TeamC-Assignment2
Team C: Therese Balleza, Marley Canfield, Suji Kang, Mandy Nip, Jillian Tan
Assignment 2 Ethical Issues in Work and Life (Group Work)
Description
This assignment is designed to provide you a greater depth of understanding regarding ethical issues in health care and your community. You will be expected to gather information about ethical issues which others face and then compare them to the ethical issues that you have encountered in your practice. You will share your reflections about these issues in a team context and then post a summary of your reflections to the class. The team will be graded on the depth of their discussions about ethical issues.
You will be discussing ethical issues with professionals in your community and analyzing the themes arising from these discussions. We anticipate that this assignment will enrich your understanding of ethical dilemmas, violations and distress in a variety of contexts. Ultimately your focus will be directed to the resolution of these ethical concerns given that ethical issues are challenging to resolve. This assignment is worth 15% of your total grade.
For further information about this assignment see the following sections:
Directions Grading
Assignment 2 Directions
The following points provide more detailed information about this assignment which is worth 15% of your total grade.
You will be required to contact professionals in your community and arrange a time to speak with them by telephone or in a face-to-face meeting. We are referring to professionals other than those found in dentistry. You can extend the boundaries of the discussions beyond health care providers to professionals in general such as teachers and ministers for example. You will then be posting your ideas to a “wiki” page and discussing the issues with your classmates.
To successfully complete the assignment you need to:
Explore your readings related to ethical reasoning and action. Develop a plan for completing the assignment: Generate the plan in a table format with the following columns: the tasks, the people responsible for each task and the time line. You may also wish to add a comment section if this would be helpful. Submit the plan to your instructor by Block 5. Collect information about ethical dilemmas, violations and distress experienced by others. You will be either talking with other health professional students or with other professionals in your community. The discussions may occur on-line, by telephone or in face-to-face conversations. These discussions will occur during Blocks 5-7. Identify issues and themes raised by others as you are involved in these discussions and relate them to the literature you have explored. Explore the similarities and differences in the type of ethical issues and actions of others, and the ones you have experienced or heard about in oral health care. Basically you will be expected to think critically about the data that you have collected and summarize it. Integrate ethical principles into the documentation of your information. Reflect on issues of confidentiality as they apply to this assignment. Post your summary / analysis to your small team area during Block 9. Each team will have a wiki page for these discussions. Provide timely and thoughtful feedback to your colleagues regarding their postings. Stimulate a deeper exploration of issues. Develop a summary of your findings and their relationship to the literature and your practice. Use Index Medicus / Vancouver Style for your citations and reference list. Post your summary to the class by the end of the block. Complete the self and peer assessment survey.
Assignment 2 Grading
You will be graded on critical thinking (10%) and professional communication (5%) as expressed through your team work. Refer to the rubric for this assignment for further guidance. The team members will receive the same grade unless extenuating circumstances result in different types of participation by team members. The following information provides some examples of how these two abilities could be demonstrated within the context of this assignment.
Critical thinking:
For example, you can demonstrate such critical thinking by:
Finding relevant and credible resources, Challenging assumptions, Posing alternative ways of thinking about issues, Relating your data to the literature, Identifying patterns and themes, and Building an argument based on logic and / or evidence.
Professional Communication:
For example, you can demonstrate such communication abilities by:
Developing a clear and concise argument, Using professional language and accurate sentence structure, Responding to peer feedback in a thoughtful manner, Drawing clear relationships between ideas, and Providing a succinct summary of complex ideas.
Note: For Faculty of Dentistry courses, papers and assignments submitted after the due date will be penalized 10% of the total marks for each 24 hour period that the paper is overdue. Saturday and Sunday will be counted as a 24 hour period.
Introduction
Professional health care practices are based on code of ethics and moral decisions. An ethical dilemma arises when a situation or an issue competes with such ethical standards or principles. (1) This assignment explores ethical dilemmas experienced by different health care professionals, their processes of making ethical judgments, and challenges found during such decision-making processes through a series of interviews. The explored ethical issues in different health care professions then compared and contrasted to that in dental hygiene profession.
