Introduction
An all inclusive and effective ethical theories and principles have been adopted to establish the extent and ethical implications a line of behavior or action may contribute. In every heath care facilities across the globe, it is in order to categorically state that every institution is faced with ethical and legal scenarios.
Reflectively, this research treatise attempts to qualitatively establish and present utilitarianism theory to solve the ethical and legal implications of scenarios as describe in the book “Legal and Ethical Issues in Physical Therapy” by Lee Laura. Besides, the research paper presents an alternative approach to legal dilemma in the health provision industry which can be used by other practitioners in decision making.
Mrs. Daniels vs. Susan and Maywood
Ethical dilemmas arise in many ways. A case in point, it rises when the physical therapist encounters conflict between patient autonomy and medical paternalism. As the physical therapists assume increased responsibilities they become more autonomous. These require them to recognize and confront ethical dilemmas in physical therapy practice.
To resolve these ethical dilemmas is quite a hard nut to crack. However, the application of ethical theories can help in the systematic and analytical examination of basic assumptions and principles. The frequently applied theories are egoism, utilitarianism, and formalism. These theories help to analyze the conflict and formulate solutions.
They also present a model for ethical decision making. The principles that normally guide the decision making are: fidelity, autonomy, beneficence, non-maleficence, justice and self-respect. Also in existence, is the American Physical Therapy Association mandated to identify and review ethical issues.
These issues involve professional rules, and patient’s welfare and rights. Ethical theories normally judge actions based on the results or consequences. Considering consequentialism, good actions are those that cause a great ratio of good results to bad results. One of such is utilitarianism theory. It judges actions to be good if they produce the greatest good for the greatest number of people.
In an event that lawsuit is filed in a court of law by a patient for medical malpractice as a result of personal injury, the legality and ethicality of the case may be used to judge on professionalism. In case two as described by Lee Laura, the plaintiff must prove four very crucial elements for her to recover in a negligence case which includes the argument that the therapist owed a legal duty to her, that the therapist breached that duty, that this breach caused an injury, and that the injury resulted in damage (Rowan 40).
In proving the existence of a legal duty between plaintiff and health care provider, the patient-therapist relationship is essential. In the event that the jury proves the existence of legal duty, then jury has the task of establishing whether that duty was breached or not. In doing so, they establish whether the therapist met the standard of care i.e. did the therapist act in a reasonable manner compared to how a reasonable therapist would do under the same circumstances? If not, then no doubt the standard of care was breached.
In such cases the courts often apply a national, regional, or local standard; the comparison group which is taken as the standard upon which other therapist’s conduct is measured (Rowan 43). Apart from the reasonable therapist’s conduct under similar conditions, the jury may turn to other factors such as the scope of practice as well as rules adopted by the licensing board.
Still the jury can use learned treatise, clinical practice, professional association guidelines, practice parameters, critical pathways, facility protocols, policies and procedures or American Physical Therapy Association (APTA) as references in delivering the verdict (Rowan 45).
If this verdict gives a nod that the duty was breached then the next duty is to assess the ramifications of the breach of duty: did the breach of duty cause an injury or not? Even if the therapist owed a duty to the patient and acted outside the standard of care, the plaintiff still has to prove beyond any reasonable doubt that the action of the therapist caused an injury failure to establish this crucial and imperative casual link between the injury and the action of therapist, the patient cannot recover the damages.
Lastly is to assess the extent of damage arising from injury. Even if negligence on part of therapist has been established, the plaintiff has to show that this negligence resulted in injury and to large extent damage (Lee 50). I delivering the verdict, the jury may rely on contributory negligence theory in which blame is squarely apportioned to the plaintiff if she is at all responsible for the injury.
However currently, many states have adopted comparative negligence theory in which the court apportions the blame according to the relative contribution to the injury by the parties involved. Apart from the aforementioned negligence theory, Respondent Superior and Corporate Negligence also come into play in delivering the verdict.
In Respondent Superior, the employer is responsible for the act of its employees and the liability is imposed on the facility if an employee is negligent while performing duties. However, the facility is not liable for the actions of a non employee such as an independent contractor. The corporate negligence doctrine on the other hand requires that health care facilities provide suitable trained staff, quality facilities and policies to provide patients with adequate care (McWay 22).
