Are Health Care Providers ethically responsible to do everything possible to save a life?

Are Health care providers ethically responsible for doing everything possible to save a life?
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Are Health care providers ethically responsible for doing everything possible to save a life?
One of the challenges of healthcare practice is to abide ethical guidelines at each and every aspect of care. The maintenance of ethical practice becomes even critical, during care of critical care patients and patients with special needs. Medical ethics is broadly defined as a protocol of moral principles and clinically applied values and judgment, which aims to benefit the health of the patient. Thus, it becomes clear that clinical decisions on a particular intervention should be taken in accordance with medical, social and economic aspects. Knowledge regarding various aspects of a patient’s social, financial and clinical requirements are difficult, as clinicians are primarily responsible for the eradication of the diseased state of the individual (Kimmelman, Weijer, & Meslin, 2009)..
However, all said and done, the healthcare providers are ethically responsible, for doing everything possible, to save the life of a patient. This is because these are the individuals who have the core knowledge regarding the medical condition of patent and therefore, they can place the facts to a patient or their families. It is up to the judgment of the family or the patient, to accept a certain decision for the benefit of the patient. Hence, healthcare providers could lead the path to ethical management of a patient, irrespective his or her clinical condition.

There might be clashes of one aspect of social variables with another aspect of financial variables, which may again jeopardize care decisions. With such a confusion regarding the clash of principles, the healthcare provider is the best judge to take any decision for saving the life of a patient.
The ethical values, through which a healthcare provider should be guided, are uniform all across the world. The common sets of values driving physicians all across the globe were postulated by Beauchamp and Childress. The first value that defines ethical intervention of care is maintaining and respecting the autonomy of the patient. This means that the patient has the right to refuse or accept a certain interventional strategy. Autonomy is a very challenging aspect of care, since therapeutic interventions might always not be pleasant to a patient. Such apprehensions or reality regarding treatment modality may have been witnessed by the patient in the near past, or must have experienced such treatment interventions and modalities in his or her sphere of friends and relatives, or he or she must have been aware through acquired knowledge. Such experiences and knowledge make him or her resistant to treatment approaches, and this puts the healthcare providers in the dilemma (Kimmelman, Weijer, & Meslin, 2009)..
For example, it might be a justified decision to go for an amputation in the patient who has suffered from deep vein thrombosis. However, the patient and his or her family members might be insensitive to such decision and resist such treatment interventions. This is because they may apprehend the pain with which an individual has to thrive for the rest of his or her life. Amputation of one leg will certainly make the individual physically challenged. Hence, there is always a possibility that such decision would increase his or her mental agony of compromising on the quality of life. However, if there is no amputation, sepsis can ensue and may lead to the death of an individual. Hence, in such situations amputation is the only possible resort for saving the life of a patient. Thus, a physician has to perform an amputation, taking everything into consideration.
However, even in such a crisis situation a physician must involve the patient and his or her family members in the decision-making process. The objective of the physician and the other members of the health care team would be to sensitize the patient and their family members, regarding such a decision. This can be done through awareness, education and transparent communication of information to the persons involved. If even after such sensitizations, a therapeutic intervention is resisted, physicians must evaluate whether such decisions will erode the psychological health of that individual. If a clinician evaluates that the need of a patient with respect to psychological well-being is much more desired than his physical well-being, certainly such intervention plans must be abandoned.
With respect to autonomy, another issue that often challenges healthcare providers is the wish for euthanasia in a patient. Such wishes are often reflected in patients who suffer from chronic and terminal illness. Certainly, euthanasia is a legal right across various countries, but it is the moral responsibility of a physician to judge such wishes considering the clinical, social and financial environment of the patient. It may so happen, that family conflicts and neglect on an individual or decreased productive engagement (especially in older persons), abolishes his or her desire for living.