1. Noel-Weiss J, Cragg B, Woodend AK. Exploring how IBCLCs manage ethical dilemmas: a qualitative study. BMC Med Ethics. 2012 Jul 23;13:18. Doi: 10.1186/1472-6939-13-18.
Ethical Dilemmas Experienced by Professionals in the Community
Ethical dilemma 1 (Suji)
According to Access to Abortion Services Act, abortions and fetal terminations are legal in BC. Yet, the Act has not addressed the risk and legality of “unsafe abortion and prevention of unintended pregnancy.” (1) Dr. L is a gynecologist who has worked at an abortion clinic. Within her 20 years of practice, she has encountered a couple ethical dilemmas around unsafe abortion for raped victims and conflicting respect for the rights of the mothers and fetus and considered how these dilemmas affect her conscience – a set of “core” moral beliefs. (2) Dr. L has found that that ethical dilemma is found among practitioners, the Society of Obstetricians and Gynaecologists of Canada (SOGC), and patients. To respect the Access to Abortion Services Act, Dr. L has performed numerous abortion and terminations of pregnancy for young women, especially raped victims. As their physician, she has to present safe ways to terminate pregnancies and make sure that the patients understand “the nature and the potential complications of the procedure” since Canadian common law of “age of consent” in which “the legal right to make health care decisions depends on decision-making ability rather than age,” applies in BC. (3) Although methods of induced abortion have developed over the years to be safe, Dr. L says that she is always reluctant of performing surgical abortions, especially to minors with systemic complications and to raped victims who are taking antidepressants because the risk of detrimental consequences of surgical abortions increases drastically (3) which violates Canadian Medical Association Code of Ethics which addresses that one of the fundamental responsibilities of physician is “consider first the well-being of the patient.” (4) As well, although Criminal Code of Canada Section 223 addresses that fetus/babies are not considered to be lawful humans as long as they are not born, Dr. L describes how emotional and dreadful each pregnancy termination is. (5) She says that both the mothers and unborn children go through tremendous amount of emotional pressure that usually induces detrimental effects on their physical health. As a designated physician, she also experiences such emotional whirlpool because she feels that she fails to meet Hippocratic Oath which addresses that “no physician should take one’s life.” (6) Performing induced abortions that can cause detrimental effects to the patients and taking lives of unborn babies have created internal conflict of conscience for Dr. L.
1. Province of British Columbia. Access to abortion services act [Internet]. 2012 [cited 2012 Oct 26]. Available from: http://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/00_96001_01
2. Wicclair MR. Conscientious objection in health care. Cambridge, United Kingdom; Cambridge University Press, 2011.
3. SOGC clinic practice guideline – induced abortion guidelines [homepage on the Internet]. 2006 Nov [cited 2012 Oct 26]. Available from: http://www.sogc.org/guidelines/documents/gui184E0611.pdf
4. Canadian Medical Association. CMA code of ethics [Internet]. 2004 [cited 2012 Oct 27]. Available from: http://policybase.cma.ca/dbtw-wpd/PolicyPDF/PD04-06.pdf
5. Action Life Online Article. Criminal code of Canada – root of discrimination [homepage on the Internet]. [cited 2012 Oct 27]. Available from: http://www.actionlife.org/index2.php?option=com_content&do_pdf=1&id=44
6. Abortion Rights Coalition of Canada. Position paper #71-abortion and the Hippocratic oath [Internet]. 2003 Sept [cited 2012 Oct 28]. Available from: http://www.arcc-cdac.ca/postionpapers/71-Abortion-Hippocratic-Oath.PDF
Ethical dilemma 2 (Therese)
Dr. B, who is a cardiologist for about 30 years, has faced some ethical dilemmas during his career. There are some cases when an individual is aware that they are at the last stages of their lives, and wish to discontinue living if they so happen to receive an irreversible condition that leads to a cardiac or respiratory arrest. A form that an individual is able to fill out is called a DNR, which stands for which stands for do-not-resuscitate. This type of form refuses any measure to restore an individual’s cardiac function from all medical practitioners during a cardiac or respiratory arrest (1). This becomes an ethical issue when the doctor is faced with an emergency case where the individual has the potential to be revived and be fully functional, but the doctor is unable to intervene based on a DNR that the individual has previously requested. The Journal of Medical Ethics stated that doctors have “witnessed instances in which potentially life-saving interventions were withheld” because of the DNR, leading to tragic deaths (2). Based on the Patient Self-Determination Act of 1990, there is an assurance of a patient autonomy, and gives their right to make decisions regarding their own healthcare. This act applies to hospitals, long-term care facilities and home health agencies (3). Dr. B has unfortunately witnessed deaths of individuals who could have potentially been saved, but because of a DNR, Dr. B was unable to perform necessary measures in restoring their lives. He values the patient’s autonomy and acknowledges that patients have the right to make healthcare decisions.
