Armando Dimas’s case presents different issues that medical professionals in the healthcare industry face. Armando Dimas, a Mexican immigrant who comes to the hospital, raises essential moral and ethical questions about gender, race and ethnicity, class, patient’s right, choice, hospital’s control, and connection (Belkin, 1993). The case highlights the crucial questions that bioethics aims to resolve in controversial situations with patients. Throughout the case, the main issues that regulate healthcare decision-making arise, including non-maleficence, beneficence, autonomy, and justice. This paper will discuss the ethical principles present in the case of Armando Dimas and assess guidelines aimed to balance the situation with ethical dilemmas.
Regarding the non-maleficence principle, it can be stated that Hermann hospital’s staff aimed to provide Armando with the best possible solution to navigate through the situation called “head in a bed” by doctors when a patient has paralysis (Dolgin & Shepherd, 2009, p. 21). The decision to transfer the patient to a less expensive site, namely Bart’s hospital, can be questioned based on the non-maleficence principle. Armando lacked equipped wheelchair and services (Belkin, 1993). Still, he was satisfied with the healthcare standard at Bart’s. Tong’s guideline that the form of infringement selected is the least possible, commensurate with achieving the primary goal of the action, is in line with a decision of Hermann’s executives (Tong, 1997). They figured out how to provide decent healthcare services to Armando but minimize patient support costs.
The beneficence principle is raised in the Hermann hospital immediately when Armando as a patient, asked for help. Doctors thought that the refusal of resuscitation and death is the most beneficent way Armando can choose not to suffer more while being paralyzed (Belkin, 1993). In this sense, professionals considered that the moral objective justifying the refusal has a realistic prospect of achievement and would be a better option for Armando and his family that live in difficult conditions. Thus, the beneficent care was almost withdrawn from Armando immediately based on doctors’ judgments that were not benevolent. Doctors also considered Armando as a cost, liability, and vegetable that would not live fully anymore; therefore, they did not see Armando’s perspective in staying alive, which can be considered beneficent healthcare.
Considering the autonomy principle, several essential issues should be highlighted. It was identified by the medical staff of the Hermann hospital that Armando is alert, mentally awake, and can make decisions about the future actions that professionals should do. When nurses and doctors started communicating with Armando about his condition, he could express his wishes and reply to questions about the possibility to resuscitate him and save a life (Dolgin & Shepherd, 2009). It was unexpected for professionals that Armando would agree with all supportive measures that staff had to do to save his life despite being informed that he could stay quadriplegic forever.
By expressing his decisions and desires, Armando used the ethical principle of autonomy that emphasizes the right of a person to make decisions using inner values and objectives when they do not harm others and infringe others’ rights (Beauchamp & Childress, 1994). By utilizing his autonomy, Armando convinced the medical staff of the Hermann hospital to focus on the guideline that no morally preferable alternative actions can be substituted (Tong, 1997). The patient’s determination helped to replace the initial disregard of non-maleficence and beneficence ethical principles that doctors had and encouraged a fair attitude (Belkin, 1993). The focus on life and autonomic behavior contributed to the hospital’s management’s decision to provide Armando with all the necessary healthcare services that he required. Moreover, there could not be any better reasons to override the norm than infringe the right to life that Armando had that could not be compared with any other right.
Considering the matter of justice in the case, several issues arise through Armando’s journey at hospitals. The ethics of justice, its rules, and regulations, guided Hermann hospital staff and decision-making because Armando became a burden not only for Hermann but also for Bart’s hospital even though Hermann hospital carried costs associated with Armando’s health management (Belkin, 1993). Hospital executives evaluated essential points when deciding to transfer the patient to Bart’s and home. Justifying the decision to move Armando, the staff used the guideline stated that the agent seeks to minimize the adverse effects of the infringement (Tong, 2007). Hermann hospital’s managers navigated through the process based on justice and fairness, considering all quadriplegic patients in the organization that require unique, expensive healthcare services and can be treated more efficiently than Armando in the long-term perspective.
To make a conclusion, it can be stated that achieving the balance in the situation that presents problems from different angles is a complex challenge. Professionals should act according to the important ethical principles: non-maleficence, beneficence, autonomy, and justice. The healthcare professionals coming from different backgrounds must encounter their experience but base their decisions on the moral principles and the code of conduct that regulates what is right and wrong and give the best standard of how a person should act. In any case, healthcare professionals should aim to provide the best solutions possible in the given complex situations.
References
Beauchamp, T. L. & Childress, J. F. (1994). Principles of biomedical ethics (4th ed). New York: Oxford University Press.
Belkin, L. (1993). The high cost of living. The New York Times Magazine. Web.
Dolgin, J. & Shepherd, L. (2009). Bioethics and law. Frederick: Aspen Publishers. Web.
Tong, R. (1997). Feminist approaches to bioethics: Theoretical reflections and practical applications. Michigan: Avalon Publishing.