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Zeena John
EthicalDilemma.docx
Summary
Submission Id: 88a753d6-c610-4bb3-a093-fc9d3a3a8b3c
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Running head: ETHICAL DILEMMA 1
ETHICAL DILEMMA 6
Ethical Dilemma
Student Name: Zeena John
Course: HLT 520
Instructor: Dr. Wendy Whitner, PhD, MPH
Date: 03-27-19
Ethical Dilemma
Physicians are often faced in ethical dilemmas in their line of duty. Ethical Decision making is needed when healthcare professionals are required to address a conflicting or uncertain issues regarding competing values. As indicated by Holt, Sarmento, Kett and Goodman (2018), physicians must consider principles of ethics like beneficence, justice, autonomy and non-maleficence as well as the ethical standards of their organization and their profession. Ethical dilemmas can stem from cases of unconscious patient with a DNR tattoo to the critical and emergency care physicians who were in charge of the patient. These physicians followed questionable recommendations from the consultants of ethics. The patient had no known identity, he was taken to the emergency department while in a critical condition, and unconscious. He had a “Do Not Resuscitate” tattoo on his anterior chest, and even a signature that goes with the tattoo. The health care team made a decision not to bother with the tattoo but the decision was later reversed after consultations were made with the ethics consultants. The agreement over the tattoo was that the tattoo could be representing authentic preferences of the patient. A case like this raises an ethical dilemma; should the patient be resuscitated against their will as seen on the tattoo, or should the health attendants honor the tattoo?
An ethical dilemma situation must meet three conditions (Holt, Sarmento, Kett & Goodman, 2018). The first condition is in a case where an individual or ‘agent’ has to decide on the best course of action. These ethical dilemmas have to offer options; they should not be hard or create uncomfortable situations which do not have alternatives. About the DNR patient, the health care team could decide to either resuscitate the patient or follow what his tattoo said. There should also be different courses of actions to choose from. In this case, there were two choices, to save or not to save the DNR patient. This is a hard decision to make for any person involved. The last condition is that regardless of the course of action taken, there will be a compromise of the ethical principles. Following the statement written on the tattoo would see a loss of life, amidst the chance to save him. However, trying to resuscitate the patient will be against the will expressed in the tattoo, and there is no information as to why it is written not to resuscitate him.
In determining the constituents of an ethical dilemma, a distinction has to be made between ethics, laws, policies, values, and morals (Holt, Sarmento, Kett & Goodman, 2018). Ethics are the standards used to determine what is right and what is wrong. They rely on rational and logical criteria for a decision to be made given that it is a cognitive process (Dolgoff, Loewenberg & Harrington, 2009). Values are the things or ideas an individual value, and these values are associated with feelings (Allen & Friedman, 2010). Morals are the codes of conduct of behavior ascribed by an individual, used to strengthen relationships (Dolgoff, Loewenberg & Harrington, 2009). Agency policies and laws are commonly applied in complex cases and it is the obligation of the healthcare attendants to take a particular ethical course of action. There is a difference between personal ethics and professional ethics and values. Values are personal and involve feelings, and cannot be used in solving an ethical dilemma. After joining a profession, in this case as a medical care provider, a person agrees to follow the standards of that profession, together with the code of ethics and values. In the case of a patient with the DNR tattoo, ethics and professional values have to be given a priority.
One important principle of ethics that must be put into consideration by the emergency physician states that withdrawing and withholding the treatments to sustain life are seen as equivalent in ethics. Therefore, when a physician is in a dilemma with regard to the wishes of the patient, he/she should take the initiative step of saving he patient’s life. When more information is obtained, the physician can deescalate the care of the patient in the appropriate way according to their initial preferences. Also, in the field of medicine, a physician should review ACP (advance care planning), which has two primary forms (Vearrier, 2018). These forms are; life-sustaining treatment being ordered by physician and advanced directives (AD). ADs can be completed at any time during a person’s life to appoint a surrogate decider or to guide future care. This legal document (AD) has to be filled by the person himself or herself in the presence of a witness. POLST forms, are orders from a physician for the care for a life about to end that can be taken to other health care facilities. The documents are only for the individuals with serious illness or those critically ill and could help in the surrogate.
