Decision-making is a crucial element in the field of health care and medicine. For example, practitioners have to determine what is wrong with patients and recommend treatment while the patients have to decide whether or not to seek medical care or go along with the treatment recommended by the practitioners. Similarly, health insurers and policymakers have to decide upon what items to approve, those that need to be discouraged, and what needs to be paid for in terms of medical requirements. These kinds of situations call for the need for a proper way to manage decisions through quantitative theoretical tools and psychological research (Gretchen, 2010).
Health care managers, students, and practitioners often have to make decisions on a number of occasions. Often, they use common steps, approaches or theories of judgment and decision making to arrive at the desired results. First, it would be ethical to first shed light on the open meaning of decision-making and judgment and bring a relevant connection between the concept and health care. There have been numerous debates on the actual meaning of health care decision-making and judgment by different writers and scholars. Moreover, much work has been done in an attempt to define the constructs of human health care and clinical decision-making and judgment.
Several writers have used different constructs and approaches of definition basically to describe one single phenomenon and there is no one universally accepted definition of decision-making arising from the varying meanings across numerous disciplines.
Decision-making largely relies on the personal judgment which is defined as an assessment of alternatives and choosing the most appropriate alternative in a given scenario. Decision-making, therefore, encompasses a mental action (also referred to as cognitive action) that results in the choice of a given cause of action from a number of available alternatives. In making such decisions, health care professionals and practitioners pay great attention to health care ethics. These are prescribed codes of conduct that control and govern the behavior and actions of a group of people in a given environment, in this case, a health care facility. Health care professionals have to make ethical decisions that are morally acceptable and professionally approved and that bring general benefit to the community at large. This is the basis of health care decision-making (Ramon, 2009).
One theory which can be used to make decisions by health care professionals is the deontological theory. This is where a person makes a decision whether or not the consequences are harmful as long as the decision is morally and ethically acceptable. The outcomes of the act are not important when one considers choosing between good and bad. Another theory is the virtue-based approach which considers much of personal feelings and thought or believes on a given matter in question.
This paper is based on the use of a utilitarian or consequence-based approach to make an appropriate decision in an arising matter in a health care facility of a given town. The case study involves a middle-sized level three medical facility in a small town that has recently suffered a cholera outbreak. The hospital spent a lot of resources of one kind fighting to ensure that all the patients who were admitted got the correct treatment. As a result, the hospital went down on the supply of re-hydration salts and cholera antibiotics which could be used to rescue the increasing number of patients. Unfortunately, the government had not dispatched the last batch of finances to be used to purchase additional drugs. The hospital medical superintendent asks the store and medical records keeper for a list of all the drugs that are currently in stock. He finds no records to provide any additional cholera treatment drugs and preventives. He decides to walk down the store and check physically if he could find just a single box of re-hydration salts to save the current situation. He realizes that there are some batches of drugs that were however still in the lower deck of the store but unfortunately sees that they have a label “Expired Drugs awaiting disposal.” On checking the “best before label” he finds that the drugs expired two weeks before. According to his medical skills, he knows that a drug once expired is implausible to be used for treatment purposes. He is rather convinced that they could help save the situation as the hospital calls for medical back up. The decision to make is whether to administer the drugs to save the situation or not to do so and wait for medical back up that could take quite a lot of time to reach the remote town.
According to the utilitarian or consequence-based approach, a person is to make decisions by considering the consequence of choosing any given alternative (Gini, 2011). A second formulation called approach utilitarianism looks at whether the option or choice conforms to a rule that attempts to maximize the overall utility. This approach upholds the fact that if the benefits are sufficiently great and the problems with the side effects sufficiently limited, then it is more beneficial and ethical to take that option. In this case, the superintendent has to consider the health care ethics of not administering any expired drugs to patients as per his medical skills or administering the drugs to the patients to save the situation. The consequences are well open. The drugs are expired and are considered poisons.
The analysis of the consequences is as follows. Since there is an increasing admission of cholera victims to the hospital due to the outbreak, the superintendent may be tempted to act on a life-saving basis to give the patients the drugs as they await a medical backup. However, the drugs that are already expired are at no conditions plausible to be used as alternatives to life-saving steps and mechanisms available in hospitals as they are considered poisons in the expired state. In fact, the administration of the drugs would even cause more damage to the patients and would even increase the severity of the pandemic to unmanageable levels. This is a great consequence that the health care panel had to consider. Moreover, it would be against the ethical structures of a health care facility to administer such drugs even with an aim of saving life.
In the above case study, it is most appropriate for the hospital medical superintendent to use the utilitarian approach to make the decision. Proper analysis of the problem along the lines of whether the selected action produces better than bad consequences proves that the outcomes would be disastrous. The patients would rather not be given the expired drugs and wait in pain, but not be “killed” by being given the “poisons” in the name of saving their lives.
The utilitarian approach has gained favor among various managers and medical practitioners since it puts focus on the rules for acting rather than on individual actions themselves. Essentially for them, a rule is morally and ethically correct when it provides more health care good and safety than any alternative rule.
In as much as the approach of utilitarianism is acceptable, it presents certain flaws that however do not change the decision made nor do they waiver the decisions made by the superintendent in the case study above. One reason to doubt this approach is its flexibility in response to various situations. Utilitarianism accommodates complex circumstances more easily than other more absolute probable approaches.
The method upholds the sense of which action is more beneficial than the other, or ideally the one which is less harmful. Those who practice most forms of utilitarianism recognize that one cannot cause great harm to others to achieve a desirable or noble end. This means that even if the selected alternative causes a little harm to the community, it is still bound to cause harm whatever the extent.
Generally, the approach of utilitarianism of making decisions is a generally accepted concept in ethical decision making which is applicable in many disciplines and not only health care and medicine. The approach is in the long run proved to be both cost-effective and easier to evaluate. In the above case study, it would be more expensive to treat patients who have been administered expired drugs than just waiting for external medical back-up and administering the correct treatment to the patients.
References
Gini, G. S. (2011). The Three Major Ethical Approaches Managers Might Use in Making Ethical Choices. Web.
Gretchen, B. (2010). Decision Making in Health Care. Web.
Ramon, S. (2009). Theories of clinical judgment and decision-making: A review of the theoretical literature. Volume 3: Issue 1-2 Article Number: 990114. Web.