Disaster Planning Ethical Scenario-CHP 400
A multi-discipline team has just been assembled at your hospital, Pace Memorial. Virginia. You all have been designated to the team from the management and administration offices. This team must quickly develop a Pre-disaster plan for the management of patients in your hospital. Your plan must address at least 3 ethical dilemmas where you will need to resolve the issues from an ethical perspective using ethical principle.
Of note: At a minimum, you must identify at least one member of your team to serve as the “legal consultant” to explore the legal issues and regulations that will assist the team in completing an ethical plan of action for this impending storm. You must submit this proposal which identifies the issues and recommended an ethical approach to the CEO and CFO and other members of the Board of Director. You have not been given a template on how this should be done so you are expected to present an organized written discussion. The CEO will be particularly interested in the ethical principles, the ethical issues and the recommended ethical actions to be taken as the hospital was recently criticized in the news for denying an indigent patient continued stay after being medically stabilized.
Situational Report
A deadly storm named, “Ohmighod” has suddenly taken an unexpected turn and is headed your way. It was not expected to hit your area by all scientific and geographic accounts. However, as nature has it, the storm will make landfall in 4-5 days. It is expected that this storm will cause significant deaths, destruction and serious life threating injuries to the local areas and residents that span 3 counties, each approx.15 miles apart. You must have this Memorandum that identifies the facts, issues, rules/principles, analysis and conclusions with recommendations.
While you might identify multiple issues for your factual discussion, you realize you will have to prioritize all of issues for this discussion, as time is of the essence. Therefore, you must prioritize, at a minimum, the top 3 priorities for this Memorandum.
For example, which patients should get a share of limited resources, and who will decide? What does it mean to do the greatest good for the greatest number, and does that end justify all means? Where is the line between appropriate comfort care and mercy killing? How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when local, state and federal government fails?
Background: Recent studies have estimated that climate change rendered Hurricane Harvey’s extreme rainfall three times more likely and 15 percent more intense. 27 trillion gallons of rain fell over Texas and Louisiana from Hurricane Harvey alone, setting the record for the highest tropical cyclone rainfall in the continental US. Sea level rise of 10 to 12 inches in cities such as Miami had dramatically increased the destruction caused by the storm surges associated with Hurricane Irma, which were as high as 10 feet. Warming waters driving hurricane development and strength ushered in Hurricane Maria – Puerto Rico’s strongest storm in 85 years – and Hurricane Ophelia, which set records for the farthest east a major hurricane has traveled in the Atlantic and the worst storm in history to make landfall in Ireland. This storm promises to surpass all of these hurricanes and will likely cripple the hospital before a full evacuation could occur.
Given the response in the past from local the politicians who are also dealing with a strained state budgets, it is likely that requests to the State’s response teams to assist with patient care or patient evacuation will be minimal or slow. The hospital is situated approximately 3 feet below sea level and is located between an esteemed community of mansions and low income housing, a small community of Muslims, undocumented aliens, and homeless, thus your patient population consists of diverse patients from varying socioeconomic backgrounds. In the years past, the hospital, has served as a shelter for the local community when hurricanes threatened. In fact, employees would bring their families and pets, as well as coolers packed to ride out the storm. As many as 200 local folks would show up seeking shelter. The hospital can comfortably accommodate these people in a street level briefing room but any excess of that figure will definitely strain the hospital. It is expected more than 500-600 folks will seek shelter. It is also expected that the sewer systems will fail given that it is also located below sea level and the street will quickly fill with sewage should the rain fall be as much as expected. It is also expected that the State’s medical helicopter will be able to evacuate transport 4 individuals out of the area. You must decide which of the 4 patients or staff will be selected.
In fact, given that you are the only tertiary hospital (maximum capacity total of 315 beds) in the local area, it is estimated that the city can only evacuate by ground, approx. 50% of the current in-patients if it becomes necessary to out of the storm affected areas. It’s likely that the 2 smaller nearby hospitals will request to transfer their in-patient to your hospital since they do not have the resources to house or conduct evacuations of patients in an emergency situation. Each of those hospitals has 50-bed capacity and are said to be full to capacity.
