stakeholder arose because of various concerns like according to family doctor cannot share detail
information of diagnosis with patient. However, as per doctor, voluntary suicide itself is dilemma
because it is the concern of mercy killing (Ranjbaran and et.al., 2014). According to religious
belief death is uncertain perceptive of life and there is no term like voluntary suicide and in case
lethal injection is given to doctor then it is considered as murder according to some religious
beliefs which leads to ethical issues and dilemma.
Social Environment
Contributions of the social environment, behaviour, psychological factors, physiological
mechanisms, and genetic variation to health. This denotes changes in individual perception over
Euthanasia. Ethnicity also play a crucial role in deriving changes in people opinion over
different health care situation. Ethnicity reflect group pf one person with different stake of mind
according to own understanding like stakeholders of hospital are well aware about diagnosis
patient’s condition, code of conduct and lethal practices (Vanlaere and Gastmans, 2017).
Therefore, according to them dilemma in Kathrine case was accepting her wish where according
to people who are unaware about certain situation dilemma will be asking for euthanasia,
disclosing of diagnosing, to patient, etc.
6

Code of professional conduct and law over ethical dilemma of the case to arrive at moral solution
Code of professional code of conduct and law are supportive tool for ethical dilemma
which helps the hospital stakeholder in arriving at moral solution. For ethical conflict. In
accordance with present case scenario there were different conflict of responsible practices of
health professional, euthanasia which is way of mercy killing for terminally ill patient and many
more. The professional code of conduct discusses about possibility if health professional where it
is necessary for the individual to disclose patient diagnoses to service user as well as family
members. It is the way of demonstrating clarity of patient’s condition and recovery. Code of
conduct of professionals are discussed below:
 It is the responsibility of health professional to be honest and integral with patient like in
case of Katherine where Doctor disclosed every information about her condition (Ten
Have and Welie, 2014).
 Respecting patient rights and will is another code of practice which needs to adhered in
hospitals (Price, 2017). In accordance with this, it can be said that doctors need to support
decision of assisted suicide of Katherine.
 Forming doctor patient relationship is another practice which needs to be adhered when
enabling care. As per this code of conduct doctor can support patient will and can also
influence decision. In palliative care it is important for the heath processional and service managers to
ensure patient dignity, compassion and comfort in every situation (Price, 2017). On the
basis of this, it can be said that considering risk of Katherine for assisted dying is
ethically and morally correct.
Nursing code of ethics
 Respect of Autonomy: In accordance with his code of practice it is the responsibility of
health practitioners to respect patient wish. The service user has liberty to make decision
and interfere in their care plan where nurses are responsible for sharing every bit of detail
of care assessment with patients (Ten Have and Welie, 2014). However, in accordance
with this the dilemma has moral solution over the situation where doctor shared diagnosis
with Katherine and it is responsibility of care workers to ensure that assisted suicide can
be considered as wish of service user as she is in the condition from where he will never
be able to move own her own and will have to seek for support in case of movement.
7

 Beneficence: The code of conduct is focused on wellbeing of patients by involving with
them in peaceful activities. Considering advice of family of patients to relive patient in
order to divert them from medication and health care environment. The code of conduct
is attained by addressing poor condition of patient.
 Non-Maleficence: In this focus of health care workers is on ensure safety of patient
where it is the duty of individual to assure that no harm is caused to patient during
treatment (De Lima and et.al., 2017). This code of conduct can be related to Katherine
case where she asked doctor for assisted suicide which is kind of harm but is with patient
wish therefore cannot consider as morally and ethically wrong.
CONCLUSION
The assessment summarized ethical issues and dilemma of the case where 68-year-old
women suffering from Gullian Barres syndrome and was paralysed for 3 year and before 10
months it was diagnosed by health professionals that there has been extreme damage to her
nerves and muscles and therefore now, she will not be able to breathe own her own and with 10-
month discussion she asked doctor for assisted suicide which led to dilemma for stakeholders.
The study outlined that doctors are not liable for disclosing diagnosis to patient. Further, truth
telling cannot be practices because can lead to distress. However, the study concluded by
deriving ethical code of conduct which helps health processional and care provider in arriving at
one ethical and moral solution of health care dilemma.
8

REFERENCES
Books and Journals
Brody, B.A. ed., 2012. Moral theory and moral judgments in medical ethics (Vol. 32). Springer
Science & Business Media.
Chisholm, J. and Sheather, J., 2018. Medical ethics in times of conflict-why silence is not an
option. Indian journal of medical ethics. 3(1). pp.39-42.
De Lima, L. and et.al., 2017. International Association for Hospice and Palliative Care position
statement: euthanasia and physician-assisted suicide. Journal of palliative medicine.
20(1). pp.8-14.
Hansoti, B. and et.al., 2013. Society for Academic Emergency Medicine's Global Emergency
Medicine Academy: Global Health Elective Code of Conduct. Academic Emergency
Medicine. 20(12). pp.1319-1320.
Kangasniemi, M., Pakkanen, P. and Korhonen, A., 2015. Professional ethics in nursing: an
integrative review. Journal of advanced nursing. 71(8). pp.1744-1757.
Kuruppuarachchi, A.N., Sundaresan, K.T. and Thivakaran, T., 2018. Rare presentation of
Guillain-Barre syndrome with complete heart block and neuropathic chest pain
mimicking acute coronary syndrome: a case report. Ceylon Medical Journal. 63(3).
Lederman, Z., 2018. Medical ethics in Israel. The Lancet. 391(10120). p.539.
Levinson, D., Humphrey, H.J. and Polonsky, K.S., 2017. The University of Chicago and the
Work of Mark Siegler in Clinical Medical Ethics. In Clinical Medical Ethics (pp. 21-
25). Springer, Cham.
Price, D., 2017. Euthanasia, pain relief and double effect. Legal Studies. 17(2). pp.323-342.
Raisio, H. and Vartiainen, P., 2015. Accelerating the public’s learning curve on wicked policy
issues: results from deliberative forums on euthanasia. Policy Sciences. 48(3). pp.339-
361.
Ranjbaran, M. and et.al., 2014. Nursing’s code of ethics: a survey of respecting the code among
nursing students. Iranian Journal of Medical Ethics and History of Medicine. 6(6).
pp.45-55.
Rumbold, B.E., 2017. The moral right to health: a survey of available conceptions. Critical
Review of International Social and Political Philosophy. 20(4). pp.508-528.
Shapiro, J.P. and Stefkovich, J.A., 2016. Ethical leadership and decision making in education:
Applying theoretical perspectives to complex dilemmas. Routledge.
Ten Have, H. and Welie, J.V., 2014. Palliative sedation versus euthanasia: an ethical
assessment. Journal of pain and symptom management. 47(1). pp.123-136.
Vanlaere, L. and Gastmans, C., 2017. Ethics in nursing education: learning to reflect on care
practices. Nursing Ethics. 14(6). pp.758-766.
Online
9

Deontological ethics. 2017. [Online]. Available through:
<https://www.britannica.com/topic/deontological-ethics>.
Ethics of euthanasia – introduction. 2014. [Online]. Available through:
<http://www.bbc.co.uk/ethics/euthanasia/overview/introduction.shtml>.
10