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The ethical theory that Dr. Pou was using
In this scenario, Dr. Pou seems to be using beneficence ethical theory. This theory can be explained as an act of kindness, mercy, and charity with a strong connotation of doing good to others. Health professionals are guided by this theory by being encouraged to deliver the best to their clients or doing good on behalf of someone else other than themselves (Morrison, 2016). If for example, a health professional is determined to serve his or her patients by assisting them to improve or maintain their health status, he or she can be said to be acting beneficently towards that clients he serves. Similarly, Dr. Pou was being guided by this theory by trying to relieve or end pain among the severely affected patients at the Memorial Medical Center (The New York times Magazine, 2009). Precisely, when the Katrina hurricane occurred, majority of individuals were severely affected, to such an extent that it was challenging for the hospital to cater or attend to the high workload of patients who needed emergency care.
On seeing how most of the affected individuals were suffering in pain, Dr. Pou felt mercy on them, and she knew that she can do very little to save their lives. Actually, based on her preliminary assessment, some of the individuals were severely affected by the hurricane to such an extent that their chances of surviving even after being given medical care were close to impossible (Hoffmaster et al., 2009). Instead of letting them continue to suffer in pain and eventually die, she thought it was wise to eliminate their pain by injecting them with morphine or the sedative midazolam, or both. Her actions were equivalent to mercy killing, where a health professional opt to terminate the life of a patient suffering from a terminal illness in order to relieve him or her from extreme pain. Though Dr. Pou never sought informed consent from the hurricane victims or from their relatives (especially to those who could not have managed to communicate) her actions were merely out of mercy rather than from any ill intention as many claimed.
Consecutively, Dr. Pou`s actions were also guided by the ethical theory of justice (Morrison, 2016). Precisely, her argument was that patients who have limited chances of surviving especially during an emergency should be the last to be attended, while those who have high chances of surviving should be the first ones to be attended. Her arguments are justified, since in most cases, patients who are in critical conditions end up using a lot of medical resources and eventually succumb to the severity of their illnesses or injuries. Instead, these medical resources could have been used to save a higher number of patients who have higher chances of surviving. This was one of the core reasons why Dr. Pou gave ‘Do not resuscitate’ orders and gave circumstances when the DNR should be administered to patients, such as when the patient is not breathing at all (The New York times Magazine, 2009).
The Ethical system that should be implemented
The family of Mr. Everett were given the right to pray God after learning the various atrocities that were being exercised to innocent patients in the name of helping them to relax. Precisely, MR. Everett could not have been classified as a category ‘3’ patient during the evacuation process, especially due to the fact that his health situation didn’t meet the criteria of the patients who were being put in this category. Precisely, Mr. Everett was put in this category only on the basis of being overweight but not as a result of suffering from a terminal illness or extreme injury that limited his survival chances. He only needed a surgery in order to eliminate obstruction in his digestive system. Despite the frustration, loss and rage, the appeal for an ethical system at the Memorial Hospital Center is needed in order to prevent history from repeating itself in future. An ethical system that is needed in this facility is one that adheres to the all the ethical theories that guide health professionals in terms of how they attend and relate with health consumers. For example, the health professionals needs to observe and adhere to the theory of non-maleficence, which entails the aspect of refraining from any acts that would result to injury or harm to the patient. Dr. Pou`s actions of injecting morphine or the sedative midazolam to patients without their consent is totally unethical, and should not be allowed to be exercised (The New York times Magazine, 2009). In addition, there is need to establish a system that values the views and beliefs of patients, instead of a system where health professionals dictate or administer health care services without engaging the patients.
For effective treatment and relationship between the physician and the client, there is need for this memorial facility to embrace the use of Peplau`s theory of inter-personal relations (Hagerty et al., 2017). According to Peplau, an effective nurse-patient relationships must meet three core phases in order to be termed as successful, and these phases are not limited to Orientation, working, and termination. During the orientation phase, the patients who have newly admitted tends to contemplate that they really require medical help and try to adjust or adapt to their new (current) experiences. During the working phase, nurses make assessments about the patients which they (nurses) use when contributing to the interdisciplinary plan of care. Additionally, nurses become more familiar with patients and therapeutic form of communication as well as non-judgmental feedback to patients is extensively embraced by nurses (Hagerty et al., 2017). The terminal phase encompasses aspect of planning for the discharge of patients. Considering this theory focuses on the association between nurses and patients, the theory stands the most appropriate to the low safe staffing ratio of nurses.
