Running Head: Ethical Dilemma Brief 1

Running Head: Ethical Dilemma Brief 1

 

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Assignment #3 – EXAMPLE

Ethical Dilemma Brief

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ethical Dilemma

 

 

2

Prepare a brief from the perspective of a lead administrator dealing with an ethical

dilemma

The HCO was recently sued for claims of delaying a diagnosis of care for a patient

treated at one of the HCO’s outpatient healthcare facilities. A 50-year-old male, Mr. X, presented

to his family physician (FP) in January 2019 due to having chief complaints of back and flank

pain. Urine labs from the appointment showed trace blood, and therefore the FP recommended a

urologist follow up. The patient returned in May with symptoms indicating an upper respiratory

infection. The patient was diagnosed with a viral infection. During this visit, the FP followed up

to see if the patient had seen a Urologist whom he had recommended to the patient in January.

The patient stated no, so the FP repeated urine labs, which showed blood in the urine once again.

The FP encouraged Mr. X to once again make an appointment with a urologist. The patient

insisted he would not due to fear of being catheterized and/or having to do a prostate exam.

Facility physician once again recommended going to a urologist and told him the risk of

kidney or bladder diseases that could be associated with the blood found in his Urine. Mr. X

once again refused to seek further evaluation from our urology clinic and thus the FP

documented their conversation in his chart. Mr. X returned to the FP office in February with

worsening pain and blood in his urine. After that, he finally agreed to go see a urologist and was

ultimately diagnosed with renal cell carcinoma. Mr. X and his wife filed a claim against our FP

stating they delayed referral to a urologist and thus delayed the diagnosis of his cancer. We are

here to discuss this ethical dilemma we tend to face on a day-to-day basis due to our patients

refusing medical treatment. Although it does not always necessarily lead to harm, in this case,

Mr. X was diagnosed with cancer and will ultimately die from this.

 

 

 

Ethical Dilemma

 

 

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Apply ethical and moral theories to a case study involving a patient and caregivers.

Healthcare facilities are faced with decisions regarding ethical and moral theories on a

day to day basis that involves patients and caregivers. Patients are given choices for medical

treatment based on recommendations of our physician’s advice. This advice from our physicians

comes from delivering quality patient care. Physicians undertook many years of medical training

to deliver patient care. Torrey states medical treatment can be broken up into four categories:

preventive, curative, management, and palliative. The Right to Refuse Treatment: A Model Act

specifically states that any competent person has the right to refuse medical treatment. “The Act

is designed to promote autonomy and respect for persons, by enhancing the individual’s right to

accept or reject medical treatments recommended by health care providers (The right to refuse

treatment: a model act. (1983).”

We have determined that anyone competent has the right to refuse their medical

treatment. Under this act, by refusing medical treatment you are choosing what you consider to

be the best outcome for yourself, even though ultimately it can have an unplanned or unfavored

outcome. There are some exceptions when one has the right to refuse treatment. Those

exceptions apply to individuals who are deemed not competent by a provider. Other examples of

those that can’t refuse medical treatment are those who may have an altered mental status,

children, and those who are a threat to our community (Torres).

As we see in this case, Mr. X was never deemed not competent and thus had the right to

make his own medical decisions. Our provider offered multiple chances for Mr. X to seek a

follow-up appointment with a urologist. Ultimately, Mr. X waited until he was in severe pain and

discomfort before following the physician’s advice and at that time was then diagnosed with

renal cell carcinoma.

 

 

Ethical Dilemma

 

 

4

Outline the ethical concerns and potential outcomes in a selected ethical dilemma.

The ethical concerns we face in this case is if the physician delayed care. If the physician

advised the patient, Mr. X, to go seek special evaluation in time this could have prevented his

renal cell carcinoma diagnosis. Our concerns to be addressed are: Was Mr. X incompetent to

make his own medical decisions? Does Mr. X have the right to refuse his medical treatment?

