Health care rationing has been a significant topic of discussion in the debate surrounding the 2010 health care bill signed into law by President Obama. Although it remains uncertain whether rationing will occur, if it does, it will have a particularly significant impact on the elderly population. Government administrators or health care panels may potentially make decisions to restrict costly medical procedures for individuals above a certain age. Furthermore, similar decisions could extend to the level of care provided in assisted living facilities and nursing homes.
In the first scenario, a competent druggist encounters a prescription from a physician for a dangerous, highly addictive, and discredited medication. The druggist raises concerns with the physician, only to be dismissed and told to mind their own business. As the customer waits in the store, the druggist is faced with a moral dilemma. Should they refuse to fill the prescription? Should they inform the customer about the potential mistake made by the doctor? Should they report the incident to the medical board? After careful consideration, the druggist decides to go ahead and fill the prescription.
The second scenario involves a doctor working in a hospital emergency room on Halloween night. The doctor treats a 15-year-old boy whose eye has been injured by an exploding firecracker. During the course of treatment, the doctor becomes aware that the boy is intoxicated. Concerned about the extent of the injury, the doctor admits the boy to the hospital and notifies his parents. However, due to sedation, the parents fail to recognize their son’s intoxicated state upon arrival. Despite this, the doctor informs them about their son’s alcohol consumption.
In the third scenario, a psychiatrist is treating a severely disturbed and potentially violent individual. One day, the patient confesses to the psychiatrist that he has persistent thoughts of randomly killing a stranger. He provides detailed plans on how he intends to carry out the crime. A few days later, the psychiatrist reads in the newspaper that the exact same crime described by her patient has occurred. She is convinced that her patient committed the crime, as every detail aligns with his previous revelation. Although the psychiatrist would like to report this to the police, she ultimately chooses not to.
These scenarios highlight ethical dilemmas faced by healthcare professionals in their day-to-day practice. Each vignette presents a complex situation where the professionals must navigate conflicting values and responsibilities. In the first scenario, the druggist is torn between respecting the autonomy of the prescribing physician and ensuring patient safety. Although the druggist may have concerns about the potential harm caused by the medication, they ultimately decide to defer to the authority of the physician.
In the second scenario, the doctor confronts a situation where they must balance the duty to provide medical care with the obligation to inform parents about their child’s substance abuse. Despite the parents’ inability to detect the intoxication due to sedation, the doctor believes it is important to communicate the information to facilitate appropriate follow-up care and intervention.
The third scenario delves into the realm of psychiatry and the dilemma faced by the psychiatrist when she becomes aware of her patient’s intentions to commit a serious crime. This case highlights the tension between confidentiality and the duty to protect potential victims. Although the psychiatrist strongly suspects her patient’s involvement in the crime and acknowledges the potential harm to others, she ultimately decides not to breach confidentiality and report to the police.
These scenarios underscore the complexity of healthcare ethics, where professionals must grapple with conflicting moral principles and navigate the intricacies of their respective fields. Decision-making in healthcare involves considering the values of patient autonomy, beneficence, non-maleficence, and justice, among others. In each case, the healthcare professionals make choices guided by their understanding of these ethical principles and the particular circumstances at hand.