Analysis of ethical issue in St. Anthony’s Medical Centre

Analysis of ethical issue in St. Anthony’s Medical Centre.

St. Anthony Medical centre is a medical center in St. Louis metropolitan area. Recently it has faced several ethical issue pertaining its management and staff. The medical centre has served all type of classes of patients since the start of its operation in 1900. The medical centre has church support and commitment and has always intended to remain in that state. It also has priests and nuns as staff in the centre.

Peter D, an experienced nurse in the hospital, had observed together with his coworkers for several years, that Dr. Bill, a neurosurgeon, had been losing dexterity in performing surgical procedures. He was careless with instruments and sometime his hand shook. This problem has made two patients burn with cauteries, but neither of them had a serious harm. The techs and the nurses discussed this issue among them and even approached the personal assistant of Dr. Bill regarding this issue. His PA seemed to be aware of this dexterity but did see it a problem. Peter approached the nurse manager and the nurse director regarding this. They requested the staff to put in writing their concern, but they seemed reluctant because they were scared of retribution by surgeons or even Doctor Bill. This is because they are aware that only a surgeon can evaluate the work of another surgeon. The chief of Neurosurgery indicated that he will pay attention to the reviews of the doctor. It took time for them to report anything about Dr. Bill since he always had an active schedule of surgery.

After a year, Dr. Bill performed a surgery and it happened he had an instrument accident during the surgery. He caused severe nerve damage on a 45yr old woman’s brain. The woman experienced damage to cognitive and reasoning function and also suffered from emotional ability. The woman could not return to work and depended on her family for supervision and support. Dr. Bill was fully aware of these damages and in his record he noted of these damages and explained it as unfrequented and unfortunate. The hospital chart reviews made resulted to no action from hospital administration and neurosurgeon. Peter had some discussion with informal staff, techs and Dr. Bill’s scrub nurse concerning the issue. Peter noted that they were all trying to white-wash what the doctor did. For his concern, he approached his manager to talk over it.

Prior to the accident, did the hospital administration conduct itself in an ethically careful manner? Is the administration act of omission relevant with the ethics? Someone reading this case might wonder why the administration did not take responsibility of making sure that the accident was prevented. Should the evidence of this case burden the staff involved? Being a catholic involved medical centre, what was its responsibility?

Peter’s values and upbringing made him feel that it was wrong to lie to the patient’s family and he also believed that the hospital was obliged to maintenance of the patient. Would it be ethical for Peter to share what he knew to the patient’s family without the consent of the hospital? What ethical responsibility do Peter’s co workers have, since they were to bring the conduct of unwilling to come forward and put in writing their concern? Does the staff hold any Ethical responsibility to the future of Dr. Bill?

 

Analysis

The case of Dr. Bill and Peter, illustrate the power of one ethical belief in confronting managerial ethics and organization culture. Peter and his co worker have no right (legally) to share their concern about the conduct of a surgeon under (external) scrutiny. They are also not bound to bring additional information that would be important valuable to an investigation of this case. It was also unethical for the medical centre not to tell the patient’s family of what exactly happened during the surgery. The staff members are the only key players in this case. All the leadership and inquiry should have been from them. What was the ethical responsibility of the chief of surgery or neurosurgery? Is there need to again monitor Dr. Bill surgery practices?

An ethical analysis of this issue lies within the hospital administrative processes and also those involved in decision making and leadership. Peter’s manager was aware of Peter’s concern but, he chooses not to lead another way. The manager failed to take the Peter’s concern forward to the administration. This is an issue of leadership and management. In general, the medical center’s management ignored what was brought to their concern and as a result a patient had a severe damage of brain nerves and cannot do her duties as before. The failure of the medical center’s management to act upon then situation is a failure of ethical management conduct (Hosmer 52).

Whatever the path will be selected to solve the issue, the case will not be straightforward. Conflict will arise among the staff and administration. According to Hosmer Model, this means that administrative ethics will affect choices of individuals in invisible and indirect way since they are less visible and tangible (Eileen 224).

The barriers to ethical follow up in health care by management or administration are all familiar to most medical staff including the nurses and techs. The negligence to carry inquiry forward is likely to be seen in many medical centers or hospitals. Barriers are always presented in management realities such as fiduciary institution’s duty; availability of competing value system; tendency by physicians to protect the peer; sanctioning discouraging others form judging and questing practices; protection of the organization from law for instance, the medical centre was certain the patient will sue them if they revealed what happened; administrative inertia; economic and historical power of physicians, for this case Dr. Bill; managers reluctance and confidentiality of patients information (Hosmer 378).

The Hosmer model states that the level of moral strength is a great determinant of ethical behavior. Social consensus among physicians leaders and administrative about highest values may be limited and the level of consequence and proximity to harm may be difficult to predict (Eileen 225). Conditions like this may result to administrative or management resistance to action. While the medical staff may reach to a consensus, that the patient’s future was paramount, it is more likely for the managers to be slow in making decisions. For Peter to pursue this case, the medical centre culture, all personnel and also the moral agency of the managers would need to be very strong. If latter was in place, a non blaming ethos would need to be included and also absence of retribution towards the staff involved and Peter.