The tattoo saying “Do Not Resuscitate” is therefore neither legal nor ethical enough because of some reasons. First, tattoos are not supposed to be in the legal considerations of POLST or ADs, and it has neither a witness nor notary. Therefore, it cannot be used as a wearable AD or to finish legal documentation. The second reason is that the medical providers cannot presume informed decision-making, no evidence exists showing that tattoos have a clear understanding of the patients DNR status. (Vearrier, 2018). Also, the tattoo has no enough guiding information to decide an intervention. Lastly, a lot of people, more than 50%, who have tattoos regret having them. The above information does not, however, mean that the data should be ignored. The AD and POLST documents could not be available when the health care attendants are deciding on crucial issues. A way of communicating should be included in the crucial decision-making process (Vearrier, 2018).
When evaluating the merits and challenges of the procedures of healthcare, bioethics is used to refer to the principles of medical ethics. For any practice to be referred to as ethical, it has to conform to the four principles including justice, autonomy, non-maleficence, and autonomy. The first principle is autonomy; where a patient is required to make informed and un-manipulated action and intention when deciding about their healthcare. A patient should be aware of all the benefits and risk of a medical procedure and the success likelihood. In this case, the patient was unconscious. The patient did not have a relative and he never spoke his mind apart from the tattoo. The second is justice, where treatment is distributed to all groups equally. Health care provider should distribute scarce resources fairly. Following this method, the tattoo patient could be revived in the same manner as other emergency cases handled in the facility. The third concept is beneficence; it demands the provision of medical procedure with the intention of benefitting the patient. It demands maintenance and development of skills and knowledge, striving for net benefit. The last principle is non-maleficence. This ethical concept requires that a procedure should not harm the involved patient or others. The physicians ought to use the aforementioned procedures to guide in making a decision regarding what is best for the patient. Autonomy states that a patient has the right to have control of his body, but since there is no accompanying relatives, the patient could not express himself. I would also do everything possible to keep the patient alive. I would also employ non-maleficence to guide the treatment process; this makes the patient’s recovery process more effective.
References
Allen, K. N., & Friedman, B. (2010). Affective learning: A taxonomy for teaching social work values. Journal of Social Work Values and Ethics, 7 (2). Retrieved from http://www.socialworker.com/jswve.
Dolgoff, R., Lowenberg, F. M., & Harrington, D. (2009). Ethical decisions for social work practice (8th Ed.). Belmont, CA: Brooks/Cole.
Holt G. E, Sarmento B., Kett D., & Goodman K. W. (2018). An unconscious patient with a DNR tattoo. N Eng J Med. 2017;377:2192-2193.
Social Worker (2014) What is an ethical dilemma? Retrieved from https://www.socialworker.com/feature-articles/ethics- articles/What_Is_an_Ethical_Dilemma%3F/
Vearrier L. (2018) Do Not Resuscitate tattoos: Are they valid? ACEONow. Retrieved from https://www.acepnow.com/article/do-not-resuscitate-tattoos-are-they-valid/
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Web Content:
http://tacfs.org/resources/Documents/2015_D1-E1_Nisenbaum_TWO_120.pdf
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http://tacfs.org/resources/Documents/2015_D1-E1_Nisenbaum_TWO_120.pdf
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Web Content:
https://www.acepnow.com/article/do-not-resuscitate-tattoos-are-they-valid/
Web Content:
https://www.acepnow.com/article/do-not-resuscitate-tattoos-are-they-valid/
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Historical Speech Analysis Paper Exemplary Work Assignment - Rhetorical Criticism
Due Date: Refer to the syllabus
This speech is worth 200 points (100 points for the Writing Center meeting & 100 points for the paper) Students will select a culturally or historically exemplary speech. You will analyze the text of a historical speech of your choice and write a paper analyzing its use of the five canons of rhetoric – invention, arrangement, style, delivery and memory – which we discussed in class and is also covered in Chapter 2 of the textbook. When writing your analysis, consider the following questions:
1. What is the topic of the speech? What led this speaker to give that speech at that time? Who is the audience and what is the setting? Do some research to learn the context and current events of the day that the speech took place within. For example, what was going on at the time the speech was given and what was its purpose overall? What was the general purpose of the speech i.e. inform, persuade, entertain or commemorate? What was the specific purpose regarding cognitive effects, affective effects and behavioral effects. Be specific.
