Which Option Best Fulfills Your Duties

Which option best fulfills your duties

Ethics Game
Write a 700- to 1,050-word reflective journal in which you answer the following questions:
o What were the ethical issues presented in the simulation?
o What decision-making steps did you take to ethically address these issues?
o What ethical perspectives, or lenses, did you use to make your decisions in the simulation?
o How did these ethical perspectives, or lenses, influence your decisions?
o How might concepts from this simulation relate to your workplace?
Dilemma 1
You are a supervising nurse in Seva Medical Center’s Ob/Gyn department.

Earlier today, a minor unwed mother in the early stages of labor was admitted, accompanied by her parents. As your night shift begins, you see a few emails about the situation….
From Subject
Brenda Willis Patient to watch
From: Brenda Willis
To: MORGAN
Patient to watch
Just a quick note as your shift starts:
Near the beginning of my shift we admitted a 16-year-old mother, Rachel Banks.

She’s in her tenth hour of labor now. Her parents have been with her, and they have chosen to limit the amount of medication and other medical assistance we’ve administered for personal reasons. Given the length of her labor, however, her situation could worsen. Keep a close eye on her.

I’m not sure her parents understand how dangerous her situation could get.
Brenda Willis, RN
Shift Supervisor
Seva Medical Center
Harold Mills Staffing Adjustment
From: Harold Mills
To: MORGAN
Staffing Adjustment
Greetings:
Due to recent financial shortfalls, we’ve had to cut back on staff in your department. This readjustment of personnel will reduce the number of on-call physicians available during your shift. We have confidence that our exemplary nursing staff, under your capable leadership, can adjust to this restructuring with a minimum of difficulty.
Harold Mills
VP of Human Resources
Seva Medical Center
Stan Kirk Visitor
From: Stan Kirk
To: MORGAN
Visitor
Hey:
We just had a visit from a Joseph Banks, brother of a sixteen-year-old patient, Rachel Banks.

He was really upset. He said Rachel’s parents were “punishing” her for getting pregnant before she was married and withholding painkillers and treatment. According to Joseph, the whole family had a big argument and the father said Rachel was being “judged” and “if God wants the child to survive, it will be Him, not the hospital, who protects her.”
I told him the staff here would do everything they could to keep Rachel and her child safe, but I also reminded him that Rachel’s a minor, and legally that means the parents make the call.

The last thing we need is a big lawsuit.
In the end, I convinced him not to go into Ob/Gyn and make a scene, but I thought I should tell you about the incident just in case.
Stan Kirk
Reception
Seva Medical Center
Harold Mills Annual Performance Review
From: Harold Mills
To: MORGAN
Annual Performance Review
Just a reminder: We’ll be conducting your annual Performance Review this week.

Be sure to review your Job Description so you can discuss with us in detail how you fulfill the requirements of your role and how you’ve attempted to meet your goals. Also, please keep Rian’s advice on ethical decision making in mind.

Finding leaders who can make ethical decisions is one of Seva’s highest priorities.
Here’s your current job description:
Shift Supervisor
Assists the Head Nurse in managing nursing staff by shift. Is clinically knowledgeable and able to perform all duties of staff under their supervision. Collaborates with physicians in assuring that care regimens for all patients are carried out by shift staff.

Which option best fulfills your duties

Skilled in communication, team-building, and electronic medical records systems.
Keep up the good work,
Harold Mills
Human Resources
Seva Medical Center
You check Rachel’s chart and notice that she has not been given any meds or been seen by the physician on duty, who is attending another emergency.

Fetal distress is not currently critical, but it has been increasing gradually, as has Rachel’s own distress and fear. The parents have clearly stated they don’t want any assistance, and the assigned nurse has acquiesced in that desire, but you are concerned that Rachel and the baby may be moving toward irreversible medical danger if some intervention is not made.

Although the unit is short-staffed, the hospital does have a chaplain on staff who could be summoned quickly.
As you reflect on the situation, you realize that it’s all a pretty sticky mess.

However you don’t have to face the problems alone, since Seva has Rian Brown, the company’s Ethics Officer, to assist.

How to Achieve Your Most Ambitious Goals - Stephen Duneier - TEDxTucson

The time seems right to contact the Ethics Coach.
Issues in your Dilemma
Thanks for visiting with me today. You’re right…you have a tough problem. I am pleased that you are willing to work through the problem by email today. I think you will find this method useful.
The first step is to figure out exactly what the problem is – what the issue is that you are facing.