Ethical consciousness extends much beyond the concept of immediate situation of anticipatory ethics (Eileen 79). Responsible behaviors by any professional require leadership, probity prudence, accountability, competence and trustworthy conducts and fulfillment of responsibility (Hosmer 373). For workers and managers of St. Anthony’s medical centre, to be aware to Dr. Bill’s endanger to patients demands for anticipatory ethics practices in the future to avert future harm.

In this case, Peter will be of help to clear the fact and also take his time to know both his professional and organizational roles allow and also know where his ethics and moral stand contrasts. This is because ethical values are open and personal to interpretation and are a great risk to the law or agency policy (Eileen 83). Regardless of the choices made in this case, medical workers should understand the relevant principles flowing into their analysis (Eileen 112). Peter should act on his personal ethical principle by pursing the appropriate medical center’s chain of command. His position in the medical centre is risky.

For this case, decision making is complex since the administration was at fault. According to Hospers model, the following guidelines are necessary. Consciously recognition of separate but relative domains of religion, economics, philosophy, government regulation, law, industry, disciplinary effects, individual context, and culture as they contribute to ethical decision and action, is an important step. The Hosmer Model states that understanding conflicting obligations are not the exception but are the rule (Hosmer 390). In a presenting situation is important to differentiate an individual’s personal values from societal values

Hosmer says that identifying the authority’s ethical value hierarchy should prevail, unless there is a likelihood that harm will present itself to others, government regulation, and the principles of law.  When there is a convincing likelihood of harm, be aware that it is insufficiently addressed by organizational policy, government regulation or law. He also states that identifying and discussing ethical situation with trusted managers and peer is important. Hosmer Model identifies the people and process to involve in addressing the challenge should be of concern when trying to solve ethical problems arising. Understanding the situation’s contingencies, including inherent risks for the patient and staff is important according to Hosmer Model. Knowing what risks, one can suppose and what actions to take.

There is a low probability of the case being solved to Peter’s satisfaction because all non-parallel powers were against his. His will leaves him morally compromised and he may consider leaving the medical centre. On the other hand, an understanding of professional, cultural, historic and contextual factors of the case, may lead him to understand that this outcome is possible and other employment setting of this kind. Most health care organizations regard their hierarchy so much, that the voice of simple workers can not be heard (Eileen 274).

Peter’s opportunity to pursue forward his professional responsibility in the medical centre had not been obliterated but attenuated. The future of Dr. Bill in the medical centre will be protected; his patients will also be protected by use of great supervision. From anticipatory ethics perspective, it could be argued that it is unethical for Peter to leave the medical centre. He was singularly and uniquely positioned by his virtues of ethical distress, experience and role to avert future malpractice.

In most cases, conflict cannot be solved through communication alone, although the health care ethics committee must convene to decide a complex matter (Hosmer 391). These bodies are run and managed by business management professionals, but may also include specialized and experienced counselors, lay people, and qualified clergy(mostly chaplains seconded in hospitals) –indeed, the general opinion around the world is that they must be incorporated for the sake of fairness .Member smust have a background in healthcare, counseling or treatment of patients; a priest or minister of religion or equivalent, societal elder; a layman; a laywoman; a lawyer and, in the case of healthcare provision.This is the holding of virtue ethics on values.

Healthcare ethics starts with organizational culture (Hosmer 373). If an organizational culture is based on shortcut-taking, as ethics holds in the deontological ethics, there is need to ensure that the cultures of healthcare institutions work towards improving the overall welfare of their employees, who when properly motivated will work effectively and ethically and further still the chief executive officer and board of directors should be people of high moral integrity and should be given their jobs and membership through competitive vetting knowledge, experience,  welfare of the patients, medical doctors and nurses and their concern in  sanctity of human life (Eileen 284). At the end of the exercise those who qualify should be given terms of reference, job descriptions with special reference to the implementation of the code of ethics and the performance of their duties during their time of work. They should also be people ready to work with the medical centres on putting into practice the ethos of the hospitals they are called to administer (Eileen 412). Relevant arms of the government should receive their reports since they are serving the people. This does not mean that the confidential report which bind them with stakeholders and managers of their specific hospitals are done away with. This is the true meaning of respecting the chain of command which is also ethical value.

 

Hosmer’s model

The Hosmer Model poses morality and moral issues in management as its working principles. However, the crux of this model lies in morality and this has to be explained further. Morality can be defined as the recognition of intentions, actions and decisions as being either good or bad. A moral code therefore is a set of morals that applies to a certain community, religion or society. In retrospect, immorality therefore refers to the lack of morality or morals. Some morals are universal hence easy to accept for example the right to life is unmistakably shared by the world over. Ethics is related to morality in that ethics connotes the moral principles of a particular group or even an individual. Ethics involves practical reasoning in life. Ethics is differentiated from morals in that morals may sometimes contradict or overlap each other while ethics are always flexible according to the situation at hand. Numerous approaches have come up with a view of understanding ethical decision making as well as distinguishing ethics and morals in decision-making.