2. How was the speech organized? Could you identify the main points? How were the ideas connected? What were there transition statements? Be specific.
3. Address the style of the speech. Was the language casual or formal? Was it accessible to those we imagine were in the audience?
4. What delivery technique did the speaker use? Was that appropriate given the topic, the audience, the setting and the time period?
5. Do you think this was a successful speech? Did it accomplish its goals? If so, why? If not, why not?
Your goal is not to tell me what was in the speech – so and so said this - but to analyze and critically think about how what it is in the speech is, or is not, an example of the use of the 5 canons of rhetoric. For example you could write, MLK used the extemporaneous delivery technique in his “I Have a Dream” speech. This was appropriate because he was able to maintain some eye contact with the large audience and make use of hand gestures. Certainly you may quote the speech, but only to use that quote as an example of the use of one of the canons – to support your statement. If you need more help with this distinction, please ask me. Your analysis must be 3-5 pages, double-spaced. At the top of your first page list your name, the name of the speaker and the title of the speech. A cover page is not necessary. You must use at least 3 credible sources for this assignment. More is fine, less if not. The speech itself – in any format, like print and video – is one source. You need at least two others, like a newspaper or scholarly article, book or other source that addresses the speech in some way. Cite your sources using MLA style, both within the paper and at the end on a Works Cited page. (See the MCC library home page for an MLA guide). This assignment must be submitted via BlackBoard > Assignments folder > Historical Speech Analysis. The list of speeches from which you may choose this assignment will be distributed separately.
9% SIMILARITY SCORE 4 PLAGIARISM ISSUES 32 GRAMMAR ISSUES Int ernet Source 9% Inst it ut ion 0%
Zeena John EthicalDilemma.docx
Summary 1305 Words
Running head: ETHICAL DILEMMA 1
ETHICAL DILEMMA 2
Et hical Dilemma
Et hical Dilemma
Physicians are oft en faced in et hical dilemmas in t heir line of dut y. Et hical Decision
making is needed when healt hcare professionals are required t o address a conflict ing
or uncert ain issues regarding compet ing values. As indicat ed by Holt , Sarment o, Ket t
and Goodman (2018), hysicians must consider et hical principles such as just ice,
beneficence, non-maleficence and aut onomy as well as t he et hical st andards of t heir
organizat ion and t heir profession. The case of an unconscious pat ient wit h a DNR
t at t oo present ed an et hical dilemma for t he crit ical and emergency care physicians
who were in charge of t he pat ient . These physicians were led by quest ionable
recommendat ions from t he consult ant s of et hics. The pat ient had no known ident it y,
he was t aken t o t he emergency depart ment while in a crit ical condit ion, and
unconscious. He had a “Do Not Resuscit at e” t at t oo on his ant erior chest , and even a
signat ure t hat accompanied t he t at t oo. The healt h care t eam had decided not t o
honor t he t at t oo, but t hey lat er reversed t he decision aft er consult ing t he et hics
consult ant s. It was agreed t hat t he t at t oo could be represent ing aut hent ic
preferences of t he pat ient . A case like t his raises an et hical dilemma; should t he
pat ient be resuscit at ed against t heir will as seen on t he t at t oo, or should t he healt h
at t endant s honor t he t at t oo?