By breaking the problem down into small parts, you can see the dilemma more clearly. If you want some additional help in sorting through the issue, check my Ethics Coach posting for this page. Remember that the Ethics Coach changes on each page with information specific to your current task.
Now, based on our conversation, I’ve included a list of possible issues for this problem.
• Check the one that you think applies to this situation.
• Then, submit your answer.
• I’ll let you know whether or not you hit the mark.
Which issue applies to this problem?
How to overcome parental objections to appropriate care without filing a dependency action.
How to assure nurses are trained to provide care for minors in the face of parental opposition.
How to accommodate patients’ religious views when these conflict with optimal medical care.
How best to assure that Rachel and her baby get appropriate and timely medical care.
re: Issues in your Dilemma
Thank you for your reply.

When analyzing a complex problem, I find it critical that the issues be identified and clearly understood.
Here’s how to read the chart:
• A appears before the issue you selected as applying to the situation.
• An appears before those issues that you did not select.
• If I disagree with your choice, these symbols are marked as and .
• For answers on which we agree, the text is highlighted in blue.
• For answers on which we disagree, the text is highlighted in yellow.
Which issue applies to this problem?
How to overcome parental objections to appropriate care without filing a dependency action.
(Incorrect) This is not the primary ethical issue you must resolve.

Instead, this is a statement of concern about legal liability. While you do not want to provoke a lawsuit unnecessarily, making this your primary concern is unlikely to result in the best solution to the actual ethical dilemma.
How to assure nurses are trained to provide care for minors in the face of parental opposition.
(Incorrect) Although this is something that you want to be sure happens in any case, this is not the primary ethical issue.

Instead this is a long-range planning need. Thinking long-term is useful, but don’t let the long-term goals distract you from solving the immediate problem.
How to accommodate patients’ religious views when these conflict with optimal medical care.
(Incorrect) In this situation, apparent religious views are a red herring.

Challenges to providing adequate care for each patient come in all shapes and sizes, not just religious views. This framing of the issue is both too broad and too narrow to best resolve the specific ethical dilemma in this case.
How best to assure that Rachel and her baby get appropriate and timely medical care.
(Correct) This is the primary ethical issue you must resolve in this situation. The core values in conflict include providing equal care for all and deferring to parental wishes.

Best solutions will allow you to do both, once you have properly identified this as the issue.
Stakeholders in your Dilemma
Nicely done.

So, we have now determined the question we will answer.
The next step is to name the primary stakeholders – those people who are:
• directly involved in this situation;
• have to carry out the decision;
• directly affected by the decision; or
• whose direct interests are to be protected.
Those who have delegated responsibility to others are not primary stakeholders.

Also those who are interested observers are not primary stakeholders. If you want more information, check the Ethics Coach.
Now, based on our conversation, here’s a list of people who might qualify as the primary stakeholders, but only six of the eight of them are directly involved. Check the box next to anyone who you think is a primary stakeholder.
Who are the primary stakeholders in this problem?
The Shareholders
Actions that affect the value of the company affect their ownership interest.
Dr.

Emerson Rogers, Chief of Staff
He is responsible for everything that goes on in the organization and often liable for ethical mistakes.
Rachel Banks
She is the pregnant patient who may need more medical care than her parents want.
MORGAN, Staff Nurse
You have to make and implement the decision.
Mr.

and Mrs. Banks, Rachel’s parents
They are the patient’s legal guardians and do not appear to want additional care for their daughter.
Yvonne Napier, RN
She is the one primarily responsible for assuring Rachel has a safe delivery.
Lily, Rachel’s unborn child
This is the child who is about to be born and may need medical intervention to assure safety.
Other Ob/Gyn nurses
They are also responsible for assuring that Ob/Gyn patients receive appropriate and timely medical care.
re: Stakeholders in your Dilemma
Thank you for working with me on this matter.

As I’m sure you’ll agree…before making a decision, understanding who will be directly affected by your action is critical.
I used the same mark-up as was done before when critiquing your answers:
• A appears before any stakeholder you selected as being directly involved.
• An appears before those stakeholders that you did not select.
• If I disagree with your choice, these symbols are marked as and .
• For answers on which we agree, the text is highlighted in blue.
• For answers on which we disagree, the text is highlighted in yellow.
Let’s see how you did.
Who are the primary stakeholders in this problem?
The Shareholders
(Correct) Because the purpose of a company is to maximize shareholder value, they are always stakeholders.

