Case Study Background

Write about an Ethical Dilemma for Broad Philosophies of Ethical Theories.

Ethics in today’s world is a very debatable yet pertinent and widely spoken issue. Often the words ethics and laws are used interchangeably, but there is a subtle difference between the two. Ethics refer to the social norms based on moralities and values and are not subjected to any sort of punishment if violated. Contrarily, laws are established rules and regulations that may result in penalty and trial if not abided. In the healthcare sector, a thorough understanding and awareness of the prevalent laws and guidelines in conjunction with the professional codes of conduct in the respective disciplines are imperative to foster improved healthcare facilities and ensure speedy recovery and well-being of the patients receiving care (Henaghan, 2012). In this context, the role of the healthcare professionals and their attitudes and actions towards their jobs may be considered pivotal to establish effective care programs (Wickramasinghe, Moghimi, & Schaffer, 2015). However, sometimes situations pose barrier to carry out one’s task smoothly due to conflict of interest arising out of mental perceptions as to follow the moral imperatives or not. This complex scenario, generally known as ethical dilemma is evident from the given case study numbered one. Ethical dilemma in healthcare practice is very much case sensitive and therefore demands insightful expertise and pragmatism on the professionals’ part to tackle the condition without disturbing the balance in the workplace (Doherty & Purtilo, 2015).

The case study one described a situation in which a reputed sports physiotherapist and specialist in treating musculoskeletal injuries named Kamil Sharma, appointed in an AFL club faced an unforeseen situation, which put him in front of an ethical dilemma. To understand the dilemma developed out of the situation it is essential to know the background of the situation in the club. Kamil maintained a cordial relationship with the players as well as the club managers and even had close association with two of the players. One evening while in a bar, he came to know that the sports scientists and coaches were supplying performance-enhancing drugs to the athletes. His information was verified at a later instance when he discovered a package of the banned peptide Thymosin beta-4 at the club headquarters. Kamil, next brought this matter to the notice of both the club management and the coach. The competent authorities instead of paying proper heed to this matter allured him of rewarding with greater salary if he chose to remain silent regarding the issue. The acknowledgement of the offer would render better care for his poor, old, ailing parents staying in Lebanon. He is fully conscious about the long term health consequences of the usage of this banned peptide of Thymosin beta-4 in addition to the violation of the anti-doping regulations in sport, apart from its performance enhancing benefit. The players being contractually under the obligation of abiding by the dictums of the management could not even refuse the use of the banned peptide. The preface of the studied case was like what has been described in the preceding text.

Stakeholders in the Case

In view of the case study, the prime stakeholders of the ensuing events may be identified. The direct group vulnerable to the outcomes of the usage of the banned peptide of Thymosin beta-4 is the players of the AFL club. Pertaining to the context of ethical dilemma, Kamil Sharma the sports physiotherapist and specialist in treating musculoskeletal injuries is the other stakeholder. Apart from the sports physiotherapist, the nurses attending the players and who are also integral parts of the sports medicine team are also among the potentially affected. The primary role of a sports physiotherapist is to apply treatment modality through physical means of thermal, electrical, hydraulic, mechanical measures alongside manual therapy-oriented exercises through distinguished techniques. Sports medicine nurses are entitled to work in assistance with the sports physicians, physical therapists to help out the patients encountering musculoskeletal injuries ranging from bone fractures and dislocations, joint sprain, muscle strain to torn ligaments. The nurses of a sports medicine team are required to document the history of the patients, assist the doctors in devising a treatment regime and educate the players to prevent sports related injuries in the future (Brukner, 2012). In the chosen scenario, these two groups of healthcare professionals are likely to be affected by the ethical dilemma issue as they are in continuous communication and are in grip of the players’ health status.

There is a very thin line of differentiation between the ethical and legal conflicts regarding the given case study. The ethical conflicts emanate from the physiotherapist’s perplexity in confronting the malpractice of using the banned peptide of Thymosin beta-4 among the players under the instruction of the sports scientists and coaches. On the contrary, the legal conflicts link to the recommendations and persuasions to unlawfully incorporate the prohibited drug of Thymosin beta-4 for the sake of enhancing sporting performance in an event. Thymosin beta-4 though not included as a scheduled prohibited drug according to World Anti Doping Agency (WADA) list of banned substances but has the potential hazards of anabolic steroids (Hatton, Green, & Ambrose, 2014). In view of its potential health hazards, Australian Sports Anti-doping agency have urged the World Anti-doping Agency (WADA) to include this drug into its updated list of prohibited substances (Harcourt, Marclay, & Clothier, 2014).The drug has the ability to increase muscle growth, endurance and strength with greater angiogenesis and anti-inflammatory effects that help in wound healing. Apart from these effects the drug has the risk as the other anabolic steroids and the person taking this drug may even develop flu like symptoms (Davison & Brown, 2013).