For a sit uat ion t o be called an et hical dilemma, it has t o meet t hree condit ions (Holt ,
Sarment o, Ket t & Goodman, 2018). The first condit ion is in a case where an individual
or ‘agent ’ has t o decide on t he best course of act ion. These et hical dilemmas have t o
offer opt ions; t hey should not be hard or creat e uncomfort able sit uat ions which do
not have alt ernat ives. In t he case of t he DNR pat ient , t he healt h care t eam could
decide t o eit her resuscit at e t he pat ient or follow what his t at t oo said. There should
also be different courses of act ions t o choose from. In t his case, t here were t wo
Spelling mistake: hysicians physicians
Passive voice: physicians were led by
accompany: accompanied go wit h
Web Content: https://www.acepnow.com/article/do-not…
Passive voice: It was agreed that
in the case of (abou...: In the case of About
choices, t o save or not t o save t he DNR pat ient . This is a hard decision t o make for
any person involved. The last condit ion is t hat regardless of t he course of act ion
t aken, t here will be a compromise of t he et hical principles. Following t he st at ement
writ t en on t he t at t oo would see a loss of life, amidst t he chance t o save him. On t he
ot her hand, t rying t o resuscit at e t he pat ient will be against t he will expressed in t he
t at t oo, and t here is no informat ion as t o why it is writ t en not t o resuscit at e him.
In det ermining t he const it uent s of an et hical dilemma, a dist inct ion has t o be made
bet ween et hics, laws, policies, values, and morals (Holt , Sarment o, Ket t & Goodman,
2018). Et hics are t he st andards used t o det ermine what is right and what is wrong.
They rely on rat ional and logical crit eria for a decision t o be made given t hat it is a
cognit ive process (Dolgoff, Loewenberg & Harringt on, 2009). Values are t he t hings or
ideas an individual value, and t hese values are associat ed wit h feelings (Allen &
Friedman, 2010). Morals are t he codes of conduct of behavior ascribed by an individual,
used t o st rengt hen relat ionships (Dolgoff, Loewenberg & Harringt on, 2009). Laws and
agency policies are most ly used in complex cases, and t he healt h care at t endant s are
obligat ed by law t o t ake a part icular course of act ion. There is a difference bet ween
personal et hics and professional et hics and values. Values are personal and involve
feelings, and cannot be used in solving an et hical dilemma. Aft er joining a profession,
in t his case as a medical care provider, a person agrees t o follow t he st andards of
t hat profession, t oget her wit h t he code of et hics and values. In t he case of a pat ient
wit h t he DNR t at t oo, et hics and professional values have t o be given a priorit y.
There is an import ant et hical principle t hat emergency physicians have t o consider in a
dilemma such as t his. This principle st at es t hat wit hdrawing and wit hholding t he
t reat ment s t o sust ain life are seen as equivalent in t erms of et hics. Therefore, when
faced wit h a dilemma regarding t he wishes of t he pat ient , t he physicians should go
ahead wit h t he int ervent ions t o save lives. Aft er obt aining more informat ion, t he care
of t he pat ient can t hen be de-escalat ed appropriat ely according t o t heir preferences.
Also, in t he field of medicine, a physician should review ACP (advance care planning),
which has t wo primary forms (Vearrier, 2018). These forms are; Advance Direct ives
(AD) and Physician Orders For Life-Sust aining Treat ment (POLST). ADs can be
complet ed at any t ime during a person’s life t o appoint a surrogat e decider or t o
guide fut ure care. This legal document (AD) has t o be filled by t he person himself or
herself in t he presence of a wit ness. POLST forms, on t he ot her hand, are orders from
a physician for t he care of end of life t hat can be t aken t o ot her healt h care
inst it ut ions. The document s are only for t hose who are seriously ill, or people who are
nearing deat h and could assist in t he surrogat e.
