SECTION 1 INTRODUCTION
Ethical dilemma implies for the obstacle in decision making process while choosing between two or more alternatives. Confidentiality, informed consent, patient autonomy, dignity and respect and equality and diversity are various ethical issues in Health and social Care (Ethical Issue in Health and social care, 2023). The current essay is based on analysis of two Health and social care case studies on the basis of ethical dilemmas. This will also include role of ethical principles and personal and professional values for identifying solution.
Case study 1
Charlie Grad’s case studies:
Charlie Grad was born on 4 Aug 2016 who was suffering from the rare genetic condition known as encephalomyopathic mitochondrial DNA depletion syndrome (MDDS). He was diagnosed at Great Ormond Street Hospital (GOSH) but there was no improvement in his health condition and eventually his heart, liver and kidney also got impacted due to which he was ventilated. His parents want to get experimental therapy called nucleoside Bypass therapy in US for which they has raised 1.3 million pound (Charlie Grad case, 2024). Doctors in GOSH examined the child’s situation and concluded that travelling in such situation is not safe for him. However, GOSH has made an ethical permission for attempting therapy which requires huge time and by that time Charlie’s situation has worsen. After consulting with large number of doctor, it was concluded that ventilators should be switched off and Charlie should be died with dignity. This case went to court in which Charlie’s parent did not want to switch off supporting system whereas both Supreme and European Court concluded that he should be allowed to die. However, US doctor believes that they could treat Charlie if they would be provided opportunity at right time. Charlie’s parents have filed a case against GOSH for not allowing them to visit US for their child treatment and lastly support system was switched off and Charlie dies.
Case study 2
David Tracey’s V Cambridge University Hospital NHS:
On 5th February 2011, Mrs Tracey was diagnosed with lung cancer and estimated that she could live for approximately nine month. However, on 19 February she was suffering with serious cervical fracture due to the road accident and this eventually leads to developing chest infection & pneumonia due to which she died on 7 March 2011. This leads to development of factual dispute between clinician and Mr Tracy as Do not Resuscitate (DNR) order was passed without consulting with patients (David Tracey V Cambridge University Hospital NHS, 2023). Organization claimed that Mrs Tracey’s daughter has agreed to not provide DNR due to which such treatment has not been offered but later on she denied. However, Mr Tracey claimed that Hospital trust has violated Articles 8 of European convention of Human right which stated that each individual should be provided right to take decision for his own life (Article 8 of Human right, 2023).
Ethical issues in Case studies
In the first case, beneficence and Non-maleficence are the two ethical principles which followed by GOSH due to which Charlie was not allowed to send US. According to principle, it was their moral duty to undertake action which will provide the utmost good care to patients and do not create additional harm (Albert, Younas and Sana, 2020). However, Charlie’s parents believe that it was there intentional action as to earn 1.3 million pound that eventually end up their child’s life.
On the other side, in the second case, consent and autonomy was the major ethical issue which confront by the professionals in NHS. Mr Tracey complained that Organization has not consulted with them regarding DNR which has results in dead of his wife. Moreover, professional in NHS articulated that their daughter has demanded for DNR due to which such services were not provided. Professional was aligning with principle of autonomy due to which they have not questioned daughter’s wish. However, this creates ethical dilemmas as DNR increase the risk of Death but they could not undertake action against the will of patient’s family member.
SECTION 2
ROLE OF ETHICAL PRINCIPLES, PROFESSIONAL’S ETHICS, CODES OF CONDUCT AND LEGISLATION
Case study 1
Utilitarianism theory of morality which emphasises on actions which should be undertaken that helps in fostering pleasure and happiness and oppose action that could cause harm and unhappiness (Ale, Slater and Hartford, 2023). Deontology is another ethical theory which stated that actions could be defined as good or bad on the basis of set rules rather than its consequences. In the context of Charlie’s case, GOSH has undertaken actions on the basis of Utilitarian thinking due to which they have not allowed Charlie to visit US. However, undertaking deontology theory does not provide information regarding ultimate consequence of particular action which result into taking inaccurate decision. As Professional in GOSH are involved in Utilitarian thinking, they were well aware that allowing Charlie to US will result in deteriorating his condition due to which they has taken decision of not allowing them and rather signed an ethical form which will help in solving all dispute in future. This thinking is most effective as it clearly evaluate potential impact of particular actions which facilitates in taking most ethical decision leading to enhancing health condition of the patients.
