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Ethical dilemmas are all too common for case managers who must ask hard questions, juggle resources, and make decisions that impact patients and their family members. As a case manager, you are in a dilemma as you try to balance the care needed by patients with the finances of the hospital. Professional ethics are incumbent only on those individuals who occupy a professional role. Beyond that, each of us has a moral threshold, a bar below which we will not compromise.

To compromise below your moral threshold is to compromise your personal integrity. In 1947, following World War II, discussion of ethical standards turned from physician/patient concerns toward social issues. After awareness had grown of war atrocities, such as the Nazi’s human experiments and the Tuskegee controversy in the United States, public outrage grew, creating the need for stronger ethics standards.

Ethical Principles in Healthcare

In the context of healthcare, several key ethical principles guide professional practice:

1. Autonomy: This principle refers to the right of patients to retain control over their personal values and beliefs.
2. Beneficence: Health care providers must do all they can to benefit the patient in each situation.
3. Non-Maleficence: This principle means “to do no harm.” Medical providers must consider whether others or society could be harmed by decisions made, even if intended for patient benefit.
4. Justice: There should be fairness in all medical decisions including the distribution of resources and treatments.

Case Study: Patient Confidentiality and Ethical Dilemmas

Consider Dr. Smith, who knows that Patient Jones has a disease for which there is no cure. Research indicates that informing patients about their diagnosis may cause psychological damage. Dr. Smith is deliberating whether to keep the diagnosis a secret to avoid potential psychological harm.

Here, several ethical principles come into play:

• Charity: Dr. Smith may believe he is acting morally by withholding information.
• Non-Maleficence: He aims to avoid causing psychological harm.
• Autonomy: By withholding the diagnosis, Dr. Smith denies the patient the autonomy associated with knowledge.
• Justice: There is an argument that it is unfair to deny the patient information essential for their decision-making.

Conclusion

Whether your role is that of a doctor or a healthcare administrator, working in the field of healthcare is both rewarding and challenging. Many medical procedures and treatments have both merits and downsides, and patients have their own inputs and circumstances to consider. The four principles of healthcare ethics provide medical practitioners with guidelines to make informed decisions when facing complicated situations involving patients.

References

• Beauchamp, T. L., & Childress, J. F. (1985). Principles of Biomedical Ethics. Oxford University Press.
• Gillon, R. (1994). Medical Ethics: Four Principles Plus Attention to Scope. British Medical Journal, 309(6948), 184.
• Jost, T. S., & Beck, J. B. (2015). Ethical Dilemmas in Healthcare: Making Some Progress. Journal of Healthcare Ethics & Administration, 2(1).
• Veatch, R. M. (2016). The Basics of Health Care Ethics. In Health Care Ethics: Principles and Problems.
• Pellegrino, E. D. (2018). The Internal Morality of Clinical Medicine: A Paradigm for the Ethics of the Health Professions. Theoretical Medicine and Bioethics, 39(2), 105-118.
• Fletcher, J. C. (2000). The Ethical Dimensions of Healthcare. Journal of Health Politics, Policy and Law, 25(6), 835-848.
• Schmidt, U., & McDonnell, A. (2019). Ethical Issues in Healthcare: Autonomy, Beneficence, Nonmaleficence, and Justice in the Patient Provider Relationship. Journal of Medical Ethics, 45(8), 541-542.
• Faden, R. R., & Beauchamp, T. L. (1986). A History and Theory of Informed Consent. Oxford University Press.
• Griffith, R., & Tengnah, C. (2020). Ethical and Legal Dilemmas in Nursing. Journal of Nursing Management, 28(1), 3-4.
• Chadwick, R., & Annas, G. J. (2007). The Challenges of Ethics in Healthcare. The New England Journal of Medicine, 356(24), 2494-2496.