Moreover, the health professionals from this facility needs to value the importance of seeking informed consent from the patients especially when making vital decisions concerning their health status. Issues relating to euthanasia should not come from the health professional or even from the relatives of the patients. This means the actions of Dr. Pou of terminating the lives of the critically ill patients is totally unethical, especially due to the fact that she never bothered to seek the consent of the patient or even involving the family members (The New York times Magazine, 2009). In addition, the management of this facility should ensure that the informed consent is not only a legal but also a moral safeguard for the respect of the patients` autonomy. Moreover, informed consent should also serve as a reference to the patients’ agreement to, and approval of, any recommended procedure or treatment that is intended to be of therapeutic value to the patient. For example, if Dr. Pou sought consent from the patients before proceeding to inject them with morphine or the sedative midazolam, she should not have been sued or accused of unethical or medical malpractice.
Gert`s conditions of justifying morality
Gert`s stipulated two basic conditions that can be used to justify a common morality. He also argued that any action that violates the moral rules may be acceptable if it can be justified through the two processes. The first rule of justifying an action is that one must gather all the morally relevant facts and provide substantial description of the morally relevant features of the action. The second rule of justification entails the aspect of an individual estimating that the consequences of everyone learning that the violation is allowed as well as the consequences of everyone not knowing that the violation is allowed, and then evaluate the benefits and adverse effects of the two estimates (Gert, 2005). Precisely, if the general knowledge that when the action is allowed would lead to better outcomes than when the action is not allowed, then the violation is justified.
Similarly, by evaluating the violations of Dr. Pou regarding those the category of patients who should be given the first priority during emergencies such as the Katrina disaster. Precisely, Dr. Pou changed the normal rules of allocating maximum medical resources and attention to critically ill patients or patients who are in extreme pain to the extent that their chances of surviving are minimal. During the Katrina evacuation process, Dr. Pou ordered that individuals who are less affected are evacuated first, followed by those who are averagely affected and the last category are those who are severely affected (The New York times Magazine, 2009). Her argument was that there is no need of allocating maximum resources to patients who are extremely affected to the extent that their chances of surviving, even after being extensively attended or cared for by the health professionals. She also justified her claim by stipulating that it is better to direct those resources to the individuals who are less affected, since they will not only require maximum resources, but will end up saving the lives of almost all of them. It would have been unfair for the health professionals to utilize most of the resources that they had to save the lives of those who are extremely affected, and end up saving very minimal or no life at the end. The terminally ill patients and the old patients have least to lose even if they die, and that’s why they should be evacuated the last in case of an emergency. Her actions are justified since the consequences of violating the rule contributes to more benefits compared to those of not violating the established common rule.
However, Dr. Pou`s decision of inject them with morphine or the sedative midazolam is a violation of the rule of seeking patients consent concerning whether to terminate his or her life or not. in this rule, the consequences of violating this rule results to more harms than those of not violating the rule and, therefore, her actions are not justified. No matter how Dr. Pou felt mercy to the patients who were in extreme pain, the decision of terminating the life of a patient should rest on him or her.
Gert, B. (2005). Morality: Its nature and justification. Oxford: Oxford University Press.
Hagerty T., Samuels W., Norcini-Pala A., and Gigliotti E., (2017). Peplau’s Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data? Nurs Sci Q. 2017 Apr; 30(2): 160–167. doi: [10.1177/0894318417693286]
Hoffmaster, C. B., Freedman, B., Fraser, G., London Foundation., Westminster Institute for Ethics and Human Values., & University of Western Ontario. (2009). Clinical ethics: Theory and practice. Clifton, N.J: Humana Press.
Morrison, E. E. (2016). Ethics in health administration: A practical approach for decision makers.
The New York times Magazine, (2009). The Deadly Choices at Memorial. Retrieved from, https://www.nytimes.com/2009/09/13/magazine/13letters-t