Running Head: ETHICAL PROBLEM 1

HA570-2: Assess national regulations regarding confidentiality and ethical considerations

of confidentiality laws

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ETHICAL PROBLEM 2

Introduction

Summary of the story of Beth Tottle, Mrs. Uwilla, and Uwilla Family

The story revolves around Mrs. Uwilla and her family regarding her condition after

collapsing on the sidewalk while walking with her daughter. After diagnosis, the physicians

determined that Mrs. Uwilla suffered a severe subarachnoid hemorrhage due to the rupture of

cerebral aneurysm. Mrs. Uwilla was immediately hospitalized and commence the treatment such

as undergoing lifesaving and emergent hemicraniectomy which is procedure of removing a

portion of the skull bone to allow for brain swelling (Doherty & Purtilo, 2015). To speed up the

treatment and recovery process, Mrs. Uwilla underwent placement of a gastrostomy tube (G-

tube) and a tracheostomy. Since she was responding well to the treatment, Mrs. Uwilla was

successfully removed from using mechanical ventilation. However, she was too weak to eat in

her own and as a result, she was fed through G-tube. Even after taken off from mechanical

ventilation, Mrs. Uwilla remained immobile and nonverbal as well as maintained a very low

level of consciousness.

Beth Tottle was assigned as case manager who ensured that clinical conditions of Mrs.

Uwella was up to date. She was also responsible for coordination of a safe discharge of treatment

plan for all the patients who were admitted at neurosurgery unit. Mrs. Uwilla’s daughter, Mica

was unable to be with her mum fulltime because she had just delivered her baby and she was still

recovering. As a result, Beth recommended to Mica for her brother to come from Haiti to the

United States to aid care for her mother (Doherty & Purtilo, 2015). Rene arrived at the United

States 1 month after his mother had been hospitalized. Upon arrival family/team meeting was

immediately schedule where the progress of Mrs. Uwilla treatment and recovery process was
ETHICAL PROBLEM 3

outlined in details. During the meeting, resident physician informed Rene that decision urgent

decision was needed about the future management of Mrs. Uwilla.

One of the recommendations to Mrs. Uwilla family was that his mother should not be

placed on resuscitate (DNR) in case her heart stopped beating. The recommendation from the

rehabilitation team was since Mrs. Uwilla was not a United States citizen, she was not eligible

for medical insurance, thus making rehabilitation option very minimal (Doherty & Purtilo,

2015). They informed Rene to consider taking her mother back to the Haiti. Rene was not happy

about these recommendations and he outrightly disagree with the team since she was not

prepared to manage all of them at that time, a reaction that got the team off guard.

Analysis of the varied perspective in all the parties involved in the story indicated that

there was miscommunication between the care team and Mr. Rene. Communication is crucial

when dealing with ethical issues in health care. As ethics dictates that informed consent must be

there before any action is taken regarding the welfare, treatment and management of the patient.

From the on-set, Beth and the entire care team must accurately analyze the reaction of Mr. Rene

because he must have reacted that way due to future uncertainty of his mother’s recovery

(Doherty & Purtilo, 2015). In addition, Mr. Rene wanted to inform the Beth and care team that

he was not the only person the family that makes decision regarding the medical condition of his

mother.

The communication between Beth, care team and Mr. Rene indicated that there is a

difference in power. These differences can be minimized when all parties involved engaged in

shared decision-making model. Studies have showed that despite the efforts put in place to

enhance shared decision-making practice, there is not clear communication between the

healthcare professionals and the families as well as patients. It is ethical principle for the
ETHICAL PROBLEM 4

healthcare professionals to be very sensitive and implicit to the unspoken messages that are

contained in language (Elwyn, et al., 2012). This must be applicable to all verbal communication

between individuals. For example, Mr. Rene outrightly asked Beth and care team “you asking

me to kill my mother?” Being a religious person, Mr. Rene reaction could have been influenced

by his spiritual or religious beliefs. Also, being Haitian, the perception of the elderly in both

countries differ because there is perception that Americans do have much regards to the elderly

and they should be allowed to die.

The other aspect that came out clearly from this story is the fact that Mr. Rene and his

family and Beth and care team comes from different cultures. Its ethical principle and morally

right for the health professionals to acknowledge the difference in culture. For example, Beth and

care team all practice under Western culture which is predominately white (Manyonga, et al.,

2014). From the team, there was no person in the care team from the Haitian original, thus

creating a conflict in cultural background. In the meeting, it was clear that Beth and care team

had no prior knowledge what disability or illness means in the Haitian’s culture. Therefore,

culture is one of the elements that should be acknowledge and accurately considered as ethically

relevant information since it plays a crucial role in decision-making process.