The t at t oo saying “Do Not Resuscit at e” is t herefore neit her legal nor et hical enough
because of t he following reasons. First , t at t oos are not legal POLST or ADs, and it has
neit her a wit ness nor not ary. Therefore, it cannot be used as a wearable AD or t o
finish legal document at ion. The second reason is t hat t he medical providers cannot
presume informed decision making, as t here is no evidence t hat t he t at t oo shows a
clear DNR st at us underst anding of t he pat ient (Vearrier, 2018). Also, t he t at t oo has
no sufficient guiding informat ion t o decide an int ervent ion. Last ly, a lot of people,
more t han 50%, who have t at t oos regret having t hem. The above informat ion does
not , however, mean t hat t he dat a should be ignored. The AD and POLST document s
could not be available when t he healt h care at t endant s are deciding on crucial issues.
A way of communicat ing should be included in t he process of crucial decision making
(Vearrier, 2018).
In t he evaluat ion of t he merit s and challenges of a medical procedure, bioet hicist s
refer t o t he healt hcare et hics’ basic principles. For any pract ice t o be referred t o as
et hical, it has t o conform t o t he four principles including just ice, aut onomy, non-
maleficence, and aut onomy. The first principle is aut onomy; where a pat ient is
required t o make informed and un-manipulat ed act ion and int ent ion when deciding
about t heir healt hcare. A pat ient should be aware of all t he benefit s and risk of a
medical procedure and t he success likelihood. In t his case, t he pat ient was
unconscious. The pat ient did not have a relat ive and he never spoke his mind apart
from t he t at t oo. The second is just ice, where t reat ment is dist ribut ed t o all groups
equally. Healt h care provider should dist ribut e scarce resources fairly. Following t his
on the other hand (...: On the other hand But
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Passive voice: attendants are obligated b...
in the case of (abou...: In the case of About
in terms of (in, for): in terms of in
Web Content: https://www.acepnow.com/article/do-not…
obtain (get): obtaining get
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on the other hand (...: on the other hand but
assist, assistance (help): assist help
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sufficient (enough): sufficient enough
in the process of: in the process of
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Web Content: https://web.stanford.edu/class/siw198q/w…
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comma between ...: relative and relat ive, and
met hod, t he t at t oo pat ient could be revived in t he same manner as ot her emergency
cases handled in t he facilit y. The t hird concept is beneficence; it demands t he
provision of medical procedure wit h t he int ent ion of benefit t ing t he pat ient . It
demands maint enance and development of skills and knowledge, st riving for net
benefit . The last principle is non-maleficence. This et hical concept requires t hat a
procedure should not harm t he involved pat ient or ot hers. The physicians ought t o
use t he aforement ioned procedures t o guide in making a decision regarding what is
best for t he pat ient . Aut onomy st at es t hat a pat ient has t he right t o have cont rol of
his body, but since t here is no accompanying relat ives, t he pat ient could not express
himself. I would also do everyt hing possible t o keep t he pat ient alive. I would also
employ non-maleficence t o guide t he t reat ment process; t his makes t he pat ient ’s
recovery process more effect ive.
References
Allen, K. N., & Friedman, B. (2010). Affect ive learning: A t axonomy for t eaching social
work values. Journal of Social Work Values and Et hics, 7 (2). Ret rieved from
ht t p://www.socialworker.com/jswve.
Dolgoff, R., Lowenberg, F. M., & Harringt on, D. (2009). Et hical decisions for social work
pract ice (8t h Ed.). Belmont , CA: Brooks/Cole.
Holt G. E, Sarment o B., Ket t D., & Goodman K. W. (2018). An unconscious pat ient wit h
a DNR t at t oo. N Eng J Med. 2017;377:2192-2193.
