Introduction
In Healthcare, the healthcare provider staff are obliged to make patient care decisions, including more than selecting appropriate treatment and interventions. Moreover, healthcare providers are obliged to make ethical decisions that ensure the benefit of the patient, respect the patient’s values, and avoid and minimize patient harm in attempts to ensure positive patient outcomes. These decisions are guided by the codes of ethics that are moral principles that guide decisions in specific situations. The principles of beneficence, autonomy, non-maleficence and justice must ultimately hold when making decisions concerning patient care. Healthcare providers are obliged to provide patient care and ensure the wellbeing of the patient’s family and protect the client’s privacy. The decisions made by healthcare professionals must also align to the values of compassion, commitment, advocacy, uplifting of human rights, responsibility, safety, and healthcare advancement. However, healthcare providers should also respect patients’ personal decisions regarding care and be responsible for decisions that may result in suboptimal patient care. The healthcare providers should also respect the family member’s decisions and culture without compromise.
Autonomy
In Healthcare, patients have the right to make rational decisions concerning their care that the healthcare providers should respect. However, the principle of autonomy does not extend to individuals incapable of making rational decisions and acting autonomously, such as those in a comatose state, people with mental health illnesses, and the children (Tattersall et al., 2018). Therefore, healthcare professionals should disclose information and treatment options that are necessary to help the client make informed decisions regarding healthcare procedures and treatment regimens. In this case, the patient has no adequate capacity to make rational decisions as they are in a comatose state. As such, their right to autonomy is compromised, and they cannot make decisions regarding the route of Healthcare and ensure proper care outcomes. As such, the patient’s family members are obliged to make meaningful decisions on behalf of the patient. Therefore, accurate information should be provided to the family members to make informed decisions. The decisions of these family members should then be respected by the healthcare providers and ensure the welfare and resource rationing in the healthcare setup.
Rationing of healthcare resources
The process of resource rationing within the healthcare setup should be guided by the principles of responsiveness, transparency, accountability, multi-stakeholder engagement, and fairness. The process of resource allocation and rationing within the healthcare organization is guided by prioritizing patients who highly require access to the resource needed to be rationed (Aziz & Brandl, 2021). Such is guided by the reliability of a patient to a resource in order to sustain their health. Patients who are highly dependent on a resource and their lives may be compromised due to lack of access to that particular resource should be prioritized during resource rationing. As such, patients requiring life support should be prioritized and provided with these resources regardless of their ages, citizenship, or family status. In this case, the patient is entitled to continued care at the AICU in the hospital organization as she depends on life support to ensure she stays alive. Therefore, the patient should be placed in life support and adequate care provided and should not be sent out of the AICU as that would further compromise her state of health and even lead to death. The available resources should be rationed adequately in favor of this patient who is in a critical state. Also, the hospital should assess the ability of the patient’s family members to pay for the daily bill wage incurred by the hospital organization in the care of the patient. The family members own a successful business organization is evidence that they can cater to the bills incurred. Such actions ensure justice and equality for all patients needing life support resources.
End-of-life care
At the end of life, care for terminally ill patients aims to alleviate suffering, provide comfort during death, and ensure the quality of life until the occurrence of death. In order to achieve these goals, the healthcare providers, together with the patient or the relatives, must make proper decisions as to whether to prolong the patient’s life with life support technologies or to allow natural death to take its course. End-of-life care is guided by four principles: beneficence, non-maleficence, autonomy, and justice. These ethical principles guide healthcare practitioners’ actions regarding patients’ end-of-life care (Greer et al., 2018). Patients have the right to assess medical services and decide their end-of-life care approach. In this particular case, the patient has no adequate capacity to engage in decision-making regarding their care, and therefore, the patents family members are entitled to make decisions on behalf of the patient. These family members insist on continued treatment that is not beneficial to the patient due to the underlying patient’s disease and her age but will only contribute to prolonging their life.