From the story, it was also evident that Mr. Rene’s anxiety was heightened by the feeling

of insecurity and helplessness due to uncertain prognosis of his mother. It is important to

understand that not patients and families alone are uncomfortable with uncertainty, health

professionals find it difficult to deal with any medical condition that present uncertainty (Elwyn,

et al., 2012). To minimizes all these differences, it is important for the healthcare professionals

to gather all the information about the cultural difference, communication strategies and

uncertainty of prognosis to enhance decision-making process.

The ethical standard relevant to this unique scenario is communication. Communication

has been described by many scholars as a key foundational aspect of therapeutic relationships.

Evidence-based studies have indicated that effective communication is a critical tool for

improved behavioral and psychosocial outcome, adherence to treatment regimes, improved

patient knowledge and successful treatment plan (Doherty & Purtilo, 2015). Communication

takes place at different levels and in various ways. People communicate frequently and they

neglect to acknowledge the importance of it in their working place especially in health care

setting. Communication occurs through language, written and spoken words. Sometime,

communication occurs nonverbally when it involves the use of mannerism, gestures and body

language.

In the scenario, miscommunication let to ethical problems between Beth, care team and

family of Uwilla. The essence of communication in health care is to achieve successful

information exchange and transfer. Health care professionals use communication to advice and

inform the patients and their families. To achieve effective communication, health care

professionals, patients and families must engage in active listening (Manyonga, et al., 2014).

This is where the health care professionals, patients and families listen to each nonverbal and

verbal. Active listening also includes the use of cues in the communication process. In addition,

active listening also involves validating and responding to information to achieve an

understanding.

Health care professionals uses communication to partnering, decision-making,

coordinating, collaborating and educating. Further studies have shown that through effective

communication, health care professionals are able to build a relational dynamic with patients and

their families thus facilitating shared decision-making (Elwyn, et al., 2012). The concept of
ETHICAL PROBLEM 6

shared decision-making is achieved when the parties involved in decision-making adheres to

underlying assumption of joint interest and mutual respect. It is moral principle for the health

care professional to share information with the patients and their families effectively and in

respective manner. Through the concept of shared decision-making, health care professionals,

patients and families are able to arrive at the best decision option.

There are several laws and regulations that govern communication practice in clinical

setting. These allows requires the healthcare professionals to actively engage the patients and

their families before making any decision regarding their treatment and management (Manyonga,

et al., 2014). These laws and regulations are under public and private communication act as well

as the act of privacy and confidentiality. All the health care professionals as well as the patients

and their families must communicate within the confines of these laws and regulations. Any

breach to these laws and regulations attracts penalty in the court of laws.

The six-step process in communication are: gather relevant information, type of ethical

problem, use ethical theories or approaches to analyze, explore practical alternatives, act and

reflect.

- Gather relevant information: It very crucial for the health care professionals to collect all

the relevant information about the condition of the patient such as the progress of the

treatment, the cultural backgrounds, eligibility to insurance and the future complications.

This first step ensures that uncertainty is minimized between the health care

professionals, patients and their families. Through these process, ethical problem is

eliminated in the decision-making process using shared decision-making model.

- Type of ethical problem: The identification of ethical problem helps the health care

professional to identify appropriate solutions to the problems. Type of ethical problem is

identified based on the condition and the situation the patient and the health care

profession are facing at that moment. This process is very critical because failure to

identify the ethical problem makes it challenging to apply relevant regulations and laws

to solve the problem.

- Use ethical theories or approaches to analyze: In the scenario of Mrs. Umilla family,

shared decision-making model is the ethical approach that can be used to resolve the

problem of miscommunication. If the Beth and care team could have embraced shared

decision-making model during the meeting with Mr. Rene, the best decision could have

been reached. This means the existing ethical dilemma could have been resolved without

any uncertainty.

- Explore practical alternative: In addition to the use of ethical theories or approaches to

analyze the problem, health care professionals should explore practical alternative that

can provide solutions to the problems. This enhance problem solving techniques and

speed up treatment and recovery process.

- Act: It is important to solve ethical problems using techniques and approaches governed

by the laws and regulations. Acts ensures that health care professionals operates within

the confirm of the law and regulations.

- Reflect: Reflection is a critical process since it enables health care professionals to

identify previous mistakes and improve in the future processes.

References

Doherty, R. & Purtilo, R. . (2015). Ethical Dimensions in the Health Professions (6th Edition).

Elsevier Science.

Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Llyod, A., Kinnersley, P., Cording,

E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A. & Barry, M. (2012). Shared

Decision-Making: A Model for Clinical Practice. Journal of General Internal Medicine,

27(10): 1361-1367.

Manyonga, H., Howarth, G., Dinwoodie, M., Nisselle, P. & Whitehouse, S. (2014). From

Informed Consent to shared Decision-Making. South African Medical Journal, 104(8):

ISSN 0256-9574.