Ethical dilemmas are quite profound in most of the working places. They are presented in either professional or moral dilemmas and staff members have an obligation of making the most coherent decision. This paper discusses a situation highlighted in a case study, where the doctor is torn between following her staff member’s advice or the pharmaceutical advice. Using the shared decision making model, the doctor manages to come up with a decision that considers all the stakeholders involved in the dilemma.
Moral vs. Professional Dilemma of Free Samples
Monrouxe, Rees, Endacott and Ternan (2014) describe an ethical dilemma as a complex situation which elicits difficulties in making a decision between moral imperatives as each of them would contravene the other. Ethical dilemmas are embedded on either morality or professionalism perspective. Monrouxe et al. (2014) define a moral dilemma as a situation in which an individual has to choose between two or more actions, that involve moral aspects in each of them. Professional dilemma, on the other hand is the difficulty engulfed in making a choice that would either lead to success of the workplace or would result in offering service at the expense of the organization success. In this light, the case study ‘Hidden Costs of Free Samples’ outlines some of the ethical dilemmas experienced in the rural primary care facilities. Primary care facilities are integral in the healthcare network as they act as the first contact and principle point for continuing care for patients. Obviously, there are ethical dilemmas that are exposed to the healthcare workers in rural primary care facilities.
Case study: Hidden Costs of Free Samples
Dr. Martinez is at the center-stage of the dilemma outlined in this case study as it highlights her predicaments in choosing, whether to allow her staff members or the pharmaceutical representatives, to engage in training sessions. The pharmaceutical representatives have been integral in helping the deprived and poor consumers with medical services and drug samples. Notably, the living standards among the people around this healthcare system are quite low as they lack even basic medical insurance. The pharmaceutical representatives are requesting to offer free samples to the patients and use these as training sessions for experiential learning. On the other hand, Dr. Francis is one of the staff members, who feels that it is imprudent to accept the drug samples as they may have adversarial impacts on patients. Dr. Martinez relies on her staff members to actualize the day to-day activities in the facility. She is, therefore, torn between prioritizing between pharmaceutical representatives and her staff members. She is supposed to evaluate her professional ethics and the advantages the free samples will have on the patients of the practice.
The Decision-making Process
The above stated mental conflict comprises both professional and moral dilemma. It is, therefore, important to make an informed decision that will serve the best interest of every stakeholder. Therefore, the most appropriate decision-making model to resolve this ethical dilemma is the shared decision making. It is a collaborative process that involves all the stakeholders, including the patients and the pharmaceutical representatives (Elwyn, Edward, & Thompson, 2016). The shared decision-making model involves reviewing the clinical evidence available, the moral grounds of the doctors and the staff members, as well as, the values and the preferences of the patients (Monrouxe, Rees, Endacott & Ternan, 2014). In this case, consultations should be made in consideration of both, Dr. Francis and Dr. Martinez, positions. Similalry, the model seeks to establish what the rural patients think and if they are willing to take drugs that may or may not have been appropriately clinically tested.
The group discussed the options of allowing the education seminars and free drug samples and the banning altogether, of the visits by the representatives without an appointment or a reference from the reliable clinical practitioner. After careful considerations, we agreed that it was not fair to deny the low-income rural people the possibility of having free drugs or drugs at a reasonable price. However, precautions were taken as we agreed representatives would only bring free samples after making an appointment and passing a thorough vetting process that ascertained the validity and accuracy of the information and drugs they brought.
The Interprofessional Core Competencies
During the ethical decision-making process, the members of the team demonstrated the core competencies of interprofessional collaborative practice on some levels. The entire team worked together, exhibiting high levels of respect for the shared and different values during the process allowing for a fast and mutually agreeable decision. All team members used their roles and knowledge to assess the situation objectively. I assessed the situation as a newly qualified doctor, not to be swayed by the fast talking and charming representatives and think on behalf of the vulnerable patients. Dr. Francis, who is much experienced, helped me understand that there was a way to get the free samples from the representatives, help the patients and protect them from being misled.
The communication between the patients and the health professionals was very fundamental, as it helped me see why the patients needed the free drugs and also create a rapport with them, which I was serving in their best interest, allowing for a smooth and mutually beneficial ethical decision in the end (Interprofessional Education Collaborative Expert Panel, 2011). Everyone in the team was very invested and objective, and as such they made the decision making smooth and effective and eventually, facilitating the delivery of population-centered care that is efficient and equitable and safe.
Reflection and Conclusion
During the process, I had a lot of conflicts based on my personal and professional moral position. On more occasions than not, I thought about allowing the free samples from all the representatives because I empathized with the rural people, who did not have money for the much-needed drugs. This stand disagreed with my professional ethics which dictates that quality care is the most primary objective and to ensure that my patients do not consume substandardly and inaccurately represented drugs (Stanford and Connor, 2012). The most heated disagreement was between me and my mentor, Dr. Francis, who held the position that we should allow all representatives to train us and bring free samples, because they helped the low-income and uninsured population who had to pay for the expensive drugs out of their pockets..
I learned that I am a very passionate communicator, who can at times, speak over people when I feel like they are compromising my ethics. It was a very difficult process because most of the team members were also passionate and lacked objectivity at the beginning. Towards the end, we all started listening to the positions of everyone in the team, and it was at that point, that we were able to arrive at the two working options. I moved forward, using both verbal and non-verbal communication, that helped put across by points and concerns clearly. I also learned that it is very important to weigh all the available options before making a stand and there is always a solution for every ethical dilemma. I exercised very strong leadership skills which made people listen to me, despite the fact, that I was the newest member of the team. My performance was affected by the fact that I was morally obligated to help but ethical bound to reject, where the help was coming from and as such making me adamant and strong-headed.
My experience from that ethical dilemma has helped me realize that just because there is a moral and professional collision, it does not mean that the matter cannot be resolved. It has taught me that different opinions on more occasions breed an even better solution. I have learned to be objective, both in my personal and professional life.
Elwyn, G., Edward, A. and Thompson, R. (2016). Shared Decision Making in Health Care: Achieving evidence-based patient choice. New York, NY: Oxford University Press.
Interprofessional Education Collaborative Expert Panel., American Association of Colleges of Pharmacy., & American Association of Colleges of Osteopathic Medicine. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.
Monrouxe, L. V., Rees, C. E., Endacott, R., & Ternan, E. (2014). ‘Even now it makes me angry’: health care students’ professionalism dilemma narratives. Medical education, 48(5), 502-517.
Stanford, C. C. and Connor, V. J. (2012). Ethics for Health Professionals. Burlington, MA: Jones & Bartlett Learning.