1. Ministry of Health. No Cardiopulmonary Resuscitation. [homepage on the Internet]. 2009 [cited 2012 Oct 23]. Available from: https://www.health.gov.bc.ca/exforms/bcas/302.1fil.pdf
2. Gelbman BD, Gelbman JM. Journal of Medical Ethics. [homepage on the Internet]. 2008 [cited 2012 Oct 29]. Available from: http://www.jstor.org.ezproxy.library.ubc.ca/stable/27720164?seq=2
3. American Cancer Society. The Patient Self-Determination Act (PSDA). [homepage on the Internet]. 2011 [cited 2012 Oct 25]. Available from: http://www.cancer.org/treatment/findingandpayingfortreatment/understandingfinancialandlegalmatters/advancedirectives/advance-
Ethical dilemma 3 (Jillian)
Pharmacists play a pivotal role in the health of clients taking medications. Pharmacists are responsible for the distribution and control of drugs while monitoring safe dosages. An ethical dilemma Mr. P, a pharmacist in Surrey, British Columbia, has faced on multiple occasions is an issue that concerns the refilling of a prescription, a specific and common example is a strong and often addictive pain relief medication. Mr. P has experienced clients coming into the pharmacy to refill this drug, claiming they had lost their bottle of tablets. Although this may be the case, Mr. P must be aware of the fact that some clients may be attempting to mislead the pharmacist in order to obtain the drugs and abuse them. In instances that abuse is suspected, the pharmacist is able to refuse the distribution of the drug. The Code of Ethics for pharmacology first and foremost states in it's first standard: "Registrants Protect and Promote the Health and Well-Being of Patients" that pharmacists are "committed first and foremost to protecting and promoting the health and
well-being of their patients (1). They are legally able to refuse to provide the medication under a few circumstances, including "the provision of the product or service on the basis of conscientious objection (a sincerely held belief that the provision of a particular product or service will cause the registrant to contravene their personal moral or religious value system)" (1). This mirrors Policy 35 -"Pharmacists Refusal to Provide a Product or Service for Moral or Religious Reasons" states that: "Pharmacists shall hold the health and safety of the public to be their first consideration in the practice of their profession. Pharmacists who object, as a matter of conscience, to providing a particular pharmacy product or service must be prepared to explain the basis of their objections. Objecting pharmacists have a responsibility to participate in a system designed to respect a patient’s right to receive pharmacy products and services" (2).
The pharmacists must base these decisions on their practice standard according to the Code of Ethics. Standard 2 of the Code of Ethics states that "Registrants utilize their professional judgment to protect the best interests of their patients in achieving their chosen health outcome" (1). Standard 3 also touches upon the importance of the client's autonomy and freedom of choice, and that they must adhere to the standard of "[ensuring] that their personal beliefs and values do not prejudice patient care and do not engage in discrimination based on age, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, lifestyle, disability, socio-economic status or any basis proscribed by law" (1).
1) College of Pharmacists of BC. "Code of Ethics (Detailed)." College of Pharmacists of BC, July 2011. Web. 29 Oct. 2012. <http://www.bcpharmacists.org/legislation_standards/standards_of_practice/code_of_ethics_detailed).php>.
2) College of Pharmacists of BC. "Professional Practice Policies." College of Pharmacists of BC, 18 Nov. 2011. Web. 29 Oct. 2012. <http://www.bcpharmacists.org/legislation_standards/provincial_legislation/professional_practice_policies.php>.
