A Case Study

1. Modupe Sarratt
Healthcare Legal Consultant
Legal Aspects of Health Care Administration
HCAD 650 Section 9043

2. Healthcare Ethics
An Issue: a Case of Ethical Violation
A Solution: a Training in Healthcare Ethics

3. CASE SCENARIO
On July 15, 2013. Patient X started experiencing dizzy spells and sought the care of
his New physician Dr. Y.
On July 15, 2013. Dr. Y diagnosed patient X with Swan Syndrome and informed him
that the standard course of treatment would consist of taking Pentamite for three
weeks.
Dr. Y made sure to discuss with the patient all the risks and benefits of the
medication. After Dr. Y was done discussing the medication, the patient consented to
taking the medication according to Dr. Y orders.
The medication dosage instructions from the manufacturer stated to take one tablet a
day for three weeks.
.

4. ETHICAL VIOLATION
Dr. Y misread the instructions and ordered Patient to take ten tablets of
Pentamite once a day for three weeks. These instructions were giving orally and
in writing.
Patient followed the instructions given by the doctor and at the end of his
second week he died due to a heart attack.
The people who are affected by this would be:
The patient’s family and Dr. Y’s family was both affected. Dr. Y prescribed the
wrong medication dosage which lead to the death of patient X.
Dr. Y is affected because she was the cause of a death due to medication
negligent.

5. LEGALASSESSMENT
This is a case of unintentional torts medical malpractice. Since the doctor failed
in her duty to prescribe the correct medication dosage which was printed on the
drug manufacturer’s warning label. So, responsibility for the death lies with the
physician – not the drug manufacturer or Littleville Family Health Plan.
The patient’s wife would have to prove that Dr. Y was negligent in prescribing
the medication. The elements that need to be proven for his wife to win the
lawsuit would be as follow:
• What the medical standard of care was under the circumstances
• How his doctor deviated from that standard
• How his death was due to being prescribed the wrong dosage.

6. ETHICALASSESSMENT
Health care ethics is a set of moral principles, beliefs and values that guide us in
making choices about medical care. So, in other words, healthcare ethics is
about our moral compass, our sense of right and wrong and our beliefs about the
rights we possess along with the duties we might owe other people (Aronson, J.
K., 2009).
The ethical principle that is involved with this case would be autonomy,
beneficence, and non-maleficence.

8. There are many dilemmas that can arise during healthcare crises which can be
difficult to analyze for ethics. Petrini (2017) states that there are four references
that can be utilize:
1) medical indication,
2) patient preference,
3) quality of life, and
4) contextual features.
Ethics has to do with….
A set of concepts and principles that guide us in determining what behavior is right
and wrong in a situation.
• It should not be confused social conventions, religious beliefs or our own personal
“feelings” unless we can show how they are related to a clearly set of defendable
actions beyond a reasonable, that the action is appropriate to the situation.
Leaders must have a very clear set of ethical principles for them to be able to do the
right thing at the right time for the right reasons

9. Why is healthcare ethics important?
 To meet patient expectations
 To address the community's health needs
 To enhance the quality of care
 To foster professionalism
 To enhance the organization's culture
 To improve staff morale and performance
 To enhance marketing and public relations
 To enhance organization's compliance to regulatory standards
 To decrease the impact of ethics conflicts on patients, families, staff, and
organization (Nelson, n.d.).

10. Purpose of Healthcare Ethics
• To address the emergence of a growing array of ethical dilemmas associated
with medical procedure, treatment, and the increasing use of health
information technology for patient health data breaching.
• To protect patients confidentiality, privacy, and security while maintaining
the transparency for coordination of services.
• To stop data breaching that rises from expedient exposure of patient m
protective medical and health record
• To enhance resolving ethical problems or issues by individual cases as well as
the ethical healthcare policies at the institutional level.

11. TRAINING IN HEALTHCARE ETHICS
What Is Healthcare Ethics?
Health care ethics (a/k/a "medical" ethics or "bioethics"), at its simplest, is a set
of moral principles, beliefs and values that guide us in making choices about
medical care.
At the core of health care ethics is our sense of right and wrong and our beliefs
about rights we possess and duties we owe others.
Thinking carefully about the ethical aspects of health care decisions helps us
make choices that are right, good, fair and just (Nelson, n.d.)

12. Two ethics that guide healthcare
The two most important ethical systems to healthcare managers are:
1. Professional ethics: is the standards of ethical behavior governing
individual behavior, particularly when that conduct directly relates to the
role and identity of the healthcare executives
2. Clinical ethics: is the basic principles guiding the practice of medicine.
They are the rules that all healthcare providers must follow to practice
“ethically appropriate” care.
.

