Case Study 8.3 Managing your own decisions
Tadelech is a member of your local community. She is usually a strong woman who is a good mother to her seven children and an active member of the community. Recently she has become seriously ill with a chest infection that has turned into pneumonia. Although the Health Extension Practitioner, Hadas, has tried to convince her that she needs to go to hospital, Tadelech is determined to stay in her own home.
Hadas is in a difficult position. Of course Tadelech should be able to decide about her own health and her own body – this is the basic ethical value of autonomy. But the healthworker knows that without proper treatment she might die and then all Tadelech’s children would suffer. Indeed the whole community would lose one of their important members.
- Which of the following actions do you think that it would be ethical and appropriate for Hadas to do? Explain your reasons.
- a.Do nothing and hope that Tadelech recovers from the pneumonia.
- b.Force Tadelech to go to the hospital by carrying her there against her will.
- c.Explain to Tadelech’s husband and parents about the serious nature of her chest infection and hope that they will be able to persuade her to take up the offer of hospital treatment.
- d.Ask for help from an experienced healthworker at the hospital or health centre.
- Answer d. will always be appropriate if you are having problems with an ethical dilemma. Seeking the advice of someone more senior or more experienced is almost always helpful. But before seeking advice, answer c. would be well worth trying. Doing extra tasks in order to try to save a life (beneficence) is an ethical principle that is always worth pursuing. Using force, as in answer b., is not correct. This would certainly be against the ethical principle of autonomy. However ill the person is, they still have rights to decide about their own issues.
8.5 Allocation of scarce resources
Health resources, such as financial or human resources, are always scarce whether you are working in developed or developing countries. Using resources to their best effect needs appropriate planning and allocation of resources to areas where they bring about the best outcomes. As a manager and healthcare provider in the Health Post you may be faced with a scarcity of resources (Figure 8.4) and need to make judgements to use your resources wisely so that you are able to satisfy the healthcare needs of the majority of your community (the principle of utility). As a manager and healthcare provider in your community, you may face ethical conflicts with regard to resource allocation.
Following some simple steps for decision making may help you resolve these difficulties (Box 8.2).
Box 8.2 Steps for decision making
- Identify the nature of the problem.
- Gather information and consider
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