Running Head: VALUE AND VIRTUE

Values and Virtue in Healthcare

VALUE AND VIRTUE

Introduction mrgncy car is on of th most prcptiv localitis of halth car. This snsitivity is routinly foundd on a blnd of componnts for xampl urgncy and crowding. Urgncy of car outcoms from a blnd of prsonal and psychological anguish, which sms in all mrgncy positions in which a rapid, unforsn, agonizing and at tims lif intimidating status, dircts a prsvring to th mrgncy dpartmnt (D). (Moskop, 2009) Th Australasian Collg for mrgncy Mdicin (ACM) charactrizs D ovrcrowding as th position whr D function is impdd mainly bcaus th numbr of patints waiting to b glimpsd, undrgoing valuation and rmdy, or waiting to dpart passs th prsonal and/or staffing capability of th D. D ovrcrowding is a widsprad scnario ovr th glob and assts lik mploys, spac and gar ar limitd. Patints oftn hav to dlay for a long tim bfor bing glimpsd by a mdical practitionr and vn longr bfor bing movd to a hospital bd. Th outcom is not only inconvninc but a dgradation of th whol car know-how - valu of car is compromisd, th patint's scurity may b thratnd, mploys moral is waknd and th cost of car incrass. (Isaac, 2010) Thsis Statmnt Th unsuitabl us and/or abus of D srvics ar on of th widsprad problms prmirs to ovrcrowding. Triag of mrgncy Dpartmnt thical Dilmmas Sociodmographic charactristics ar prdictors of non-urgnt us of mrgncy dpartmnt. Public orintation, rinforcing and incrasing prim car srvics can b an answr to th problm. Whn living dsirs will not b contactd by th accssibl assts a schm is rquird to contnd with th position and numrous hospitals us a triag schm in alignmnt to manag

VALUE AND VIRTUE

this. Th objctiv of triag is to advanc th valu of mrgncy car and prioritiz situations as assrtd by th right trms. (Thompson, 2006) Th priod "triag" is drawn from th Frnch phras Trir (to sort) which was initially utilizd to rcount arranging of th farming products. Today, "triag" is narly solly utilizd in xact halth car contxts. Isrson and Moskop dscrib th obligation of thr situations for triag in mrgncy practic: 1. At smallst unassuming shortag of assts xists. 2. A halth car mploy (oftn calld a "triag officr") asssss ach patint's halth dsirs foundd on a short xamination. 3. Th triag agnt valus an stablishd schm or dsign, gnrally foundd on an algorithm or a st of critria to work out an xact rmdy or rmdy main concrn for ach patint. From th viwpoint of thical idas, triag is routinly glimpsd as a classic dmonstration of distributiv fairnss, which locations th inquiry of how advantags and burdns should b circulatd insid a population. It is convntionally utilizd insid th thical publications as a dmonstration of a pushing thical confrontation btwn th utilitarian standard to manag th utmost halthy th utmost numbr, th standard of idntical stm for all, th standard of non-malfasanc, and th standard of non-abandonmnt. (Wallis, 2006) Th basic issu of triag is th following: not vry individual who dsirs a spcific pattrn of halth car, for xampl surgry, tratmnt, surgry, transplantation, intnsiv car bd, can gain dirct gt accss to it. Triag schms ar concivd to aid shar conclusions in this rgard. Ths conclusions ar toughr whn a status is lif-thratning and th scarc asst possibly lif-saving. In lif intimidating situation, th inquiry can bcom: "Who will rsid

VALUE AND VIRTUE

whn not vry individual can liv?" Th crux of th issu is th apparing inappropriatnss of abstract shar valus at th grad of fac-to-fac rlationships. Th gnral utilitarian anxitis of th schm, which in th contxt of shortag arrivs down to assssing and slcting btwn patints on th cornrston of abstract rasoning (focusd on "statistical livs", rcognizing th bst outcoms out of an abstract cost-bnfit invstigation dirctd to patints as abstract cass), appars to collid with th Hippocratic obligation of managing as much as you can for th patints who rquir car (focusd on "idntifiabl livs", that is, on th patints as spcific individuals with who on stands in a fac-to-fac car rlationship). (Vanlar, 2011) thical Issus in mrgncy Dpartmnt thical issus ar barly advisd in mrgncy dpartmnt stting. A study by AndrsonShaw t al has proposd that patints hospitalizd through D oftn prsnt with thical dilmmas considrably affcting thir inpatint car and gnral wllbing outcoms. Thr is rquiring of mor study considring th proactiv us of thics discussion in D. (Rhods, 2004) Within living halth publications, th controvrsis prtaining to th thics of triag in halth practics prdominantly dsignatd day back to th arly ightis. Rcnt invstigations aim on th up to dsignatd day notion of triag , inhrnt standards and prfrncs , volution of schms and thir varity as assrtd by customs, hritag, communal contxt and dvout convictions , rvis on guidlins and plac statmnts. (Moskop, 2009) Currntly, th living publications on triag ar dficint in two ways. ithr thr is a prdominant aim, from a halth viwpoint, on th functional componnts of triag and on clinical-basd guidlins. Or thr is an aim, from an thical viwpoint, on th domain of distributiv fairnss, with its inconsistnt valus, as such rsidual on th abstract grad of rasoning. Th objctiv of this papr is to convy th two strands togthr. (Isaac, 2010)

