NHS FPX 4000 Assessment 3 Attempt 1 Applying Ethical Principles

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Applying Ethical Principles

NHS FPX 4000 Assessment 3 Attempt 1 Applying Ethical Principles

Ethics is an inherent and inseparable part of clinical medicine. (Varkey, 2020). Ethical issues often arise in healthcare and medical professionals must know where to look for a problem-solving approach to these dilemmas. There are four widely accepted ethical principles in healthcare – Autonomy, beneficence, nonmaleficence, and justice. These principles act as measuring tools to aid healthcare workers in making moral, principle-based decisions. The best outcomes result from all aspects of a case being taken into consideration.

Overview of the Case Study

I chose Incident 10: “To vaccinate or not.” for my case study. In this study I was introduced to Jenna and Chris Smith, proud parents of a healthy, five-day-old baby girl named Ana. Ana’s parents have been very vocal about their desire to raise Ana as naturally as possible. For the Smith’s, that means Ana gets nothing but breast milk for the first six months and then only homemade, organic food to follow. No vaccines. 

The Smith’s are college educated and tell their new pediatrician, Dr. Angela Kerr, all about the research they have done on vaccines, including online mommy-blogs that detail how vaccines may have caused autism in children. The Smith’s are adamant that Ana not be vaccinated because they believe that the potential for harm outweighs any benefits, despite the recommendations of the medical community.

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Dr. Angela Kerr acknowledges their concerns and recognizes the controversy that has sparked in recent years, but strongly recommends that Ana become fully vaccinated. Dr. Kerr goes on to explain how vaccines have saved millions of children’s lives and how they are largely responsible for the decrease in child mortality worldwide. She also educates them about the decreased rate of infection with potentially fatal Haemophilus influenzae type b in response to routine immunization. Similarly, how epidemics like the recent outbreak of measles are usually associated with individuals who have not been vaccinated against that pathogen.

Dr. Kerr continues to endorse the general safety of vaccines and educates Jenna and Chris on vaccine safety profiles. She goes on to explain how they are updated regularly through the federal government’s Vaccine Adverse Event Reporting System (VAERS). Which is sponsored by the Food and Drug Administration and the Centers for Disease Control and Prevention. She further educates the Smith’s by addressing the research done on Thimerasol; an ingredient once thought to cause autism and how medical research has proven that it does not increase the risk of ASD.

Finally, Dr. Kerr reminds the Smiths that some children cannot be vaccinated because they have weakened immune systems and that others are too young to be vaccinated. She goes on to say that these children are protected because almost all other children (and adults) have been vaccinated, thus decreasing their exposure to vaccine-preventable illnesses (VPIs). This is known as “herd immunity” and the more parents refuse immunization for their healthy children, the more the rate of VPIs increase. This puts vulnerable children at significant risk of morbidity and mortality. 

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Dr. Kerr concludes by informing the Smith’s that most states require vaccinations before children can attend school. She adds that parents may decide not to vaccinate under specific circumstances, but that it varies by state. Ana’s parents confirm their understanding of what was explained to them but continue to decline vaccinations for Ana. Dr. Kerr is puzzled and isn’t sure how to move forward.

NHS FPX 4000 Assessment 3 Attempt 1 Applying Ethical Principles

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Analysis of Ethical Issues in the Case Study

The Smith’s refusing to have Ana vaccinated is a perfect example of an ethical dilemma for the healthcare team. Ana’s parents stand firm in their decision to keep vaccines away from Ana despite medical advice, because they wholly believe that the risks outweigh the benefits.

Dr. Kerr’s teachings have taught her the importance of vaccinations and she wants to protect Ana from acquiring vaccine-preventable infections while also having her contribute to herd immunity for the health of the general public. However, Dr. Kerr has hit a wall and despite her best efforts, Ana’s parents continue to refuse her vaccines. Dr. Kerr, their pediatrician has properly educated the Smith’s on the importance and the rationale behind the vaccines, but it falls on deaf ears. Their research has convinced them otherwise.

Using the Ethical Decision-Making Model to Analyze the Case Study

Moral awareness, moral judgement and ethical behavior, which are the main pillars of the ethical decision-making model, can assist in analyzing this case study. Moral awareness, the first step to behaving ethically, refers to a health care professional’s ability to detect and appreciate 

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ethical aspects of a decision that they must consider. Dr. Kerr understood that Jenna and Chris Smith thought they were morally right in making the choice to not have Ana vaccinated and that going against their wishes would be a breach of the ethical provision which provides for autonomy.