Social justice implies to the perception in which each individual is deserved to have equal economic, political and social opportunities. It also plays critical role in taking the most accurate decision as it guide professionals to take decision without considering race, culture, religious, age and gender of the patients. In this context, GOSH has undertaken Human right concept while taking decision in which Charlie is having right to get accurate treatment (Anyanwu et al, 2024). However, restricting parents from not taking Charlie outside UK, abstained him from getting adequate treatment which eventually results in deteriorating his health condition. On the other hand, idea of social justice also guide professionals to take decision after involving all the stakeholders which guides them in formulating most accurate policies while managing overall dignity and integrity of patients. In this case, Charlie’s parents were given equal autonomy to take decision but due to ethical dilemmas and issue, they were asked to clear all the ethical formalities before transferring Charlie which has resulted in negatively impacting on his overall health condition.
All the decision regarding patient’s life and welfare is taken after aligning with principle of human rights which ensures that patient’s rights should not be snatched away while taking any decision. In case of Charlie, Right to life principle has helped professional in determining accurate solution for prevailing issue. According to principle, every individual is having right to live and their rights could not taken away except in accordance with prescribe legal procedures (Greaney and O’Mathúna, 2024). This article of human right guides GOSH in taking decision by which life of Charlie could be saved and ethical dilemma could be resolved. Based on this principle, professionals were able to decide that Charlie should not be transferred at this point of time as it results in snatching away rights of life.
The UK’s mental capacity Act (MCA) 2005 also plays a significant role in guiding professional to take most accurate decision regarding the patient health (Mental Capacity Act 2005, 2023). Under this, family members are given rights to take decision on the behalf of all the patients that lack capability to make rational decision. In the current case, this legislation help GOSH in making accurate decision as Charlie is unable to take decision due to which his parent’s decision were treated as final. However, according to principle 4 of this act, decision should be taken which will be in best interest of the patients. So, the decisions of parents were not optimum as using an experimental therapy could result in hampering condition of Charlie (Grosek et al, 2020). Moreover, this legislation provide GOSH with an opportunity to guide parents and other family members while taking decision which help in overall welfare of patients.
Case study 2
In the context of David Tracey’s, Deontology thinking has been adopted due to which they have followed DNR order even after knowing best practices for patient’s welfare. This thinking helps professional and healthcare organization to avoid any type of legal dispute and support in promoting overall dignity and autonomy (Kooli, 2021). This thinking helps professionals to align with ethical framework and support in avoiding all type of issue in upcoming time. However, NHS professional has not focused on clearly communicating all the actions and rationale behind such decision to family members of Tracey which creates legal obligations. On the other hand, if professional would align with utilitarian thinking than they will involve in evaluating consequence of DNR based on which most accurate action could be taken. This thinking would helps in maintaining autonomy of patients and also aids in avoiding any type of legal obligation for company.
Social justice has been followed in the Mrs Tracey’s case as she was not provided an equal opportunity to take decision for her own. Idea of social justice guide professional to carefully listen to the patient’s perception and needs which aids them in taking most accurate decision (Tudy, 2020). However, social justice has not been efficiently followed within this case as even after knowing potential consequence of DNR for Mrs Tracey, professional have not emphasis over changing her decision. Along with this, Social justice includes four crucial principle that are access, equity, human rights and participation which were not adequately followed by professional. In this context, NHS is violating Human right articles 8 which indicate that lack of social justice results in inaccurate decision. Moreover, organization should have taken various actions that include consulting with other member’s family, notify her daughter regarding the consequences of decision, and define DNR policy which help in taking most reliable and accurate decision.