Social Worker (2014) What is an et hical dilemma? Ret rieved from
ht t ps://www.socialworker.com/feat ure-art icles/et hics-
art icles/What _Is_an_Et hical_Dilemma%3F/
Vearrier L. (2018) Do Not Resuscit at e t at t oos: Are t hey valid? ACEONow. Ret rieved
from ht t ps://www.acepnow.com/art icle/do-not -resuscit at e-t at t oos-are-t hey-valid/
Spelling mistake: benefitting benefit ing
Legal jargon referri...: aforementioned t hese
accompany: accompanying go wit h
Rubic_Print_Format
Course Code | Class Code | |||||||
HLT-520 | HLT-520-O500 | Lawsuit Recommendation Paper | 75.0 | |||||
Criteria | Percentage | Unsatisfactory (0.00%) | Less than Satisfactory (74.00%) | Satisfactory (79.00%) | Good (87.00%) | Excellent (100.00%) | Comments | Points Earned |
Content | 70.0% | |||||||
Advantages and Disadvantages of an Arbitration Resolution | 10.0% | A description of the advantages and disadvantages of an arbitration resolution is not included. | A description of the advantages and disadvantages of an arbitration resolution is incomplete or incorrect. | A description of the advantages and disadvantages of an arbitration resolution is complete but lacks supporting detail. | A description of the advantages and disadvantages of an arbitration resolution is complete and includes supporting detail. | A description of the advantages and disadvantages of an arbitration resolution is extremely thorough and includes substantial supporting detail. | ||
Advantages and Disadvantages of a Mediation Resolution | 10.0% | A description of the advantages and disadvantages of a mediation resolution is not included. | A description of the advantages and disadvantages of a mediation resolution is incomplete or incorrect. | A description of the advantages and disadvantages of a mediation resolution is complete but lacks supporting detail. | A description of the advantages and disadvantages of a mediation resolution is complete and includes supporting detail. | A description of the advantages and disadvantages of a mediation resolution is extremely thorough and includes substantial supporting detail. | ||
Advantages and Disadvantages of a Settlement Resolution | 10.0% | A description of the advantages and disadvantages of a settlement resolution is not included. | A description of the advantages and disadvantages of a settlement resolution is incomplete or incorrect. | A description of the advantages and disadvantages of a settlement resolution is complete but lacks supporting detail. | A description of the advantages and disadvantages of a settlement resolution is complete and includes supporting detail. | A description of the advantages and disadvantages of a settlement resolution is extremely thorough and includes substantial supporting detail. | ||
Resolution Recommendation | 40.0% | An explanation of the recommended resolution option and the rationale for choosing it is not included. | An explanation of the recommended resolution option and the rationale for choosing it is incomplete or incorrect. | An explanation of the recommended resolution option and the rationale for choosing it is complete but lacks supporting detail. | An explanation of the recommended resolution option and the rationale for choosing it is complete and includes supporting detail. | An explanation of the recommended resolution option and the rationale for choosing it is extremely thorough and includes substantial supporting detail. | ||
Organization and Effectiveness | 20.0% | |||||||
Thesis Development and Purpose | 7.0% | Paper lacks any discernible overall purpose or organizing claim. | Thesis is insufficiently developed or vague. Purpose is not clear. | Thesis is apparent and appropriate to purpose. | Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. | Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. | ||
Argument Logic and Construction | 8.0% | Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. | Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. | Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. | Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. | Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. | ||
Mechanics of Writing (includes spelling, punctuation, grammar, language use) | 5.0% | Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. | Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied. | Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed. | Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech. | Writer is clearly in command of standard, written, academic English. | ||
Format | 10.0% | |||||||
Paper Format (use of appropriate style for the major and assignment) | 5.0% | Template is not used appropriately or documentation format is rarely followed correctly. | Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent. | Appropriate template is used. Formatting is correct, although some minor errors may be present. | Appropriate template is fully used. There are virtually no errors in formatting style. | All format elements are correct. | ||
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) | 5.0% | Sources are not documented. | Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. | Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. | Sources are documented, as appropriate to assignment and style, and format is mostly correct. | Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. | ||
