Morals and Ethical Decision Making in Healthcare Marsha R. Lackey ...

Running head: MORALS AND ETHICAL DECISION MAKING 1

Morals and Ethical Decision Making in Healthcare Marsha R. Lackey

University of Central Oklahoma

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INTRODUCTION Imagine having a loved one needing emergency medical attention, but depending on their social standing or financial situation, not being able to receive it. In the following, I will give an example of a first-hand incident I witnessed. It was a normal day in a common emergency room in the metro area. We were working our tails off as normal and attempting to save lives, make patients feel better, and working as any other hard working people do. As I am coming back from transporting a patient to CAT scan, a patient is brought back straight from triage for immediate attention. You can obviously tell the patient is in distress, but at the same time you can tell he is an everyday patient of ours who comes in all the time. He is usually being escorted in by Emergency Medical Services Authority (EMSA) or the local authorities because he is homeless. Does that make him any less needy when it comes to medical care? Of course not! Actually it would put him higher on the scale of needing help. A little while later the nurse, the physician, and I were talking about what actions to take with this patient and his care. X-rays and blood work had already been run and this patient really needed a CAT scan for appropriate diagnosis. The physician brought up the issue of hospital policy and whether the patient had insurance or could afford their recommended procedure. Can he afford it? No. Does that mean we don't do it? It shouldn't. And it didn't this time. But in many cases, all over this country, lifesaving diagnostic treatment is avoided or not utilized because money or lack of insurance is a factor. Obviously this situation shows a good case of how morality affects work practices and ethical decision making in regard to how things go on a daily basis in just a tiny part of the medical field. Is it moral and/or ethical to deny anyone lifesaving treatment or diagnosis for any reason including insurance constraints or budgetary concerns? That is the question this paper will attempt to answer.

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Moral vs. Ethical In order to determine what is moral or ethical, it is important to try to define what these

terms mean and how they apply to individuals in society. These two terms are often used as synonyms which create a problem for some people when trying to apply the terms to their lives. While it is common for people to use them as meaning the same thing, they do not mean the same thing. Morals are beliefs that are grounded in teachings or practices that are taught, usually by parents or parental figures to people usually from birth. They govern how individuals conduct themselves in relationships as well as in society. Ethics are similar but different. Ethics are a system of principles usually with a philosophy or theory that helped form them. Ethics are usually set by societal norms and practices or business norms or practices. Morals are dictated by an individual while ethics are dictated by a system or society. This is where it the issue gets a little fuzzy. In explanation, a person lives according to his or her morals, but also adheres to their system of ethics while doing so. For example, an attorney may have a definite moral belief that murder is wrong no matter what the reason is. However, he may be faced with defending a client that he knows or believes is guilty of murder. For the attorney, is it moral to defend that client? No it is not because he has a moral set of beliefs that is against murder. However, in the legal system, it is ethical because the legal system says that he has an obligation to defend his client according to the law and the law says that everyone is entitled to due process of law.

It would seem that it is not always easy to ask the question of whether something is moral and ethical in certain circumstances. Depending on the profession you may find yourself in, you may be faced with difficult decisions where your accepted code of ethics may conflict with your deeply held moral beliefs. Lawyers, doctors, nurses, accountants, and numerous other professions put people in contact with situations that have the potential to create moral and

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ethical decisions. An individual's morals can make some working situations extremely stressful. In our personal lives, it is much easier to make decisions based on our morals because we have more control over how the decision making process is applied. However, in the business world, the working environment within which we work is often infused with a multitude of different factors that make ethical decision making a nearly impossible task at times. Morality is only a part of that decision making process. Ethical Decision Making

Valasques (2012) identified a framework for ethical decision making. In this framework, five steps are outlined that help lead to what most people consider ethical decision making. The first step is recognizing that there is an ethical decision to be made. In other words, is there a decision to be made that would be seen as good, bad, or damaging to a particular person or group? The second step is gathering pertinent facts. What facts are relevant? Have all the facts been gathered? Have all angles been identified and are they known? The third step is evaluation of alternative actions. This step includes questions that appeal to different sets of values. Which option will produce the most good and do the least harm (a utilitarian approach)? Which option best respects the rights of all who have a stake (a rights approach)? Which option treats people equally or proportionately (a justice approach)? Which options best serves the community as a whole, not just a member or members (a common good approach)? And which option leads me to act as the sort of person I want to be (a virtue approach)? The fourth step is making a decision and testing it. Which option best addresses the situation and if I were to confer with people whom I respected, what would they say about the decision? The last step is acting and reflecting on the outcome. How can the decision be implemented with the greatest care and address everyone involved. What was the outcome? What did I learn from this process? While these

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steps were listed in order, they do not necessarily happen in that order and some even occur at the same time.

When looking at the steps that an individual takes to making ethical decisions in any setting, the framework described previously will also involve that individual including their moral standards in those decisions. This most likely happens during the evaluation of alternative actions step which includes the questions that appeal to certain values. The things we value are made up of many of our moral foundations. When you add all of these together, it is a complex set of steps that leads one to a decision. Whether that decision is moral and/or ethical depends on the situation, the ethical system within which they are making the decision and the moral values of that individual. Question Answered

Go back to the story in introduced in the introduction. Is it moral and ethical to deny anyone lifesaving treatment or diagnosis for any reason including insurance constraints or budgetary concerns? There were three of us trying to determine what was in the best interests of this patient. In this case a doctor, a registered nurse, and an ER technician conferring together as to the best course of treatment. Each of us came from varying backgrounds that led to differing moral foundations. However, each of us subscribe to the same set of professional ethics in the medical profession. First and foremost we are to follow the Hippocratic Oath. That is to practice in this profession in an ethical and honest way. We are to do no harm and act in the best interests of the patient.

Unfortunately, the medical profession has become so weighed down with budgetary constraints, insurance company restrictions and agreements, and astronomical health care costs, that it is no longer an easy task to do what is best for the patients, at least in the opinion of many

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