Also, as you may recall, during prior storms of less threatening nature, you had to deal with power outages, and the loss of fresh running water. The system was designed to power only emergency lights, certain “critical equipment” and a handful of outlets on each floor; the air-conditioning system will inevitably shut down and the temperatures inside the hospital could raise to above 100 degrees once the generators fails. There have been no recent upgrades or increase of the same generators that are used to power the hospital’s medical equipment for patients as well as the hospital facility. Upgrading or purchasing new generators was costly and would have deferred money used to community education and the “free clinic” program.
You also know that you have approximately 300+/- patients and about 60 of these patients are extremely ill and on some form of life support in the intensive care unit. 20 of these patients are new born or infants; 18 of these are children under the age of 17. The last bed count found that 14 of the remaining are 80+ years old and 8 are suffering from terminal illness but not expected to die imminently; of the 8 suffering from terminal illness 6 have executed an Advance Directive and have “do not resuscitate (DNR) order in their chart. The remaining patients are pre and post-surgical patients, (approx. 40) but expected to recover and the balance of the 200 patients are recovering from flu like symptoms, drug overdose withdraw, alcohol, diabetes or injury related ailments. Lastly, it’s been determined that 5 patients identified in intensive care might not survived any form of evacuation though they are not near death as they are receiving intensive medical care in the hopes of recovering, therefore, these 5 have not executed any advance directive or DNR. The board would also like that you consider that there are about 26 women in late term pregnancy that can be expected to take shelter prior to the storm in the event they go into labor.
Most of the support staff has already begun to request time off/vacation time to care for their loved ones and families or to evacuate from the area. A recommendation must be made regarding these staff member’s request and the need for expertise in the various clinical areas. It’s also expected that pharmaceutical shortage will occur, thus making it more difficult to care for certain patients. The board would be interested to know whether funds should be spent to purchase pain and anesthetic medication that could be used for physician assisted death if needed over “maintenance or management medication” and extra food items to care for the patients, staff and expected visitors. Therefore, the team must also recommend whether euthanasia should be established as a temporary measure or policy during this event. The local media has contacted the hospital requesting that a team of 5 reporters are allowed to document and report the storm from the hospital since their building will be evacuated. These media folks will need to be housed and fed while in the hospital.
Time is of the essence and your team will have to work quickly. Your report should be typed, completed in Memorandum format, should not exceed 6 pages, double spaced, Times New Roman, 12-font. You must have a minimum of 8 authoritative references. You must include a cover page and a reference page (not included in the page count).
It is preferred that the FIRAC format is used with the subheadings in bold letters so the Board can quickly identify the facts, ethical issues/legal concerns, your critical thinking and analysis and your recommendation. Your memo must be in discussion format. Thus, do not use bullets, any colloquial language, or slangs in your written discussion. Do not use pronouns or personal nouns. Your cover page should identify the Chairperson and the legal adviser for the team.
FIRAC FORMAT BELOW
The use of the FIRAC format for the and CHP 400 class.
Facts* Write a brief summary of the facts requires that you focus on information that will help to support your analysis. It is essentially the “what happened” in the story or scenario. A story or scenario will have lots of information, some of which is relevant to you point while other information adds no value to the conversation. Eliminate facts that are not relevant to your analysis. For example, a business’s street address is probably not relevant to whether the patient fell from the bed and therefore, the care provided was not only unethical but negligent. However, suppose the nurse who was attending to the patient was looking out the window at the time the patient fell, then the fact that there was some commotion in the busy street may be relevant to the time the patient allegedly fell from the bed; or , if the hospital is located in a remote section of town and the nurse stated that she could not have been looking out the window allegedly at a busy street, then that may be a fact that may have relevance on the matter if the patient fell. Instead of including the street address in the summary of facts, you may want to simply describe what was stated and by whom, then cite the conversation. (Again, the time of day would be another relevant factor in this analysis, among others). Facts can and often do include chronological history of an event). For example, the hospital received a call requesting supplies just prior to the inventory delivery; however, according to Dr. Zobel, “because of the outbreak of the virus, the inventory was soon depleted” (Personal communication, Zobel, August 6, 2017).