Principle of Human right helps in defining all the potential impact of particular decision on individual’s right which aids in taking most accurate decision. Professionals are involved towards evaluating all the decision on the basis of Human rights principle which help them in determining all the potential impact of each strategy and decision. In the current case, NHS was able to adequately align with Human right Act 1988 as their actions were not aligning with Article 8 (Human right Act 1998, 2024). The court concluded that Mrs Tracey’s right to respect for private life have been violated due to which NHS needs to face higher legal consequences. Court stated that it was unlawful action of NHS to initiate DNR without consulting with Mrs Tracey. However, if NHS professional have adequate information regarding Human rights than they would have adequately communicate the information to family members which could help them in avoiding such legal issues.
According to the legislation, if a patient is unable to take decision for their own then the family members should be provided with adequate authority to take decision while prioritizing patients’ welfare (van Loon et al, 2021). In the current case, Mr Tracey was not provided with autonomy to take decision which indicates violation of Mental Capability Act 2005. In accordance with this, NHS professional were well aware that DNR will result in deteriorating health condition of the patients but then also they have not taken any actions. This indicates that decision was not taken while considering the best interest of the patients which eventually impact on overall welfare and health condition of Mrs Tracey. This also denotes that principle 5 of Mental Capacity Act was also violated as instead of taking suggestion from Mr Tracey, professional has followed daughter’s opinion which creates issue in delivering adequate treatment.
SECTION 3
ROLE OF PROFESSIONAL AND PERSONAL VALUES IN DETERMINING SOLUTION
Case study 1
Virtue ethics refers to carrying out action which will help in providing good consequences in future (Farrow, 2020). In the current case study, Charlie, his parents, GOSH, Professor Hirano, Supreme and European court were involved. There were large numbers of ethical dilemmas which were faced by all the interested parties which are as follows:
Charlie’s parents: They were ready to take him US but the guideline of GOSH doctor creates issue in identifying most optimum decision for him (Cammaerts, 2022). Further, they have agreed for experimental therapy with the view of Charlie’s interest but this defines that parent have not prioritized Charlie’s interest while taking decision.
GOSH: There was disagreement within perception of physicians and parents which creates ethical issue in taking most accurate decision for Charlie. GOSH believe that involved in experimental therapy will risk life of Charlie, however opposing to patient’s parents was also an ethical issue for the organization.
Professor Michal Hirano: He is professor at Columbia university Medical centre which articulated that child could; be improve within 11 month after provided with Experimental therapy. This statement was not supported with an evidences rather it indicates his financials interest.
Supreme and European court: The legislations are present with the aim of offering equal rights to each citizen within country (Blanco et al, 2020). However, it was ethical dilemma for court to identify whether the claim of GOSH to switch off ventilator is accurate or not.
It has identified that virtue plays a crucial role in taking accurate decision in the case of Charlie. Professionals of GOSH were virtuous due to which they have decided to opposed the parent’s decision and stick to the actions which will help in overall welfare of the patients. Moreover, they have also suggested switching off ventilator so that child could die with dignity as there was no available alternative by which child’s condition could improve. However, doctor could agree with parents and allow them to transfer child to US but they did not compromise with Virtue and filed a case to get most accurate decision. This indicates that virtue ethics helps in clarify actions on the basis of rights and wrong which help in taking most accurate decision (Eneanya et al, 2022). On the other hand, it has identified that non alignment with virtue ethics result in taking decision which eventually impact on the well being of patents. Professor Hirano was focusing on his personal financial benefit due to which he suggested an experimental theory to his parents. He was concentrating over gaining 1.3 million pound due to which he misguide Charlie’s parents and forced them to take irrelevant decision.
From the above case study, it has been identified that inadequate thinking abilities create huge influence in ethical dilemmas (Harrison and Laco, 2022). Charlie parents were not able to understand the risk associated with experimental therapy rather emphasis on initiating such therapy which will eventually give rise to ethical dilemma.
