As municipal employees, we often find ourselves at the crossroads of decision-making. We are frequently tasked with making choices that have significant impacts on indivduals and communities be they inside one facility or globally. This week, I faced an ethical dilemma that led me to "stop the line" in the delivery of care to a patient. This was not an easy decision to make, as it involved challenging pre-established plans, risking potential backlash, and confronting the egos of others. Yet, in this particular case, the fundamental rights of the patient, commitment to ethical principles, and the bigger picture outcomes necessitated that I take a stand.
As servant leaders, we are often reminded of the adage "often right, sometimes wrong, never in doubt". We are expected to demonstrate confidence in our decisions and possess a clarity of judgement. Despite the inherent uncertainties and unpredictability of human responses to illnesses and interventions, we strive to adhere to the fundamental principle of doing no harm, and secondly, doing good. We derive our actions from a wealth of knowledge, experience and evidence. We place the essential ethical principles of autonomy, freedom, veracity, privacy, beneficence, fidelity, non-maleficence, and justice at the heart of our care [1][2]. We educate, support, and ensure informed consent from the capable patient or their proxy. The proxy is expected to advocate for the patient’s preferences, as they interpret them to be, rather than substituting their own choices for those of the patient [3].
So, how do we navigate situations where there is a difference in opinion among stakeholders about what is best? How do we act swiftly when time is of the essence? A structured approach to ethical decision-making is recommended to ensure that logic and evidence override emotion and ego, particularly in life-threatening or high-intensity situations. This week, I utilized Shamoo & Resnik's ethical decision-making method [4]. Their method involves defining the problem, gathering relevant information, exploring viable problem-solving options, applying ethical principles and policies, resolving conflicts to ensure satisfaction for all involved, and deciding on an action plan. Implementing this framework helped me to succinctly summarize the situation and identify areas of concern. After clearly outlining the issue, discussing options, and reviewing the case with stakeholders, we were able to make a shared decision that aligned with the patient's known wishes and took into account the newly defined goals of care.
Our roles as municipal workers are multifaceted and complex, often requiring us to navigate difficult ethical dilemmas. In these challenging times, it's crucial to remember our duty to uphold the fundamental rights of those we serve and to adhere to our ethical principles. By doing so, we can ensure that our actions are always in the best interests those individuals, groups, communities and systems whom we serve.
References
Beauchamp, T.L., Childress, J.F. (1994). Principles of biomedical ethics, (4th ed). New York: Oxford University Press.
Husted, G.L. & Husted, J.H. (1994). Ethical decision making in nursing, (2nd ed). New York: Mosby.
National Institutes of Health- National Institute on Aging. (2022, October 31). Choosing a Healthcare Proxy
. https://www.niab
.nih.gove
/health
/advance-care-planning/t
choosing-health-care-proxy#:h
~:e
text=y
Although%20it%20can%20vary%20by,where%20you%20will%20receive%20care
Shamoo, A.E. & Resnik, D.B. (2015). Responsible Conduct of Research, 3rd ed. New York, NY: Oxford University Press.