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1. Determine at least three different internal and external stakeholders that Dr. DoRight might have to deal with on a daily basis at the hospital. Stakeholders are individuals who are involved in, have a vested interest in, or a “stake” in the success of an organization (Merriam-Webster, 2011), such as a hospital. Dr. DoRight is an influential decision maker as the President of the Universal Human Care Hospital and it is important for him to consider how his decisions and actions affect the stakeholders of the hospital. In the course of his daily activities Dr. Do Right will interact and impact many of the hospital’s internal and external stakeholders. Internal stakeholders are be committed to an organization’s success. Often internal stakeholders will participate in the strategic development of coordinating resources to fund and sustain an operation. Examples of internal stakeholders which Dr. DoRight might engage daily would be: Director of Public Health, Head of Health Intelligence and Information, Director of Nursing, Public Health Strategists, Vice President of Human Relations or Members of the Board of Trustees (Markwell, 2010).
External stakeholders are not directly connected to the organization; however, they are vested in the hospital’s success as clients, business or community partners. These stakeholders have influence over organizational activities by contributing their views and experiences related to issues which are important to them. Medical providers or suppliers, Patient Advocacy Groups, Quality Assessors, the Media, and Heads of Local Community and Special Interest Groups are examples of external stakeholders Dr. DoRight may deal with on a daily basis (Markwell, 2010). 2. Compare and contrast potential conflicts of interest that may exist between the internal and external stakeholders. Conflicts of interest exist between the hospital’s internal and external stakeholders. Medical providers such as, staffed research doctors or pharmaceutical manufactures want to provide the ‘best’ wellness plan by providing cutting-edge tests, treatments and medications which are likely to be more expensive to the payer or patients.
Payers, such as insurance providers and private paying patients, would prefer a more cost effective approach to wellness with accurate diagnosis and treatments with fewer visits and tests (Wiseman, 2005). Although internal and external stakeholders may have different priorities, they will share common objectives. All stakeholders will share common ambitions for Universal Human Care Hospital to provide quality medical services to its patients. Additionally, all stakeholders will appreciate the hospitals efforts to improve the quality of life for the community it directly serves. (Markwell, 2010). 3. Discuss whether Dr. DoRight has fulfilled his ethical duty by reporting the illegal procedures. Dr. DoRight has reported the illegal procedures and patents dying due to negligent supervision and oversight to his Regional Director, Compliance Manager, as well as an Executive Committee in January 2009, but he has not fulfilled his ethical duty.
As a doctor it is his responsibility to protect all patients from criminal acts including the illegal procedures and negligent supervision which has been reported at Universal Human Care Hospital. As there has been no result from the investigation after two years he has a responsibility to take further action to preserve the lives of patients. His ethical duty should include reporting the illegal procedures, as well as, the negligent supervision and oversight to higher ranking internal authorities. If the appropriate investigation and corrective actions do not occur he has a further ethical obligation to report the incidents to external authorities. As a doctor he is legally bound to take reasonable action. The law recognizes several exceptions the “no duty to rescue” rule and several apply to Dr. Do Right’s ethical dilemma (Halbert & Ingulli, 2012). Continued deaths due to negligence and illegal procedures should be reported beyond the Regional Director, Compliance Manager and the Executive Committee as the failure to do so may result in his dismissal or even criminal prosecution.
As a doctor he assumes contractual responsibilities to medically help others, and prevent them from being harmed. Patients in the hospital in which he is President may be lulled into a false sense of security, believing they will be helped, only to be neglected when lifesaving assistance is needed. Doctors and nurses employed in the medial facility which he oversees are endangering their patients and he is currently participating in creating a dangerous situation for several patients. Finally, there is a “special relationship” between Dr. DoRight’s medical facility and their patients. This relationship has a degree of dependency from the patient to the hospital and those whom govern the medical facility. As the President of Universal Human Care Hospital he is required to reasonably protect all patients from harm including the protection from the illegal procedures performed by the medical staff, and neglect or oversight of the supervising staff (Halbert & Ingulli, 2012).
4. Describe the deontology principle and apply it to the ethical dilemma that Dr. DoRight faces in this case. The deontology principle “is marked by steadfastness to universal principles …[of] respect for life, fairness, telling the truth, keeping promises – no matter what the consequences” (Halbert & Ingulli, 2012). Immanuel Kant, the most famous deontological thinker, believed humans could rationally develop an absolute set of rules to govern behavior, and these rules should be applied in all situations without consideration of the consequences. For example, Immanuel Kant believed there is a never good time to lie, even if it could produce a favorable outcome, such as lying saving someone’s life (Halbert & Ingulli, 2012).
