Bioethics of Reporting Intra-Operative Errors
Bioethics of Reporting Intra-Operative Errors
There are powerful forces working to transform the US healthcare provision system. For instance, there are numerous ongoing public debates about financing healthcare as well as insurance coverage access seeking to enhance the delivery of such services (Wu et al., 1997). Underneath it all, there is a more subtle most definitely the more important transformation process that is ongoing. This change revolves around the issue of healthcare delivery and management systems (Mavroudis, 2005). Such change not only involves health professional operations but also greater education research to foster desired learning outcomes so as to positively influence the improvement concerning healthcare quality.
Quality improvement with regard to the US healthcare apparatus has borrowed heavily from reform methods successful in other industries. Quality improvement in the contemporary healthcare provision is essentially driven by a wide body of medical research studies which have revealed the appallingly widespread prevalence of medical errors (Mavroudis, 2005). More so, the research studies have further revealed that there is a, astonishing lack of professional consistency concerning standards of care accorded to patients seeking healthcare services from different practitioners in different facilities (Wu et al., 1997). Quality improvement can be described as an innovative and by extension, an interdisciplinary crusade aimed at changing ingrained practices, attitudes and management paradigms which fail to address patient needs as well as those of patient families. Through quality improvement initiatives, the healthcare systems within the US are beginning to manifest significant progress in the delivery of associated services. As such, it is a process that integrates knowledge sourced from diverse healthcare disciplines like nursing, medicine, healthcare and medical services research as well as healthcare management (Wu et al., 1997). This has created an environment in which all the different professionals within the US healthcare apparatus are systematically mobilized to work in tandem with the primary aim of improving the current standards of care to new heights.
Focused and disciplined quality improvement efforts present favorable increases in the safety and effectiveness of standards in the healthcare system. More importantly, it seeks appraise professional sensitivity concerning the interests and rights of patients and more so, ethical responsibility by all players in the system (Wu et al., 1997). Prior to 2000, the aspect of ethics about quality improvement was not comprehensively addressed. It is also critical to point out that issues like the ethical values of disclosing medical errors were previously vaguely addressed. The ethical under consideration with respect to quality improvement in the healthcare sector include non-maleficence, beneficence and autonomy. As such, the bioethics of reporting intra-operative errors has been unsatisfactory in the past thus diminishing the general public’s confidence and trust in the entire healthcare industry in the country. This paper seeks to discuss means through which the reporting of intra operative errors is indeed a critical imperative that compels physicians to manifest practices, attitudes and management paradigms that reflect respect for patient autonomy (Wu et al., 1997). This will play a pivotal role in encouraging patients and their families and by extension, the general public in gaining trust as well as confidence in the services delivered by this particular industry.
The fiduciary nature of physician patient relationships supports that it’s a physician’s responsibility to ensure disclosure to a patient concerning a medical mistake (Wu et al., 2007). This fiduciary nature also conforms to the principles of patient autonomy, beneficence, justice and non-maleficence. The non-maleficence principle expressly states that the caregiver is solemnly responsible to ensure no harm affects a patient. The beneficence principle points out that physician should always act in the interest of a patient’s health. This is the case regardless of the fact that the physician fails to benefit from doing everything possible towards ensuring optimum patient health outcomes (Wu et al., 2007). For instance, is during a medical procedure such as a surgery a medical instrument remains in the patient, the physician has to ensure the foreign matter is professionally removed and infection controlled. Such an action however, calls for the physician to ensure full disclosure and a subsequent apology to the patient.
Regarding patient autonomy calls on physicians to ensure full disclosure where a mistake results in a patient suffering harm. According to Wu et al. (2007), full disclosure enables patients to become free from mistaken beliefs about their present, past or future medical conditions. This implies that even when a mistake is insignificant, disclosure can play a pivotal role in future medical intervention as he or she will be able to make informed decisions concerning their health (Mavroudis, 2005). Respecting patient autonomy implies that medical professionals are ethically obligated to communicate incidence of medical error to patients.
Adedeji, Sokol, Palser and McKneally, (2009) critically address the issue of ethics concerning reporting medical mistakes. By looking at issues about surgical complications, the authors describe medical errors as undesirable outcomes of a surgical procedure. Four primary medical ethics principles are discussed herein. They are in essence derived from four fundamental moral principles which are combining or used discretely to enable the medical profession to identify and consequently resolve arising ethical issues (Wu et al., 2007). As such, these principles are not considered as binding or hierarchically superior to each other. For instance, a surgeon or physician may opt to bypass prima facie obligations like seeking informed consent in situations requiring emergency surgery towards ensuring the health of a patient. The four basic principles which have been briefly described above are respect for a patient’s autonomy, beneficence, non-maleficence and justice.
Autonomy relates to aspects of an individual’s freedom to reach decisions founded on personal values and beliefs. As such, a physician is expected to honor a capable patient’s considerate wishes and thus, avail information that serves to enable patients reach logical decisions (Wu et al., 2007). Beneficence appertains to a physician’s Hippocratic vow towards ensuring services offered to patients are offered while ensuring these clients’ best interests. It is important to note that the concept on individual perceptions as to harm and benefit and thus, encompasses respecting patient autonomy. The non-maleficence principle appertains to the moral endeavor to ensure no harm comes to a patient in a physician’s care. It, however, has to be related to the beneficence principle as it involves ensuring physicians partake all options possible to avoid patients suffering harm (Wu et al., 2007). The justice principle involves the commitment towards the fair distribution of scarce healthcare resources. It also positively relates with respect for the universally accepted human rights and legislation.
It is from these 4 principles of ethics that more discrete rules and ethical standards are founded. Rules like respect for patient confidentiality, obtaining consent as well as avoiding deception are derivatives of the autonomy principle (Wu et al., 2007). The above stated principles cannot solve all ethical dilemmas in the medical profession conclusively. They, however, play a central role in creating fundamental moral considerations when systematically addressing the issue of