Basing arguments on this discussion, in the unfortunate event that Mrs. Daniels files the law suit in a court of law, in the litigation process she would have to proof that the four elements of negligence-duty, breach, causation, and damage are present to successfully recover the damages. First and foremost, Susan and Maywood owe duty to Mrs. Daniels; she is not only a patient in the facility, but also receiving physical therapy care under Susan’s direct supervision.
By failing to grant Mrs. Daniels permission to use the bathroom before therapy and failing to lock the wheelchair brakes strongly indicate a breach of duty. Causation is implicitly present but still remains jury’s duty to decide. The first question would dwell on the possibility of the hip being unstable before the fall. Forecasting ability is also a fact question the jury has to deal with. Could Susan foresee that Mrs. Daniels might attempts to stand?
Was she having urinary tract infection or was she on diuretics? But it is quite clear that if she had been assisted to the bathroom earlier, she may not have attempted to stand independently and had the wheelchair brakes been locked, she may not have fallen; this points breach of duty. And the injury arising from the breach of duty is manifested in the damages which led to Mrs. Daniels undergoing additional surgery and being hospitalized. This clearly accumulates to related expenses which are compensable damages.
But again, the outcome will be affected by the state law. For instance, if the incident occurred in a state that recognizes contributory negligence, then Mrs. Daniels may not be successful given that she stood up in spite of clear instructions that she should request for assistance, presuming that she is mentally capable of following the given instructions.
However, if the state applies comparative negligence, then the damages may be apportioned between the parties. From the legal point of view, it can be argued that Susan failed to exercise sound judgment. She failed to prevent harm to her patient and compromised her patient’s right to dignity and autonomy. This resulted in her patient sustaining injuries in an attempt to regain her dignity and autonomy.
However, ethically Susan was carrying a delicate act of balancing Mrs. Daniels’ needs for self-determination in going to the bathroom and the clinical desire to provide efficient care. However, if Susan had anticipated asking Mrs. Daniels to postpone her trip to the bathroom, the plaintiff would not have fallen.
Susan would not have acted in this manner. It was not her intention to harm Mrs. Daniels. Therefore Susan’s ethical behavior cannot be judged on the basis of intention or unintended consequences.
The principle of beneficence and non-malfeasance should to be considered to determine whether Susan promoted good beneficence while avoiding harm (non-malfeasance) through her actions. The APTA Code of ethics and guide for professional conduct should also be referred to as a guideline to establish whether Mrs. Daniels’ rights and dignity was respected considering her physical, psychological, and socioeconomic welfare.
According to Hippocratic Oath theory, Susan’s first duty was to promote Mrs. Daniels’ health and prevent injury to her. It is crystal clear that she failed to fulfill her duties of beneficence and non-malfeasance by placing Mrs. Daniels in a situation she was unable to attend to her needs safely.
Still Susan failed to adequately train and supervise the technician to prevent harm to the patient. However, applying the utilitarianism theory, Susan wanted to do good to the greatest number of patients. By delaying to attend to other patient, the rights of other patients would have been compromised.
Maywood would be liable for Susan’s actions as an employee unless she was a contract therapist with her own liability insurance and in that case, Maywood would only be liable for portions of Mrs. Daniels injuries attributed to the technician under the doctrine of respondent superior. Moreover, if Mrs. Daniels could show that the facility was negligent in its policies and procedures, staff or physical facilities then Maywood could also be liable as corporate negligence.
In conclusion, Maywood and Susan had apportioned of damage to pay as well as Mrs. Daniels. It is critical that the institution avoids the occurrence of such similar incidence in the future and it paramount that the employees be made aware of patients’ rights and responsibilities and good communication skills stressed.
As witnessed above in which the incidence occurred simply as a result of communication breakdown or lack of understanding. Many a times the ethical duties and obligations exceed legal duties and in decision-making it is better to have retrospective look to ensure that all factors are considered to come out with a sound judgment.
It is also important the institutions create structures that embody the values, rights, and goals of beneficence as APTA code and guide describes. The ethical challenge that needs to be answered by practitioners is what level of autonomy is appropriate and possible? And to establish a process that safeguards individual’s rights.
Works Cited
Lee, Laura. Legal and Ethical Issues in Physical Therapy. Oxford: Butterworth-Heinemann Ltd, 1997. Print.
McWay, Dana. Legal and Ethical Aspects of Health Information Management. Alabama: Cengage Learning, 2009. Print.
Rowan, John. Ethics for the professions. California: Wadswoth publishing, 2002. Print.