Under the deontology principle, moral and ethical behavior “is a matter of holding, without exception, to certain principles” or categorical imperatives (Halbert & Ingulli, 2012). The first of these principles is that people should act under the assumption that the same action they chose should be repeated if roles were reversed and they ended up on the receiving end of those actions. In Dr. DoRight’s ethical dilemma a deontological approach would require him to make his decisions in the frame of reference of being a patient whose death resulted from the hospital’s negligence or oversight. If Dr. DoRight made decisions in this frame of reference it is doubtful two years would pass without any definitive findings from the internal investigation into patient deaths (Halbert & Ingulli, 2012).
Another categorical imperative of the deontology principle is that it is unethical for people to use others for their own gain. A mutually beneficial relationship should exist where all stakeholders gain something they want. In Dr. DoRight’s ethical dilemma, the relationship could be mutually beneficial if the patient receives suitable medial services and attention in exchange for monetary compensation. Dr. DoRight’s decisions can be considered unethical as the relationship is not mutually beneficial. Patients within his hospital to continue to die as a result of a variety of illegal procedures, while Dr. DoRight continues to win awards for his leadership and meeting his business goals (Halbert & Ingulli, 2012). Patients have a right to make a fully informed decision when selecting their medical providers. Making fully informed decision for oneself is “of great ethical value in deontology” (Halbert & Ingulli, 2012).
In the last two years, Dr. DoRight has told his Regional Director, Compliance Manager and the Executive Committee about the patient deaths due; however, disclosures are not provided to patients. With the insight of increased mortality rates due to the illegal procedures coupled with negligence and oversight it less likely patients will chose his medical facility for their health care needs. It is unethical according to the deontology principles to keep this information from patients. An infringement is being placed on some of the patients most basic rights; the right to life and health. Within the deontology principle this is never acceptable. Dr. DoRight falls short of several deontological principles, and is unethically infringing on the rights of his patients who are dying as a result of his decisions (Halbert & Ingulli, 2012).
5. Describe the utilitarianism principle and apply it to the ethical dilemma that Dr. DoRight faces in this case The utilitarianism principle guides individuals, like Dr, DoRight, to ethically “behave in a given situation … to choose an alternative that is likely to produce the greatest overall outcome.” This principle evaluates the advantages and costs of an individual’s actions not only for the decision maker, but for all stakeholders who will be impacted by the decision. Within the utilitarianism principle the long and short term consequences to the stakeholders are analyzed when evaluating a dilemma, while weighing the size of the group and the effects of the decision upon the stakeholders (Halbert & Ingulli, 2012). In Dr. DoRight’s dilemma some consequences may be shared by numerous stakeholders, both internal and external. For example, the media could tarnish the reputation of the hospital and several of its staff by publicizing the deaths as preventable.
This consequence could result in an increase of livelihood for external stakeholders such as the media, medical malpractice attorneys, or the extended family member of deceased patients. At the same time, it could result in the loss of livelihood amongst internal stakeholders such as; doctors, nurses and other members of as the hospital’s 5,000 employed staff (Halbert & Ingulli, 2012). Smaller external stakeholders carry the burden of the greatest negative consequences. Most costly would be the loss of life to patients who died as a result of illegal procedures and negligent supervision. Although this group of stakeholders may be small in comparison to the 20,000 patients treated at the hospital, “losses of life and health weigh heavily on the scale” when assessing the consequences of a decision within the utilitarianism principle (Halbert & Ingulli, 2012).
The causes of deaths have not been revealed after two years of internal investigation. If an outside organization investigated the details of the illegal practices and neglect it could negatively impact some internal stakeholders. An external investigation could have a negative impact on hospital finances, the Executive committee, and the livelihood of the Regional Director, Compliance Manager or their direct staff. On the other hand, patients, doctors and other stakeholders could benefit from this same decision in the form of additional staffing, proper training and technology to provide accurate diagnosis. Ultimately, the short-term costs a few internal stakeholders of the hospital would be outweighed by the long-term benefits to several stakeholders if Dr. DoRight made this decision (Halbert & Ingulli, 2012).
Halbert, T. & Ingulli, E. (2012). Law, Ethics, Business. In Law & Ethics in the Business Environment (7th ed.). Mason, OH: South-Western Cengage Learning. Markwell, S. (2010). Health knowledge. Retrieved from http://www.healthknowledge.org.uk/public-health-textbook/organisation-management/5b-understanding-ofs/managing-internal-external-stakeholders Merriam-Webster. (2011). Stakeholder. In Merriam-Webster Dictionary. Retrieved from http://www.merriam-webster.com/dictionary/stakeholder Wiseman, B. (2005). Who are the stakeholders in healthcare?. Retrieved from http://patientsafetyed.duhs.duke.edu/module_a/introduction/stakeholders.html