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Ethical dilemmas in a health care environment

An ethical dilemma is one in which you are forced to choose between two or more morally acceptable courses of action that have different consequences (that may be negative, or by choosing one path over the other you eliminate options for future care), or being forced to select between two or more equally undesirable options. Please describe a probable ethical dilemma that you will face in school or practice and how you would handle it. Also, comment on my or someone else's dilemma.

Here is one I faced:

The case:

A male patient aged 36, a career navy seal officer, presented with blurred vision and numbness in his hands. He said he has had it on and off for a while, but decided to come seek medical attention since it is interfering with his ability to do his job. He said his ophthalmologist didn't note any problems with his eyes and just gave him a new prescription. He stated that he is still having blurred vision, despite the new glasses. I asked him what particular duties he was having problems with and he stated that he was having a hard time using his respirator when diving and that he once lost his vertical orientation. Coupled with the numbness in his hands and the blurry vision, he was fearful that he might endanger his team. I agreed and then asked him why he didn't go to the base medical office. He said he thought he would get better care outside of the "military system", but I suspected it was because they would put him on desk duty until they determined the cause of his illness and if it turned out to be a chronic problem he would be on permanent desk duty or retirement. A physical exam thorough history led me to believe that he had multiple sclerosis. I informed him of my suspicions and that he would have to have further testing (MRI and blood work to start).

The dilemma:

His continued service would almost certainly put his team at risk, he needed to get care, and I cannot contact his superiors or medical doctor without his permission.

My decision:

I informed him of my suspicions about his condition, what testing and therapy would be available to him, and what the normal prognosis/natural history is of the disease. I also advised him to seek care within the military medical system, or to voluntarily remove himself from any activity that might endager his or someone else's life, and then I informed him that I was unwilling to see him as a patient unless he had informed his superiors of his condition as I would not be complicit by supporting his hiding this fact from his employers.

Solution Preview

Ethical dilemmas are always going to be present in a health care environment. Religious and moral beliefs often clash with medical treatment and patient's best interest. In the medical ethics case proposed, a patient is "suspected" to have a disease that can not only affect how he performs at work but also affect the well being of coworkers. The patient doesn't want to inform the employer of his symptoms for fear of losing his position. The doctor bound by confidentiality informs the patient what he should do to confirm the diagnosis, he advises to seek treatment under his employer's health plan, or to voluntary remove himself from a position that can cause harm to others and refuses to continue treating him unless he informs his superiors of his condition.

A patient and a physician are considered to be free to enter or not in a relationship, although the physician may be forced to see a patient in emergency situations. When a physician accepts to see a patient and the patient accepts being seen by the physician, they entered in a contractual agreement that carries both rights and responsibilities.

Related to this case the patient has the right to be informed in an honest and open way of his condition. He should be clear of any misconceptions or belief, and receive guidance of the appropriate course of action. He has the right to have control over the decisions related to his health care and to continuity of health care. With his rights comes a responsibility, the most important related to this situation is the responsibility of refraining from behavior that unreasonable ...

Solution Summary

A case describing an ethical dilemma in the doctor-patient relationship is discussed. It includes rights and obligations of each party when they enter a contractual relationship and discussion of conflicting options.

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