Informed consent is one of the ethical values that guide the work of medical professionals. These professionals are required to obtain the permission of their patients to perform certain procedures (Hall, Prochazka & Fink., 2012). As they seek consent, the professionals should ensure that the patients understand the risks and benefits of the procedure. For the most part, medical practitioners obtain informed consent in compliance with medical ethics. However, there are instances where the practitioners extend the consent provided by patients to issues that the patients did not originally agree to. This practice amounts to a flagrant violation of patient rights and medical ethics.
Data and Conflicting Moral Claims
Data on the situation being explored was gathered through personal observation. It was noted that physicians were extending the consent that they originally received from patients. The patients consented to specific procedures. The physicians then added details to the effect that the consent would apply to other procedures found to be necessary. What makes this issue an ethical one is that it violates the rights of patients as it imposes a financial burden. The patients are charged for the additional procedures yet they did not consent to have these procedures performed. The fact that appears to be most important is that failing to obtain consent for every individual procedure imposes an unfair financial burden on patients. The cost of care in the US is already prohibitively high. There are various emotions which also shape this ethical issue. A sense of betrayal is among these emotions. It must be that the patients feel betrayed when physicians perform procedures to which they (patients) did not consent.
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Key Participants/Stakeholders
Ethical guidelines that govern medical practice empower patients to make their own decisions regarding their health. Ultimately, the patient has the authority to issue or withdraw consent. Physicians are other important stakeholders in the ethical issue. Their power is rather limited as they rely on the consent that patients issue. In the ethical issues described above, the physicians clearly exceeded the limits of their authority. The patients are the main parties who are affected. Among the rights that patients have include autonomy and providing consent (Wear, 2012). Both of these rights were violated. Moreover, the patients were made to pay for services to which they did not consent. Personal observations revealed that the patients were mostly incompetent. They did not possess the insights needed to make informed decisions and issue consent. This can be blamed on their low levels of education.
The patients and physicians have rights, duties and authority. Some of the rights of patients include being provided with information, confidentiality and informed consent. Other rights are unhindered access to medical services, to be treated with dignity and being accorded privacy (“Patient Rights and Responsibilities”, n.d). The patients are also required to execute some duties. These duties include issuing accurate information on such issues as their medical history. Patients also have the authority to determine their health. For example, they may issue or withhold consent. The authority also empowers patients to accept or refuse treatment. As part of their mandate, the physicians are assigned a number of duties. The duties range from obtaining informed consent, providing quality care, ensuring the privacy and confidentiality of patients, and providing patients with all necessary information, among others. Physicians also have rights that should be respected. Refusing to offer treatment is one of the important rights that physicians have (Hood, 2008).
To ensure that they are able to execute their mandate, physicians possess authority. Through the authority, they are able to determine such issues as the type of treatment that patients need. For the most part, physicians possess the capabilities required to perform their duties. They have received training and accreditation. The same cannot be said about patients. Many patients lack knowledge and the education required to fully understand medical practice (Brenner, Brenner & Horowitz, 2009). This lack of sufficient capability exposes the patients to the threat of violations and abuse as is the case in the ethical issue described earlier. To understand this issue better, it is helpful to examine the larger contexts within which it occurred. The imbalance of knowledge and capabilities is the main contextual issue that allowed the issue to occur. The patients did not fully understand their right to issue or withhold consent and the physicians exploited this to provide additional services for which they charged the patients. The physicians betray the immense trust that patients place in them.
Moral Perspective and Phase of Moral Development
It was observed with concern that the patients do not think in terms of their rights or duties. They simply trust that the physicians will offer them the treatment that they find to be effective and appropriate. On the other hand, the physicians think in terms of duties and rights. Despite this, they still do not honor the rights of patients or faithfully execute their duties. For example, the physicians have a duty to obtain consent. While they understand this duty, they routinely fail to obtain consent for every individual procedure. An examination revealed that the patients and physicians have different moral perspectives. On one hand, the patients’ perspectives places focus on trusting physicians. On the other hand, the perspective that the physicians have adopted goes against the interests of the patients and their (physicians’) moral obligations. While there are differences in the perspectives of the patients and physicians, there is some common ground. Both parties strive to safeguard the health of the patient. The additional services that the physicians offer are usually necessary and aimed at securing the wellbeing of the patients. The difference emerges when the physicians fail to seek consent for these services. The main principle that is most important to the patients is receiving quality care. The patients would pay any price to ensure that they receive the best treatment. On the other hand, convenience appears to be the key principle that guides the physicians. For example, they use consent issued once to offer multiple services because they find this to be more convenient than seeking consent for every treatment that the patient needs.