Moral judgement refers to a health care professional’s personal beliefs about what is right and wrong. Dr. Kerr demonstrated moral judgement when she informed Ana’s parents about the advantages of having her vaccinated because she felt it was the right thing to do. She hoped that she could convince the parents to allow Ana to be immunized by doing so. Health care professionals should ensure that patients and their parents make informed decisions. The pediatrician also understood that informing the Smith’s was the right thing to do so that their decisions would be based on facts. 

 Ethical behavior results from the application of moral awareness and moral judgement. It refers to applying the core bioethical principles when making ethical decisions. Dr. Kerr’s ethical behavior appeared to manifest in her observation of the bioethical principles of ethics – autonomy, beneficence, justice and nonmaleficence. Whereas autonomy refers to the patient’s right to make informed decisions about their medical care. Beneficence denotes the determination to do good to others by showing kindness, charity and mercy. Meanwhile,  nonmaleficence requires health care professionals to weigh the medical benefits and risks of their actions in patients, while justice ensures that an ethical practice abides by the law. Dr. Kerr should consider all of these principles before making a decision regarding Ana’s case.

NHS FPX 4000 Assessment 3 Attempt 1 Applying Ethical Principles

Effectiveness of Communication Approaches in the Case Study

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Dr. Kerr maintained a professional demeanor throughout her interactions with the Smith’s. She listened to them intently and established rapport. She acknowledged their fears surrounding vaccines and attempted to allay them with facts and medical-based research. She effectively communicated the reasoning and importance of getting Ana vaccinated when she addressed vaccine prevented illnesses, the CDC/FDA’s updates on the safety of vaccines, the significance of herd immunity and how most states require vaccinations before children can attend school. All of this information was essential in ensuring that the Smith’s would be able make a well-informed decision.

Dr. Kerr effectively communicated her points, but she could have done more to convince the Smith’s to vaccinate Ana. Maybe if Dr. Kerr had done some more digging to find out if there were any other reasons they refused to vaccinate their daughter, or she could have given them some medical literature or pamphlets on vaccines. Maybe that would have been the tipping point.

Resolving the Ethical Dilemma by Applying Ethical Principles

The four ethical principles of autonomy, beneficence, nonmaleficence, and justice are often employed to resolve ethical dilemmas related to health care. (Varkey, 2020) Autonomy refers to a patient’s right to self-determination and informed consent, beneficence refers to acting on the welfare of patient’s, nonmaleficence refers to doing no harm, and justice refers to treating patients fairly and without bias. 

The ethical dilemma that Dr. Kerr faces in this case involves three of the four basic principles of medical ethics. In the case study, the ethical dilemma is created by a conflict between the Smith’s right to autonomy and Dr. Kerr’s obligation to beneficence and 

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nonmaleficence towards Ana. Dr. Kerr preserves Jenna and Chris’s autonomy by respecting their beliefs and not forcibly vaccinating Ana.

  Approaching Child Protective Services—a social service agency run by the government to counsel and support children and their families and promote child welfare—could be considered by Dr. Kerr as an ethical means to resolve the dilemma. As Dr. Kerr is obligated to provide proper medical care to Ana (beneficence) and prevent any harm to her and the general public (nonmaleficence), she could seek intervention from Child Protective Services. Although involving Child Protective Services could result in overriding the ethical principle of autonomy, Dr. Kerr will have to make this decision keeping Ana’s best interests in mind.

NHS FPX 4000 Assessment 3 Attempt 1 Applying Ethical Principles

Conclusion

In conclusion, healthcare professionals should use the ethical – decision making model concurrently with the four ethical principles of health care to resolve any and all ethical dilemmas. At the end of this case study, Dr. Kerr is perplexed and unsure of what to do after the Smith’s rebuke her attempts to convince them to vaccinate their daughter Ana. Dr. Kerr and the interdisciplinary team should regroup and analyze both the model and ethical principles and then follow-up with the parents to try again.

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References

Varkey, B. (2020b). Principles of Clinical Ethics and Their Application to Practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

Capella University (2018). NHS-FP4000 Exemplar Sample Ethical Case Study. Capella Website:Ethical Case Studies (capella.edu)