CONFLICTING DUTIES

Conflicting Duties



Conflicting Duties

The case scenario

Three years ago, Ms EH, an 86-year-old woman, was referred to me after a debilitating stroke affected her right side (pre-morbidly her dominant side). Ms EH was admitted under home health after running out of Medicare allowable days at a skilled nursing facility (SNF). Ms EH needed considerable assistance with all activities of daily living (ADL) and was primarily wheelchair-bound due to her inability to walk independently. She lived with her 88-year-old husband Mr. RH, who was also not in the best of health (Ferrell, 2010). Due to financial constraints the couple opted against long-term or assisted living placement in favour of their trailer home. Ms EH demonstrated good rehabilitation potential and progress with all her home health services (Forte, 1997).

One night, approximately three weeks after her return home from the SNF, Mr. RH suffered a massive myocardial infarction. He was hospitalised and underwent cardiac catheterisation. It indicated diffuse blockage of multiple vessels and he was deemed a poor candidate for surgery. Subsequent medical interventions were primarily conservative with a poor prognosis. He was later transferred to a nursing home. Ms EH obviously was very concerned and depressed about the situation. She was devoted and would visit Mr. RH for four to six hours everyday at the nursing home after being driven there by her friends and family (Ferrell, 2010).

Ethical principles at risk

As per organisational requirements (Medicare's as the regulatory and the home health agency's as the regulated body), Ms EH was clearly homebound based upon her physical limitations; however, her daily absences did not exactly fit the "infrequent" or "short-duration" requirements for Medicare coverage (Forte, 1997). Much of the ethical confusion was also caused due to the inability of the coverage guideline to exactly quantify the terms "infrequent" and "short duration" and leaving it for further interpretations (Ferrell, 2010). The client's expectation and what could be perceived as her right to receive health care at her home based upon her medical necessity (client/consumer rights), and my moral duty to provide treatments and my obligation toward her well-being (my personal beliefs) were thus in conflict with the organisational interpretation/ procedures based on regulations that set criteria for services (rules of practice, possible legal issues involved).

The various ethical principles at risk were as follows:

Autonomy: The client's right based upon her self-determination to receive occupational therapy services at home, and my own professional autonomy to decide where the client should receive the services were under question. As stated by Shanawani and Lowe, our professional schooling prepares us with, "guidelines, rules and regulations, and legal judgments relevant to our decisions about where to treat patients... (Forte, 1997) (based on) medical variables of the patient's health... and the anticipated care needs of the patient. Nowhere do non-medical variables of patient financial resources, insurance reimbursement, and patient and family preference play an explicit role in those decisions" (Ferrell, 2010).

The theories of ethics applicable to my dilemma

My dilemma involved various ethical principles that are based upon different ethical ...