Solving Ethical Dilemma in Bioethics with Example
Bioethics or medical ethics refers to the study of ethics in the fields of medicine and biology. In the course of advancement in medicine and biology, ethical issues and dilemmas often arise. Thus, the ethics of medicine focuses on the moral values and principles that can be applied in healthcare to promote effective primary care and other medical practices (Henningfeld, 2011). Ethical practice in medicine should meet the following basic principles: autonomy, justice, non-maleficence and beneficence (Campbell, 2017). In case of any confusion, conflict or dilemma, professionals in the field of clinical medicine and scientific research use the four basic principles to develop a solution. The values allow doctors, nurses, care givers, and families to develop an effective treatment plan and achieve common objectives without conflicts.
The Ethical Dilemma: Psychiatric Medication Compliance
One of the conflicts that may arise in the medical practice is the situation in which psychiatric patients refuse to take medicine. Patients suffering from schizophrenia often fail to adhere to medication for various reasons, including cultural beliefs, personal choices, lack of awareness, and influence of substance abuse (El-Mallakh and Findlay, 2015). Due to non-adherence, patients may develop complications and face significant risks of relapse, suicide and hospitalization (Latha, 2010). An ethical dilemma occurs when the patient refuses to take medicine due to personal and cultural beliefs about medication (Campbell, 2017). While the principle of autonomy requires the physician to respect the decision of the patient, the medical practitioner also has the responsibility or duty to save the life of the patient by providing the required medicine.
To enhance adherence to medication, some physicians use covert medication which involves hiding medication in drinks and food. This approach infringes the patient’s autonomy, but can save the life of the patient. Thus, the circumstances cause ethical dilemma for the medical care providers. When such a situation arises, the four principles of ethical medicine are applied.
Values and Principles
The principle of autonomy requires that patients should be given the freedom of thought and action when deciding about their medication (Campbell, 2017). Thus, the decision-making process during medication and provision of healthcare services should be free of force and coercion. The patient is required to make autonomously informed choices with a clear understanding of the risks, benefits, and chances of success of a medical procedure (Henningfeld, 2011). Nonetheless, psychiatric medication is often complicated and hence it is difficult for patients to make fully informed decisions conscientiously. The role of the medical practitioner is to inform the patient and his or her family and caregivers about the risks and benefits of the medical procedure.
Justice entails the equal distribution of treatments to all members of society. The medical procedures should be based on existing legal frameworks and fairness to all parties involved (Campbell, 2017). In this regard, the medical practitioner must ensure that there is fair distribution of resources and harmonization of competing interests, needs, rights and obligations. When there is scarce resources to provide medical care to all schizophrenia patients, an ethical dilemma occurs, and justice requires that each patient must be given equal treatment with the available resources.
Beneficence and non-maleficence are also important principles in advancing medical ethics. Beneficence is based on the idea that any medical procedure should focus on doing good to the patient (Campbell, 2017). In this case, physicians should update their knowledge and skills through training and look at specific situations for each patient with the intention of creating net benefit for the patient. Non-maleficence requires that the health care procedures should not do harm to the patient involved, and other people in society. In the case of schizophrenia patients refusing medication, the doctor must minimize harm by pursing the greater good – educating patients and convincing them to take medication.
My view towards the dilemma is that the needs and interests of patients suffering from schizophrenia and other people around them should be protected (Henningfeld, 2011). Non-maleficence, I believe, is the best way to reduce harm to the patience while at the same time respecting the rights and freedoms of patients to make informed decisions conscientiously. The doctor must advocate for the safety of the patients and other people around him while at the same time respecting their autonomy. In most cases, it is difficult to achieve these two goals at the same time, but the theory of utilitarianism can be used to resolve the dilemma.
The utilitarian approach requires medics to make decisions that maximize the net benefit to the greatest number of people. This model is also referred to as consequentialist approach because the outcomes of medication justifies the medical procedure (Mandal et al, 2016). An intervention is morally justifiable if it causes the least harm and maximum benefits to the society. In this regard, the parties involved must evaluate the benefits and costs or harms that a given intervention may cause. For instance, a schizophrenia patient who refuses medication may be forced to take the medicine if the decision will enhance safety and reduce harm to him and all the people around him.
To maximize the benefits and reduce harm to patients with schizophrenia and other people around him, doctors may use covert medication. According to Mandal et al (2016), using covert medication is essentially necessary in some situations to promote the wellbeing of the patient who is not competent or knowledgeable enough to make informed choices. However, the doctors and nurses should respect the autonomy of the patient who has all the information and knows the consequences of their decisions.
Solving the Ethical Dilemma
The first step in solving the ethical dilemma is to inform the patient about his or her situation as accurately as possible to ensure that they are aware of their condition. The medics should inform the patient and his family members about the effects of adherence and non-adherence to medication. The doctors should also assess the patient to establish whether he or she is competent to make informed choices based on the principle of autonomy (Henningfeld, 2011). If the patient is reasonably aware of the dangers of non-adherence and benefits of adherence, and continues to deny medication, the physicians should continue assessing whether the decision enhances net benefit to the society.
The next step is to use the utilitarian approach to measure the benefits and harm involved in medication and non-medication. In this case, the opinion and feelings of family members, caregivers, and members of society should be considered. Sometimes the patient’s death may affect the family members who could be dependent on him. Having all the information regarding the possible outcome of the medication procedure, the medics can decide whether to provide medication or not. If the decision to provide medication leads to the patient’s safety, common good and net benefits to the patient and the society, the medication should be provided covertly. Based on my values, the doctors must advocate for the safety of the patient and common good for society; hence the utilitarian needs of society must be prioritized.
Campbell, A. V. (2017). Bioethics. Milton: Taylor and Francis.
El-Mallakh, P. and Findlay, J. (2015). Strategies to improve medication adherence in patients with schizophrenia: the role of support services. Neuropsychiatric Disease and Treatment, 11, 1077-1090.
Henningfeld, D. A. (2011). Medical ethics. Detroit: Greenhaven Press.
Latha, K.S. (2010). The Noncompliant Patient in Psychiatry: The Case For and Against Covert/Surreptitious Medication. Mens Sana Monographs, 8(1), 96-121.
Mandal, J., Ponnambath, D.K. and Parija, S.H. (2016). Utilitarian and deontological ethics in medicine. Tropical Parasitology, 6(1), 5-7.