An Acute and critical clinical scenario involving life threatening conditions that requires high degree of accuracy with a very small allowable error margin calls for a quick judgement and response from intellectuallyand emotionallyprepared social care professionals ( Stannard, Benner &Kyriakidis 201, p. 1). In this situation, all the ethical principles are found to be in conflict with each other, necessitating the professional to use ethical theory to enable him/her in determining the relevant principle applicable in that particular situation through metalevel evaluation of all the possible clinical decisions with all their possible consequences and not merely on consequences only ( Zygmond &Boorhem 1989 p. 5).

Critical Evaluation of Application of Ethical Principles in solving the identified ethical dilemma

According to Stannard, Benner and Kyriakidis (2011), acute and critical patient conditions demands that the social care professionals respond with thinking-in-action (clinical reasoning while on the move). All the moral problems arising out of this situation must be dealt with autonomy, justice, non-maleficence and beneficence through careful identification, analysis and resolution whilst combating the problem at hand (Mueller, Hook & Fleming 2004, p. 554). According to Kitchener’s (1985) model as put forth by Zygmond and Boorhem (1989), critical-evaluative level reasoning, comprising of ethical rules, principles and theory,generates the required knowledge to be used in clarification, change and modification of beliefs as regard to attitudes, behaviours and perceptions of both the client and the Health/Social worker professional.

The appropriate actions to be taken should be preceded with ethical principles originating from the declaration of Helsinki that states that; in times of acute and critical conditions, the patient should be handled with respect, his/her needs coming first, be given the right to self-determination and the right to make informed decisions (Glod 2008, p.27).

1. Application of Consequentialism Principle and/or Theory of Ethics in Critical Health/Social Scenarios

Hammond (1992) while quoting Sen (1987) gives an overview of Consequentialism as being the judgement of a given action as either being right/good or wrong/bad by solely basing the judgement on the resultant consequences that comes out of that action and not in the action itself or anything else (p. 12). Consequentialism therefore requires that all the resultant consequences be assessed first and be weighted as either being harmful or beneficial to the client while overlooking the action itself. If the beneficial consequences are found to outweigh the harmful ones, then the action is justified otherwise it should be done away with.

Consider a case of a 16-year old teenage girl, who having been raped by a un(known) gang six months earlier, has all along kept this as a secret to herself. Unfortunately, unknown to her was the fact that she had conceived in the process of rape. At the sixth month, being obvious that she won’t hide her pregnancy any longer, she is advised to visit a pre-natal clinic. She is confirmed to be HIV positive and suffering from acute depression relaxed disorders. She decides to disclose all that happened to her six months earlier to the clinician. The clinician is left deliberating the termination of the pregnancy through abortion under the following ground: if left to continue growing, the pregnancy will weaken the girl further,the girl being financially unstable will be unable to cater for the baby, the sight of the baby shall be bringing the rather forgotten ugly memories of rape back to her, there is a high possibility that the child to be born shall also be HIV positive among others against the consequences of the girl dyeing in the process of abortion and the development of other complications.

1. Application of deontologicalPrinciple and/or Theory of Ethics in Critical Health/Social Scenarios

According to Hinman (2010), deontology is the moral obligation and duty of the doer (in this case a social worker or clinician) to act according to the rules that are justified to be right and to avoid doing otherwise as this would be wrong(Hinman 2010, p.4).This implies that whatever the clinician might decide to do, the action must be within certain set professional rules and code of conduct. According to Jones and Bartlett Publishers while quoting Beauchamp and Childress (2008) argue that telling the truth under the ethical principle of autonomy, the clinical professional should always respect the privacy of the patient, seek consent from patients before intervening, guard all the patients’ confidential information and in consultations with patients, to always guide the them in making informed decisions (p.42). In obeying the principle of nonmaleficence, which requires the clinical professional to refrain from causing harm or inflicting pain and all other evil on the patient, the clinician should under all circumstances refrain from in(voluntarily) causing suffering/pain on the patient, incapacitating the patient, deprive patients of life’s goods, offending and even killing the patient under whichever circumstances (Jones and Bartlett Publishers p. 52).

According to Jones and Bartlett Publishers, a patient is brought to the hospital in the advanced stages of lung cancer and COPD that was metastatic to the bones. The wife to the patient instructed the clinicians to inject him with enough morphine sufficient to end his pain even if possible bring about his eventual death(Jones and Bartlett Publishers, p. 52). According to the deontological application of the principle of nonmaleficence, the clinicians should never act on the demands of the patient’s wife, because in so doing they would bring about the death of the patient, which is against the rule of not killing.