Case study 2
There were four crucial people included in the case study which Mrs Tracey, Mr Tracey, their daughter, NHS professionals and Supreme court. Following are various perceptions of different people regarding ethical dilemma:
NHS professional: Mr Tracey daughter have asked for DNR due to which professional were not able to take adequate actions even after knowing its consequences.
Mr Tracey and Daughter: According to their view point, NHS professional has deliberately not conveyed information regarding DNR which has resulted in death of Mrs Tracey.
Supreme Court: They perceive that there was lack of adequate guidelines regarding DNR which has resulted in generation of ethical dilemma (Shaw et al, 2021). Due to this context, Court has provided new guidelines in which reason for DNR should be clearly stated and the rationale for not involving patients should be conveyed before taking decision.
Virtue ethics play a crucial role in taking adequate decision by defining potential negative and positive of particular decision (Russell, 2023). It has been identified that virtue ethics were not adequately followed in the current study as professionals were not concentrated over clarifying potential impact of DNR to patients. They were also focused over communicating this information to family member as this could create negative impact on overall health situation of patients. Moreover, it was stated that Daughter of Mr Tracey was also not aligning with virtue ethics due to which she denies the information regarding DNR. So, it has been identified that alignment with Virtue ethics guides people to take actions against ethical principle and support them in enhancing welfare of patients. A virtuous individual will prioritize best interest of patient while providing services which aids in enhancing overall quality of decision making.
Along with this, difference in perceptions is major factor which influences individual’s opinion regarding ethical dilemma. At the time of Ethical dilemmas, NHS professionals would have considered long lasting consequence of particular decision rather than focusing over fulfilling ethical principle which would allow them to overcome such legal obligation (Hindocha and Badea, 2022). However, they have explicated that taking actions against family wish would create huge liabilities on them due which they have used DNR. This denotes that diverse interpretation of similar issue could results in taking unrealistic decision for overcoming ethical dilemma.
SECTION 4 DISCUSSION AND CONCLUSION
From the above case studies, it has been identified that ethical dilemmas needs to be accurately handled as it could eventually impact on overall health and welfare of the patients. From the Charlie’s case study, it has been depicted that health professional should go against ethical principle if family’s decision are not in interest of patient’s welfare. Further, second case study describe that lack of consent, autonomy and communication could be major reason behind developing ethical issue within health and social care. It has been stated that Virtue framework, duty framework and consequentiality framework are necessary while encountering ethical dilemma in healthcare. This framework will guide them in evaluating each action on positive and negative basis which helps in effectively evaluating all the ethical issue. It has been determined that conservatism behaviour, NHS professionals and patients has created huge impact on overall; decision making in the above case. If GOSH has been confident in adapting to experimental therapy and did not waste time in ethical practices then it could be possible to save Charlie. From the above case, it has been recommended that adequate communication is the major strategy by which any legal obligations and ethical dilemmas could be adequately conquered. Along with this, the entire healthcare professional should take written consent from family members and describe reason behind issue of DNR which aids in avoiding any ethical issue in upcoming time.
Ethics-based health and social care case studies demand critical reasoning, accurate application of ethical theories, and clear linkage to legislation and professional values. If you need assistance structuring arguments, strengthening ethical analysis, or ensuring academic clarity and compliance with marking criteria, professional assignment help can significantly improve the quality and impact of your work.
REFERENCES
Books and Journals
Albert, J.S., Younas, A. and Sana, S., 2020. Nursing students' ethical dilemmas regarding patient care: An integrative review. Nurse education today, 88, p.104389.
Ale, B.J., Slater, D.H. and Hartford, D.N., 2023. The ethical dilemmas of risky decisions. Risk analysis, 43(2), pp.219-233.
Anyanwu, E.C., Okongwu, C.C., Olorunsogo, T.O., Ayo-Farai, O., Osasona, F. and Daraojimba, O.D., 2024. Artificial intelligence in healthcare: a review of ethical dilemmas and practical applications. International Medical Science Research Journal, 4(2), pp.126-140.
Blanco, C., Wiley, T.R., Lloyd, J.J., Lopez, M.F. and Volkow, N.D., 2020. America’s opioid crisis: the need for an integrated public health approach. Translational Psychiatry, 10(1), p.167.
