Stakeholders are those people who are involved in each step of a process. They provide suggestions, participate in all aspects, give ideas on what can be done to improve something and support the process in all aspects. The stakeholders involved in the case are; baby Thomas’ parents, head of Intensive Care Unit Department, nurses, physiotherapists, a social worker and the head of the Finance Department. The stakeholders listed suit all the characteristics of a stakeholder in the medical scenario. Each of them participate in all aspects of baby Thomas’ health situation. Through their involvement however, they present various ethical and legal conflicts.
Ethical and Legal Conflicts
The health and human rights charter argues that each person has a right to access both physical and mental health. Everybody is entitled to health protection from the medical practitioners, and health care must be given in for of a public good which is financed publicly and fairly. The dignity and rights of the stakeholders will be affected in the following ways; the patient is an important stake holder because he/she has the right to autonomy. However, in the case study, Thomas is unable to contribute because he is an infant. Therefore, the responsibility of making decisions falls on the parents (Leenen, 2014). On the other hand, the parents of baby Thomas, taking into consideration that the evaluation conducted by the social worker concludes that they were not prepared for the probability that baby Thomas may not survive at all, cannot be said to be in the right state of mind to make a reasonable decision. This is because they are looking at the situation subjectively instead of objectively, that is, they still insist on continuation of treatment despite its futility, not taking into consideration that the resources lost (Miracle, 2004).
Another important stakeholder in the decision making process is the finance department. This is the department issuing the finances used in the medical care of baby Thomas. The finance department in the case scenario can be assumed to be in charge of disbursing funds for patient healthcare taking into consideration that in the case study withdrawal of NICU care due to limited funds after performing an evaluation of expenses. This makes them responsible for ensuring that treatment is availed to patients. Their request to withdraw NICU care was due to limited funds and considering baby Thomas’ treatment had already been considered futile. The request can however not be said to have been made on reasonable grounds. This is because the funds can be rerouted to help people with higher chances of survival. This is however not ethical because it goes against principle of justice (Chalom, Raphaely & Costarino, 2009).
Nurses and doctors also make up the list of stakeholders. They are in charge of baby Thomas’ care. They administer the baby’s treatment and work at his best interest. In the case study, it was after them giving it their all to ensure the survival of Thomas that they had come to a conclusion that continued medical treatment would be futile. They then suggested that Thomas be withdraw from life support which is within their rights. However this goes against the Hippocratic Oath because their action would lead to the death of the baby (Manias & Street, 2011).
The boarding management is yet another stakeholder. This refers to the hospital. The hospital is expected to offer medical assistance to anybody without any discrimination. It should ensure that the quality of medical services offered are at par with the standards. It does this by managing all resources including nurses, doctors, pediatricians, facilities and funds. The hospital is usually concerned with the outer greater picture. Extravagant expenditure on a child with almost no chances of survival goes against the greater picture as they have to consider all their patients and ensure that the hospital experiences lower mortality rates. Therefore they are likely to support the decision to withdraw advanced life support systems for Thomas as they will see it as sacrificing a single individual to save more lives. In addition, they will also view it as an act compassion and empathy as Thomas will suffer no more. This however is not ethical as their actions will violate the principles of non-maleficence and justice. In addition, their actions would also go against the sense of morals and virtues they are required to uphold as not doing everything within one’s power to save an individual is neither morally upright not virtuous (Lynk, 2015).
Principles and Virtues of Health Care Ethics
Principles in Thomas’ case is as follows; first of all, medical practitioners are guided by principles such as respect for autonomy, respect for persons, beneficence, non-maleficence and justice. Respect for autonomy refers to a case where the patient has a right to accept or refuse treatment. Respect for persons is where the patient and the medical practitioner have a right to be treated with dignity (Ashcroft, Dawson, Draper & McMillan, 2007). Beneficence refers to a case where a medical practitioner is required to act in the interest of the patient in the best way possible. Non-maleficence refers to a case where medical practitioners are not expected to cause harm or inflict pain. Lastly, justice refers to where health resources are distributed fairly and equally, irrespective of how scarce the resources might be (Beauchamp, 2007). In this case, Thomas, a baby with poor health needs to be treated with dignity irrespective of his condition. The medical practitioner attending to him should also be treated with dignity and his/her decisions should be greatly respected. Beneficence applies in this case as well because the medical practitioner is required to work to the best interest of Thomas (Gillon & Lloyd, 2014). However, Thomas’ interest is with the parents so the medical practitioners should work to achieve their interest, which is Thomas getting well. Non maleficence can be used in this case. Medical practitioners should not inflict pain (Engelhardt & Wildes, 2014). By withdrawing Thomas’ life support system, the medical practitioners will be causing harm to the baby and to his parents. Ethically, the medical practitioners should thus not withdraw the life support system. The principle of justice is also relevant because baby Thomas, regardless of his age and medical condition is entitled to the medical resources which have been distributed fairly and equitably (Veatch, 2011).
