Ethical Decision-Making in Healthcare
Professionals are expected to adhere to ethical guidelines while executing their roles. Ethics is based on morality or societal expectations. The primary significance of ethics consists in guiding the decision-making process and increasing the quality of services delivered. According to Braveman, Kumanyika, Fielding et al. (2011), the extension of health care services is adversely affected by inequalities. Based on this factor, the current paper assesses the necessity to make ethical judgments in the delivery of care.
Ethics is important to consider when making decisions. Thus, it is not surprising that principles of ethics are applied across many fields and professions. Many organisations have ethical frameworks to guide behaviour of their workers. Despite the presence of such provisions, circumstances are sometimes contentious. As a result, professionals must think critically before arriving at a peculiar decision, determining what should be done in a given situation.
Though being a complicated philosophical phenomenon, ethics, can be understood in the light of two diverse schools of thought: deontological and utilitarian. Primarily, the utilitarian school of ethics focuses on calculation of consequences that a given course of action is likely to yield (Paul & Elder, 2006). Thus, decision-makers need to apply the utility principle. The utilitarian approach is commonly related to the Common Good Approach, which borders on major people’s preferences. The deontological ethics deposition reveals the belief that actions/ behaviour should be assessed individually rather than based on their outcomes (Paul & Elder, 2006). According to the deontological school of ethics, consequences do not matter. For instance, individuals are obliged to keep their promises, tell the truth, be fair, and respect others. The deontological approach does not allow for convenience, but it rather focuses on what is right. The rights approach, the fairness approach, and the virtue approach are some of the ethical dispositions that fall within the deontological framework.
Efficiency, Effectiveness and Equity
Assessment of national health systems is an issue of concern among the sector’s stakeholders. Measurements have assumed an international dimension paying peculiar attention to ethical matters related to international bodies, such as the World Health Organisation (WHO), the Commonwealth Fund and the OECD (Klassen, Miller, Anderson, et al., 2010). Observing the frameworks proposed by such bodies, it is apparent that efficiency, effectiveness and equity/ equality are widely regarded as the best measures of healthcare delivery. Ethical practices are expected to increase efficiency, effectiveness, and equity.
Within the sector, efficiency has been assessed based on the number of days patients spend while receiving care (Navarro-Espigares & Torres, 2011). On the one hand, when individuals spend more days than expected, the system is deemed inefficient. On the other hand, effectiveness relates to inpatient admissions that occur within thirty days of their earlier admission (Davis, Milner, Parker, et al., 2013). The admissions do not have to be based on the same health complications. A high number of readmission cases demonstrate ineffectiveness of a health system. In practice, equity is assessed based on access to health care services and needs. Equity can take an ethnic, race, age, and socioeconomic status, as well as other related factors (Geiger, 2004). In essence, the aim is to understand how people of different classifications access healthcare. An equitable system is one which provides each person with health services based on his/ her needs.
Disparities often occur at various levels within the healthcare system (Geiger, 2004). For example, variations are seen at the individual, community, and patient-provider levels. At the individual/ community level, social networks, individual health care enhancement, care-seeking conduct, and socio-cultural norms play an influential role (Geiger, 2004).The focal point of the patient-provider category is the level of communication between patients and providers. Factors such as patient participation, respect and trust within clinical settings are crucial determinants of equity.
Addressing inequality is already identified as an issue that can be resolved through ethical conduct. Within the healthcare services sector, an ethical decision based on the utilitarian approach leads to the greatest advantages but harms the least number of people (stakeholders- environment, co-workers, shareholders, patients and the larger community) (Giles, Barn, Künzli et al. 2010). A deeper reflection elucidates that utilitarian ethics supports the principle of efficiency in the delivery of health care services. However, the approach would support neglecting the minority as long as the majority are satisfied.
The Common Good approach promotes the idea that life is shared as people live in communities (Hugh, 2014). Further, the assumption that life is good within a communal set-up supports the need to engage in actions that contribute to all individuals’ wellbeing. It is also thought that the interlocking relations formed within societies necessitate ethical conduct, which allows everyone to benefit. Having an effective healthcare system would be based on the need to promote community welfare, which predetermines an ethical action.
Shifting attention to the rights approach, it is considered that a decision is ethical if it respects and protects the rights of those involved (Hugh, 2014). The orientation commences at the point where human beings are assumed to have dignity and inalienable rights. In this regard, people must be treated as ‘ends rather than as means’. Rights in the category include the right to make personal choices, the right to know the truth, the right to receive healthcare, the right to privacy, and the right against being injured, among others. In a healthcare setting, those involved should respect the rights of other parties irrespective of their statuses.
