Healthcare ethics are a set of principles meant to guide care providers in the course of their duties to ensure high-quality service delivery and safeguard patients against harm likely to arise from a lapse in judgment from the healthcare provider or carelessness. With the healthcare professionals often faced with challenging scenarios, these ethics provide the most appropriate manner in which to deal with the situation encountered, some of which are life-threatening if improperly handled. Various healthcare principles guide the practice of care providers such as doctors and nurses, these including the principle of autonomy, beneficence, non-malfeasance, and justice. Failure to observe these principles lead to the emergence of ethical issues, such as in the case of Iturralde Versus Hilo Medical Center. In this case, several ethical issues are highlighted.
The use of a screwdriver shaft that is not approved for or intended for human implantation is one of the ethical issues that led to the malpractice identified in Iturralde Versus Hilo Medical Center, this compounded by the failure by the doctor to inform the patient, or his caretaker, of the critical information. These are medical errors due to negligence that could have been avoided if Dr Ricketson adhered to the principle of autonomy, respecting the right of Arturo to make his own decisions. This intentional upholding of information from the patient directly led to the incident because if the patient, Arturo, or his caregiver, Rosalinda, would have been informed, they would have probably postponed the operation until the proper titanium rods were delivered. In turn, placement of the proper rods would have prevented the continued deterioration of Arturo’s health, for example, preventing the more falls sustained and the consequent shattering of the screwdriver.
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Duty-based ethics would resolve the issue of negligence on the part of Dr Ricketson and prevent harm to Arturo. For example, following the deontology theory, practitioners should adhere to the stipulated procedures for operations and not change the pre-set rules on any occasion. Here, the act should be morally correct as opposed to using the result to justify the means. In the case of Iturralde versus Hilo Medical Center, therefore, if the HMC staff had completed an inventory of the contents of the Kit as per the policy guidelines, the surgery would not have commenced. Consequently, Dr Ricketson would not have been faced with the dilemma that led to him opting to use a stainless steel screwdriver shaft which led to further complications to the patient.
Shared decision making is an important element in ensuring quality healthcare is accorded to patients. One of the models of shared decision-making is the three-talk model that is based on the aspects of option talk, team talk, and decision talk. It involves specific conversational steps between the care providers, the patient, and the family or caretakers, a process that is initiated by introducing options while providing support to the parties, strategies comparing the options available, their benefits and tradeoffs, and a final step of deliberation based on informed preferences. This model is ideal for providing safe and quality healthcare experience to the patient. By informing the patients and the family of available options and their attributes they will feel appreciated and valued by the healthcare facility or doctor, leading to their satisfaction. Shared and discussed options will also ensure the best alternative is opted for, one that is not only satisfactory to both the patient and care provider, but also safe.
Close adherence to ethical principles, and more so the principle of autonomy, upholding duty-based ethics, and ensuring shared decision making through the three-talk model can significantly improve healthcare, making care providers accountable. The principle of autonomy will ensure they respect they include patients in decision making and respect the opinions of the patients. Duty-based ethics, in turn, facilitate accountability to the healthcare profession, that of the care facilities and the public through close adherence to set procedures and eliminating carelessness and negligence. Shared decision making, on the other hand, will provide for quality care to patients and overall improvement in care satisfaction.
References
Intermediate Court of Appeals of Hawai‘i, (March 30, 2012) Iturralde v. Hilo Medical Center USA : retrieved from: https://caselaw.findlaw.com/hi-intermediate-court-of- appeals/1597588.html
