A 48-year-old patient with normal cognition presents to the ER in acute respiratory distress. After assessment, the team diagnoses the patient with COVID-19 and realizes the patient will require a ventilator to survive.

Ethical and Risk Management Issues in healthcare

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Healthcare providers need to have a well-organized response grounded in science and ethics, especially when responding to pandemic and resources are limited, as in the case scenario provided.  In the case scenario, all patients require a ventilator to survive, but there is only one ventilator. This scenario has been witnessed in different parts of the world, especially in the current overburdened healthcare system due to COVID-19. Healthcare providers are faced with ethical issues as they try to decide who to treat or not to treat.  The potential ethical issues they often face are related to admission or non-admission to ICU, human errors that may to the transmission of infection to other patients, to withholding or withdrawing life support, communication with families about their decisions, and the safety of patients (Continental Assurance Company, 2014). Besides the ethical issues, there are also potential risks management issues with the decision to treat or not, including issues such as determining the standard of care, infection control procedures, preventive care, medication administration, referrals, drug or device recalls, and patient education.

While trying to find solutions to ethical issues, conflict often arises while meeting the risk management issues. For instance, the conflict will arise between patient safety and infection control procedures; preventive care and withholding or withdrawing life support, which in this case is denying the patients the opportunity to use the only available ventilator; admission or non-admission to ICU and referrals; whether to communicate with patient’s family before determining the standard of care such as to treat or not to treat (Johnstone, 2007).

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However, in the case scenario, the best recommendation would be to treat the patient with the highest chance of survival after hospital release while applying the principle of fairness when distributing the one ventilator to the patients. However, the 48-year-old COVID-19 patient does not seem to qualify for the treatment with the only ventilator due to the underlying COPD condition, meaning that even when treated, the patient has less time to live considering that this patient does not adhere to COVID-19 regulations like wearing a mask or social distancing. There are high chances that after being released, the patient will continue to engaging in risky behaviors that put his or her life at risk of infection and transmitting to other people. A more deserving patient, without an underlying condition and with more years left should be given priority. This recommendation aims to maximize the number of “life-years” saved and prioritize patients who have had the least chance to live through life's stages (White, Katz, Luce, & Lo, 2009). Moreover, these principles are relevant to all patients and, therefore, must be applied to all patients instead of applying them selectively to the elderly, those with functional impairment, and those with certain chronic conditions.

Therefore, it is important to handle the differences of opinion about how to proceed within the team very carefully to avoid misunderstanding. It is necessary to inspire team members to become transparent, show compassion to patients be truthful about medical errors to enable the team to collaborate to improve care, as Leilani Schweitzer at TED University of Nevada puts it in the video. Besides, encourage members to listen to each other’s opinions to create a channel of constructive communication, serving both to warn of simmering problems and bolster loyalty and morale within the team. Therefore, according to Groszkruger (2020), as the facility risk manager, one needs to communicate changes to governance, facility leadership, and clinical professionals and monitor all laws and changes in regulations concerning care to ensure that there are no conflicts in procedures and regulations.

References

Continental Assurance Company. (2014). Healthcare Perspective: A Risk Management Resource to Manage Liability In The Healthcare Practice. Retrieved from> http://www.hpso.com/Documents/pdfs/Principles_of_Healthcare_Risk_Management_-_2014-1.pdf

Groszkruger, D. (2020). How case law impacts risk management. Journal of Healthcare Risk Management, 39(4), 10-13.

Johnstone, M. J. (2007). Patient safety ethics and human error management in ED contexts Part II: Accountability and the challenge to change. Australasian emergency nursing journal, 10(2), 80-85.

White, D. B., Katz, M. H., Luce,