Codes of Ethics and Codes of Professional Conduct
Apart from principles and virtues of health care ethics, there are codes of ethics and codes of professional conduct. According to the American Medical Association, the relevant codes of ethics and/or codes of professional conduct include; first, patient-physician relationship where medics are expected build trustworthiness with their patients. In the case of Thomas, the medical practitioners should build a trust relationship with his parents so that Thomas’ parents can at least believe that the medics will save their son’s life (Butler, 2012). Second, opinions on consent, communication and decision making where patients participate in making decisions about their health and medical practitioners provide information to help their patients understand their medical condition. The medical practitioners should explain the condition of Thomas to his parents such as cerebral perfusion, hypothermia, thrombosis, sepsis and malnutrition, and also the medical procedures he is undergoing such as resuscitation and extubing the baby (Thomas, Sage, Dillenberg & Guillory, 2012). Thirdly, medical practitioners are expected to respect a patient’s privacy and confidentiality. The doctors, nurses and social workers should keep information about Thomas private and should avoid sharing his medical condition to third parties, otherwise they will be going against the code of privacy and confidentiality (Siegler, 2012).
Fourth, as a patient nears the end of life, medical practitioners are expected to help their patients and provide them with compassionate care. In Thomas’ case, medical practitioners are almost certain that Thomas is not going to make it out of his condition alive. However, according to the ethics of medical practitioners, at this crucial time, Thomas needs greater medical care (Jonsen, Siegler & Winslade, 2012). Fifth, a medical practitioner should provide medical service basing on human need and should not be influenced by age, gender, color, race or status. They should therefore not allow the socio economic status of the patient influence the care being provided. In the case of Thomas, the head of the Finance Department suggests that the treatment the baby is getting in the Neonatal Intensive Care Unit be withdrawn because it is costly on the parents. This is against the code of conduct of doctors (Shuster, 2010).
In Thomas’ case study, there exists a legal and ethical conflict. Legally, medical practitioners have the right to withdraw or withhold medical treatment from their patients, which is the action the medical practitioners are opting for in the case of Thomas. The withholding and withdrawal of life support systems is legally justified by the principles of informed consent and informed refusal which both have strong roots in common law. Consequentially, palliative care has to be offered in order to satisfy legal requirements (Reich, 2013). Withdrawal or withholding life support systems are supported by the principles of autonomy and beneficence. However, in as much as the action of withdrawing baby Thomas’ advanced life support systems maybe legal, it can be considered unethical. This is because the action goes against the code of ethics that medical practitioners are sworn in to, the Hippocratic Oath. Withdrawal of baby Thomas’ advanced life support would most likely lead to death, either instantly or after a period of time. This goes against the principle of non-maleficence as it requires medical practitioners not to kill, inflict pain, incapacitate or deny an individual the benefits of life. These conflicts lead to increased difficulty in making a decision on the course of action (Beauchamp & Walters, 2012).
The above discussed principles conflict greatly with one another, especially with regard to Thomas’ case. For instance, there is conflict between principle of beneficence and autonomy. This usually happens when the recommendations given by medical practitioners are not agreed upon by a patient. In the case of Thomas, the head of the Intensive Care Unit and Anesthesia Department has recommended that Thomas be removed from the advanced life support system (Brazier & Cave, 2012). The reason for this is that the nurses and physiotherapists argue that in any case Thomas survives, he would suffer great neurological damage and other disabilities, and would therefore not be able to lead a normal life. The conflict comes in when his parents reject this view. They even go to an extent of contacting the media so that they can make public their situation and that of their son (Ramsey, 2015).
A Legally and Ethically Defensible Resolution to these Conflicts
Ethically, the withdrawal of the life support system from a patient is not acceptable in the medical profession. This is because it is against the principles of autonomy, beneficence and non-maleficence. However, legally, the medics can withdraw and withhold the life support system. This however, must be done with consideration of the offering of palliative care. The medical practitioners might withdraw the life support system and baby Thomas happens to survive. They should ensure that the baby experiences the best medical treatment in the hospital. Medical practitioners such as doctors, nurses and social workers should provide an extra layer of support. The palliative care team should also ensure that there is constant communication between them and Thomas’ parents so that they are aware of what is going on. Since this could be considered as end of life for Thomas, the medics should apply end of care support. This should enable the medical practitioners help Thomas live well until he dies. They should also ask his parents on their wishes and preferences with regard to Thomas’ life. The parents should receive social, psychological and spiritual care as well. Thomas is in the stage of end of life because the medicals have ruled out his chances of survival.
The situation of baby Thomas is conflicting when it comes to legal and ethical terms. The recommendations given by the medical practitioners is to withdraw life support from baby Thomas. Legally this is allowed as long as the medical practitioners apply palliative care. Ethically however, it is not allowed because it goes against various principles in the medical field such as autonomy, beneficence and non-maleficence. Before the medical practitioners come to a common solution, they should assess a lot of aspects. They should consult one another, major stakeholders and Thomas’ parents so as to avoid legal and ethical issues.
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