The Ethical Decision-Making Process
All healthcare providers struggle to establish ethical decision-making standards that provide guidance in a challenging practice environment, and the challenge is not unique to case managers. One threat to ethical practice arises from within each profession as a result of materialistic self-interest and from the outside in terms of profit motivation. An example of an ethical dilemma that didn’t exist decades ago but now does due to technology is the result of scientific advances such as mapping of the human genome. Advances in technology made possible some procedures that raise ethical issues as to whether certain things should be done just because they are possible (eg, cloning of animals or even of people).
A wealth of literature exists on the subject of ethical decision-making. A search of this literature reveals that professionals are inconsistent in ethical decision-making (Singer, 2005). The literature speaks of the “science” of decision-making but cautions that human limitations result in inconsistencies in their decision-making skills that professionals acknowledge.
An additional dilemma is that various healthcare professional groups all have different codes of ethics depending on their perspective. For example, physicians focus on “First, do no harm,” while a hospital administrator’s code of ethics focuses on fair and judicial allocation of resources. For generations, the code of ethics for anyone in medicine was based on the physician’s Hippocratic oath. Gradually, healthcare specialties began to develop their own codes.
While they were helpful to establish guidelines, the wide variety and range of codes often created confusion for interdisciplinary groups. In 2000 a group of multidisciplinary healthcare professionals gathered together at Tavistock, England to create one ethics code for all healthcare professionals. This new code, is a step in the right direction to improve quality of care, collaboration, and continuity of care (Stanford & Conner, 2012).
Decision-making is a complex process that involves time needed to think critically with the goal of decreasing uncertainty. At some point, if action was not taken the decision will be made by default. Note that failure to make a decision may place the patient in a potentially harmful situation.
Ethical decision-making is the integration of ethical principles with practical wisdom. Codes of ethics are generally broadly written. They help to identify issues, but they are not meant to serve as a methodology for ethical decision-making. To recognize an action and decide on that action requires both knowledge and skill in the art of ethical decision making.
Patients have the right to expect that their healthcare providers are involving themselves in thoughtful deliberation of ethical issues, with a commitment to take reasonable and rational action. These steps warrant the trust of the patient and society. Unethical, self-serving behaviors result in a loss of trust by patients and their families.
End-of-life issues, caregiver burnout, and right-to-choose plans often challenge the medical team, patients, and families to make complex ethical decisions. This is made even more challenging when the issues involve more than one generation; they may have the same interests at heart but prefer different expressions of them.
Setting priorities is a strategy for all those who are working together to protect a patient’s best interest. Case managers can rely on an ethical decision-making model that is similar to the nursing process, which comprises the steps of collecting data through assessment, defining the problem, identifying possible actions and solutions, implementing the actions, and evaluating the effectiveness and results.