Case Management Chapter 9: Ethical issues in Case Management

Question 1

Describe the process of ethical decision making:

Answer 1

1. Assessment and Problem Identification: gather all the facts, opinions, and perceptions about the situation, identify key players and their roles, identify available resources, indentify the problem, be a patient advocate
2. Planning: Identify types of moral dilemmas that are involved, identify possible courses of action, list goals and objectives of people involved in the situation, determine ethical obligations of those involved
3. Implementation: develop an ethical goal that maximizes the most benefits and good in the situation, determine the course of action that will produce results most like the ethical ideal, determine if that course of action violates any legal or ethical principles, if so, change plan, implement the plan.
4. Evaluation: Ask questions…D o the results bring the situation closer to the ethical ideal? Do the outcomes satisfy the parties involved, especially the patient and family?, If not, have any new moral dilemmas been created?

Question 2

Recognize ethical dilemmas in CM practice:

Answer 2

1. A family member will not consent to DNR status for a patient. Patient has multisystem failure and a Cold Blue is imminent. A code occurs, and patient survives, and the rest of story is a nightmare.
2. A patient, mentally competent to make decisions, insists on being discharged home-to a clearly unsafe situation. He has the right to self-determination and you know well that the home environment will jeopardize his health condition.
3. A 75 year old man had cardiac bypass surgery in 1983 that necessitated several blood transfusions. He is admitted with a perplexing diagnosis. Tests show that he is positive for the HIV virus and has full-blown AIDS. He wants to know what is wrong, but his wife insist that no one tell him the diagnosis.

Question 3

List 4 ethical principles important to case management practice:

Answer 3

1. Autonomy: a form of personal liberty whereby the individual possess sufficient mental capacity to determine his or her course of action in accordance with a plan chosen and developed by him- or herself
2. Beneficence: the obligation or duty to promote good, to further another’s legitimate interests, and to actively prevent harm or diminish its impact as much as possible.
3. Nonmalificence is refraining from harming others, or if harm is inevitable, insuring that as little harm occurs as possible.
4. Justice: achieving a fair distribution of benefits and burdens.
   Veracity: simply being honest and truthful.

Question 4

Differentiate between clinical and organization ethics:

Answer 4

The main focus of clinical ethics committees is dealing with decisions regarding treatment such as in cases of terminal/end-of-life care. Organizational ethics committees, however, focus on utilization management issues, including resource allocation, delays in care, and appropriateness of the level of care.

Question 5

. Identify 5 strategies for the effective management of ethical dilemmas.

Answer 5

1. Use various schools and theories of ethical thought, which may help bring the case to a point of resolution.
   
   2. Use a sense of humor to gain or maintain a sense of perspective.
   3. Consider contemporary thought on a particular issue.
   4. Use effective communication skills
   5. Use honesty…”Ethics is honesty in action