VALUE AND VIRTUE

Th cntrd inquiry is th following: how can triag schms in mrgncy car b thically considrd, so as to rcogniz optimal us of scarc assts in an thically just way without rsidual on th abstract grad that is by taking th rsult of triag on th on-by-on patints and cargivrs into account? (Thompson, 2006) In alignmnt to manag this, w will aim on D triag. W objctiv at complmnting living publications on D triag with an thical structur that can assist D administration groups in dsigning and xcuting triag for th car of mrgncy patints in th vryday practic. (Wallis, 2006) Triag in Halth car Common contxts of triag in up to dsignatd day halth car practics ar pr-hospital car , mrgncy car, intnsiv car (who to admit), waiting rgistrs (.g. for lifsaving tratmnts for xampl body part transplants) and battlfild situations. In cas of criss and catastrophs, thr phass of triag hav appard in up to dat halthcar systms. (Vanlar, 2011) 1. First, pr-hospital triag in alignmnt to dispatch hospital vhicl and pr-hospital car rsourcs. 2. Scond, triag at th viw by th first clinician assisting th patint. 3. Third, triag on apparanc at th hospital D. During th last tn yars, th issu of pandmic triag has gon into th considration of triag. Th apparing contagious infction lik Svr Acut Rspiratory Syndrom (SARS) and Pandmic Influnza has notifid mrgncy agncis to th rquir for contingncy plans. This concrns to triag for intnsiv car srvics as wll. In such public wllbing criss, th managrial focus movs from th on-by-on to th community, from "individual" to "statistical" inhabits, sking to rcogniz a maximal conclusion out of th accssibl rsourcs.

VALUE AND VIRTUE

Nvrthlss, mrgncy mploys xtnd to b battld, on a fac-to-fac grad, with th car for on-by-on patints in rquir, who thy might not b adpt to hlp. (Rhods, 2004) Conclusion In this papr, w hav rcognizd th thical proportions of D triag, which supply th lsson structur for conclusions mad by triag officrs. In alignmnt to convy out thir task comptntly, it is absolutly crucial that hospitals nlist in mrgncy dpartmnt triag planning. Diffrnt from triag schms, that ar solly clinical-basd and narrowly concntratd on th D, it is significant to opt for an incorporatd clinically and thically foundd pattrn of triag dsigning, as glimpsd from a comprhnsiv thics viwpoint that intgrats both th abov-dscribd valus and car-orintd approach. Such a way of D triag dsigning would intgrat th nxt charactristics. (Moskop, 2009) 1) From th complmntary dialogu btwn th principl-basd st about and th carorintd st about, w can rsolv that a clinically and thically foundd D triag mthod is not only foundd on a momntary conclusion mad by on prson. It furthrmor taks applicabl thical valus as stm for autonomy, non-malficnc, bnficnc, and fairnss into account, as wll as th dtail that triag is a part of dynamic car mthod intgrating th four proportions of car. (Isaac, 2010) 2) Basd on th absolutly crucial significanc of a supportiv institutional structur, it is absolutly crucial to opt for a hospital-wid schm of triag dsigning with a vry broad ngagmnt of applicabl popl. Hospital administration, D administration and mploys, triag agnts, controllrs and mploys of othr agncis ar significant stakholdrs in th procss. As triag ngags important lsson significancs, it is significant to ngag public rprsntativs and thics scholars in th dvlopmnt of institutional thics principls on triag planning. (Thompson, 2006)

VALUE AND VIRTUE

3) Just as triag itslf is a dynamic mthod, and in itslf part of th dynamic mthod of gnral prsvring car, it is significant to addrss triag dsigning as a occurrnc that is suscptibl to chang. Hnc, it is significant to convy out normal rconsidrs of th hospital's D triag protocol, foundd on knowldg of mploys and patints, and on volutions in car. Proposd modifications of th protocol could thn b rconsidrd and assssd by multidisciplinary task forcs, hospital thics managing assmblis, or by associations of mrgncy surgry and nursing profssionals, as assrtd by its complianc with th comprhnsiv thics viwpoint that intgrats both th abov-dscribd valus and carorintd approach. (Wallis, 2006) 4) D mploys hav to function in highly hctic, thically prcptiv, and occasionally vn traumatic circumstancs. Providing adquat support on informativ (communication, tnsion and aggrssion managmnt), psychological (fdback) and thical grad, is absolutly crucial for rcognizing a clinical-thical foundd mthod of triag planning. A good and supportiv hospital hritag is a vital dtrminant for this. (Vanlar, 2011) As such, th divrs thical facts that ar intrinsically associatd to D triag, and which w hav rcognizd by our thical invstigation, can assist to conciv a supportiv clinicalthical structur for D triag. (Rhods, 2004)

VALUE AND VIRTUE

References Moskop JC, Sklar DP, Geiderman JM, Schears RM, Bookman KJ. (2009). Emergency department crowding, part 1- concept, causes, and moral consequences. Ann Emerg Med, 53(5):605-11. Ben-Isaac E, Schrager SM, Keefer M, Chen AY. (2010). National profile of nonemergent pediatric emergency department visits. Pediatrics, 125(3):454-9. Thompson AK, Faith K, Gibson JL, Upshur RE. (2006). Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethics, 7:E12. Wallis LA, Gottschalk SB, Wood D, Bruijns S, Vries S, Balfour C. (2006). The Cape Triage Score - a triage system for South Africa. S Afr Med J, 96:53-56. Vanlaere L, Gastmans C. (2011). A Personalist Approach to Care Ethics. Nursing Ethics, 18:161-173. Rhodes KV, Vieth T, He T, Miller A, Howes DS, Bailey O, Walter J, Frankel R, Levinson W. (2004). Resuscitating the physician-patient relationship: emergency department communication in an academic medical center. Ann Emerg Med, 44(3):262-7.