Background
Ethics in healthcare counselling are the foundational principles which direct attention to relevant ethical duties and responsibilities in health care. Ethical principles of counselling offer good practical guidelines for counteracting various health care circumstances. Decisions made in health care practice do not however become unethical due to its foundational framework but rather other decisions and conclusions have taken precedence. Counselling practitioner thus has a duty of assessing the relevant circumstance of an issue and offering appropriate decision that suits the situation basing on the principles of ethics practice. These principles include; autonomy, beneficence, trustworthiness, non-maleficence, justice and self respect. For effective ethical principles practice, moral values play key role, they include, empathy, sincerity, resilience, respect, humility, competence, farness, wisdom and courage. In analysing these ethical principles practice in counselling, we shall consider the case study below.
This is a case study concerning to Dr. Susan Lim, a medical professional in Singapore health care facility, faced with ethical dilemma in her field of practice. She is faced with medical challenge in her practice, she is accused of charging high fee than the amount to her patient for the services rendered and now she has been summed by Singapore Medical Council to explain and defend her action. The disciplinary allegations brought against her are so intensive and heart breaking that she is in desperation move not knowing her second course of action. She has been summoned to give her evidence at the panel for discipline panel for medical council. She is deeply concerned and worried, about the issue. She has resorted to threaten other people as way of trying to solve her problem. Dr. Lim has decided to contact the government of Brunei for help as she is resident of Brunei. She has written to Foreign minister about the issue. She states that she would appear at the panel and she may be forced to defend herself and give evidence.
She tells the minister that the information she has are sensitive and divulging them can be a threat to the government of Brunei and Singapore. The information she has is concerning the patient and the government of Brunei with Singapore. She claims that the information she has will cause embarrassment to both the countries, and thus have consequence on the planned merger between the two regions. The tone of her letter is threatening and she gives herself high stakes and allows for the pride and more credit on the matter. In the letter, she is demanding immediate communication and consensus about the pay status and compensation plans if her pleas are not heard and handled. However later she was given feedback, that her concern cannot be intervened by minister as it is under legal proceedings. She is thus humiliated her threats have been ignored and now she looks like a fool. She is inn big ethical dilemma on her next move o action.
Application of Moral Theories Review
The moral dilemma she is in is ensuring the patient gets quality care and high efficiency and maintained the confidentiality she has with the patient. Dr. Lim has already facilitated quality care for the patient , however the patient is complaining Dr. Lim has put in her practice. She feels that considering the service rendered to the patient, she can be compensated with the amount she is going to receives her compensation on the pocket of the patient.
However with view of this, in a move the patient has complained to the medical council, however in her reasoning she thought she was doing well for the patient. In a desperate move not to appear in the panel, she writes to the minister of foreign affairs in abide to salvage the situation, but that route she has taken flops and now she is in state of confusion. As a member of the counselling team, there is need to offer her the needed guidance at this critical moment, (Wood, 2001). The responsibility herein is that there is need to guide her as she makes the right decision regarding her career with the practice care for the patient. However in making such decision there is need for comprehensive search for knowledge facts, and the law and the application of critical thinking skills to facilitate positive outcome for Dr. Lim, (Trevino, 1986).
The theory bases its action on rights and respects of individuals or parties and focuses on the being the outcome. It focuses on regulations, functions and roles, it stresses on discipline and acting while in duty signifies ethical action is followed. It follows the principle of duty on what is wrong and right, (Monterverde, 2014). Hover there has been critic of the theory that strict adherence to the approach leads to conflicts between two equal parties or people.
Dr. Lim’s decision is thus appropriate in this context in that she performed her duty fairly and taking into consideration the principle of quality to the patient. She was fair in treating the patient and giving him the reasonable price in which in her view it was right and fair regardless of outcome.
The theory dictates that best actions are the on the ones that are based on maximizing utility. It bases its reasoning on what is right or wrong on the basis of outcomes. It identifies the process of choosing an action from the other. Decisions are valid if it yields greater well or wrong, (Wagner & Dahnke, 2015).
Evaluation of Theories
Dr.Lim’s decision is to based on her reasoning she was doing the right in charging the high fee to the patient. On seeing the quality of care provided to the patient she sees that it is the right thing to charge the patient the high fee and so went ahead and did it. Her decision was rationalised in the context that it yielded the greater good by offering good compensation plan.
The limitation of deontology theory is that to the decision that Dr. Lim made to charge the patient high fees is that whether quality treatment and care should be as good as motive of high fees. The high charge probably was due to the quality of care the patient has received, but now the board has overlooked that rational, thus is duty as good as motive?
A limitation of utilitarianism theory is that it advocates injustice, (Clifford, 2014).The patient sees that an injustice has been done to him while providing care and the council on the other end also sees that Dr. Lim has done an injustice for charging the patient, however for Dr, Lim she was doing the right thing based on the outcomes the patient had received under treatment.
