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As a healthcare manager, you will need to make ethical decisions that will have an impact on your employees and the organization. Completing this ethical review process will help with your decision-making and help you explain the theories, values, and methodologies used in making ethical decisions.

Preparing for the Assessment

In this assessment, you will discuss your experiences with ethics, including your ethical values, ethical theories, and an ethical decision you made. Remember, as you share your ethical experiences with your faculty member, do not discuss information and details regarding a company or individual by name that is not public information.

Review the following Ethical Decision Models & Problem-Solving Methodologies:

7 Step Guide. State the problem (specific thought or feeling that prompts you to feel uncomfortable). Check facts (consider all points of view). Identify relevant factors (people involved, laws, personal codes of conduct, etc.). Develop a list of options (consider a variety of decisions or solutions). Test the options. Harm test: Does this option do less harm than the alternatives? Publicity test: Would I want my choice of this option published in the newspaper? Would I want my grandmother to know? Defensibility test: Could I defend this choice of option before a committee of peers, or a Congressional Committee without appearing self-serving? Reversibility test: Would I still think this choice of option was good if it were applied to me instead of others especially if some of the effects are adverse? Colleague test: What might my profession's governing board or ethics committee say about this option? Organization test: What does my organization's ethics officer or legal counsel say about this? Virtue test: Would a virtuous person do this? What kind of person does this? What kind of person would I become if I did this kind of thing all the time? Make a choice. Review previous steps (consider how you could avoid having to make this decision in the future). Moral Model. Massage the dilemma. Outline the options. Resolve the dilemma. Act by applying. Look back and evaluate entire process.

Assessment Deliverable

Respond to the following investigation prompts in 75-150 words each:

Identify an ethical dilemma you may encounter in the workplace. (Your answer to this item does not need to be 75-150 words.)
Describe how you would use an ethical problem-solving methodology or decision model to investigate your current ethical dilemma.
Describe the possible solutions and impacts of making decisions about this dilemma.
Explain what impact your values may have on your decision.
Explain what impact 2 specific ethical theories may have on your decision for the dilemma.
Explain what impact 2 specific ethical principles may have on your decision.
Explain how you could use this formal ethical problem-solving method to have a positive impact on future ethical decisions in the workplace.

Cite at least two reputable references according to APA guidelines. One reference must be your textbook, Ethics: Theory and Contemporary Issues. Reputable references include trade or industry publications, government or agency websites, scholarly works, a textbook, or other sources of similar quality.

Please Note:

Each response (other than the first one) must be 75 – 150 words in length.
You must use a heading for each of the required elements. Failure to do so will result in a 5% or more penalty.
You must remove all instructions prior to submission. If you include instructions, a 5% penalty will be assessed for failure to follow instructions.
Please submit as an attachment using a Word document. Do not submit .pdf files or any other format that the instructor may not be able to open or insert comments on. If you do so, a 5% penalty will be assessed for failure to follow instructions.

hcs335_v10_wk2_decision_making_investigation_example1.docx

HCS/335 v10

Summative Assessment: Decision-Making Investigation Example

HCS/335 v10

Page 2 of 2

Summative Assessment: Decision-Making Investigation Example

Respond to the following investigation prompts in 75 -150 words each.

Cite at least two reputable references used to complete your responses. One reference must be your textbook, Ethics: Theory and Contemporary Issues. Reputable references include trade or industry publications, government or agency websites, scholarly works, a textbook, or other sources of similar quality.

· Identify an ethical dilemma you may encounter in the workplace. (Your answer for this item does not need to be 75-150 words.)

An ethical dilemma that I encountered in the workplace involved an 80-year-old male who was admitted to the hospital with complications from Stage 4 lung cancer treatment. The further treatments he received in the hospital left him in intractable pain, sleepy, unable to take nourishment by mouth, and incoherent. The gentleman’s doctor talked to his daughter about treatment options. The options (and thus the crux of the dilemma) were to continue with the chemotherapy or to withdraw treatment. His daughter, who was his designated surrogate decision-maker, wanted to take him off his intravenous fluids and medications to allow him to die a natural death. I was that daughter.

