31 Mar Ethical Theories and Principles
Review the following lectures:
Ethical Theories and Principles
Patient Abuse
The project assignment provides a forum for analyzing and evaluating relevant topics of this week on the basis of the course competencies covered.
Introduction:
In each of the previous weeks, you had the opportunity to explore an ethical theory—consequential ethics, utilitarian ethics, deontological ethics, and nonconsequential ethics—in the context of a case scenario from your textbook. In this week, the focus will be on how those ethical paradigms apply to legal issues involving patient abuse.
Tasks:
Review the following case:
The defendant in State v. Cunningham, the owner, and administrator of a residential care facility housed thirty to thirty-seven mentally ill, mentally retarded, and senior residents. The Iowa Department of Inspections and Appeals conducted various surveys at the defendant’s facility between October 1989 and May 1990. All of the surveys except one resulted in a fifty-dollar daily fine assessed against the defendant for violations of the regulations.
On August 16, 1990, a grand jury filed an indictment charging the defendant with several counts of wanton neglect of a resident in violation of the Iowa Code section 726.7 (1989), which provides, “A person commits wanton neglect of a resident of a healthcare facility when the person knowingly acts in a manner likely to be injurious to the physical, mental, or moral welfare of a resident of a healthcare facility. . . . Wanton neglect of a resident of a healthcare facility is a serious misdemeanor.”
The district court held that the defendant had knowledge of the dangerous conditions that existed in the healthcare facility but willfully and consciously refused to provide or to exercise adequate supervision to remedy or attempt to remedy the dangerous conditions. The residents were exposed to physical dangers and unhealthy and unsanitary physical conditions and were grossly deprived of the much-needed medical care and personal attention. The conditions were likely to and did cause injury to the physical and mental well-being of the facility’s residents. The defendant was found guilty on five counts of wanton neglect. The district court sentenced the defendant to one year in jail for each of the five counts, to run concurrently. The district court suspended all but two days of the defendant’s sentence and ordered him to pay $200 for each count, plus a surcharge and costs, and to perform community service. A motion for a new trial was denied, and the defendant appealed.
The Iowa Court of Appeals held that there was substantial evidence to support a finding that the defendant was responsible for not properly maintaining the nursing facility, which led to prosecution for wanton neglect of the facility’s residents. The defendant was found guilty of knowingly acting in a manner likely to be injurious to the physical or mental welfare of the facility’s residents by creating, directing, or maintaining hazardous conditions and unsafe practices. The facility was not properly maintained (for example, findings included broken glass in patients’ rooms, excessive hot water in faucets, dried feces on public bathroom walls and grab bars, insufficient towels and linens, cockroaches and worms in the food preparation area, no soap available in the kitchen, and at one point, only one bar of soap and one container of shampoo found in the entire facility). Dietary facilities were unsanitary and inadequate to meet the dietary needs of the residents. There were inadequate staffing patterns and supervision in the facility, and improper dosages of medications were administered to the residents.
The defendant argued that he or she did not “create” the unsafe conditions at the facility. The court of appeals disagreed. The statute does not require that the defendant create the conditions at the facility to sustain a conviction. The defendant was the administrator of the facility and responsible for the conditions that existed.
In a 5- to 7-page document, complete the following tasks:
Analyze this case from the perspective of the four ethical theories presented throughout the course—consequential ethics, utilitarian ethics, deontological ethics, and nonconsequential ethics.
Discuss how ethics and the law are intertwined in this case.
Present your assessment of the court’s finding and whether it was just.
To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Submission Details
Name your file as SU_MHA6060_W5_Project_LastName_FirstName.
Ethical Theories and Principles
The term “ethics” is derived from Greek and Latin terms for custom or habit, but current usage of the term communicates a manner of action—doing what is right or good over what is wrong or bad. It is important to note here that ethics involves the how and why of what ought to be versus what is. The study of ethics provides us with a framework to make appropriate choices on the basis of some universal guidelines set by community values and laws. There are a number of different ethical theories that help to guide the development of such community values and laws that, in turn, support ethical decision making. In this course, you will explore the following ethical theories in depth:
Consequential Ethics: A value-based theory that suggests the ends justify the means—the decision to act in a certain manner must be driven by a desired outcome to maximize good
Utilitarian Ethics: A result-based theory that says the moral worth of an action is determined solely by its ability to maximize happiness or pleasure for all
Deontological Ethics: A duty-based theory that originated from the work of Kant suggests that doing the right thing is important whether it results in maximum good
Nonconsequential Ethics: An intent-based theory that denies that the consequences of behavior are the only criteria to determine moral action; right and wrong stem from the intent of the action
Ethical Theories
Review each tab to learn more.
Consequential
Right and Wrong
Rightness and wrongness of actions are determined by the consequences generated.