Cammaerts, B., 2022. The abnormalisation of social justice: The ‘anti-woke culture war’discourse in the UK. Discourse & Society, 33(6), pp.730-743.
Eneanya, N.D., Boulware, L.E., Tsai, J., Bruce, M.A., Ford, C.L., Harris, C., Morales, L.S., Ryan, M.J., Reese, P.P., Thorpe Jr, R.J. and Morse, M., 2022. Health inequities and the inappropriate use of race in nephrology. Nature Reviews Nephrology, 18(2), pp.84-94.
Farrow, K., 2020. Policing the pandemic in the UK using the principles of procedural justice. Policing: a journal of policy and practice, 14(3), pp.587-592.
Greaney, A.M. and O’Mathúna, D.P., 2024. Patient autonomy in nursing and healthcare contexts. In Key concepts and issues in nursing ethics (pp. 85-103). Cham: Springer Nature Switzerland.
Grosek, Š., Kučan, R., Grošelj, J., Oražem, M., Grošelj, U., Erčulj, V., Lajovic, J., Borovečki, A. and Ivanc, B., 2020. The first nationwide study on facing and solving ethical dilemmas among healthcare professionals in Slovenia. Plos one, 15(7), p.e0235509.
Harrison, T. and Laco, D., 2022. Where’s the character education in online higher education? Constructivism, virtue ethics and roles of online educators. E-Learning and Digital Media, 19(6), pp.555-573.
Hindocha, S. and Badea, C., 2022. Moral exemplars for the virtuous machine: the clinician’s role in ethical artificial intelligence for healthcare. AI and Ethics, 2(1), pp.167-175.
Kooli, C., 2021. COVID-19: Public health issues and ethical dilemmas. Ethics, Medicine and Public Health, 17, p.100635.
Russell, C., 2023. Virtue Ethics. In Global Encyclopedia of Public Administration, Public Policy, and Governance (pp. 13255-13260). Cham: Springer International Publishing.
Shaw, E., Walpole, S., McLean, M., Alvarez-Nieto, C., Barna, S., Bazin, K., Behrens, G., Chase, H., Duane, B., El Omrani, O. and Elf, M., 2021. AMEE Consensus Statement: Planetary health and education for sustainable healthcare. Medical teacher, 43(3), pp.272-286.
Tudy, R.A., 2020. The ethical dilemma among healthcare professionals in the midst of COVID-19 pandemic. Eubios Journal of Asian & International Bioethics, 30(5).
van Loon, J., Luijkx, K., Janssen, M., de Rooij, I. and Janssen, B., 2021. Facilitators and barriers to autonomy: A systematic literature review for older adults with physical impairments, living in residential care facilities. Ageing & Society, 41(5), pp.1021-1050.
Online
Article 8 of Human right. 2023. Online. Available through: < https://www.equalityhumanrights.com/human-rights/human-rights-act/article-8-respect-your-private-and-family-life#:~:text=England-,Article%208%20protects%20your%20right%20to%20respect%20for%20your%20private,and%20emails%2C%20for%20example).>
Charlie Grad case. 2024. Online. Available through: < https://www.bbc.com/news/health-40554462>
David Tracey V Cambridge University Hospital NHS. 2023. Online. Available through: < https://www.bbc.com/news/health-27886265>
Ethical Issue in Health and social care. 2023. Online. Available through: < https://studyrocket.co.uk/revision/level-3-health-and-social-care-btec/meeting-individual-care-and-support-needs/ethical-issues-and-approaches#:~:text=Common%20ethical%20issues%20include%20patient,their%20own%20healthcare%20and%20wellbeing.>
Human right Act 1998. 2024. Online. Available through: < https://www.equalityhumanrights.com/human-rights/human-rights-act#:~:text=The%20Human%20Rights%20Act%201998,the%20UK%20in%20October%202000.>
Mental Capacity Act 2005. 2023. Online. Available through: < https://www.legislation.gov.uk/ukpga/2005/9/contents>
