Microethical and Macroethical Dilemmas

Full Answer Section

Macroethical Dilemma:

• Scenario: A hospital system, facing budget constraints, must decide whether to close a rural clinic that provides essential services to an underserved community. The closure would save money but significantly reduce access to care for vulnerable populations.
• Ethical Principles Involved: Justice (fair distribution of resources), beneficence (promoting well-being), and utilitarianism (greatest good for the greatest number).
• Impact: This affects the entire community's access to healthcare, exacerbates existing health disparities, and raises questions about the hospital's social responsibility.

Legal Case Law Example:

• Darling v. Charleston Community Memorial Hospital (1965):
  • This case involved a young man whose leg was improperly treated at a hospital, leading to amputation. The court held the hospital liable for failing to provide adequate care, even though the physician was primarily responsible.
  • Microethical Relevance:
    • The case established that hospitals have a duty to ensure the quality of care provided by their staff. It reinforces the ethical obligation of healthcare organizations to oversee and maintain professional standards, impacting how individual doctors are monitored.
  • Macroethical Relevance:
    • Darling significantly influenced hospital administration and policy. It led to increased hospital oversight, the development of quality assurance programs, and the establishment of standards for medical staff credentialing. It highlighted the organization's responsibility for patient safety and the broader implications of healthcare delivery.
    • The case also helped to solidify the idea that hospitals have a corporate responsibility to their patients, not just an individual doctors responsibility.
  • This case is a good example of how a case can have both micro and macro ethical implications.

Connecting the Dilemmas and Case Law:

• Both the microethical and macroethical dilemmas highlight the tension between individual obligations and organizational responsibilities.
• • Darling v. Charleston Community Memorial Hospital demonstrates how legal precedents can shape ethical practices within healthcare organizations, influencing both individual clinician behavior and broader hospital policies.
• The case also displays the importance of hospitals having clear policies and procedures, that help to mitigate the ethical dilemmas that arise

Sample Answer

Microethical Dilemma:

• Scenario: A physician discovers a colleague is consistently falsifying patient records to expedite insurance approvals. The physician is torn between their duty to report unethical behavior (non-maleficence) and their loyalty to a colleague (fidelity). This directly affects individual patient care and trust.
• Ethical Principles Involved: Non-maleficence (avoiding harm), fidelity (loyalty), and veracity (truthfulness).
• Impact: This impacts the individual patient's care, the trust between colleagues, and the overall integrity of the medical practice.