Goodness
Good breeds good.
Theorists
Milton Friedman and Niccolo Machiavelli
Utilitarian
Deontological
Nonconsequential
Ultimately, while there are a number of theories to help influence ethical conduct, there are some agreed-upon principles in healthcare that drive ethical behavior for healthcare professionals. Following are the principles:
Autonomy: Recognizing the right of individuals to make their own decisions without interference from another
Beneficence: Recognizing the principle of showing kindness and compassion to others and doing good
Nonmaleficence: Recognizing the importance to avoid causing harm and to avoid options that provide no short- or long-term benefits
Developing a working knowledge of ethical theories and principles helps to provide a moral compass. This moral compass will guide the decisions you make throughout your life as individuals and as healthcare administrators, particularly as you align your organization to meet a growing body of governing healthcare laws.
Additional Materials
From your course textbook, Legal and Ethical Issues for Health Professionals, review the following chapter:
Introduction to Ethics
From the South University Online Library, review the following articles:
The Burden of Choice: A Qualitative Study of Healthcare Professionals’ Reactions to Ethical Challenges in Humanitarian Crises
Eliciting, Documenting, and Honoring Patient’s Goals of Care and Life-Sustaining Treatment Decisions: Building Systems to Ensure Success (FR479)
From the Internet, review the following:
American College of Healthcare Executives. (n.d.). About ACHE. Retrieved from https://www.ache.org/abt_ache/code.cfm
Patient Abuse
There are a number of ways that a healthcare professional may become involved in a case of abuse, which is pervasive. Hospital-based workers are most often confronted with patient abuse, which is any level of mistreatment of individuals receiving care from the agency. It is important to note that a physician may be the perpetrator of the abuse or the one to identify and report the abuse a patient experienced outside the facility. Such abuse may include any physical, psychological, medical, or financial abuse inflicted on a patient.
Child abuse is the abuse of a child under the age of eighteen years, and all states have child abuse statutes to mandate accurate reporting. Detecting child abuse may prove challenging, and any caregivers who suspect a pattern of abuse, such as repeated visits for broken bones or bruises, should report suspicions. In order to promote quick identification and intervention in child abuse cases, the caregivers are immune from liability for any good faith reporting.
Senior abuse is a significant concern as many older adults fail to report incidents out of fear. A majority of states mandate reporting of senior abuse, which may involve anything from emotional outbursts or malnourishment to unexpected bank activity or death. Caregivers who suspect abuse are encouraged to document accurately and extensively and report suspected abuse.
Case 1
Abusive Search
A nurse in People v. Coe (1988) was charged with a willful violation of the public health law in connection with an allegedly abusive search of an eighty-six-year-old resident at a geriatric center and with the falsification of business records in the first degree. The resident, Mr. Gersh, had a heart disease and difficulty in expressing himself verbally. Another resident claimed that two $5 bills were missing. Nurse Coe assumed that Gersh had taken them because he had been known to take things in the past. The nurse proceeded to search Gersh, who resisted. A security guard was summoned, and another search was undertaken. When Gersh again resisted, the security guard slammed a chair down in front of him and pinned his arms while the defendant nurse searched his pockets, failing to retrieve the two $5 bills. Five minutes later, Gersh collapsed in a chair gasping for air. Coe administered cardiopulmonary resuscitation but was unsuccessful, and Gersh died.
Case 2
Forcible Administration of Medication
The medical employee in In re Axelrod sought review of a determination by the commissioner of health that she was guilty of resident abuse. Evidence showed that the employee, after a resident refused medication, “held the patient’s chin and poured the medication down her throat.” There was no indication or convincing evidence that an emergency existed that would have required the forced administration of the medication. The court held that substantial evidence supported the commissioner’s finding that the employee had been guilty of resident abuse.
Case 3
Deficient Care
In Montgomery Health Care Facility v. Ballard (1990), three nurses testified that the facility was understaffed. One nurse testified that she asked her supervisor for more help but that she did not get it. A nursing home resident, Mrs. Stovall, expired as the result of multiple infected bedsores. The estate of the patient brought a malpractice action against the nursing home. First American Health Care, Inc., is the parent corporation of the Montgomery Health Care Facility, a nursing home. The trial court entered a judgment on a jury verdict against the home, and an appeal was taken. The Alabama Supreme Court held that reports compiled by the Alabama Department of Public Health, concerning deficiencies found in the nursing home, were admissible as evidence.
Additional Materials
From your textbook, Legal and Ethical Issues for Health Professionals, review the following chapter:
Patient Abuse
From the South University Online Library, review the following article:
Using Forum Play to Prevent Abuse in Health Care Organizations: A Qualitative Study Exploring Potentials and Limitations for Learning
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