Although originally shareholders were considered the only stakeholders, the stakeholder theory reminds us there are others whose interests should be considered.
Dr. Emerson Rogers, Chief of Staff
(Incorrect) Excluding the Chief of Staff may seem odd. However, he has delegated responsibility for the day to day running of divisions within the hospital to appropriate staff.

Remember that those who have delegated their responsibilities to others are not primary stakeholders.
Rachel Banks
(Correct) Whatever decision you make will impact her directly. Your decision may very well affect whether she becomes a mother today as well as life-long health issues. Your decision is also likely to impact her relationship with her parents.
MORGAN, Staff Nurse
(Correct) You are always a stakeholder in the decisions you make. How you balance your own interests with those of other stakeholders shows your level of ethical maturity.

In this case, your decision will also impact several lives and an on-going family system.
Mr. and Mrs. Banks, Rachel’s parents
(Correct) They are both directly involved – legally they are responsible for their daughter – and will be directly impacted by your decision.

You will either affirm or challenge their decision about necessary medical intervention for their daughter. Thus, they are primary stakeholders.
Yvonne Napier, RN
(Correct) Because she is the person with primary responsibility in this setting for assuring that Rachel gets appropriate care, your decision will impact her directly.

She is therefore a primary stakeholder. Your decision will impact her work conditions and her future.
Lily, Rachel’s unborn child
(Correct) Although this dilemma is not about the question of broad legal rights for fetuses, this baby long ago crossed the threshold of viability and is on the edge of live birth.

The baby’s direct interests need to be protected, just as her mother’s do. Here, the baby is a stakeholder.
Other Ob/Gyn nurses
(Incorrect) Your decision will not directly impact their work. Ultimately, depending on what you decide to do and whether the baby has a healthy delivery, they may be affected. However, this conditional and tangential potential for impact means they are not primary stakeholders.
Rights/Responsibilities Lens
Now that we’ve identified the issue and determined the stakeholders, let’s start looking at the problem through the Rights/Responsibilities Lens.
The Rights/Responsibilities Lens helps you identify your obligations – your duties – as well as your rights in this situation.

The idea is that as we think carefully about our choices we will know our rights and responsibilities, no matter what anyone else says.
The first step is to identify your duties to the various stakeholders. This lens requires that we treat people the way they have agreed to be treated…either because of our stated agreements (contracts) or our implied agreements.
Below is a list of the duties that you might owe the stakeholders. Three of the six of them are actually your responsibility.

Considering your leadership role in the company, check those which you believe apply to you in this situation.
Which duties do you owe the stakeholders?
Duty to abide by the parents’ wishes.
Duty to support your staff’s professional improvement.
Duty not to interfere with competent staff in doing their jobs.
Duty not to accommodate parents who are harming their child.
Duty to provide the best patient care possible.
Duty to make parents do the right thing for their daughter.
re: Rights/Responsibilities Lens
Defining your duties can be difficult.

Are you surprised by the answers?
People who find the focus of this lens appealing are often called idealists:
1. each person is supposed to work to be the very best that they can be;
2.

as individuals use reason, they identify the principles that all people should follow;
3. people often do not live up to the ideals and so need rules; and
4. punishment or the threat of punishment keeps people in line.
As before, I have marked your responses:
• A appears before any stakeholder you selected as being directly involved.
• An appears before those stakeholders that you did not select.
• If I disagree with your choice, these symbols are marked as and .
• For answers on which we agree, the text is highlighted in blue.
• For answers on which we disagree, the text is highlighted in yellow.
Now, let’s review your duties.
Which duties do you owe the stakeholders?
Duty to abide by the parents’ wishes.
(Incorrect) In reviewing the list of duties created by W.D.

Ross to flesh out Kant’s theories, we see there is no duty such as this. Indeed, due to the fact that the parents seem to be making decisions that are not in their daughter’s best interests, duties exist to go against their wishes.
Duty to support your staff’s professional improvement.
(Correct) Not only is this good professional practice in all settings, it corresponds to the duty of beneficence.

This duty requires that, if you have the capacity to do so, you should improve the capacity of others for virtue, intelligence, or pleasure. You have this capacity with your staff.
Duty not to interfere with competent staff in doing their jobs.
(Incorrect) Although a good supervisor will tend to give staff wide latitude, no duty to avoid intervening exists.

However, competing duties exist that may require you to intervene if staff who are generally competent make decisions that violate the general medical duty to do no harm.
Duty not to accommodate parents who are harming their child.
(Correct) This combines the duties of non-maleficence and justice. Justice requires a proportional response. Here the parents do not appear to have their daughter’s best interests at heart and so justice – as well as your duty to do no harm – requires that you not defer to their wishes.
Duty to provide the best patient care possible.
(Correct) This is primarily an expression of the duty of fidelity.