· Describe how you would use an ethical problem-solving methodology or decision model to investigate your current ethical dilemma.

The following are steps to an ethical problem-solving methodology to have a positive impact on ethical decisions in health care. The first step is to identify the ethical problem. This step is when you evaluate the problem within and try to distinguish between ethical problems and other medical, social, cultural, linguistic, and legal issues. The ethical problem I faced was whether to continue chemotherapy, giving a few more months of life filled with severe pain to my father, or to withdraw treatment, permitting my father to die a natural death only with comfort care. The second step is to get the facts. This step is when you find out as much as you can about the problem through history and investigation. The doctor presented all the facts to me as the surrogate decision-maker for my father. Once I knew the facts, I was able to make a choice that I thought was right for my father. The third step is to consider core ethical principles. The core ethical principles consist of autonomy, beneficence, non-maleficence, justice, confidentiality/privacy, and veracity. I protected my father’s autonomy by carrying out his last wishes as his designated surrogate decision-maker. Beneficence entered this decision as I thought of the welfare of my father and did not want to have him harmed through the severe pain of futile chemotherapy in his last days of life. The fourth step is to consider how the problem would look from another perspective or using another theory. If one looked at this ethical problem from another ethical theory, the same conclusion can be reached. For example, using the Deontological Theory (proposed by Kant) that states that a person’s ethical actions come from a sense of duty with the right intentions. In this case, I had a duty to carry out my father’s last wishes to die the way he wanted. I felt my motives (intentions) were pure. The fifth step is to identify ethical conflicts. This step is done by explaining why the conflicts occur and how they may be resolved. In this case, ethical conflicts may occur between those individuals who believe that quality of life is not as important and quantity of life. These individuals may not be educated about the ethical issues surrounding terminal pain relief. For example, there are still those who are hesitant to use increasing amounts of opioids for patients who are dying or who have only months to live because they do not want them to become “addicted”. This is a specious argument. The sixth step is to consider the law. This step is achieved by identifying relevant legal concepts and laws and how they might guide management. It is also done by examining the relationship between clinical-ethical decision and the law. In this case, the law is clear. A patient is within their rights to refuse any treatment a doctor proposes even if by doing so it will result in their death. As my father’s surrogate decision-maker, I have the legal authority to make that decision for him. The final step is to identify a way forward. This step may be achieved by identifying ethical viable options, clarity on who was responsible for the decision, documenting the process, and evaluating the outcome (Scher & Kozlowska, 2018). After the decision was made, I felt a sense of relief. Of course, there was paperwork. After any such ethical decision, a time of evaluation is needed; this is the same when one is dealing with one that is personal. Once my father died, I spent time to reflect on the entire process. I was glad that my father already had an advance directive in place, which saved much heartache and confusion. I was glad that ethical decision-making plans or models exist that helped us all make sure nothing was missed. I was glad that the hospital staff were professional, respectful, and empathetic.

· Describe the possible solutions and impacts of making decisions about this dilemma.

The impact of my decision was based on the ethical values in which I believe. I believe in quality over quantity of life. In my father’s situation, the GI tube was prolonging my dad’s suffering with the excruciating pain that he was experiencing from the cancer. Since he was unable to receive treatment due to his complications, the GI tube seemed unnecessary. I thought it would be selfish of me to keep him connected to the GI tube just to have him with me.. It was a difficult decision to make, but I felt in my heart and mind that it was the right decision.

· Explain what impact your values may have on your decision.

There are five main ethical values that categorize me as the individual I am today. The first ethical value is integrity. I believe in being honest and truthful in my actions. The second ethical value is loyalty. It is important for me to demonstrate trustworthiness and fidelity in all I do and be trusted by others to maintain my loyal behavior no matter what the situation. The third ethical value is respect. It is also important for me to demonstrate respect for those around me. Respecting others’ autonomy, rights, and interests, without discriminating one’s religion, sex, or race is also my priority. The fourth ethical value is selflessness. Placing others first and not acting in a selfish or self-serving way is vital. Considering the needs and situations of others and prioritizing their needs before my own is a value that means a lot to me. The fifth ethical value is responsibility. It is important to me that I always uphold a strong moral code. I am willing to take responsibility for my actions and make corrective changes when necessary.

