Ethical Considerations in Healthcare Management: A Case Study Report

This report delves into the ethical dimensions of healthcare management, using a case study to illustrate key challenges and potential solutions. The analysis begins by examining a conflict between family members regarding a patient's medical condition and explores how a healthcare administrator can apply conflict resolution strategies and ethical principles to mediate the situation. The report then addresses the ethical dilemma arising from a patient's advanced directive for DNR and DNI orders being disregarded, highlighting the importance of respecting patient autonomy and wishes. Finally, the report considers the complexities of providing appropriate discharge and end-of-life support, navigating conflicts between patient wishes and family preferences. The report emphasizes the importance of ethical principles like autonomy, beneficence, non-maleficence, and justice in guiding healthcare decisions, and it offers recommendations for healthcare professionals to ensure quality patient care and uphold ethical standards. The conclusion stresses the significance of patient-centered care and the necessity of adhering to ethical guidelines within the healthcare setting.

Running head: ETHICS IN HEALTHCARE MANAGEMENT 1
Ethics in Healthcare Management
Name
Institution

ETHICS IN HEALTHCARE MANAGEMENT 2
Ethics in Healthcare Management
Introduction
Ethics and ethical practices are essential in the management of healthcare. Several ethical
issues surround the nursing profession. These issues are common in healthcare management,
patient care, and the considerations of end-of-life as indicated in the provided case study. It is the
ethical duty if the health practitioner to respect the patient’s decisions in consultation with the
family of the patient (Shanks, 2016). In this paper, we discuss how a nurse can apply good
communication skills, critical thinking and good decision-making to assess and immediately
address a situation. The paper additionally discusses the investigation and evaluation of the
claims related to the clinical procedures in addition to staff’s ethical behaviors. Finally, we
discuss how the nurse can ensure that the Brookside Hospital provides Nichol’s family with the
required discharge and end-of-life support.
Challenge 1
The problem faced by Ms. Abrams when she arrives at her office is trying to understand
the main cause of the scuffle that was experienced between Mary and John regarding their
father’s medical condition. The decision regarding the best approach to solving the problem she
has at the office. This is simply because the problem is about a misunderstanding between Mr.
Nichols’ family. The situation and how it can be handled is the sole responsibility the
management of Brookside Hospital. The manager in cooperation with the hospital’s security
must ensure that the misunderstanding is solved promptly to prevent any physical confrontations.
The decision made by Ms. Abrams as the administrator at Brookside Hospital may affect
the family. This impact may happen in such a way that both Mary and John may not be allowed

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within the facility or the patient’s room at the same time. This is due to their differences
regarding the clinical procedure that is best for their father. The difference in opinions may result
in another confrontation if the two are allowed access at the same time. As an administrator, Ms.
Abrams should be the decision maker in this situation. The ethical principles of conflict
resolution strategies could be helpful in this situation (Finkelman, 2012). Some of the possible
options that can be used to solve this problem may include calling John and Mary into the office
and having a discussion with them about the importance of being peaceful and reasonable for the
sake of their ailing father. Additionally, they could be prevented from visiting the patient at the
same time if they cannot agree to work together in harmony.
Challenge 2
When Ms. Abrams arrives in her office, she is faced with the challenge of assessing and
dealing with the situation that initially involved a scuffle between the family members of a
patient admitted in the ICU. There is an ethical conflict in the decision made by both Ms.
Abrams and the Brookside Hospital. Mr. Nichols had an advanced directive that included DNR
and DNI orders in addition to a preference for no life-support device. The hospital, however,
decided to place Mr. Nichols in extensive life support. This is thus an indication that the wishes
of Mr. Nichols were not granted and Mary his daughter is furious that the Hospital failed to do
thorough research on her father’s medical history to ascertain his preferences and directives
(Shanks, 2016).
From the provided case, we are informed that Mr. Nichols had made an advanced
directive regarding the types of treatment and designated Mary to speak on his behalf and make
the decisions. However, Mary was not available at the time of admission, and the physicians,