In part it is also an outgrowth of the duty of non-maleficence. The hospital has at least implicitly, and in many cases explicitly, promised its patients to avoid harming them and to provide the best care they are capable of providing.
Duty to make parents do the right thing for their daughter.
(Incorrect) In rare cases, you may have an obligation to comply with a court order to provide treatment against a parent’s wishes.

However, legal obligations are not the same as the duties of the Rights/Responsibilities Lens, and the duty of beneficence only requires you to encourage parents to do the right thing, not force them.
re: Rights/Responsibilities Lens
Just to review . . . we’ve determined that you have the following duties owed your stakeholders in this problem:
• Duty to support your staff’s professional improvement.
• Duty not to accommodate parents who are harming their child.
• Duty to provide the best patient care possible.
Now let’s take a look at your options.
I’ve made a list of what I think are the possible choices in this situation.

Considering your duties to your stakeholders, choose the option that you think is the most ethical.
Ethics Game
Write a 700- to 1,050-word reflective journal in which you answer the following questions:
o What were the ethical issues presented in the simulation?
o What decision-making steps did you take to ethically address these issues?
o What ethical perspectives, or lenses, did you use to make your decisions in the simulation?
o How did these ethical perspectives, or lenses, influence your decisions?
o How might concepts from this simulation relate to your workplace?
Dilemma 1
You are a supervising nurse in Seva Medical Center’s Ob/Gyn department.

Earlier today, a minor unwed mother in the early stages of labor was admitted, accompanied by her parents. As your night shift begins, you see a few emails about the situation….
From Subject
Brenda Willis Patient to watch
From: Brenda Willis
To: MORGAN
Patient to watch
Just a quick note as your shift starts:
Near the beginning of my shift we admitted a 16-year-old mother, Rachel Banks.

She’s in her tenth hour of labor now. Her parents have been with her, and they have chosen to limit the amount of medication and other medical assistance we’ve administered for personal reasons.

Given the length of her labor, however, her situation could worsen. Keep a close eye on her. I’m not sure her parents understand how dangerous her situation could get.
Brenda Willis, RN
Shift Supervisor
Seva Medical Center
Harold Mills Staffing Adjustment
From: Harold Mills
To: MORGAN
Staffing Adjustment
Greetings:
Due to recent financial shortfalls, we’ve had to cut back on staff in your department.

This readjustment of personnel will reduce the number of on-call physicians available during your shift. We have confidence that our exemplary nursing staff, under your capable leadership, can adjust to this restructuring with a minimum of difficulty.
Harold Mills
VP of Human Resources
Seva Medical Center
Stan Kirk Visitor
From: Stan Kirk
To: MORGAN
Visitor
Hey:
We just had a visit from a Joseph Banks, brother of a sixteen-year-old patient, Rachel Banks.

He was really upset. He said Rachel’s parents were “punishing” her for getting pregnant before she was married and withholding painkillers and treatment. According to Joseph, the whole family had a big argument and the father said Rachel was being “judged” and “if God wants the child to survive, it will be Him, not the hospital, who protects her.”
I told him the staff here would do everything they could to keep Rachel and her child safe, but I also reminded him that Rachel’s a minor, and legally that means the parents make the call.

The last thing we need is a big lawsuit.
In the end, I convinced him not to go into Ob/Gyn and make a scene, but I thought I should tell you about the incident just in case.
Stan Kirk
Reception
Seva Medical Center
Harold Mills Annual Performance Review
From: Harold Mills
To: MORGAN
Annual Performance Review
Just a reminder: We’ll be conducting your annual Performance Review this week.

Be sure to review your Job Description so you can discuss with us in detail how you fulfill the requirements of your role and how you’ve attempted to meet your goals. Also, please keep Rian’s advice on ethical decision making in mind.

Finding leaders who can make ethical decisions is one of Seva’s highest priorities.
Here’s your current job description:
Shift Supervisor
Assists the Head Nurse in managing nursing staff by shift. Is clinically knowledgeable and able to perform all duties of staff under their supervision. Collaborates with physicians in assuring that care regimens for all patients are carried out by shift staff. Skilled in communication, team-building, and electronic medical records systems.
Keep up the good work,
Harold Mills
Human Resources
Seva Medical Center
You check Rachel’s chart and notice that she has not been given any meds or been seen by the physician on duty, who is attending another emergency.