Ethical Dilemma 4 (Mandy)
With Canada being such a culturally diverse country, the health care system must also account for the health practices of different cultures when providing health care. Registered Traditional Chinese Medicine (TCM) practitioners are health professionals who use various methods, including herbal medicines as well as acupuncture, to deal with illnesses. Ms. S is a registered TCM practitioner who has encountered an ethical issue, where there was a conflict between the registered TCM practitioners' code of ethics and the Health Professions Act. An elderly Chinese patient had entered her private practice seeking treatment, and it was later determined that this patient had cancer. The patient strongly refused to seek medical attention from Western health professionals, refused to listen to the rationale behind seeking that medical attention, and believed that TCM would be able to cure her of her disease. Like dental hygienists, registered TCM practitioners are bound by the code of ethics to respect the decisions made by the patient(1). However, another similarity between registered TCM practitioners and dental hygienists is that the practitioner "may [not] treat an active serious medical condition unless the client has consulted with a medical practitioner, naturopath, dentist or doctor of traditional Chinese medicine, as appropriate"(2). So, much like the 365 rule for dental hygienists restricts the care of clients who have not seen a dentist in the last year, Ms. S was unable to treat the patient because she refused to see Western health professionals. Following the concept of autonomy, which implies that "people should be able to control the most basic decisions in our life, regardless of whether it is efficient to do so," (3) Ms. S had no choice but to advise that the patient go to a hospital and not treat the patient. The end result of this patient's situation remains unknown; unless the patient accepted Western medicine it is unlikely she received any treatment for her cancer at all. The issue in this situation was the decision that the patient made to refuse all Western medical care. With autonomy, the patient has the right to know and understand the care being provided before accepting the care. However, that also means that the patient also has the right to refuse to know and understand. This particular situation is also an issue in itself; a study has shown that "participants [of the study] who identified more strongly with traditional Chinese cultural values and beliefs also reported less favorable health outcomes"(4). The ultimate goal of any health professional is to help patients or clients improve their health; what does a health professional do when a patient comes seeking help but the only service you are able to offer is a referral to someone who they refuse to see?
- College of TCM Practitioners and Acupuncturists of British Columbia. 101129 Amended Schedules.pdf (application/pdf Object). [homepage on the Internet]. 2010 [cited 2012 Oct 29]. Available from: http://www.ctcma.bc.ca/upload/101129%20Amended%20Schedules.pdf
- BC Laws. Traditional Chinese Medicine Practitioners and Acupuncturists Regulation. [homepage on the Internet]. 2008 [cited 2012 Oct 29]. Available from: Government of British Columbia, Web site: http://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/32_290_2008
- Dees RH, Health Literacy and Autonomy. Am J Bioeth 2007; 7(11):22-23.
- Lai DW, Tsang KT, Chappel N, Lai Db, Chau Sb. Relationships between Culture and Health Status: A Multi-Site Study of the Older Chinese in Canada. CJA 2007; 26(3):171-183.
Ethical Dilemma 5 (Marley)
Dietician Ethical issue: Issues may arise when an individual doesn't speak the truth about their diet. Commonly, individuals try to make their diet sound healthier than it actually is. However, this makes it more difficult for a dietician to get to the root of the problem at hand. A more severe type of ethical dilemma arises when decisions must be made in the institution of artificial feeding in individuals who are suffering from chronic illnesses or terminal illnesses (1). Ultimately, this issue becomes more complex when one is deciding if nutrition and hydration are to be withdrawn from an individual or maintained. This not only involves the expertise of a dietician, but also includes the physician, speech pathologist, family, and other health professionals(1). For example, individuals living with severe dysphasia may need to be introduced to artificial feeding, or they may suffer from malnutrition and dehydration leading to death. Decisions of whether artificial feedings should be instituted or withdrawn are determined when an individual cannot ingest by the mouth. This becomes more complex when an individual chooses to be removed from artificial feeding, seeing as their life depends on it.
