Uustal (1993) proposed a decision-making model that provides concrete steps in which to arrive at a morally acceptable solution when faced with an ethical dilemma. What type of an ethical dilemma have you encountered in the clinical setting? How can the decision-making model identified by Uustal be applied to this sitaution ? Be specific when describing each of the nine steps.

Answer:

Ethical Dilemma

Pamela is asking me to write a DSM-IV diagnosis in a patient , a patient who I have never met , let alone diagnose . DSM-IV is the bible for any professional who deals in making psychiatric diagnosis . This means that it is used as an authority to treat patients in our country

The record will be carried over to another hospital if the patient was to ever move from our facility , and that is a worrying factor . Within our facility , I might be able to meet the patient soon and then make relevant changes to the diagnoses that I might be forced to write in but if the patient is not admitted to our facility than it would be impossible for me to ever change what I write . Moreover , in the first place I do not want to write a diagnosis about a patient who I have not diagnosed myself . In the medical practice , it is obvious that I have to trust other people while making my decision or deciding on my course of action on a particular patient , I do this because I put faith in the doctor who had diagnosed the person before . I put faith in the laboratory report that the patient carries , I put faith in the competence of other people . However , if the treatment I administer does not show the desired results I am compelled to go back into the case and assess if another person could have gone wrong in diagnosing a patient or if any of the reports may be wrong

Our profession like all other professions relies on other people . We cannot do everything all by ourselves . My favorite example is that if I were the CEO of Boeing , I could not have designed a plane , manufactured it , sold it and done other parts of testing and researching about a plane all by myself , I would need and have to trust the work of other people . In the same fashion , I cannot do everything about a patient , I have to rely on others and go with their diagnosis and work on the basis of their diagnosis

In the same way , other people are going to work on the basis of what I am going to write on that piece of that is his report . A wrong diagnosis by another person might kill him , but then the other person who wrote the report before may be is more qualified and skilled than me . So let me put it this way , if the person who wrote the report before me (but did not sign it ) is a senior of mine and is a reputed doctor , I will call him and talk to him about the patient , based on our discussion , I will copy and sign the report - although it is still against my wishes , I would personally want to meet the person before I do this , but because I have faith on others I would sign it . At the end of the day , it is the faith that we have in others that makes us go forward . In other industries , they would have called it teamwork

You see there are very few reasons to sign that report but many more not to . Ideally , one should verify and if the best I can do is to call the person who report the previous report than that is what I will do It keeps my conscience clear , I do not want a patient to get wrong treatment because someone else diagnosed him wrong and I would consider myself a culprit for not raising an alarm but rather giving in cheaply for something that was against my wishes

The only reason that I can think of for signing that report would be to be a part of the team that works there and have faith in everyone around , well in the beginning , I would probably not know the competence of other people . Pamela gives me the impression that this is normal practice , which means that in the future this would be expected off me all the time and this worries me , if this is the case , I would like to talk to Pamela or her supervisor about this and let them know my feelings about it

I do not want to have a bad impression in the job , but I do not want to work in a place where I cannot have a clear conscience , as good and important as it may be for my career , if the place of my dreams is not the destination that I dreamt of , than I would rather not be there . I would rather work for a smaller organization and have a clear conscience than to work for a big organization that does not give me peace of mind

Would I raise this issue with the medical community and get this agency off the recognized agency lists , perhaps no . would I report Pamela to the top bosses before I leave , yes . I will talk to Pamela first about my discomfort and if need be - which I guess will be the case as this is the usual practice here , I will find myself another role in the organization till the time I find my desired role in another agency . However , upon leaving this place I will let the reason for my leaving the place known to the top brass of the organization so that hopefully more patients will not get affected by this practice

The medical profession is a profession of faith , the patient treats you like god and feels that you can save his or her life and that is why we must adhere to the standards that our heart sets us and hold ourselves against the highest and faith that the patient has in us.