In this particular case, the physician may decide to withdraw from the patient’s care and adequately explain that the efforts being undergone by the family members are futile and expensive and only contribute to the prolonging of the patient’s suffering life. Although the healthcare providers have a duty to patient’s life and act to ensure the best interest of the patients, they should not use unnecessary resources to provide ineffective medical treatments. The principle of fidelity should also be integrated into providing end-of-life care to this particular patient. As such, physicians should ensure honesty to the relatives of the dying patients about the possible consequences and prognosis of the patient’s disease. The honesty ensures relative psychological preparedness and acceptance of the outcome of the patient’s disease. It also ensures proper decision-making, ensuring that the family members do not undergo unnecessary financial costs to provide futile medical treatment to the patient. After a proper prognosis has been established for this patient, the physician must properly empower the family members and relatives. In case conflicts arise between the family members and the physicians in the Adult Intensive Care Unit, there will be need to seek assistance from the institutional ethics committee to ensure the proper decisions regarding the care of the patient are made.
Ethical obligations to the institution
As the director of respiratory therapy in a healthcare organization, I am obliged to several responsibilities towards the healthcare organization. To begin with, I am obliged to ensure proper supervision of my juniors engaged in the provision of respiratory therapy in the organization. As a director, I must ensure that proper healthcare services are provided to patients who need respiratory therapy services. Also, I am obliged to ensure that proper diagnostic procedures and educational services are provided to patients with respiratory disorders in the organization. I am also obliged to implement respiratory care services according to the organization policies and regulations and maintain proper records and reports of all patients receiving respiratory therapy services. The director of respiratory services is also obliged to ensure daily turn up reports to the organization management and ensure proper decision making regarding the rationing of resources available in the organization. As a director of respiratory services in the organization, I also have a moral obligation to ensure proper organizational public image.
The ethical obligation to the hospital staff
The director of respiratory services is obliged to help other hospital staff, such as the physicians, in the decision-making regarding the course of action in delivering healthcare services in specific scenarios. The director is obliged to make superior decisions regarding the continuation or withdrawal of life support ventilation services in terminally ill patients and other patients on ventilators which are scarce resources in a hospital organization. The director of healthcare services is also obliged to solve disputes between other hospital staff in the respiratory services department and ensure inter-professional cooperation. The director of respiratory services is also obliged to show respect to other hospital staff regardless of their work positions and roles. They also act as role models to the student physicians and the junior staff within the department of respiratory services. As such, these directors are obliged to show moral justice and positive regard to the junior staff and participate in educating the junior staff and respecting their decisions regarding a patient’s course of care. The director of healthcare services is also obliged to keep all other hospital staff informed of the patient care and the rationale of these care approaches.
Ethical obligations to the patient
A director of respiratory services in an organization is entitled to several obligations towards the patient as they are superior decision-makers in their care. They are more so obliged to ensure the patient’s welfare and act in ways that ensure the benefit and positive outcome of the patient. The director of respiratory services is entitled to make decisions in the patient’s best interest without considering their nationality, age, or financial status. The director’s primary interest is ensuring the welfare and best interests of the patient in preventing or treating illness and helping the patient cope with disability or death. Also, the director of respiratory services is obliged to respect the patients’ decisions regardless of the healthcare setting, patient nationality, decision-making capacity, behavior, and financial arrangements (Zhou & Shelton, 2020). Also, regardless of the director of respiratory services compensation by the healthcare organization, the interests of the patients must take an interest, and they should ensure a sense of duty towards the patient. The director of respiratory services should also respect the patient’s cultural and religious beliefs and not violate the patient’s values. Also, the director of respiratory services in an organization is entitled to ensure the confidentiality of the patient personal data by ensuring appropriate security protocols for the storage and transmission of patient data. Lastly, the director of respiratory services in this organization is obliged to ensure that complete and accurate information regarding the patient’s state of health is provided to the patient or other meaningful decision-making personnel. Such proper information ensures that the patient can make informed decisions regarding care.
In this situation, the director of respiratory services is obliged to ensure the patient’s best interests by providing resources and services that ensure the continuation and comfort of life. Also, the director of respiratory services will make decisions meant to ensure the patient’s wellbeing. In doing such, the director will have to integrate the ethical considerations of rationing of resources and ensure a correct prognosis for the patient. Such will ensure the course of action for the end of life care and proper consent provided to the family members and relatives of the patient. Also, the director will review the relative decisions and provide adequate information to the relatives in order for them to make informed decisions. Also, the director will respect the decisions made by the patients’ family members and respect the religious and cultural perspectives of the patient family members. Furthermore, the director of respiratory services in this department will ensure the confidentiality of the patient is kept by withholding information and data about the patient from the media. Such requires the integration of proper data transfer protocols and ensuring that patient information is not disclosed to the unethical staff.