1. Application of theEthical Theory ofprinciplism in Critical Health/Social Scenarios

According to Bulger(2007), Principlism is an approach to moral ethics that is based on culturally accepted judgements as regards to respect of all persons, justice and beneficence that are particular relevance to ethics concerning biomedical practice (p. 84 ). Principlism heavily relies on the principles of autonomy, beneficence, nonmaleficence, justice, fidelity and confidentiality to determine any serious moral obligation that out outweighs other obligations in deriving inferences from any given medical/clinical ethical dilemma to solve it. Bulger (2007) further argues that since principlism is consistent (and not in conflict) withtheological, ethical and social principles from where it is derived, it is therefore the best approach suited in solving these problems.

Consider the case above of an advanced lung cancer patient and all the demands of the patient’s wife. If the clinicians acted according to the patient’s wife, this would result to the death of the patient. If they opted not to inject the patient with morphine, the patient’s pain would be worse, thus causing more pain to the patient. All the non-action/action of the clinicians results to bleach of the obeying the principle of nonmaleficence.

1. Application of Respect forAutonomy Principle and/ or Theory of Ethics in Critical Health/Social Scenarios

According to O’Neill (2001), Respect for autonomy refers to involvement of the patient by seeking the patient’s informed consent to all disclosure of personal information in relation to medical treatment, analysis and research of the patient’s condition (p. 2). It is not allowable to force an action on a patient without his/her consent (either formal/written or oral). After careful and thorough professional guidance to the patient of all the possible actions and their outcomes/consequences concerning their condition, they should be left to choose the action.

Consider a case of a 42-year-old patient suffering from a severe toothache. It started just as a simple ache that used to come and go. However, the pain has become excruciatingly painful that the patient decides to sake for the dentist’s advice. The dentist finds out that there is a gaping hole on the patient’s affected tooth. The dentist’s proceeds to explain to the patient all the possible actions that should be taken in order to remedy the situation and their implications on the patient either short term all long term, among them being: tooth extraction, tooth refilling and tooth carnally. It is solely the patient’s choice to decide on any of the three actions. In this scenario, even though the patient was with a severe toothache, he finally has a choice of making an informed decision regarding which actions to be taken on him to lessen the pain, and not merely an action being performed on him without understanding how, why and what possible future complications it might carry.

1. Application of Justice as a Theory and/or the Principle ofEthics in Critical Health/Social Scenarios

The theory of justice advocates for equal share/rights to every individual in an expansive society offering these rights as basic liberties and are available fairly to all individuals in this society (Johnson p.5). Everybody in a given society should be given their rightful share fairly like anybody else in that society. According to Lawrence (2007), Justice is respecting other peoples’ rights and morally acceptable laws and equal distribution of few healthcare resources among the members of any given society (p. 36).

According to Jones and Bartlett Publishers, every individual has a right to equal share according to need, effort, merit, contribution and free market exchanges (p. 58). Consider a case of two critical ill patients in need of a heart transplant: one affluent and another indigent. There is only one viable heart in the healthcare facility ready for immediate transplant. This situation posse a clinical dilemma: of who to be chosen for the heart transplant and who to leave out. Should they choose either of them, an injustice has been done to another. Should they choose not to act they have violated the principle of nonmaleficence.

Conclusion

Ethics in the Biomedical field constitutes of five main theories among them being: theory of consequentialism, deontology, principlism, autonomy and justice. There are also four main principles of bioethical essence as far as clinical practice is concerned. These principles include: nonmaleficence, beneficence, autonomy and justice. Autonomy and justice can act as either a principle or theory of Ethics.

References

Stannard, DS., Benner, PB &Kyriakidis, PH. 2011. Clinical Wisdom and Interventions in Acute and Critical Care, Springer Publishing Company, LLC, 11 West 42nd Street, NY 10036,

New York

Zygmond, MJ & Boorhem, H. 1989. Ethical Decision Making in Family Therapy, Fam Proc 28:269-280, 1989

Mueller, PS., Hook, CC & Fleming, KC. 2004. Ethical Issues in Geriatrics: A Guide for Clinicians, Mayo Foundation for Medical Education and Research.

Hammond, PJ. 1992. Consequentialist Decision Theory and Utilitarian Ethics, Department of Economics, Stanford University, CA 94305–6072, U.S.A

Glod, J. 2008. Principles and Ethics of Clinical Research, Departments of Pediatrics and Pharmacology, Robert Wood Johnson Medical School, The Cancer Institute of New Jersey

Hinamn, LM. 2010. Ethical Theories:A Very Brief Overview,Phil.321: Social Ethics, Summer 2010, University of San Diego

Jones and Bartlett Publishers. Nd. Principles of Biomedical Ethics

Bulger, JW. 2007. Principlism, Teaching Ethics, Fall 2007

O’Neill, O. 2001. Autonomy and Trust in Bioethics, The Gifford Lecturers, University of Edinburg

Johnson, J. Nd. Some Major Ethical Theories Handout Two: Deontology and Justice,philosophy 164: medical ethics

Lawrence, DJ. 2007.The Four Principles of Biomedical Ethics: A Foundation for Current Bioethical Debate,Journal of Chiropractic Humanities.

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