Trust, a sense of betrayal and resentment appear to be the main emotions that the patients exhibit. The patients have faith in the physicians. However, when they receive huge bills, their faith is shattered and they feel betrayed. The physicians resent the accusations that they face regarding their failure to obtain consent for every procedure. They feel that their efforts are not being appreciated and that they are demonized for simply striving to secure the health of their patients. Both the patients and the physicians fail to display maturity in moral development. While the patients do not understand their rights and moral obligations, the physicians violate their obligations despite clearly understanding their moral mandate.
Desired Outcomes
The patients and physicians appear to have conflicting desired outcomes. On one hand, the patients wish to be involved in every step of care. They desire to be consulted and to have their consent sought for every procedure. On the other hand, the physicians desire ease and convenience. They wish to be able to perform their duties conveniently and without any unnecessary hindrances. They consider being required to seek consent for every procedure to be a hindrance which hampers the delivery of care. The desired outcomes of the patients and physicians have different consequences. If the desires of the patients are to be satisfied, there may be delays in the delivery of care. On the other hand, satisfying the desires of the physicians would result in violating the privacy, autonomy and informed consent rights of the patients. While they disagree on most issues, the physicians and patients agree that certain outcomes are unacceptable. Failing to provide the patient with needed treatment is one of these outcomes. The patients expressed a willingness to have their rights violated to guarantee that they would receive all necessary treatment.
Options
There are two main options that can be used to resolve the ethical issue. One, physicians may pledge to seek consent from patients for every individual treatment. Two, the patients may permit the physicians to conduct procedures they find necessary without necessary seeking consent. The first option mainly satisfies the needs and rights of the patients. However, this option would make it difficult for the physicians to offer treatment since they would spend huge amounts of time obtaining the content. The patients may also find the first alternative to be rather inconvenient as they would need to make countless trips to give consent. The second alternative is mostly in line with the lifestyle and values of the physicians. It delivers convenience and enables the physicians to offer treatment with much ease. There are some alternative solutions that both physicians and patients will reject. Making no changes to the current situation is one of the unacceptable alternative options. Both physicians and patients concur that informed consent is important. The present situation is untenable and a threat to the interests of both parties. The impact that the alternatives have on the wellbeing of patients and the ease with which the physicians are able to perform their duties is the primary criteria used for weighting, ranking and prioritizing the different alternatives.
Act on Choice
It is not possible to apply all the alternative options identified above. The best solution is clearly the first one; the physicians need to seek consent for each individual treatment or procedure. This option has been selected for a number of reasons. One, it will allow patients to understand their power and authority. Two, the option will challenge physicians to fully execute their moral obligations. Three, research shows that informed consent is key to the effective delivery of medical services (Dogan et al., 2015). Another reason for advising that physicians should always seek patient consent is that this will help to rebuild patient trust. It will assure patients that physicians are truly committed to safeguarding their welfare.
Evaluation of Outcomes
It is unfortunate that the facility where the ethical issue involving informed consent took no action to resolve the issue. Physicians continue to regard the consent that the patients provide as blanket permission to conduct any and all procedures they find necessary. As a result, patients have received bills that surprise them. The bills far exceed the amounts they expected to pay for treatment. I find the facility’s failure to address the ethical issue to be unacceptable. When physicians fail to obtain informed consent, they expose themselves and their institutions to the threat of legal action (Park et al., 2016). Unless action is taken soon, the facility could be the subject of a lawsuit.
Ethical Principles
As noted above, the facility has failed to address the dilemma. Had it made a decision to fix the ethical issue, there are a number of ethical principles that would have guided the decision. Some of the principles that guide medical practice are autonomy and justice (“How the Four Principles”, n.d). Using these principles, the facility would have required all physicians to obtain consent every time they need to perform a procedure. The physicians would be respecting the independence of the patients while ensuring fairness in billing.
ANA Code of Ethics
The American Nurses Association (ANA) has developed a code of ethics which governs the conduct of nursing practitioners. Some of the provisions of this code apply to the ethical dilemma. Among other things, the code requires nurses to display compassion and respect while remaining committed to the patient (“ANA Code of Ethics”, n.d). Moreover, this code challenges nurses to engage in patient advocacy and promote the health and safety of patients. Nurses are also challenged to collaborate with other practitioners to promote patient wellbeing (“ANA Code of Ethics”, n.d). All these provisions are relevant to the ethical issue. For example , by engaging in advocacy and collaborating with physicians, nurses at the facility can remind the physicians that they should always obtain consent. As they urge the physicians to obtain consent at all times, the nurses will also be displaying respect and compassion for the patients.
Conclusion
The progress that the healthcare community has made is partly the result of adherence to ethical guidelines and principles. Informed consent is among these principles. The physicians at the facility where I work as a nurse routinely violate this principle. Their conduct goes against established practice standards and requirement. Moreover, when they fail to seek patient consent, they risk facing legal action. Patients are the greatest victims of the failure to seek consent. Their rights are violated and their faith in the medical community is shattered. There is need for the institution to move with speed and require all physicians to seek patient consent in all situations.
References
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