Gathering of Facts
The situation here at hand is the case of Dr. Lim, with the Singapore medical council and the Royal family of Brunei, they are in a complicated situation and Dr. Lim is really terrified on her next course of action. Care was offered to patent and high fee charged by her. Dr Lim now doesn’t know where to run for help and who to approach as the foreign minister has turned down her threat letter. She is left to defend herself with the council and she is terrified. She was doing better good but now she is dilemma. Assumptions are that the minister refused to be embroiled in the legal tussle at hand and Dr. Lim was doing the service for the greater good of higher compensation for service done.
The ethical issue at hand is that Dr. Lim is caught up with the act of balancing quality care and maintaining the confidentiality of her and the patient. She has made threats on divulging the information and now she is worried on whether she should face the disciplinary council and reveal patient information. The principle of beneficence is at play whether she is to do well and be kind or not by revealing the truth. By doing so, the next consequence might be a law suit for breaching code of conduct for breaking patient- to doctor confidentiality. Singapore medical council also is of interest party as this issue falls squarely on their role and the royal family at stake and in the middle is their staff. Any decision made has high stakes of either positive or negative outcomes.
Ethical Decision Making
In the medical field, there is code of conduct for staff, there is code of ethics. As practitioner in the medical field she is obliged to maintain patient confidentiality and offer due care to the patient, (Schefer, 2016). The code covers on the responsibilities and limit of the employees in the facility. Ethics guidelines are meant to cushion everyone from adverse law suits and offer practical guideline for health service delivery.
Also the information regarding the patient family as she alleges could create a big attention which it will also cost her attention. If the information goes public is that it will be a condemnation for her for accusations of exploiting the a patient opportunity regardless of quality of care for the purpose of charging high fees. Dr. Lim decision to spill over the whole matter has key legal issues, she may be liable to laws suits, on the other hand the royal family could sue the family and demand compensation for damaged caused, while the hospital could suffer immensely.
Dr. Lim should take the initiative to seek further advice in a sober manner for her superiors, peers, colleagues and friends. In this ways she would broaden her mind in order to make a critical mind decision over the issue. Legal expert opinion might be sourced order to know if there are laws which protect her beyond code of ethics in revealing the patient information to the council and more likely spilling to the larger public.
Action to be taken by Dr. Lim is that by revealing the confidential information she knows about the patient might have both positive and negative impact. The positive consequence is that she would have justified her decision of charging high fees to the patient and she will lessen blame on her. The negative consequences are that revealing the patient confidentiality information might endanger her in a law suit of breaking the code of ethics.
Her task in Medicare is always bounded by law and service conduct, in revealing the information to the public is most likely to open for her law suits, which she would not like to. Ethical principles to the situation are that principle of beneficent should override others and privacy should prevail, (Clark & Weaver, 2015).
Consequences of the various decision that might be encountered by the Dr. Lim are that; deciding to break the code on confidentiality of the patient and hi, will result in major setbacks and leeway for suits against her from both the patient, family, and even the medical council, who might accuse her of breach of services. Telling the truth will result in slapping of penalties on her and eventually lead to being slapped with penalties.
After careful and tough balancing act, the decision Dr. Lim will take will have consequences and risks, however, a decision must be made and risks will be determined and the principles of beneficence and non-maleficience will apply, (Singh & Ivory, 2015). The decision she has on has both negative and positive impacts. However as a counsellor the decision best offered to Dr. Lim, is come out of her fears and face the bull by its head, by appearing at the panel and give an account of what happen in relation to having the interest of the patient at heart.
Conclusion
The challenge of ethical decision entails that counsellors and other practitioners in health care will definitely encounter challenges that misdirect them form an ethical perceive angle, so as to be an escape route for decision process. Application of these ethics to Dr. Lim plays a key role making assessing approaches that serve the best interest of everyone.
References
- Clark, C. D., & Weaver, M. F. (2015). Balancing beneficence and autonomy. The American Journal of Bioethics, 15(7), 62-63.
- Clifford, D. (2014). Limitations of virtue ethics in the social professions. Ethics and Social Welfare, 8(1), 2-19.
- Monteverde, S. (2014). Undergraduate healthcare ethics education, moral resilience, and the role of ethical theories. Nursing ethics, 21(4), 385-401.
- Schaefer, G. O. (2016). Code-consistent ethics review: defence of a hybrid account. Journal of medical ethics, medethics-2015.
- Singh, J. P., & Ivory, M. (2015). Beneficence/Nonmaleficence. The Encyclopedia of Clinical Psychology.
- Trevino, L. K. (1986). Ethical decision making in organizations: A person-situation interactions model. Academy of management Review, 11(3), 601-617
- Wagner, J. M., & Dance, M. D. (2015). Nursing ethics and disaster triage: Applying utilitarian ethical theory. Journal of Emergency Nursing, 41(4), 300.
- Wood, J. (2001). Ethical decision making. Journal of PeriAnesthesia Nursing, 16(1), 6-10.
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