Total Weightage | 100% |
Running head: ETHICAL DILEMMA 1
ETHICAL DILEMMA 6
Ethical Dilemma
Physicians are often faced in ethical dilemmas in their line of duty. Ethical Decision making is needed when healthcare professionals are required to address a conflicting or uncertain issues regarding competing values. As indicated by Holt, Sarmento, Kett and Goodman (2018), physicians must consider ethical principles such as justice, beneficence, non-maleficence and autonomy as well as the ethical standards of their organization and their profession. The case of an unconscious patient with a DNR tattoo presented an ethical dilemma for the critical and emergency care physicians who were in charge of the patient. These physicians were led by questionable recommendations from the consultants of ethics. The patient had no known identity, he was taken to the emergency department while in a critical condition, and unconscious. He had a “Do Not Resuscitate” tattoo on his anterior chest, and even a signature that accompanied the tattoo. The health care team had decided not to honor the tattoo, but they later reversed the decision after consulting the ethics consultants. It was agreed that the tattoo could be representing authentic preferences of the patient. A case like this raises an ethical dilemma; should the patient be resuscitated against their will as seen on the tattoo, or should the health attendants honor the tattoo?
For a situation to be called an ethical dilemma, it has to meet three conditions (Holt, Sarmento, Kett & Goodman, 2018). The first condition is in a case where an individual or ‘agent’ has to decide on the best course of action. These ethical dilemmas have to offer options; they should not be hard or create uncomfortable situations which do not have alternatives. In the case of the DNR patient, the health care team could decide to either resuscitate the patient or follow what his tattoo said. There should also be different courses of actions to choose from. In this case, there were two choices, to save or not to save the DNR patient. This is a hard decision to make for any person involved. The last condition is that regardless of the course of action taken, there will be a compromise of the ethical principles. Following the statement written on the tattoo would see a loss of life, amidst the chance to save him. On the other hand, trying to resuscitate the patient will be against the will expressed in the tattoo, and there is no information as to why it is written not to resuscitate him.
In determining the constituents of an ethical dilemma, a distinction has to be made between ethics, laws, policies, values, and morals (Holt, Sarmento, Kett & Goodman, 2018). Ethics are the standards used to determine what is right and what is wrong. They rely on rational and logical criteria for a decision to be made given that it is a cognitive process (Dolgoff, Loewenberg & Harrington, 2009). Values are the things or ideas an individual value, and these values are associated with feelings (Allen & Friedman, 2010). Morals are the codes of conduct of behavior ascribed by an individual, used to strengthen relationships (Dolgoff, Loewenberg & Harrington, 2009). Laws and agency policies are mostly used in complex cases, and the health care attendants are obligated by law to take a particular course of action. There is a difference between personal ethics and professional ethics and values. Values are personal and involve feelings, and cannot be used in solving an ethical dilemma. After joining a profession, in this case as a medical care provider, a person agrees to follow the standards of that profession, together with the code of ethics and values. In the case of a patient with the DNR tattoo, ethics and professional values have to be given a priority.
There is an important ethical principle that emergency physicians have to consider in a dilemma such as this. This principle states that withdrawing and withholding the treatments to sustain life are seen as equivalent in terms of ethics. Therefore, when faced with a dilemma regarding the wishes of the patient, the physicians should go ahead with the interventions to save lives. After obtaining more information, the care of the patient can then be de-escalated appropriately according to their preferences. Also, in the field of medicine, a physician should review ACP (advance care planning), which has two primary forms (Vearrier, 2018). These forms are; Advance Directives (AD) and Physician Orders For Life-Sustaining Treatment (POLST). ADs can be completed at any time during a person’s life to appoint a surrogate decider or to guide future care. This legal document (AD) has to be filled by the person himself or herself in the presence of a witness. POLST forms, on the other hand, are orders from a physician for the care of end of life that can be taken to other health care institutions. The documents are only for those who are seriously ill, or people who are nearing death and could assist in the surrogate.
