Abstract
Healthcare supervisors have a very important part to play in creating an atmosphere and programs which directly impact the delivery of care to patients. However, many times dilemmas crop up requiring a healthcare manager to make tough decisions most of which are about ethical concerns. Ethical leadership and decision making are key ingredients for being ready for any of the ethical issues that may arise in a health care system. There are a number of ethical issues which can affect doctors, nurses, patients, and families in a healthcare environment. In this paper, a number of different ethical issues which healthcare supervisors face are discussed.
Introduction
Day after day, healthcare supervisors handle a range of responsibilities such as budgeting, patient care, staff leadership, training, hiring, record keeping, all of which come with their set of ethical dilemma. Ethical issues occur when decisions have to be passed, the responses might not be vivid plus the options may not be ideal (Harrison, Logar, Le & Glass, 2016) . The outcome could be a decline in patient care quality, clinical associations that are problematic or even moral distresses. Healthcare supervisors are vulnerable to ethical issues as well as moral distress because of their mentoring and leadership responsibilities (Hand, Robinson & Creel, 2013) . As such, as the healthcare sector changes, it is significant to consider the ethical issues which the healthcare supervisors face. This is because they are the individuals who ensure those facilities and offices are running properly besides being responsible to the way patients are handled.
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Franzblau, (2010) explains that although the health care industry is fast-paced, there are new challenges that crop up each day. A number of health care managers report experiencing similar ethical dilemmas. A current research found out that many of those stressful and frequently occurring ethical situations are protecting the rights of patients, decision making, advanced care planning and staffing (Reid, 2017) . Such ethical challenges cause health care supervisors to be extra critical to the daily needs of the healthcare industry. This paper examines some of the common ethical issues that health care supervisors face. The dimension taken is how the issues/ situations might relate to the treatment and care of patients or the personal feelings and thoughts of the supervisors.
Medical Errors
According to Karnik and Kanekar, (2016) the life of an individual can be completely changed even with the slightest medical error. Because medical supervisors are responsible for the day to day operations of a medical facility, they are the people who make sure that doctors get all the documents they require. Such documents ought to have medical history and allergies of a patient if any and also the procedures and treatments that the patient needs. As such, this is one of the ethical issues which healthcare supervisors face due to the fact that they might be so busy with personal commitments and work to an extent that they make some mistake on the job or forget/ fail to document the right paperwork. This can turn out to be very injurious to the patient.
Death
Among the ethical issues that healthcare supervisors face is related to dying and death. There is a common debate in the media over physician-aided death or suicide. That is a situation where a doctor assists a patient to terminate his or her life. Even though it is legal in some states such as Washington and Oregon, many other states do not permit doctors to assist terminate the lives of the patients who are fighting with terminal diseases (Harrison, Logar, Le & Glass, 2016) . Health care supervisors, besides contributing to debates on ethical effects of physician-assisted deaths, introduce their individual thoughts as well as religious beliefs into the motion.
Confidentiality of Patient Information
According to Reid, (2017) it is a requirement for all medical professionals to keep the information of patients private and secure. They are not supposed to discuss the conditions of any case with people away from the job or at home. Such a requirement is both a moral and an ethical issue since it restricts the extent employees can talk to one another plus what they can talk about. Whereas they may discuss the patient’s needs as well as other basic information, in general they cannot discuss the particulars of a case. In case a supervisor slips a patient’s name, that becomes a serious violation.
Informed Consent
Prior to any procedure being done on a patient by a doctor, an informed consent must be given by the patient. This implies that a doctor supplied the patient with information regarding the treatment plus any possible risks or side effects of the procedure. In addition, the patient must get all the necessary information in order to decide. In case the health care supervisor loses the signed paperwork by the patient, or makes a false data on the forms, or even signing a name of an individual on the form or adding extra information after a patient signs the paperwork, the supervisor can be imprisoned (Karnik & Kanekar, 2016) .
Honesty Versus Information Withholding
Members of a family could want to withhold medical information from their sick member with an aim of protecting his or her emotions. But it is a right for a patient to know the whereabouts of their medical situation (Hand, Robinson & Creel, 2013) . Making a decision on the way to share such information can be a touchy situation particularly if it contradicts the beliefs of the family. The code of ethics on the other hand advocates for telling the truth, or veracity as the main element in healthcare practitioner to patient relationship.
Science and Spirituality
Personal or religious beliefs can be impeded by healthcare, which is result-driven and also science based. According to Harrison, Logar, Le & Glass, (2016) some religions limit some lifesaving procedures and medical interventions. Health care supervisors concentrate on offering medical care to lessen suffering and enable patients to focus on self-care. For families or patients having strong spiritual or religious convictions, the concentration might be on adhering to stringent set of rules. The health care mangers are required to respect the special differences of the patients alongside their religious beliefs, value system, and lifestyle (Hand, Robinson & Creel, 2013) . But respect for such beliefs does not mean that the health care supervisor to condone them or practice them.
Resources Allocation Against Health Care Needs
The cost of health care is ever rising. This is alarmingly placing the health care supervisors at odds with the needs of the patients as well as the constraints of budgeting. A good number of medical facilities are suffering from lack of adequate resources and this in turn places the patients at the risk of not obtaining the care they need. Such resources range from health care staff to medical equipment. Studies propose that health care supervisors ought to include staff in the process of budgeting so that they can comprehend better the demands and needs in a healthcare facility (Hand, Robinson & Creel, 2013) .
