One can have one of the following outlooks on life either as Carlos Ruiz Zafn said, “There are no second chances in life, except to feel remorse”, or as Lailah Gifty Akita said, “We all make mistakes, everybody should be given a second-chance”. The problem occurs when you have the first outlook and your patient the second.
Moral distress can be defined as when a person is unable to act on their own moral judgement (Morley, Ives, Bradbury-Jones & Irvine, 2017). During my clinical practice I experienced moral distress. At my clinical placement my clinical partner asked me to come and help her with a patient. This is a common thing to ask you clinical partner, if you need a second opinion. However, I was shocked because she did not need my help in reasoning but rather my help in protecting her. When I joined her session, I started to become scared. How can one treat an aggressive intoxicated patient?
The patient was commanded by the clinician to go back home and not come back to physiotherapy unless he gets another doctor referral. He continued to come back every day of the rest of the clinical week to demand an appointment date. With every return to the clinic he was aggressive towards the person helping him and still smelled of alcohol. I was afraid to deny him another appointment. However, I was unable to give him one due to the strict commands we were given by the clinician. This caused my moral dilemma. Should I follow Zafn’s words or Akita’s? If the decision was up to me, I still would not give the patient a second change. He must first feel remorse in order to deserve a second chance. However, then I will be violating the patients’ rights.
One of the fundamental rights of a patient is that the patient should be able to enjoy the highest attainable standard of health without discrimination of race, religion, political belief, economic or social condition (Ghebreyesus, 2017). One can argue that this patient has the right to medical care and that I should give him a chance to redeem himself. Where on the other hand, one could argue that this patient is taking up the spot of a patient that needs rehabilitation and that he should feel remorseful that he wasted his session and future rehabilitation.
As known with every right there comes responsibility. A patient has the responsibility to take care of his health. He has the responsibility to care and protect the environment. He has the responsibility to respect other patients and the health care workers’ rights (Patients’ Rights and Responsibilities, 2019). My rights correlate with the patient’s responsibilities. Therefore, if we have rights against one another we all have responsibilities against one another.
This ethical dilemma causes moral stress that is ambiguous of nature. Prolonged moral distress might affect students negatively. It might lead to a variety of problems such as burnout, anxiety, depression, indifference to moral issues, counterproductive coping strategies, and impaired physical and psychological well-being (Elpern, Covert & Kleinpell, 2005). Forcing students to make certain decisions that goes against their beliefs will always cause moral distress that will have a negative effect on the students. Furthermore, when faced with a dilemma where the right action is ambiguous, students will also suffer from the negative affect. From my personal experience I felt anxious to go to clinical from that day forward. At night when I tried to sleep, I would keep on thinking of the next days’ work and what if the same situation occurred again. By the end of the block I was completely burned out.
Moral distress will always be a grey area due to everyone having different beliefs. What is concerned as the “right” decision for one might never be the “right” decision for another. Therefore, it is important to treat patients according to their rights. That is if they obey their responsibilities.
References
3 thoughts on “Second chances”
Good evening Megan.
I enjoyed reading your post and definitely understand the ethical dilemma you were faced with.
I thought you explained the definition of moral distress really well, and made it easy to understand.
I would suggest that you perhaps indicate whether the patient was intoxicated when he returned to make a new appointments and also explain in sightly more detail how he behaved… Was he like Akita’s quote and wanting a second chance as you said he was at the end of your first paragraph.
I would also suggest you perhaps include what your opinion was regarding the situation. You end one of your paragraphs with “Should I follow Zafn’s words or Akita’s?” so then possibly explain that you agreed with Zafn as you stated in your first paragraph, and the reasons why you felt this way.
I thought your spelling and grammar was good and that your writing flowed well. I thought you had a fair amount of references and that you referenced them correctly. Perhaps find another more recent reference as the one is from 2005.
I hope these suggestions assist you completing you assignment.
Regards,
Halinka.
Hi Megan
Thank you for sharing your writing piece and clinical experience.
Unfortunately, working in a public health sector exposes us as students to many of these unwanted situations. I am sorry you had to go through this and experience moral distress, but also thankful that you chose to write and reflect on your situation. I believe a lot of students will be able to relate to your incident and it is an important topic worth discussing.
Content: The content of your piece was good. I liked how you defined all the ethical concepts that you used, such as moral distress and patients rights. This made the content more clear and easy to understand and read. I think that possibly adding your own feelings at the time will greatly benefit the content. Perhaps you could describe your feelings at the time towards the patient when you saw him drunk, when he returned or how you felt when you experienced moral distress. You added literature regarding the impact of moral distress on students – were any of these effects applicable to you? In the last sentence you mentioned patient responsibility, which I think plays a big role especially in a situation like this, so maybe you could elaborate a bit more on this (the responsibilities of patients regarding health) as I think we often only look at the rights of patients – very one-sided – forgetting that all rights actually have responsibilities.
Argument: In the beginning of the piece you mentioned that you believed in Zafn’s words, but your argument later on in became a bit unclear to me. You questioned later on whose words you should follow – I think it would perhaps make the argument a bit more clear if you described the side which you believed to be right. I think explaining if you wanted to give the patient a second chance or not will make this more clear. You could maybe also add what you would have done, if you were not under strict commands to not give the patient another appointment. Did you feel as though you were violating his rights or did you agree with the clinician that he should be refused treatment?
I think if you could also perhaps look into possible solutions or actions to take in these situations in the future, it would have a positive impact on the argument of your writing piece – so maybe this is something you can look into and reference to external sources.
References:
Your references were very good, you referenced correctly (in-text and reference list). I could find no fault here.
Grammar and spelling:
Overall your piece was well written and easy to follow. There were a few minor grammar and spelling error, which I have indicated for you with the annotations side bar – this will make it easy for you to find.
Overall I really enjoyed your piece and I believe a few of these changes will benefit your writing piece.
I hope you find my comment helpful, please let me know if anything was unclear.
Good luck and all the best
Janine
Hi Megan.
Thank you for sharing this experience with us. I think it is a topic worth discussing and commonly one which is not looked at often. I think most students will be able to relate with your experience and if not the chances of experiencing something like this in future is quite high. So thank you for sharing this with us, it can help us to keep an open mind and already think of possible ways to deal with this.
Content:
I think your piece covers the content covered in class quite thoroughly. You reminded me and encouraged me to reflect on the content. I think you explained the terminologies quite well and made it easy to understand. I think you can expand more on moral distress by giving your thoughts on the patient, how and why he acted in that way?
You asked yourself the question which one should you follow. I think this is a good base to start from, tell us more how you went about before making a decision.
Argument:
At the beginning of your piece you indicated that it is a problem if your patient believes in second-chances and if you do not. I assumed that you sided with Zafn. However, there were few references to what you actually decided. I think after you’ve given a bit more on the case presentation, you can tell us what you believe is the right thing to do and whether you were able to do it or not. I think the topic will allow you to get very nice sources which can strengthen your argument.
References:
Good referencing both in-text and reference list. You can try and use a few more to strengthen your argument and your piece overall.
Writing:
Your piece was well-written. I enjoyed reading your piece, it was easy to read and follow the thread.
Comment:
I hope your find my comment of some use. All the best with the final.
Tameron-Lee