Therefore, a physician and the healthcare team must ensure a patient-centric care on understanding the issues of euthanasia. If it is revealed that the agony of a chronic and terminal illness, really forces him or her to such decision, then the clinician must respect such decision. However, a healthcare physician and his team must try to implement alternative treatment approaches including clinical and psychological aspects to increase his or her coping mechanisms. If even after such interventions, a patient seeks euthanasia, then it should be extended as per the laws of the respected countries (Kimmelman, Weijer, & Meslin, 2009)..
The next ethical value, which drives a healthcare provider, is to ensure “beneficence” in a patient. This means that the healthcare provider should always take such actions that ensure the preservation of health and interests of their patients. However, ensuring beneficence is not always possible, under different contexts. Hence, various ethical experts have argued regarding the definition of beneficence and the moral values associated with beneficence. It is often noted by ethical experts that beneficence would be the central and core ethical value. Certainly, from the perspective of the health of the patient, beneficence must be the core value and such value does provide the care provider of enough independence in ensuring clinical judgment and interventions. However, the definition is ill-defined and the framework can be debated, because what the physician thinks as a benefit for the patent, might not be perceived as a benefit to the patient. Apart from such issues, beneficence mandates that the interests of the patient should always be preserved. This is where clashed between decision-making process develops and compromises health care interventions. As discussed, the patient or his family members might resist a treatment or intervention approach, under various interventions (Kimmelman, Weijer, & Meslin, 2009)..
One such clash is between beneficence and autonomy. In certain situations, it becomes very prudent that if autonomy has to be maintained, then it will erode the value of beneficence in a patient. In fact, under various situations it is observed that a patient dictates too much treatment options that are beside the theory of evidenced based guidelines and may ultimately jeopardize be beneficence. However, most of the westernized countries are in favor of autonomy and they speculate that a patient if properly explained the pros and cons of a treatment modality, can take independent decisions. On the other hand, certain countries are strict on the preservation of ‘beneficence” in an individual patient. Physicians and healthcare providers are asked to take the decision in the best interests of a patient. Hence, to draw the line between beneficence and autonomy, clinicians must prioritize health interests of a patient, in preference to the autonomy of care (Kimmelman, Weijer, & Meslin, 2009)..
The next ethical issue that guides clinicians in practice is non-maleficence. Non-maleficence means a clinician while providing any intervention must always ensure that the patient is not harmed by the treatment approach. It is true that in various situations clinicians considers patients as scapegoats and intervene with self-declared approaches that cause more harm than good. For example, a small cell carcinoma surgery may be useful and successful, however, it may lead the cancerous tissue would more potential for metastasis. Apart from surgery, often new medications like antibiotics or chemotherapeutic agents are administered to a patient as a part of clinical trial or medical intervention. If such a drug is new and proper evidence has still not accumulated, it may give rise to issues with toleration profile. This may ultimately lead to grave consequences and even the risk of mortality in a patient cannot be ruled out. In this situation, a physician or a healthcare provider should be held responsible for such acts of jeopardizing “non-maleficence “in a patient (Kimmelman, Weijer, & Meslin, 2009)..
It simply cannot be a will or wish of a physician to explore newer medicines on a patient. Whether it is a clinical trial or a treatment plan, interventions should always weigh the risk-benefit analysis of therapeutic modules. If the therapy or treatment indicates that it would do more harm than good to a patient, such plans should be abandoned. Even in clinical trials, we witness there are a treatment arm and a control arm. Although the treatment arm receives some form of treatment (established or new), the control arm receives placebo. This means the control subjects are not given any active ingredients of medications and hence, for the entire trial period, they are left without treatment. This is the strong violation of medical ethics and to an extent, eroding non-maleficence in the patient. Although no interventions are given, it may be argued that such patients are not exposed to any harm. However, denying a patient his or her treatment rights is itself a causative factor of producing harm to a patient. Therefore, considering all the above clauses and values, I certainly feel that health care professionals are responsible for the ethical treatment of patients which ensures safety and improved treatment outcomes in them (Kimmelman, Weijer, & Meslin, 2009).
References
Kimmelman, J.; Weijer, C; & Meslin, E (2009). “Helsinki discords: FDA, ethics, and
international drug trials”. The Lancet 373 (9657), 13–4