The justice approach rests on the idea that all people should be treated equally given that they are born equal. In the present time, decisions are deemed ethical when individuals are treated equally (with equality) or fairly (with equity) (Hugh, 2014). This contributes to the understanding of equity, which is a critical component of the 3Es of health care. Whereas equality calls for matching services irrespective of differences, equity draws on the concession that differences exist, and allows for justified/ fair treatment. For instance, in the delivery of care services, regions most affected by a disease should receive more attention in order for equity to be attained. However, huge disparities are always witnessed in the delivery of health services across nations. Hence, those from higher social classes enjoy first-class services while representatives of lower social classes suffer from acute shortages (Geiger, 2004). Ethical conduct cannot accept such discrimination.
According to the virtue of ethical orientation, actions are ethical if they are consistent with given virtues, which form the basis of humanity. Such virtues are habits that guide people in their actions based on the highest human character potential (Paul & Elder, 2006). Values such as truth, honesty, compassion, tolerance, courage, generosity, fidelity, love, fairness, integrity, prudence, and self-control should guide the conduct of people if they are to behave ethically. In this regard, a person operating within the health care system needs to consider what kind of person he/ she is before acting.
From the above-mentioned facts, it appears that the deontological school differs from the utilitarian school of ethics because the former focuses on the duty to do what is right while the latter concentrates on the outcomes. Instead of taking the two dispositions antagonistically, it is suggested that finding a compromise would be critical towards embracing an ethical professional way of life within the health care system. An ideal scenario would witness practitioners taking the right decisions that generate the best achievements. However, acceptance of principles of the two schools is likely to leave an individual in a dilemma. For instance, if a service provider has few in-patients receiving treatment and, at the same time, an emergency case arises where more people need attention, a dilemma emerges. If the provider has a small staff that cannot handle the emergency and the inpatients at the same time, a difficult decision must be made. In accordance with the deontological thought, the provider is obligated to attend in-patients since they have a right to care. However, the utilitarian school underscores the need to generate the greatest benefits while reducing the cases of adverse effects. Thus, it would be advisable to abandon the inpatients in favour of the emergency victims. The implication is that ethics present dilemmas that overwhelm health practitioners.
Health care professionals must demonstrate leadership when extending care services. Those responsible for such roles need to demonstrate ethical conduct when they carry out their daily duties. For instance, Yukl (2006) expounds on how ethical leadership should operate in the delivery of services. Yukl (2006) concedes that leaders should use their power and influence to serve their followers. In addition, when serving diverse interests, a leader is required to strike a balance by integrating all needs. In the process of a vision development, a leader must consider the values and expectations of those who are inferior to him. Integrity is equally an important aspect of ethical leadership. In this regard, leaders must show consistency in making decisions. Leaders must also take risks, sacrificing personal comfort in the hope of guiding a subordinate group forward. Such individuals must disclose information to those in need of it, positively respond to criticism, as well as coach/ mentor followers.
Significance of Ethics
The above evaluation of ethical principles helped to learn some lessons regarding the role of ethics. Without a doubt, it is significant to operate according to ethical rules within the healthcare sector. In the first instance, ethics guide decision-making. Health care experts deliver important services to societies. While carrying out their duties, the professionals are confronted with challenging circumstances, which require them to make decisions. In such conditions, existence and employment of ethical codes are crucial because they help to determine the course of actions. Adherence to ethical ideals during accomplishment of responsible work also contributes to a culture of standardisation, which is helpful for improvement of the conduct of stakeholders who interact with organisations.
The primary function of health care facilities is the delivery of care services. Ethical standards promote the extension of the services (Smith, Mossialos, Papanicolas & Leatherman, 2009). Such practices enhance the quality of health care by doing away with errors committed by health practitioners who sometimes act without regard to procedure. Thus, ethics streamline the delivery of care services, outlining how to handle issues.
Organisations are a part of society. Consequently, working in unison is necessary within the healthcare environment. Promotion of ethical standards in medical organisations improves the support that such facilities receive from the public. Trust in the health fraternity follows from the premise that ethical organisations are obliged to act in order to serve the best interests of other stakeholders. For instance, such actions are likely to attract funders for various activities.
Research is a major factor for the success of healthcare services delivery. In practice, illness and diseases continue evolving, thus posing a challenge to the sector. Behind this background, the industry must always conduct studies to identify trends in order to develop appropriate cures and interventions. Ethics are critical in guiding the accomplishment of research. For instance, when handling matters of inequality studies, reliance on ethics is required to guide the process.
The above discussion helps to determine two strands of ethics. Primarily, one side deals with distributive justice while the other focuses on procedural justice. Thus, it is apparent that the two groups are concerned with justice. The distributive justice group highlights fairness of outcomes while the procedural justice idea focuses on the process used to pursue objectives. Based on this finding, virtue, deontological and entitlement theories align with the process of procedural justice. On the other hand, utilitarianism and rights approaches fall into the category of distributive justice. Taking on a leadership role aligns with ethical conduct in the delivery of healthcare services. It has been distinguished that ethical conduct would be critical in order to enhance quality and equity in the health sector.