Ethical Obligations to other patients and the community
The director of respiratory services in an organization is entitled to several obligations to other patients in a department apart from the illest patient in that particular department. The director is responsible for ensuring that other patients have proper access to the needed healthcare services. The director of respiratory services is obliged to ensure proper rationing of resources and ensure patient prioritization to ensure patients in critical need of healthcare resources have access to them. Also, the director is obliged to ensure justice and equitability in accessing resources. The director of respiratory services also ensures the values of proper decision-making inpatient care in the department. The director is obligated to show compassion, mercy, and positive regard to all patients as to the community. In doing such, the director should ensure care consistent with correct social, political, and economic policies. Also, the director ensures the conduction of research and dissemination of information about aging to the community. The director of respiratory services is also obliged to encourage active resident participation in the delivery of healthcare services and incorporate resident preferences and goals in the planning of patient care within the respiratory department.
In this scenario, as the director of respiratory services in the organization, I will ensure the proper response to the needs of the other patients by prioritizing patients who are in desperate need of health care resources. In this scenario, proper actions and good decision-making should be integrated into the case a new patient has a better probability of living longer and recovering from the condition and requires ventilator and life support resources. Also, I will ensure justice and equitability in the rationing of resources by ensuring all patients are served on equal terms and ensuring community and client satisfaction with the care offered in the organization. I will also ensure continued community education on their role in determining the course of the care. Such will ensure progressive community participation in Healthcare and the integration of self-care techniques that ensure proper community health.
Documents to be signed by the patient
The patient in this situation is receiving end of life in the hospital organization and has an uncertain prognosis that means that the patient is at risk of death. Also, the patient’s underlying conditions are precarious, and considering the patient’s age, there is a negligible probability for the patient to recover. As such, there is a need to ensure that the patient signs the correct documents prior to death. The patient in this particular scenario must sign several documents. However, the patient is currently not able to self-understand the information in the documents and self-sign them. In this scenario, the family members will need to appoint a representative for the patient who will sign the documents on her behalf. The family members will need to sign several documents, including The Health Information Portability and Accountability Act (HIPAA) document, the Medical power of attorney document, advance care directives, and the health consent documents. The HIPAA is essential for creating a better physician-client relationship that is bound to trust as the patient feels secure to provide data to the client. It ensures that patients’ data is kept safe from access by unauthorized persons. The Medical power of attorney document ensures that the chosen family member is eligible to make decisions on behalf of the patient and help plan the course of care and actions regarding end-of-life care.
On the other hand, the advance directive document ensures that the patient’s personal property wishes are outlined as required. It also ensures a guideline for decision-making to be implemented by the chosen medical power of attorney. The medical consent ensures that the patient and the family members are informed of the route of care and the possible outcomes of the care procedures and actions. It also ensures that the family accepts the implementation of medical actions and is willing to accept all the possible outcomes of the patient care process.
Patients privacy
In Healthcare, the maintenance of patient’s privacy is essential to ensure the patient’s vitality and effective continued care. It ensures that the patient’s data is protected from unauthorized patients without their will and that media houses do not cover their stories live without their will. Therefore, it is essential for healthcare personnel and staff to withhold data about a patient (Tariq & Hackert, 2018). Such requires the integration of sound ethical principles by the staff and avoiding unnecessary communication about patient information. In this scenario, the patient’s data is at risk of access by unauthorized persons and possible coverage on the media, a breach of ethics, and a signed contract if the patient’s family members have no consent of these happenings. As such, the director of respiratory services in this organization and the other junior staff are obliged to adequately protect the patient’s privacy. However, if an act of compassion requires integration, the director of respiratory services will need to ask for consent from the family members to share the patient’s data.
Federal laws relevant to the patient
Some federal laws will take a toll on the patient’s care as the patient is a foreigner and does not have any legal documents that certify her legal living on American soil. Although the patient has children who are citizens of America, she does not qualify to be labeled as legally living in America. However, the patient has a possible violation of the American constitutional requirements for immigration. She is still entitled to receive appropriate healthcare services in American-based hospital organizations (Martin et al., 2018). The American government ensures the protection and safeguard of all individuals living on American soil without the discrimination of the patient’s nationality. However, the patient cannot acquire insurance coverage in America as per the Affordable Care Act. These federal laws affect patient care if the patient’s family members are financially able to continue funding the expensive patient care services.
