Read the case excerpt on page 232 of Chapter 10 of your textbook titled, Gates v. Jensen
Share your opinion of the incident in the case? Take a position and discuss 3 critical legal and/ or ethical outcomes from the case. Detail why the legal and/or ethical outcomes are important, what the ramifications of them are and what alternative action(s) could have been taken and why.
You must support your essay with evidence from objective sources (reputable articles, relevant statistics etc). Your opinion alone is not sufficient.
Bonus Question: In your own opinion, what is imperative to current health care systems and access to quality care.
Gates v. Jensen Case Study
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The case of Gates v. Jensen is based on the duty of disclosure where the ophthalmologist, Dr. Hargiss, failed to inform the patient, Mrs. Gates that she was at a risk of developing glaucoma due to her myopia and high blood pressure. The ophthalmologist also failed to perform other tests such as eye examination and visual field tests which would have detected glaucoma. Additionally, Mrs. Gates complained of vision gaps, blurriness, and poor visual acuity in subsequent hospital visits for two years before she was diagnosed with glaucoma. The purpose of this essay is to share my opinion regarding the case and discuss the important legal and ethical outcomes, their ramifications, and possible alternatives.
In my opinion, the incident was a violation of the duty of disclosure. As per Appel (2019), the duty of disclosure states that physicians must disclose all information that patients may want to have before making their decisions regarding their treatment. Physicians must disclose the conditions they are treating the patient for, the nature of the treatment, and any risks and complications that may arise from the patient’s conditions. Additionally, physicians are required to disclose to patients any diagnostic tests that may be needed to rule out possible health conditions based on the patients’ symptoms. In the case study, the patient demonstrated significant risk factors for glaucoma, and the ophthalmologist failed to inform her that she is at risk of developing glaucoma and did not take appropriate tests when examining her. According to Ha et al. (2022), the risk for glaucoma is as high as 20 percent for patients with myopia and even higher for those with high-degree myopia. Nislawati et al. (2021) add that high blood pressure leads to increased intraocular pressure which is regarded as the most significant risk factor for the development of glaucoma. Based on this evidence, the ophthalmologist should have informed the patient of the risk and taken appropriate tests to ascertain that she may have had glaucoma. Moreover, other symptoms that the patient presented within the next two years, including lack of visual acuity and blurriness indicate that she should have been tested for glaucoma before her vision worsened considerably.
The critical ethical outcomes associated with the case include beneficence, non-maleficence, and patient autonomy. As per Bhartiya (2020), beneficence is an ethical principle where physicians are expected to act in the patients’ best interests when assessing patients, diagnosing them, and treating them. Beneficence is important in the case study because if the physician had adhered to this principle, he would have taken the risk of glaucoma seriously and informed the patient about it to protect her interests. Failure to adhere to beneficence led to late glaucoma diagnosis and poor vision for the patient. An alternative action would be to consider glaucoma as a risk to the patient and conduct the appropriate diagnostic tests because such actions would have indicated that the ophthalmologist has the patient’s best interests in mind.
The non-maleficence principle states that physicians should not harm. When working with patients at risk of glaucoma, healthcare providers need to weigh potential risks and take actions that would minimize complications (Bhartiya, 2020). In the case study, the ophthalmologist did not assess the patients’ risk factors for glaucoma and wrote off symptoms such as gaps in vision and difficulty focusing as issues associated with using contact lens. Failure to consider her symptoms as possible indicators of glaucoma were a violation of the non-maleficence principle since the patient’s vision went from bad to worse. An alternative action would have been to take all measures to prevent the patient’s eyesight from worsening including conducting a proper assessment of risk factors and conducting appropriate tests which would have ensured that the patient is treated and prevented her eyesight from worsening.
Patient autonomy includes the right to make decisions regarding healthcare (Bhartiya, 2020). Although glaucoma is often asymptomatic, patients should be fully informed about risk factors and should be allowed to make decisions regarding treatment. In the case study, the patient was allowed to exercise her autonomy since she was not aware that she had glaucoma symptoms and risk factors and would have sought treatment early before her vision worsened. An alternative action could have been to give the patient full information about possible differentials for the symptoms and risk factors she presented with and allow her to make informed decisions regarding assessment and treatment.
Bonus Question:
In your own opinion, what is imperative to current health care systems and access to quality care?
In my opinion, current healthcare systems should focus on building a qualified workforce and addressing issues such as nurse and physician shortages to improve access to quality care. A qualified workforce, in my opinion, is one which is sufficiently trained and can cater to the needs of diverse patients. Since the healthcare workforce is also becoming diverse, healthcare systems should focus on creating work environments that promote cultural competence. Addressing nurse and physician shortages is the key to the provision of quality care and preventing adverse events that may lead to poor patient outcomes.
Appel, J. (2019). Trends in Confidentiality and Disclosure. FOCUS, 17(4), 360-364. https://doi.org/10.1176/appi.focus.20190021
Bhartiya, S. (2020). Patient Centricity and the Ethics of Glaucoma Care. Journal of Current Glaucoma Practice, 14(2), 68-71. https://doi.org/10.5005/jp-journals-10078-1281
Ha, A., Kim, C., Shim, S., Chang, I., & Kim, Y. (2022). Degree of Myopia and Glaucoma Risk: A Dose-Response Meta-analysis. American Journal of Ophthalmology, 236, 107-119. https://doi.org/10.1016/j.ajo.2021.10.007
Nislawati, R., Zainal, A., Ismail, A., Waspodo, N., Kasim, F., & Gunawan, A. (2021). Role of hypertension as a risk factor for open-angle glaucoma: a systematic review and meta-analysis. BMJ Open Ophthalmology, 6(1), e000798. https://doi.org/10.1136/bmjophth-2021-000798