The tattoo saying “Do Not Resuscitate” is therefore neither legal nor ethical enough because of the following reasons. First, tattoos are not legal POLST or ADs, and it has neither a witness nor notary. Therefore, it cannot be used as a wearable AD or to finish legal documentation. The second reason is that the medical providers cannot presume informed decision making, as there is no evidence that the tattoo shows a clear DNR status understanding of the patient (Vearrier, 2018). Also, the tattoo has no sufficient guiding information to decide an intervention. Lastly, a lot of people, more than 50%, who have tattoos regret having them. The above information does not, however, mean that the data should be ignored. The AD and POLST documents could not be available when the health care attendants are deciding on crucial issues. A way of communicating should be included in the process of crucial decision making (Vearrier, 2018).
In the evaluation of the merits and challenges of a medical procedure, bioethicists refer to the healthcare ethics’ basic principles. For any practice to be referred to as ethical, it has to conform to the four principles including justice, autonomy, non-maleficence, and autonomy. The first principle is autonomy; where a patient is required to make informed and un-manipulated action and intention when deciding about their healthcare. A patient should be aware of all the benefits and risk of a medical procedure and the success likelihood. In this case, the patient was unconscious. The patient did not have a relative and he never spoke his mind apart from the tattoo. The second is justice, where treatment is distributed to all groups equally. Health care provider should distribute scarce resources fairly. Following this method, the tattoo patient could be revived in the same manner as other emergency cases handled in the facility. The third concept is beneficence; it demands the provision of medical procedure with the intention of benefitting the patient. It demands maintenance and development of skills and knowledge, striving for net benefit. The last principle is non-maleficence. This ethical concept requires that a procedure should not harm the involved patient or others. The physicians ought to use the aforementioned procedures to guide in making a decision regarding what is best for the patient. Autonomy states that a patient has the right to have control of his body, but since there is no accompanying relatives, the patient could not express himself. I would also do everything possible to keep the patient alive. I would also employ non-maleficence to guide the treatment process; this makes the patient’s recovery process more effective.
References
Allen, K. N., & Friedman, B. (2010). Affective learning: A taxonomy for teaching social work values. Journal of Social Work Values and Ethics, 7 (2). Retrieved from http://www.socialworker.com/jswve.
Dolgoff, R., Lowenberg, F. M., & Harrington, D. (2009). Ethical decisions for social work practice (8th Ed.). Belmont, CA: Brooks/Cole.
Holt G. E, Sarmento B., Kett D., & Goodman K. W. (2018). An unconscious patient with a DNR tattoo. N Eng J Med. 2017;377:2192-2193.
Social Worker (2014) What is an ethical dilemma? Retrieved from https://www.socialworker.com/feature-articles/ethics- articles/What_Is_an_Ethical_Dilemma%3F/
Vearrier L. (2018) Do Not Resuscitate tattoos: Are they valid? ACEONow. Retrieved from https://www.acepnow.com/article/do-not-resuscitate-tattoos-are-they-valid/
Running head: ETHICAL DILEMMA
1
Ethical Dilemma
Physicians are often faced in ethical dilemmas in their line of duty.
Ethical Decision
making is needed when healthcare professionals are required to address a conflicting or uncertain
issues regarding competing values.
As indicated by
Holt, Sarmento, Kett and Goodman
(
2018
),
physicians
must consider ethical principles such a
s justice, beneficence, non
-
maleficence and
Running head: ETHICAL DILEMMA 1
Ethical Dilemma
Physicians are often faced in ethical dilemmas in their line of duty. Ethical Decision
making is needed when healthcare professionals are required to address a conflicting or uncertain
issues regarding competing values. As indicated by Holt, Sarmento, Kett and Goodman (2018),
physicians must consider ethical principles such as justice, beneficence, non-maleficence and

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