The biblical implication of patient care
The administrative regulations of both private and public hospitals differ in healthcare delivery services and the rationing of resources. While a public hospital may require the continuation of care of patients receiving ineffective treatment in life support, the private hospitals are against this as it may be expensive for the hospital facility, such as a director of respiratory services in a private hospital organization I may be required to withhold care of the patient receiving end of life care. Several biblical laws depict the course of the end of life care from a biblical perspective. According to Ephesians 15, the bible requires that truth be told in love about every situation (NIV Bible, 1978, Eph.15). The bible states, “Instead, speaking the truth in love we will grow to become in every respect the mature body of him who is the head, that is Christ.” (NIV Bible, 1978, Ephesians 4:15). As such, the patients receiving end-of-life Care are entitled to know the truth about their conditions and make adequately informed decisions. Also, Christian love is practical and responsible. According to (NIV Bible, 1978, Romans 13:8-10), such love does not require us to offer or accept medical interventions whose burdens outweigh the positive output as such futile medical interventions can be withheld or withdrawn but in harmony with divine principles regarding the sanctity of life. From a utilitarian philosophical point of view, the patient must receive proper treatment, and proper actions that foster happiness to the patient and the family should be incorporated (Mulgan, 2018). This patient’s withdrawal of life support would lead to her death, eliciting unhappiness among the family members. Such an action would be wrong according to the utilitarianism philosophy. However, some Christian beliefs are against euthanasia and are therefore opposed to the intentional taking of people’s lives (Exodus 23:7). Christian compassion requires the alleviation of suffering in dying patients and pain relief to the fullest extent possible. It is a Christian responsibility to relieve suffering in a patient. On the other hand, the biblical principle of justice requires that added care be given to defenseless and dependent patients (Psalm 84:3-4, Proverbs 24:11-12). Because of the patient’s vulnerable conditions, special care should be taken to ensure that patients in end-of-life care are treated with respect for their dignity and without unfair discrimination.
Conclusion
Ethics in Healthcare play a significant role in determining the course of patient care and the withholding or withdrawal of patient care. Professionalism in Healthcare is guided by autonomy, beneficence, non-maleficence, and justice. The ethical obligations of all healthcare staff are based on these principles and should not be broken unless in rare cases. A director of respiratory services in an organization is obliged to several responsibilities to patients, the community, the healthcare staff in the institution, and the institution itself. The director is obliged to protect patients’ privacy at all costs and ensure the proper outputs of patient care. The director is required to make decisions deemed in the patient’s best interests. However, the director may be required to withhold or withdraw life support in a patient receiving end-of-life care as there may be no need to offer expensive futile medical treatments. A patient who is a non-American citizen is eligible to receive proper healthcare services according to the federal laws, although they cannot receive universal healthcare coverage in America as they have no proof of American citizenship. Patients receiving end of life need to sign documents that verify consent to accept the physicians’ actions and the document of power of attorney to certify whom to make decisions on behalf of the patient. From a biblical point of view, there is a need to alleviate patient suffering and pain and ensure proper care is offered to vulnerable patients.
References
Tattersall, M. H. et al., (2018). Patient autonomy and advance care planning: a qualitative study of oncologist and palliative care physicians’ perspectives. Supportive Care in Cancer, 26(2), 565-574.
Aziz, H., & Brandl, F. (2021). Efficient, fair, and incentive-compatible healthcare rationing. In Proceedings of the 22nd ACM Conference on Economics and Computation (pp. 103-104).
Greer, J. A. et al. (2018). Defining the elements of early palliative care associated with patient-reported outcomes and the delivery of end-of-life care. Journal of Clinical Oncology, 36(11), 1096.
Zhou, Y. M. J., & Shelton, W. (2020). Physicians’ End of Life Discussions with Patients: Is There an Ethical Obligation to Discuss Aid in Dying?. In HEC Forum (Vol. 32, No. 3, pp. 227-238). Springer Netherlands
Martin, D. et al. (2018). Canada’s universal healthcare system: achieving its potential. The Lancet, 391(10131), 1718-1735.
Mulgan, T. (2019). Utilitarianism. Cambridge University Press.
Tariq, R. A., & Hackert, P. B. (2018). Patient confidentiality.
New International Version (1978). Biblica (worldwide) Zondervan (US) Hodder & Stoughton (UK). (Originally published 1973)
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