Ethical Dilemmas in Healthcare

This past Friday, after only weeks of negotiations over the American Health Care Act (AHCA), Republicans had to admit defeat as they were forced to pull their repeal from the House Floor. The recent turmoil surrounding healthcare in the United States has shed light on my existing issues in healthcare, and defining new terms for the same.

With all the potential changes healthcare professionals will have, their boundaries will be tested in terms of moral obligations versus personal well-being and sustenance. Being on the other side of the fence, we often don’t consider what healthcare professionals (doctors, nurses, administrators etc.) go through on a regular basis. At some point in their careers, healthcare providers are bound to face an ethical dilemma.

Healthcare Money plays a huge part in any industry, and healthcare is no different. Very often, money is responsible for ethical dilemmas, especially in terms of financial reimbursement and allocation of resources. For healthcare staff, like administrators, it becomes hard to balance ethics and fiscal responsibility. Since budgets are used for many purposes, it can be very challenging to balance competing demands, and this sometimes pits budget, quality, and ethics against each other.

An example given by Ohio University’s Master in Health Administration is that of administrators having to choose between hiring more staff to decrease nurse-to-patient ratios, and buying or repairing equipment. What would be the right thing to do, from an employee’s (as well as patient’s) perspective? The question of loyalties, and whether they lie with the workplace (hospital clinic etc.) or with the patient, in the event that the two are in opposition to each other comes into play here.

In terms of reimbursement, doctors and nurses too face the regular dilemma of dedicating time and effort above and beyond what is required of them based on their monetary compensation. For example, what happens if your patient needs assistance, just as your shift has ended? Do you clock out and leave, tending to your own personal needs and time, or stay? These sorts of questions have led to doctors feeling as though they were practicing a form of triage to best meet patient’s’ medical needs.

According to a study in 2009, a primary care doctor would have to work nearly 22 hours each day to meet all of the guidelines for preventive care and chronic disease management for a typical patient panel of 2,500. After a point, this leads to burnout, and complete neglect of personal well-being, particularly as it relates to mental health. Marc Tunzi, MD, a family practitioner at Natividad Medical Center in Salinas, California, further explains this dilemma –  “You want me to do more work, but then you want me to be empathetic. So I need to deal with my own wellness. I need to get some exercise. There’s only 24 hours in the day.” Because of the nature of the field, not being able to provide healthcare leads to a sense of innate guilt, even though, theoretically, a professional knows that he cannot possibly appease everyone.

Another ethical dilemma stems from the fear of malpractice suits. From an administrator’s side, mitigating legal risks might result in having to take action against certain employees from within the healthcare team. For healthcare professionals, the fear of legal action often leads to what is known as “defensive medicine,” which involves departing from normal medical practice as a safeguard from litigation. This includes the over prescription of medication, which can lead to many different problems, including drug addiction and abuse (think: overdosing on Xanax).

In fact, 53%, of physicians say they would order an unnecessary test if the patient was “quite insistent,” according to findings from an ABIM Foundation survey. The reason for doing so was cited as “malpractice concerns” by 52%. This is also due to the easy availability of information these days. People are able to look up medical conditions at the click of a button and often convince themselves that a simple pain is something so much more, and warrants serious testing. According to Terry McGeeney MD, a visiting scholar at the Brookings Institution and chief medical officer for VillageMD, “It’s time consuming to argue, and there is always that nagging worry at the back of the doctor’s mind that the patient’s worst fear will become a reality, thus risking a lawsuit. It’s easier to just order the test. And they [doctors] very often do.”

Healthcare is one of those fields where emotions run high, and considering that health care decisions can determine the course of someone’s life, this is to be expected. Consequently, in trying to quantify and gauge the value and repercussions of a health care decision, interests and obligations of patients and professionals are often pitted against one another, with recent political changes regarding the same only making it worse.

Healthcare policy should be improved in such a way that the decision making process becomes easier, and professionals are faced with fewer dilemmas, especially regarding money and legal fears. It’s easy to get caught up in the ethical dilemmas of healthcare, and while these will always exist in such a field, policy and lawmakers should strive to create a support system that promotes quality health care with fewer hassles.

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AkshataAkshata has a passion for traveling and exploring the world. She in very interested in entrepreneurship and sustainability in everyday life. Being a foodie, she spends a good amount of time cooking up concoctions in her kitchen, recording her recipes and travel adventures on her blog, With Love From Akshata.