Ethical and Legal Conflicts in the Case

The dignity and rights of all the stakeholders in the chosen case may be assessed depending upon the ethical theories, health care and human rights charters. The deontologist theory may be referred to in this context of the given case study. As per this ethical theory, an ethical action rather than being performed by means of assessing the consequences is done by virtue of certain moral guidelines.  Rather than evaluating the outcomes of the unique actions against every circumstance or how much happiness is gained out of that action, the healthcare professional upheld a set of universal moral principles or duties (Townsend & Luck, 2012). The physicians and other healthcare professionals working in the realm of competitive sports setting come across distinct ethical challenges, mostly generating out of the conflict of interests.  Team management recruited physicians are under the obligations to deliver their duties in sync with the best interest of the club, in addition to taking proper of the athletes playing for the club. They are entrusted to do a balancing act in maintaining the individual health data of the athletes by ensuring safety and confidentiality of the data as per the data protection law. Additionally, they have to handle issues related to autonomous informed consent and authoritative decision making to evaluate whether an athlete is fit enough to compete in an event without any harm. Simultaneously, the physician plays a crucial role in taking decisions regarding the performance enhancement as well as come back to play of an athlete that may not be of good effect for the athletes in the long run but certainly would benefit the team management in the immediate days that follow. Dearth of evidence based protocols in the territory hugely impacted by the temptations of financial profits for multiple parties’ participations; render these arduous tasks of the members of the Sports medicine team to become more complicated (Testoni et al., 2013).

Distinction of the ethical and legal conflicts may be done in the perspective of the principles and virtues of healthcare ethics that inform professional practice.  Healthcare ethics is governed by some definite principles that are mutually interrelated to optimize the care in the healthcare infrastructure. In this respect, four key principles supplemented by four rules may be discussed to better understand the idea of healthcare ethics. The prime ethical principles fostering improved healthcare facility are autonomy, beneficence, non-malfeasance and justice (Pelletier et al., 2015). Autonomy encourages people to make their own choices without any persuasion or coercing. Informed consent is a vital effect of this principle. The other virtue of beneficence is intended for the welfare of the people to help them enjoy quality life. Moreover, non-malfeasance considers the notion of not inflicting harm or pain whatsoever, do not incapacitate or cause offense or deprivation of any sort and most importantly do not kill the patient. It is important to note in this matter that both beneficence and non-malfeasance underpins the concept of evidence based practice (EBP). Justice on the other hand encompasses treating everyone fairly in a non-discriminatory, respectful and non-prejudicial manner complying the existing laws and rules (Allhoff & Hall, 2014). Referring to the case study, all these virtues and their conflicts may be illustrated. The physiotherapist is under a conflicting ideal of ethics associated to beneficence and non-malfeasance. Despite being fully aware of the ill-effects due to administration of the banned peptide of Thymosin beta-4, in the athletes, he is in a dilemma to articulate words of protest against the team management who are endorsing the drug usage. The laws prohibiting the use of the drug and the penalties of such legal violations are known to him as well. Therefore a breach of the justice ethical principle is challenging his interest as well. The ethics forum is under constant evaluation and exploration of such precarious and conflicting issues regarding medical ethics in Sports Medicine. The fundamental problem of the physicians working privately for professional sports teams has been scrutinized by the researchers (Instances & Pappas, 2015).

Ethical Theories and Healthcare Ethics

The codes of ethics and codes for professional conduct act as sources of reference for the professionals in the healthcare setting to abide by the guiding rules and regulations without any hassle and ensure improved care. Multi-spectral data accessible from disparate backgrounds in the modern times have made it increasingly critical for the people associated with the healthcare industry to successfully implement the various interventional strategies. The predictive mode of data analysis is relevant in this context where the physicians have to forecast the complications and other health related issues of the administered drug (Wickramasinghe, Moghimi, & Schaffer, 2015).  The Inter-professional Professionalism Collaborative (IPC) has put forward certain guiding principles of inter-professional practice. Notable among the mentioned principles are the virtues of altruism, respect, ethics, communication, accountability and excellence. The feasibility of the collaborative job among the inter-professional healthcare workers is thus essential to establish a common set-up within the healthcare framework (Tsou, Shih, & Ho, 2015). Proper registration, accreditation, formulation of national standards in conjunction with appropriate defining decorum in terms of profession identity have paved the way for advanced healthcare regime in the developed nations as in Australia. Professional skills include competency in the particular field supported by enough technical, theoretical knowledge acquired through dynamic learning process, together with personal attributes such as prudence, critical thinking and reflection, respectful behavior, caring attitude and others (Murcot et al., 2014). The codes of professional conduct for the healthcare personnel are very much related to their other counterparts as healthcare is a multidisciplinary field and therefore measures and treatment modalities generally follow a holistic approach. The standards of ethical conduct as proposed by the International Council of Nurses (ICN) may be relevant where enough emphasis has been laid on the relationship aspects of the nurses related to their practice, profession, colleagues or co-workers and finally with the people under their care (Masters, 2015). In the chosen scenario of the case study, the ethical standards of the physiotherapist and the nurse assisting the physician is desired to be of utmost priority for proper functioning of the healthcare management pertaining to the athletes’ context. In the sports domain, the multiple stakeholders encounter the traditional challenges related to autonomy and confidentiality of the data (Greenfield & West, 2012). In the given case study situation, the conflicts of interest on the part of the specialist physiotherapist emanate from the colliding obligations to the athletes as well as to the members of sports management team including the coaches and team officials. However, pragmatic following of the codes of conduct for the healthcare professionals with an individualized approach in compliance with the existing laws may guide towards an ethical practice of the relevant profession.

