Ethical aspect of health care team

M Zaenuri S Hidayat, SpKF,MSiMed,dr Lab Forensik dan Medikolegal FKIK Unsoed

Health care team

Two or more health professionals (and, when appropriate, other lay or professional people) Apply their complementary professional skills To accomplish an agreed upon goal Primary goal : comprehensive patient care Include : education of health professional, patient, family, community outreach, advocacy, abuse prevention, family support, institutional planning, networking and utilization review in hospital.

Ethical issues
Challenges arising from the team metaphore itself The locus of authority for team decisions The role of the patient as team member Mechanisms for fostering morally supportable team decisions .. etc

Team metaphore
HCT : arose from asumptions about sports teams and military teams Team loyalty, a moral obligation to other members and to the team itself. A member not only to perform maximally but also protect team secrets, thereby promoting a tendencyfor cover ups or protection of weaker members

A troubling ethical conflict arise when : The members moral obligation of faithfulness to other team members or captain does battle with moral obligations to the patient ??

The locus of authority for team decisions

Traditionally the physician was the person in authority by virtue of his/her office At the same time, the team metaphor created expectations of more equality among members based on competence to provide input. In ethical decisions regarding patient care, the question of authority must be viewed in terms of who should have the morally authoritative voice Technical expertise does not automatically entail ethical expertise. In both types of decision making situations, the locus of authority is movable Clarification of role identity and boundaries helps to create reasonable expectations and mitigate this type of conflict regarding locus of authority regarding team decisions.

A critical question regarding such collective decision making is : Whether team decisions are the sum of individual members, with accountability allocated only to the individuals, or whether a team itself can be regarded as a moral agent .

The role of the patient as team member

The doctrine of informed consent and its underlying legal and ethical underpinning dictate that patients and families should have inpute into decisions affecting themselves and their loved ones. At the same time, much of the teams work proceeds with out direct involvement of patients and families. Some have argued that primary care orientation places the patient as focus and arbiter of the care, and that present team practises fall short of that essential condition Other argue that conceptually a primary care approach is consistent with the goals of good teamwork ..

Mechanisms for fostering morally supportable team decisions

Develop a common moral language for discussion of the issues Engage in cognitive and practical training in how to articulate feelings about pertinent ethical issues Clarify values to uncover key interests among team members Participate in common experiences upon which to base workable policies Refine a decision making method for the team to use ..

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