· Explain what impact 2 specific ethical theories may have on your decision for the dilemma.

The two ethical theories that I will discuss include natural law theory and the theory of human rights. The first ethical theory is natural law theory. This theory focuses on moral laws found in nature and discernible by using reason. Natural law is the moral law written into nature itself (MacKinnon & Fiala, 2018). Because moral laws tell us how we ought to behave, this theory leads to how we ought to examine our nature as human beings to see what is essential for us to function well as members of our species (MacKinnon & Fiala, 2018). The natural law theory would promote a natural good, such as the health of individuals and society. Physicians and organizations using this theory must act in the best interest of those they serve and protect and promote life. In the above case, this theory relates by using our inherent reasoning and acting in the best interest of the patient. The second theory is the theory of human rights. This theory was founded by the “natural right” developed by the Greek philosopher Aristotle then fully developed by Thomas Aquinas. This theory focuses on rights of human nature. In conclusion, according to Ethics: Theory and Contemporary Issues, “Natural law and the idea of natural human rights presume that there is a common core to the human experience–that we are endowed with basic capacities, that we share common purposes, and that we value and enjoy a common set of intrinsic goods. In short, natural law and human rights rest upon an objective account of human nature” (MacKinnon & Fiala, 2018, pp. 286-300). This theory of human rights allowed me to base my decision on my father’s (the patient’s) rights and the care he deserved. My father deserved to be free of pain and to spend his last days in comfort knowing that his human dignity had been treated with respect.

· Explain what impact 2 specific ethical principles may have on your decision.

Several ethical principles guided my decision, but two impacted more than the others. First, I considered my father’s autonomy in this situation. Autonomy can be thought of as having the freedom to make one’s own decisions. In this case, my father did not have decision-making capacity. He had, fortunately, made his advance directive and had given me health care decision-making ability as his surrogate decision maker. However, one must know that guarding the autonomy of a person does not end just because they are a patient without mental capacity. They still are a human being and they deserve all the dignity that entails. Thus, we must carefully guard his bodily autonomy as well because he is considered a vulnerable person.

The next ethical principle that guided my decision was veracity. Veracity is known as truth telling. I had to come to terms with the truth of what the doctor was saying when he told me my father’s prognosis was very poor even with continuing chemotherapy. The doctor told me it was up to me if I wanted to continue with the chemotherapy, which would not be a cure, or to withdraw chemo and provide comfort care to allow a natural death. This would occur within a month. While the truth hurts, it was better than false hope. I was able to talk to my extended family and we prepared for my father’s funeral. I was also able to spend time with my father, talking and singing to him up until the time he drew his last breath.

· Explain how you could use this formal ethical problem-solving method to have a positive impact on future ethical decisions in the workplace.

The ethical problem-solving methodology that I mentioned earlier can be used to have a positive impact on future ethical decisions in health care in many ways. First, it is a non-biased model to use when an ethical situation arises. It meets every aspect of the situation, and the end goal is finding a solution. Secondly, this model carries the ethical values that are meaningful to me that I can portray in determining my ethical decision. Lastly, this model touches every facet necessary to make an ethical decision. It is highly detailed and looks at each point of view.

References

MacKinnon, B., & Fiala, A. (2018). Natural Law and Human Rights. In Ethics: Theory and contemporary issues (9th ed., pp. 286-300). Cenveo® PublisherServices. https://bibliu.com/app/#/view/books/9781337467926/epub/OEBPS/13_9781305958678_Chapter7.html#page_286

Scher, S., & Kozlowska, K. (2018). The Elusiveness of Closure. In Rethinking Health Care Ethics. NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. https://www.ncbi.nlm.nih.gov/booksNBK543565/box/ch5/FPar1/?report=objectonly

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