Managers have a real problem in addressing moral issues because of their nature. Moral problems present a conflict of interest between pursuing an organization’s goals and attending to societal interests and needs. At the workplace, it is inevitable to avert any moral issues as between employees; there exists many avenues of conflicts. Moral standards are quite difficult to establish as well. In the Hosmer model, it is outlined how moral standards are “subjective and personal”. This denotes their volatility according to the following criteria as well as other minor ones. People are uniquely different and therefore each individual has their own moral standards, which may be higher or lower according to many other factors. People also have different moral standards as defined by the group in which they associate with for example school groups or informal groups. Different cultures also have different moral standards, which are socialized into their people for example the working culture in Asian cultures. Other minor factors that make up for different moral standards include countries of origin as well as time.

The Hosmer Model proceeds to prescribe guidelines for resolution of moral problems. The solutions outlined by Hosmer take managers on a systematic, descriptive method of resolving ethical issues. The first step involves understanding the term moral standards. This includes comprehending all the parties’ moral standing to argue from an informed point. At this stage, a manager should also recognize all moral impacts. These benefits or harms will surface because of the intended course of action. Other factors to be judged are the right things being accentuated and the wrong things being erased.

The next stage is defining the complete moral problem. In many cases, this problem is being addressed. On must ask themselves questions like: Do the ethical standards address the issue directly? All the parties involved should also be aware of the issue that arose which means the manager should clearly define the problem particularly as extended questions to invoke insight among the parties involved. Stating the moral problem is a big part of the success of Hosmer’s Model. Therefore, the problem should be carefully drafted to put everyone in the know without being biased to one party.

The next step is determining the economic outcomes. This stage has many considerations in addition to compromises to be made as it is directly related to the firm’s primary goals of making profits in any market. Most moral decisions are usually economically beneficial to society. Economic analyses are not always straightforward activities. The cost benefit analysis has to be done in order to determine the viability and feasibility of any decision. Hosmer speaks of the “net balance of benefit over costs for the full society” (Hosmer 386) indicating his concern that some moral decisions may not completely satisfy all parties equally.

After determining the economic outcomes, the manager must consider the legal outcomes. Within any organization, many legal obligations govern their operation. When making ethical decisions, it important to consider all levels of rules and regulations applying to the particular situation. The most common legal issues are covered in the national constitution, the firm’s constitution or other provisions for different contract and so on. Within a particular society, people also decide that certain rules are the most appropriate for them. In this way, people can compromise their own interests at the expense of communal interests, a concept proposed by John Locke and Thomas Hobbes. This theory has been used by Hosmer to explain how society can achieve peace, growth and uniformity by laying aside individual ethics and agreeing on a set of communal ethics to govern them in their social groups.

The next stage involves the manager evaluating the ethical duties of the members of that particular group. Ethical duties refer to the “obligations owed by members of a society to other members of that society” (Hosmer 396). Also branded as deontological duties, these involve people having their own morals that may influence them to do the right thing as well as doing it because it’s the right thing to do. The vice versa is also true in that people should not do wrong things alongside avoiding them because they are wrong. This also covers universal rules .Lastly; one has to propose convincing solutions to the problem based on the above steps.

In conclusion, Hosmer’s model is vital in solving the deadlock at St. Anthony’s Medical Center. The surgeon in question, Doctor Bill had been practicing even though he had developed complications that would have jeopardized the lives of his patients. Consequently, he was rendered incompetent by the hospital. The management should have applied Hosmer’s approach in finding an amicable yet efficient way of handling Doctor Bill even before the accident occurred.

Conclusion

Engaging in ethical reflection requires an environment marked by trust, role flexibility, empowerment, open inquiry and honesty (Hosmer 296). In this case, money and power are the key play to the ethics in place. Money and power have fully influenced the decision making in health cares and also its leadership. It is a call for health care workers to establish an environment where trust and honesty thrive. This analysis reflects how ethics is distinguished from context, law, culture, philosophy and religion. This situation illustrates ethical conflict in the administration or management of health cares.

In order to develop and nurture a healthy and productive future generation, there is need to consider employing ethics in healthcare management (Hosmer 212). Most stakeholders like; physicians, patients, healthcare institutions and other institutions should work and develop ethical committees and centers that are guide their members. Self control and responsibility values should be adopted through ethical application, by the physicians.

 

Works Cited

Eileen, Morrison. Health Care Ethics Critical Issues for 21st Century. 2nd ed. Jones and Bartlett Publishers. 2009. Print

 

Hosmer, L. T. Trust: The connecting Link between Organizational Theory and Philosophical Ethics. Academy of Management review. 20(2): 250-397. 1995. Print

 

Hosmer, L. T.  The ethics of management. Chicago: The McGraw-Hill  Companies, Inc. 1996. Print

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