Healthcare Ethical Principles and the Case

In this context, the case can be aligned with the professional conduct and the codes of ethics for nurses in Australia. In this context, according to the conduct statement 2 in professional conduct, “Nurses practice and conduct themselves in accordance with laws relevant to the profession and practice of nursing”, thus, Kamil should follow the legal procedure and report the illegal incident to the higher sports authority, instead of maintaining silence. Moreover, the purpose of the Code of ethics for nurses in Australia highlights that professionals should be capable of identifying the fundamental ethical standards and values to which their profession is committed. In addition, according to value statement 7 and 8, “professional should value ethical management of information” and “professionals should value a socially, economically and ecologically sustainable environment promoting health and wellbeing”. Therefore, it can be interpreted that, Kamil should ensure that he is contributing in promoting a sustainable environment of health and wellbeing in the sport club. For sustainable environment, he should be accountable for the player’s health and should report about any kind of unethical incident to the higher authority. Thus, ethically, the codes of professional conduct and codes of ethics will help Kamil to take right decision in that critical situation.

Considering the findings and proceedings in the given case study situation, and the challenges faced due to ethical dilemma, suitable ethically as well as legally acceptable resolutions may be provided. The two broad philosophies of ethical theories of consequentialism and deontology, compatible with the outcomes of the chosen case scenario may be suggested as the possible solution.  Consequentialism takes into account the repercussions of the actions executed, while actions based upon a set of morals and principles form the foundation of the deontology philosophy. A synergistic balance maintained through these two ethical theories may ally the ethical dilemma arising out of the conflicting interests in the given case situation. The best overall result may be expected if these theories are stringently followed in compliance with the legal implications. Pertaining to the diversity of the professional codes of conduct, the recommended solutions may have case-sensitive outcomes but the central objective of the theories will be in place subjected to proper application.

References:

Allhoff, F., & Hall, M. (2014). The Affordable Care Act Decision: Philosophical and Legal Implications (Vol. 57). Routledge.

Brukner, P. (2012). Brukner & Khan’s clinical sports medicine. North Ryde: McGraw-Hill.

Davison, G., & Brown, S. (2013). The potential use and abuse of thymosin β-4 in sport and exercise science. Journal of sports sciences, 31(9), 917-918.

Doherty, R. F., & Purtilo, R. B. (2015). Ethical dimensions in the health professions. Elsevier Health Sciences.

Greenfield, B. H., & West, C. R. (2012). Ethical Issues in Sports Medicine A Review and Justification for Ethical Decision Making and Reasoning. Sports Health: A Multidisciplinary Approach, 4(6), 475-479.

Harcourt, P. R., Marclay, F., & Clothier, B. (2014). A forensic perspective of the AFL investigation into peptides: an antidoping investigation case study.British journal of sports medicine, 48(10), 810-813.

Hatton, C. K., Green, G. A., & Ambrose, P. J. (2014). Performance-enhancing drugs: Understanding the risks. Physical medicine and rehabilitation clinics of North America, 25(4), 897-913.

Henaghan, M. (2012). Health professionals and trust: The cure for healthcare law and policy. Routledge.

Instances, G., & Pappas, A. (2015). Sports Medicine Ethics Forum Welcome. Sports Medicine.

Masters, K. (2015). Role development in professional nursing practice. Jones & Bartlett Publishers.

Murcot, P., Williams, B., Morgans, A., & Boyle, M. (2014). Community perceptions of the professional status of the paramedic discipline. Int Paramed Pract, 4(1), 13-8.

Pelletier, C., Stevenson, F., Chrysikou, V., Park, S., & Gibson, W. (2015). Reconsidering ‘ethics’ and ‘quality’in healthcare research: the case for an iterative ethical paradigm. BMC Health Services Research.

Testoni, D., Hornik, C. P., Smith, P. B., Benjamin Jr, D. K., & McKinney Jr, R. E. (2013). Sports medicine and ethics. The American Journal of Bioethics, 13(10), 4-12.

Townsend, R., & Luck, M. (2012). Applied Paramedic Law and Ethics: Australia and New Zealand. Elsevier Health Sciences.

Tsou, P., Shih, J., & Ho, M. J. (2015). A comparative study of professional and interprofessional values between health professional associations.Journal of interprofessional care, 29(6), 628-633.

Wickramasinghe, N., Moghimi, H., & Schaffer, J. L. (2015). Leverage Healthcare Data Assets with Predictive Analytics. Improving Health Management through Clinical Decision Support Systems, 237.