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therefore, deemed that the benefits of the life support outweighed the risks and thus acted to
prevent more harm.
The situation is thus as much the facility as the manager’s responsibility. The
management of the hospital provides the leadership that should guide the operations within the
organization. Any conflicts in the ethical issues experienced in Mr. Nichols scenario stems from
the failure of the manger in creating an environment that ensures good and ethical practice
(Finkelman, 2012). The individuals who will most likely be affected by the decisions in this
scenario are the attending nurses and Mr. Nichols’ family. Mary who is Nichols’ daughter should
be the appropriate decision maker because she had been picked by Mr. Nichol as a surrogate
responsible for any decision making in the event Mr. Nichol becomes unresponsive due to his
condition.
It is important to know Mr. Nichols’ medical history and the available paperwork to
ascertain the advanced directive he had initially made. This information helps the medical team
in knowing the wishes of the patient before an informed decision on the course of action can be
made (Runciman, Merry & Walton, 2017). The key principles of medical ethics include
autonomy, beneficence, non-maleficence, and justice. Autonomy requires that the nurse respects
the decision of the patient as they can act voluntarily with a full understanding of the
consequences of their decision (Elwyn et al., 2012). This principle was however not respected as
Nichols was placed on a life support machine. Non-maleficence requires that the patient is not
put in a situation that would cause more harm, beneficence ensures that the proposed care
benefits the patient, while justice demands fair treatment of the patient without any
discrimination.

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As an administrator, it would be appropriate if Ms. Abrams ensures that the wishes of Mr.
Nichols are respected. The life support should, therefore, be withdrawn as per the request of the
patient through his daughter Mary. This course of action is appropriate as it suites everyone
especially the patient’s family who would love to Nichols to experience a dignified death
according to his wishes. According to the laws by most accrediting bodies, a patient who has
made a living will express their desires concerning any life-prolonging procedures should have
their wishes respected especially if the patient has a terminal condition as is the case with Mr.
Nichols.
Challenge 3
The final problem in the case study is the provision of an appropriate discharge and the
end-of-life support that suits the family. An ethical dilemma compounds this problem. Mr.
Nichols is currently on minimal life support and wants to be taken home even though being
withdrawn from the support would end his life within one week. His daughter agrees that he
should be taken home so he can experience death with dignity. His son John, on the other hand,
is adamant that Mr. Nichols should be taken to a hospice facility. It is, therefore, a conflict
between the wishes of the patient and the ethical principles of care.
The situation in this challenge is owned by Mr. Nichols himself as he is the one who can
make decisions regarding his life and the course of action he deems appropriate for him.
Additionally, as Mr. Nichols has gained consciousness, he is the one responsible for making the
decision on the action to be taken (Elwyn et al., 2012). This decision should thus be implemented
by the management, and it may affect the patient’s family especially John who feels that Mr.
Nichols’ life should still be prolonged. The ethical principles associated with this problem

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include autonomy, non-maleficence, beneficence, and justice (Elwyn et al., 2012)S. There could
be several ways of addressing this situation that may include talking with the patient and his
family about the benefits of proceeding with the treatment and how these benefits outweigh the
risks. If the patient cannot be convinced, then it would be advisable to grant him his wish and
provide appropriate end-of-life support.
Conclusion
Patient care is one of the most critical aspects of the healthcare setting. Hospitals must
aim to provide quality care based on the ethical principles of care. These principles include
autonomy that requires that the patient’s consent and decisions are respected, non-maleficence
that demands that no harm is caused to the patient during care, beneficence that ensures that the
benefits of a particular course of action outweigh the risks, and justice which ensures that care is
provided to all patients equally and fairly. The above principles should, therefore, be considered
in care.

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References
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., ... &
Edwards, A. (2012). Shared decision making: a model for clinical practice. Journal of
general internal medicine, 27(10), 1361-1367.
Finkelman, A. W., & Finkelman, A. W. (2012). Leadership and management for nurses: Core
competencies for quality care. Pearson.
Runciman, B., Merry, A., & Walton, M. (2017). Safety and ethics in healthcare: a guide to
getting it right. CRC Press.
Shanks, N. H. (2016). Introduction to health care management. Jones & Bartlett Publishers.