Was our provider delaying care? What constitutes enough notifications or advisements when it

comes to medical advising treatment?

If our physician did not urge the patient, Mr. X, to see a urologist he would be considered

negligent and would have failed to provide adequate medical treatment. Our physician urged Mr.

X at his initial visit to see a urologist specialist about his flank pain and blood in his urine and he

refused. He refused several more times after repeatedly being told by the physician to go seek

help and was educated on the potential negative outcomes from delaying care. Despite all the

education, Mr. X still declined until he reached severe pain and blood in his urine.

Propose a solution to mitigate the issues raised in a selected ethical dilemma.

Due to this being a consistent issue in the health care industry, we must have a solution to

protect our physicians’ license, our health care facility, and to help protect us from any further

lawsuits concerning patient refusal to medical treatments. To solve this issue from happening

again we must have our nursing staff, physicians, therapist, and every other healthcare team

member on the same page about the importance of educating the patient on the specific benefits,

treatments, and risks that are involved if they choose to not follow the treatment guidelines. Our

providers must be keen on proper documentation of a patient’s refusal of treatment.

If the patient is still refusing treatment, our providers must try and understand what the

patient’s reasoning is for refusing treatment to see if there is a way to work with the patient to get

 

 

Ethical Dilemma

 

 

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said treatment. If allowed, speak with the patients’ family member(s) and educate on the said

treatment and diagnoses to see if they can help convince the patient to continue with said

treatment. Hopefully, with enough education and family encouragement, the patient will be

encouraged to get treatment. However, if the patient still refuses medical treatment that is

advised by our providers, the patient can sign a refusal of treatment form. A refusal of treatment

form states the provider educated the patient on the diagnosis and treatment and the patient

understands the risk(s) involved with refusing such treatment.

Defend the solution from an ethical standpoint.

The case was dismissed since the provider had adequately documented the patient’s visits

showing the recommendations to the patient to see a urologist for further workup of his pain and

blood in his urine. We had outside expert physicians review the case and believed the physician

had adequately informed the patient about the risk of refusing treatment. I also think that

informing the patient several times, and even insisting he would make the referral for the patient

is adequate to convince a patient to receive medical treatment. The patient is a competent 50-

year-old male and thus has the right to make his medical treatment. He chose not to go see a

urologist despite being educated on the risk. I urge every healthcare provider to understand the

importance of proper documentation and consistent education of our patient population to help

prevent any further scenarios in which we have seen today.

 

 

 

 

 

 

 

 

 

 

Ethical Dilemma

 

 

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References:

Norcal. “Medical Ethics and Physician-Patient Encounters: Case Studies and Best

Practices.” NORCAL Group, www.norcal-group.com/library/medical-ethics-and-physician-

patient-encounters-case-studies-and-best-practices.

Kessler D. P. (2011). Evaluating the medical malpractice system and options for reform. The

journal of economic perspectives : a journal of the American Economic Association, 25(2),

93–110. https://doi.org/10.1257/jep.25.2.93

 

The right to refuse treatment: a model act. (1983). American journal of public health, 73(8),

918–921. https://doi.org/10.2105/ajph.73.8.918

 

“Right to Refuse Treatment.” Vermont Ethics Network, vtethicsnetwork.org/medical-ethics/right-

to-refuse-treatment.

Torrey, Trisha. “Do You Have the Right to Refuse Medical Treatment?” Verywell Health,

Verywell Health, 22 Feb. 2020, www.verywellhealth.com/do-patients-have-the-right-to-

refuse-treatment-2614982.

“When a Patient Refuses Treatment, What Should Doctors Do?” Columbia University Irving

Medical Center, 24 May 2018, www.cuimc.columbia.edu/news/when-patient-refuses-

treatment-what-should-doctors-do

Selde, William, MD. “Know When and How Your Patient Can Legally Refuse Care.” JEMS, 2

Sept. 2019, www.jems.com/2015/03/25/know-when-and-how-your-patient-can-legal/.

 

 

 

 

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