Groher E. Michael. Ethical Dilemmas in Providing Nutrition. Department of Veterans Affairs Medical Center. Dysphagia 5: 102-109 (1990)
Main themes and Comparison of similarities and differences in different health care professions and dental hygiene profession
Assignment 5 Topic: Minimum 30 years of dental recordkeeping retention
Limitation Law
Ultimate limitation 8 (1) Subject to section 3 (4) and subsection (2) of this section but despite a confirmation made under section 5, a postponement or suspension of the running of time under section 6 or 11 (2) or a postponement or suspension of the running of time under section 7 in respect of a person who is not a minor, no action to which this Act applies may be brought
(a) against a hospital, as defined in section 1 of the Hospital Act, or against a hospital employee acting in the course of employment as a hospital employee, based on negligence, after the expiration of 6 years from the date on which the right to do so arose, (b) against a medical practitioner, based on professional negligence or malpractice, after the expiration of 6 years from the date on which the right to do so arose, or '(c) in any other case, after the expiration of 30 years from the date on which the right to do so arose.' (2) Subject to section 7 (6), the running of time with respect to the limitation periods set by subsection (1) for an action referred to in subsection (1) is postponed and time does not begin to run against a plaintiff until the plaintiff reaches the age of majority. (3) Subject to subsection (1), the effect of sections 6 and 7 and subsection (2) of this section is cumulative. Source: [[1]]
Recordkeeping Regulation from the College of Dental Surgeons of British Columbia (CDSBC)
Retention of Records The B.C. Limitation Act governs the retention of dental records. In general, clinical, financial and drug records, and radiographic and consultant reports that are made in respect to an individual patient must be maintained for at least 30 years from the date of the last entry in that record. In the case of a minor, these records must be kept for at least 30 years after the day on which the patient reached the age of 19. In addition to clinical records, other records that must be retained include appointment records, lab prescriptions and invoices. Diagnostic or study models are also considered part of the permanent patient record and must be kept for the prescribed period. Working models do not have to be retained for any specific period of time. A decision to keep working models should be based on the complexity of the case and is left to the judgment of the individual practitioner.
Source:http://www.cdsbc.org/~ASSETS/DOCUMENT/CDSBC_Dental_Recordkeeping_Guidelines.pdf
British Columbia Dental Association (BCDA)'s statement for supporting changes in Limitation Act
BCDA supports proposed changes to the Limitation Act Vancouver, BC – The British Columbia Dental Association (BCDA) welcomes and supports the proposed changes to the Limitation Act, which balances the public interest with the need for clarity and consistency for dentists and other health professionals around limitation periods for filing a civil suit. The reduction of the maximum limitation period from 30 years to 15 years is of significant importance to BC dentists. Currently BC dentists are required to retain patient records for a period of 30 years, placing considerable demands on record management. "BC Dentists wholly support this change," says Dr. Bruce Ward, BCDA spokesperson. "Most dental problems are resolved within two years of when treatment is provided and any action is resolved well before 15 years. Retaining dental records beyond 15 years has no measureable benefit to the public."
Royal College of Dental Surgeons of Ontario (10 year dental record retention period)
In general, clinical, financial and drug records, and radiographic and consultant reports that are made in respect to an individual patient must be maintained for at least 10 years from the date of the last entry in that record. In the case of a minor, these records must be kept for at least 10 years after the day on which the patient reached the age of 18 years. This includes appointment records, lab prescriptions and invoices. Two exceptions to this requirement involve working models and copies of dental claim forms
Source: http://www.rcdso.org/pdf/guidelines/RCDSO_Guidelines_Dental_Recordkeeping_May08.pdf
Record keeping retention regulation for Ordre des hygiénistes dentaires du Québec
13. A dental hygienist shall keep or ensure that each record is kept for at least 5 years from the date of the last service rendered
Source: http://www.ohdq.com/Ressources/Documents/RegulationNov2011.pdf
Dolden Wallace Folick LLP Insurance Lawyers: Professional Liability for dentists in Canada: Managing the risk'Italic text
Records of prescriptions made must be kept for at least two years.
In addition to Freedom of Information and Protection of Privacy Law, the Canadian Dental Association and the dental associations of the provinces and territories prescribe a code of professional ethics that describes the duty of confidentiality and the disclosure of dental records.