Autonomy Versus Beneficence
It is a requirement for the health care supervisor to make sure that the prescribed medication is administered as required, but at the same time patients may refuse them (Reid, 2017) . This means that the autonomy of patients could go contrary to medical directives irrespective of needs that are vividly described. A patient has a right not to accept all medical prescriptions. The nursing code of ethics points out that it is paramount for health care supervisors and nurses to understand both the background and personal circumstances of patients and to inform the patients of the necessity of medication (Hand, Robinson & Creel, 2013) . As such, the health care managers will battle with the ethical issue of employing ethical principles to reach to a solution in an atmosphere of honesty, openness, respect and caring.
Reporting a Colleague
Most often healthcare supervisors find themselves in a dilemma about a colleague who is conducting himself or herself in a manner that is questionable. In such a situation, the healthcare manager encounters an ethical challenge whether to be loyal to the patient or the colleague. There are many professional and personal dynamics which can be jeopardized in upholding the safety of patient (Hand, Robinson & Creel, 2013) . Therefore, in a number of ethical issues in the healthcare, understanding the doing what is right is the struggle but not knowing it.
VIP Treatment Versus Equal Treatment
In many healthcare facilities, the influential people like financial donors are given elite care. It could be in the form of shorter waiting time and long consultation with the doctor, or even at times it could imply a healthcare manager passing by to ensure they do not have an issue or that their services are first class (Harrison, Logar, Le & Glass, 2016) . Whereas taking into account the VIP, healthcare managers often struggle with the question whether the wealthy people, financial donors among other influential persons are different than the general public. This is because ethically all people are subject to equal healthcare treatment.
Balancing Profit while Providing Better Patient Care
Healthcare managers are often tasked with making ethical decision regarding their healthcare operations. They have to choose where to invest more resources in order to ensure profit-making while at the same time investing in resources such as equipment and drugs in order to improve patient care (Hand, Robinson & Creel, 2013) . Therefore, it is critical for healthcare facilities to underpin better care via policies that are ethically sound, through fair and clear processes as well as continuous ethics training for providers of patient care. In addition, the healthcare supervisors struggle with all levels of care providers make consultations on cases that are difficult by providing access to a clinical ethics consultation environment plus services.
Misconduct
Healthcare supervisors at times have to make serious decisions regarding a doctor or other staff working in a medical facility. If evidence exists that a doctor is misbehaving towards patients or subordinates, an action would be necessary to be taken before a lawsuit if file against the facility (Karnik & Kanekar, 2016) . In case the doctor is influential or popular, making a decision could be difficult. But failure to do the right action could lead to possible consequences that are even worse.
Outside relationship
Handling business relationships amid outside providers and doctors is a dilemma which healthcare managers face. For example, if a doctor makes an arrangement with a pharmacy so that he gets a bonus for prescribing its products, he may tend to prescribe such medication oft that he actually should (Harrison, Logar, Le & Glass, 2016) . Since such kind of relationship can develop the image of impropriety, a number of health care supervisors ban the entirely.
Balancing ethics and fiscal responsibility
It is the responsibility of the healthcare managers to make financial decisions which can affect the quality of care that can be delivered and the health care facility as well. According to Karnik & Kanekar, (2016) b alancing competing needs is a huge hurdle because often it pits ethics, quality and budget against one another. For instance, healthcare supervisors have to decision between recruiting additional staff to reduce the ratio of nurse to patient and purchasing an equipment.
Management of Influential Relationship
Healthcare supervisors might work in managing relationship with a number of key stakeholders such as external service providers, vendor, pharmaceutical organizations, software providers, equipment servicing, and so on. It is essential for healthcare manager to make decisions in the best interest of the patients without external influence. For instance, avoiding a nurse or physician prescribing medication in favor of or to get benefits from a pharmaceutical representative (Harrison, Logar, Le & Glass, 2016) .
Health care supervisors certainly face tough ethical decisions more often as opposed to any other type of professional (Reid, 2017) . In resolving ethical considerations in relationship with pharmaceutical companies, cost control and patient care they ought to have both a concrete comprehension of the issues at hand and a dedication to perform things right even in tough situations.
In addition, health care supervisors must be in a position of providing guidance and direction to organization with respect to their functions, responsibilities and roles. As such, they must devise and review strategies each individual can comprehend and abide by. Finally, they should create a collaborative atmosphere in which every individual will be engaged in the strategies development process (Karnik & Kanekar, 2016) . This would aid in overcoming challenges as they crop up. Therefore, staying updated to changes as well as implementing action plan will ensure success for healthcare supervisors.
References
Franzblau, M. (2010). Ethical issues in health care: facing our responsibilities in 2010. Clinics In Dermatology , 28 (1), 112-114. doi: 10.1016/j.clindermatol.2009.04.005
Hand, W., Robinson, J., & Creel, E. (2013). Ethical Issues Surrounding Weight Bias and Stigma in Healthcare. Online Journal Of Health Ethics , 8 . doi: 10.18785/ojhe.0802.04
Harrison, J., Logar, T., Le, P., & Glass, M. (2016). What Are the Ethical Issues Facing Global-Health Trainees Working Overseas? A Multi-Professional Qualitative Study. Healthcare , 4 (3), 43. doi: 10.3390/healthcare4030043
Karnik, S., & Kanekar, A. (2016). Ethical Issues Surrounding End-of-Life Care: A Narrative Review. Healthcare , 4 (2), 24. doi: 10.3390/healthcare4020024
Reid, L. (2017). Ethical issues in health philanthropy. Healthcare Management Forum , 30 (6), 298-301. doi: 10.1177/0840470417733360