Issue: What is the question presented to be resolved? Usually, only one or two main issues will be discussed, but sometimes there may be more. For our purpose, you should have at least one legal and one ethical issue at a minimum unless more is required. What about someone actions represent a legal or/and ethical issues and which legal or ethical issue is in question. For example, in the case of a patient being assaulted by a staff member in the nursing home, the issue may be whether slapping the patient while the patient was being combatant was an intention act? Or, whether the hospital is liable for the acts of their employees? From an ethical perspective, the issue might be whether the patient’s right to autonomy was violated when she refused to get into the wheel chair to be transported for her blood tests or whether the nurse’s insistence on getting out of the bed was an act of malfeasance ? The answer to the question will be developed during your analysis
Rule: IN this discussion, you will provide the reader an understanding of the “terminology”. Thus, what is the meaning of autonomy or one’s right to autonomy. Or what is the definition or elements of an assault. It is important that you cite authoritative resources for these definitions. For example, the business is liable for negligently failing to provide security patrols: whether the defendant owed plaintiff a duty of care, and what that duty of care is, are the key issues in a negligence claim. Rule discussion helps the reader determine what the relevant rules of law or ethical principles used to arrive at a conclusion. The reader will have examined the facts you identified as relevant in light of the rule, and probably considered all “sides” of the arguments and your presentation in the analysis discussion. How you applied the rule to the facts and analyzed the scenario must be understood in order to properly support your conclusion and recommendations. Thus, what you consider to be a relevant fact given the rule of law will be examined closely?
Analysis: Resist the temptation to merely repeat the facts unless it relates to the issue and rules: what does it mean to you? Summarize your facts or only refer to the facts when it supports your reasoning. If you are using facts in your analysis that was NOT identified and cited in your Factual discussion, then it is not a fact. If you encounter that you omitted a fact necessary for the critical thinking and analysis, go back and insert the fact into your factual discussion. The analysis is the crux of demonstrating to the reader how you are applying critical thinking and analysis to arrive at your conclusion.
Conclusion What is the response to the questions you asked in the Issue Section of the memo. Here you can apply the Three step Ethical Decision Making model or you may alternatively use the “Analysis” discussion to complete the analysis) the final outcome of the case? Note: This section should not take more than a couple of sentences, if you discussed the Ethical Decision Making Model in the analysis section of your memo. DO NOT RESTATE THE FACTS.
When providing the conclusion discussion, be brief and succinct. Do not overstate the matter to be decided. For example, … given that the patient sustained an injury from one of the hospital staff members, malfeasance was demonstrated in violation of the ethical principle, deontology. Therefore, the nurse’s action was unethical.
WRTING STYLE BELOW
(1) Critical thinking and analysis – to include identification and integration of relevant facts, issues and that the legal and ethical principles applied to a specific setting or scenario is reasoned; also that the integration of facts and principles must be used to support logical conclusions and recommendations. Maximum credit up to 0-34%
(2) Substantive ethical content- to include proper use of ethics terminology, concepts, theories and principles related to the problem or scenario; Note: Simply stating an ethical theory will not earn credit Authoritative resources are demonstrated by quality research. Able to correctly identify, define and discuss ethical principles, universal values in ethical decision making; and to demonstrate in writing, the steps in the process for ethical decision making; demonstrate and use the process for ethical decision making while utilizing the models for ethical decision making discussed in the reading materials.. Maximum credit up to 0-33%
(3) Organization -Writing mechanics – Excellent flow of content, use of language, ability to transition key elements in the discussion. Grammar must reflect collegiate level vocabulary-to include but not limited to: spelling, punctuations, or use of word choice; the ability to follow directions and instruction for completing the assignment. Complete assignment using proper FIRAC format; Reflect proper use of the APA 6th rules for citations and formatting discussion in assignments. Maximum credit up to 0-33%. Excessive and repeated plagiarism (more than 9 errors) may result in 0 credit. (When working in Group assignments, up to 10% of this criteria may deducted).