13. The Four Principles of
Healthcare Ethics in Medicine
1) Autonomy
2) Beneficence
3) Non-maleficence
4) Justice

14. AUTONOMY
Autonomy refers to the capacity to think, decide and act on one's own free
initiative.
• Patients should be given enough information to come to their own decision
regarding their care.
• We also need to respect a competent adult making the “wrong” decision.
• Honor the patients wishes for directive care to make their own decisions

15. Example of Autonomy is Patient Informed Consent
No medical intervention done for any purpose - whether diagnostic,
investigational, cosmetic, palliative, or therapeutic - should take place unless
the patient has consented to it.
Consent may be expressed or implied; the former (e.g., via a signed consent
form) typically occurs in hospitals and relates to specific procedures. For
routine procedures such as a blood pressure check, consent may be implied if
the patient comes voluntarily to the doctor’s office for a check-up.
For consent to be ‘informed’ the patient must receive a full description of the
procedure, its risks and benefits, the prognosis with and without treatment,
and alternative treatments.

16. Beneficence
Beneficence refers to what is best for the patient.
Beneficence implies consideration of the patient's pain; their physical and mental
suffering; the risk of disability and death; and their quality of life.
At times, beneficence can imply not intervening, if the benefit of therapy would
be minimal.
To be generous or doing good

17. Non-maleficence
• Means Do no harm to a patient, either intentionally or indirectly
• Is the moral principle in bioethics that all students are taught in school about
using humans in clinical research and it is a fundamental principle of
medicine throughout the world
• the moral promise to abstain from doing harm.
• Non-maleficence is the physician moral to gauge whether given an existing
problem, it may be better not to do something, or even to do nothing, than to
risk causing more harm than good.

18. Non-maleficence Core Value
Non-maleficence is the moral conscience that one considers in violating
professional obligation, organization policy, and the medical ethical standard for
practicing medicine.
Non-maleficence is a reminder in health care and medical care that the
healthcare professionals and providers must consider the possible harm that any
intervention might do.
It can be use to invoked when debating the use of intervention that carries an
obvious risk of harm or a less chance of benefit.

19. Justice
Justice in principle: Equal access for equal treatment. To dictates that patients in
similar situations should have access to the same care, and in allocating
resources to one group should be the same measure that impact the choice on
others.
Justice in fairness: Patient should be treated with respects and dignity.
Healthcare providers will make fair decision to emphasizes that patients are
treated equally and that healthcare services is accessible to all patients.

20. The fundamental objectives of the healthcare management profession are to
maintain or enhance the overall quality of life, dignity and well-being of every
individual needing healthcare service and to create a more equitable, accessible,
effective and efficient healthcare system. Dilemmas/Conflicts are often resolve
because of the guidelines provided in the codes of ethics of medical associations
or healthcare institutions, ethics training and implementation of ethical decision-
making model.

21. According to Beauchamp and Childress (2001) and Gillon (1994), the role of
ethics in healthcare industry is based on five basic values that all healthcare
providers must adhere:
Autonomy: Decision making may be different, and healthcare providers
must respect their patients’ decisions.
Beneficence: The best interest of the patient should always be the first
priority of the healthcare provider.
Non-maleficence: Meaning the healthcare provider will not take any actions
to harm the patients.
Justice/fairness: Healthcare providers will make fair decision to emphasizes
that patients are treated equally and that healthcare services is accessible to
all patients.
Dignity/respect: Respect patient directiveness and directedness for how they
want to be treated should be honor and respects .

22. Justice is related principle concerns confidentiality
Confidentiality forms a cornerstone of the doctor-patient relationship, but it is
increasingly hard to maintain with the growth of electronic data.
In order to protect the trust between the healthcare provider and patient, personal
medical information should not be released without the patient's consent.
Like other ethical duties, however, confidentiality is not absolute. It can be
necessary to override privacy in the interests of public health, as in contact
tracing for partners of a patient with a sexually transmitted disease.
Note that healthcare providers are legally obligated to report a possibly HIV
infected patient to the public health authorities. However, this should always be
done in a way that minimizes harm to the patient.

23. Questions for the Case
Do you believe that the physician's actions can be justified in any way?
Is there anything else that they could have done?
Is it ever right to take away someone's autonomy?
Would a court order make the physicians' decisions ethical?
What would you do if you were one of the health care workers?
How do we do the right thing as healthcare leaders?

24. Video for Reviewing Ethic Training

25. References
Aronson, J. K. (2009). Medication errors: what they are, how they happen, and
how to avoid them. Qjm, 102(8), 513-521.
Beauchamp, T. & Childress, J. (2001). Principles of Biomedical Ethics (5th ed),
Oxford, UK: Oxford University Press
Gillon, R. (1994). Principles of medical ethics. British Medical Journal, 309;184
Nelson, W. (n.d.). Vermont Ethics Network.
http://www.vtethicsnetwork.org/ethics.html
Petrini, C. (2017). Bioethics of Clinical Applications of Stem cells.
International Journal Of Molecular Sciences, 18(4),
doi:10.3390/ijms18040814