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Zeena John EthicalDilemma.docx Summary Submission Id: 88a753d6-c610-4bb3-a093-fc9d3a3a8b3c   1315 Words   4% SIMILARITY SCORE        2   CITATION ITEMS        21   GRAMMAR ISSUES          Internet Source   4% Institution   0% Running head: ETHICAL DILEMMA 1 ETHICAL DILEMMA 6 Ethical Dilemma Student Name: Zeena John Course: HLT 520 Instructor: Dr. Wendy Whitner, PhD, MPH Date: 03-27-19 Ethical Dilemma Physicians are often faced in ethical dilemmas in their line of duty. Ethical Decision making is needed when healthcare professionals are required to address a conflicting or uncertain issues regarding competing values. As indicated by Holt, Sarmento, Kett and Goodman (2018), physicians must consider principles of ethics like beneficence, justice, autonomy and non-maleficence as well as the ethical standards of their organization and their profession. Ethical dilemmas can stem from cases of unconscious patient with a DNR tattoo to the critical and emergency care physicians who were in charge of the patient. These physicians followed questionable recommendations from the consultants of ethics. The patient had no known identity, he was taken to the emergency department while in a critical condition, and unconscious. He had a “Do Not Resuscitate” tattoo on his anterior chest, and even a signature that goes with the tattoo. The health care team made a decision not to bother with the tattoo but the decision was later reversed after consultations were made with the ethics consultants. The agreement over the tattoo was that the tattoo could be representing authentic preferences of the patient. A case like this raises an ethical dilemma; should the patient be resuscitated against their will as seen on the tattoo, or should the health attendants honor the tattoo? An ethical dilemma situation must meet three conditions (Holt, Sarmento, Kett & Goodman, 2018). The first condition is in a case where an individual or ‘agent’ has to decide on the best course of action. These ethical dilemmas have to offer options; they should not be hard or create uncomfortable situations which do not have alternatives. About the DNR patient, the health care team could decide to either resuscitate the patient or follow what his tattoo said. There should also be different courses of actions to choose from. In this case, there were two choices, to save or not to save the DNR patient. This is a hard decision to make for any person involved. The last condition is that regardless of the course of action taken, there will be a compromise of the ethical principles. Following the statement written on the tattoo would see a loss of life, amidst the chance to save him. However, trying to resuscitate the patient will be against the will expressed in the tattoo, and there is no information as to why it is written not to resuscitate him. In determining the constituents of an ethical dilemma, a distinction has to be made between ethics, laws, policies, values, and morals (Holt, Sarmento, Kett & Goodman, 2018). Ethics are the standards used to determine what is right and what is wrong. They rely on rational and logical criteria for a decision to be made given that it is a cognitive process (Dolgoff, Loewenberg & Harrington, 2009). Values are the things or ideas an individual value, and these values are associated with feelings (Allen & Friedman, 2010). Morals are the codes of conduct of behavior ascribed by an individual, used to strengthen relationships (Dolgoff, Loewenberg & Harrington, 2009). Agency policies and laws are commonly applied in complex cases and it is the obligation of the healthcare attendants to take a particular ethical course of action. There is a difference between personal ethics and professional ethics and values. Values are personal and involve feelings, and cannot be used in solving an ethical dilemma. After joining a profession, in this case as a medical care provider, a person agrees to follow the standards of that profession, together with the code of ethics and values. In the case of a patient with the DNR tattoo, ethics and professional values have to be given a priority. One important principle of ethics that must be put into consideration by the emergency physician states that withdrawing and withholding the treatments to sustain life are seen as equivalent in ethics. Therefore, when a physician is in a dilemma with regard to the wishes of the patient, he/she should take the initiative step of saving he patient’s life. When more information is obtained, the physician can deescalate the care of the patient in the appropriate way according to their initial preferences. Also, in the field of medicine, a physician should review ACP (advance care planning), which has two primary forms (Vearrier, 2018). These forms are; life-sustaining treatment being ordered by physician and advanced directives (AD). ADs can be completed at any time during a person’s life to appoint a surrogate decider or to guide future care. This legal document (AD) has to be filled by the person himself or herself in the presence of a witness. POLST forms, are orders from a physician for the care for a life about to end that can be taken to other health care facilities. The documents are only for the individuals with serious illness or those critically ill and could help in the surrogate. The tattoo saying “Do Not Resuscitate” is therefore neither legal nor ethical enough because of some reasons. First, tattoos are not supposed to be in the legal considerations of POLST or ADs, and it has neither a witness nor notary. Therefore, it cannot be used as a wearable AD or to finish legal documentation. The second reason is that the medical providers cannot presume informed decision-making, no evidence exists showing that tattoos have a clear understanding of the patients DNR status. (Vearrier, 2018). Also, the tattoo has no enough guiding information to decide an intervention. Lastly, a lot of people, more than 50%, who have tattoos regret having them. The above information does not, however, mean that the data should be ignored. The AD and POLST documents could not be available when the health care attendants are deciding on crucial issues. A way of communicating should be included in the crucial decision-making process (Vearrier, 2018). When evaluating the merits and challenges of the procedures of healthcare, bioethics is used to refer to the principles of medical ethics. For any practice to be referred to as ethical, it has to conform to the four principles including justice, autonomy, non-maleficence, and autonomy. The first principle is autonomy; where a patient is required to make informed and un-manipulated action and intention when deciding about their healthcare. A patient should be aware of all the benefits and risk of a medical procedure and the success likelihood. In this case, the patient was unconscious. The patient did not have a relative and he never spoke his mind apart from the tattoo. The second is justice, where treatment is distributed to all groups equally. Health care provider should distribute scarce resources fairly. Following this method, the tattoo patient could be revived in the same manner as other emergency cases handled in the facility. The third concept is beneficence; it demands the provision of medical procedure with the intention of benefitting the patient. It demands maintenance and development of skills and knowledge, striving for net benefit. The last principle is non-maleficence. This ethical concept requires that a procedure should not harm the involved patient or others. The physicians ought to use the aforementioned procedures to guide in making a decision regarding what is best for the patient. Autonomy states that a patient has the right to have control of his body, but since there is no accompanying relatives, the patient could not express himself. I would also do everything possible to keep the patient alive. I would also employ non-maleficence to guide the treatment process; this makes the patient’s recovery process more effective. References Allen, K. N., & Friedman, B. (2010). Affective learning: A taxonomy for teaching social work values. Journal of Social Work Values and Ethics, 7 (2). Retrieved from http://www.socialworker.com/jswve. Dolgoff, R., Lowenberg, F. M., & Harrington, D. (2009). Ethical decisions for social work practice (8th Ed.). Belmont, CA: Brooks/Cole. Holt G. E, Sarmento B., Kett D., & Goodman K. W. (2018). An unconscious patient with a DNR tattoo. N Eng J Med. 2017;377:2192-2193. Social Worker (2014) What is an ethical dilemma? Retrieved from https://www.socialworker.com/feature-articles/ethics- articles/What_Is_an_Ethical_Dilemma%3F/ Vearrier L. (2018) Do Not Resuscitate tattoos: Are they valid? ACEONow. Retrieved from https://www.acepnow.com/article/do-not-resuscitate-tattoos-are-they-valid/ Grammatical problem: Instructor Grammatical problem: Instructor Possible agreement error. The noun 'Instructor' seems to be countable, so consider using: " instructors " . Three successive sentences begin...: Ethical Three successive sentences begin with the same word.: Ethical Three successive sentences begin with the same word. Consider rewording the sentence or use a thesaurus to find a synonym. 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