Fetal distress is not currently critical, but it has been increasing gradually, as has Rachel’s own distress and fear. The parents have clearly stated they don’t want any assistance, and the assigned nurse has acquiesced in that desire, but you are concerned that Rachel and the baby may be moving toward irreversible medical danger if some intervention is not made.

Although the unit is short-staffed, the hospital does have a chaplain on staff who could be summoned quickly.
As you reflect on the situation, you realize that it’s all a pretty sticky mess. However you don’t have to face the problems alone, since Seva has Rian Brown, the company’s Ethics Officer, to assist.

The time seems right to contact the Ethics Coach.
Issues in your Dilemma
Thanks for visiting with me today. You’re right…you have a tough problem. I am pleased that you are willing to work through the problem by email today.

I think you will find this method useful.
The first step is to figure out exactly what the problem is – what the issue is that you are facing. By breaking the problem down into small parts, you can see the dilemma more clearly. If you want some additional help in sorting through the issue, check my Ethics Coach posting for this page.

Remember that the Ethics Coach changes on each page with information specific to your current task.
Now, based on our conversation, I’ve included a list of possible issues for this problem.
• Check the one that you think applies to this situation.
• Then, submit your answer.
• I’ll let you know whether or not you hit the mark.
Which issue applies to this problem?
How to overcome parental objections to appropriate care without filing a dependency action.
How to assure nurses are trained to provide care for minors in the face of parental opposition.
How to accommodate patients’ religious views when these conflict with optimal medical care.
How best to assure that Rachel and her baby get appropriate and timely medical care.
re: Issues in your Dilemma
Thank you for your reply.

When analyzing a complex problem, I find it critical that the issues be identified and clearly understood.
Here’s how to read the chart:
• A appears before the issue you selected as applying to the situation.
• An appears before those issues that you did not select.
• If I disagree with your choice, these symbols are marked as and .
• For answers on which we agree, the text is highlighted in blue.
• For answers on which we disagree, the text is highlighted in yellow.
Which issue applies to this problem?
How to overcome parental objections to appropriate care without filing a dependency action.
(Incorrect) This is not the primary ethical issue you must resolve.

Instead, this is a statement of concern about legal liability. While you do not want to provoke a lawsuit unnecessarily, making this your primary concern is unlikely to result in the best solution to the actual ethical dilemma.
How to assure nurses are trained to provide care for minors in the face of parental opposition.
(Incorrect) Although this is something that you want to be sure happens in any case, this is not the primary ethical issue.

Instead this is a long-range planning need. Thinking long-term is useful, but don’t let the long-term goals distract you from solving the immediate problem.
How to accommodate patients’ religious views when these conflict with optimal medical care.
(Incorrect) In this situation, apparent religious views are a red herring. Challenges to providing adequate care for each patient come in all shapes and sizes, not just religious views.

This framing of the issue is both too broad and too narrow to best resolve the specific ethical dilemma in this case.
How best to assure that Rachel and her baby get appropriate and timely medical care.
(Correct) This is the primary ethical issue you must resolve in this situation.

The core values in conflict include providing equal care for all and deferring to parental wishes. Best solutions will allow you to do both, once you have properly identified this as the issue.
Stakeholders in your Dilemma
Nicely done.

So, we have now determined the question we will answer.
The next step is to name the primary stakeholders – those people who are:
• directly involved in this situation;
• have to carry out the decision;
• directly affected by the decision; or
• whose direct interests are to be protected.
Those who have delegated responsibility to others are not primary stakeholders.

Also those who are interested observers are not primary stakeholders. If you want more information, check the Ethics Coach.
Now, based on our conversation, here’s a list of people who might qualify as the primary stakeholders, but only six of the eight of them are directly involved. Check the box next to anyone who you think is a primary stakeholder.
Who are the primary stakeholders in this problem?
The Shareholders
Actions that affect the value of the company affect their ownership interest.
Dr.

Emerson Rogers, Chief of Staff
He is responsible for everything that goes on in the organization and often liable for ethical mistakes.
Rachel Banks
She is the pregnant patient who may need more medical care than her parents want.
MORGAN, Staff Nurse
You have to make and implement the decision.
Mr.

and Mrs. Banks, Rachel’s parents
They are the patient’s legal guardians and do not appear to want additional care for their daughter.
Yvonne Napier, RN
She is the one primarily responsible for assuring Rachel has a safe delivery.
Lily, Rachel’s unborn child
This is the child who is about to be born and may need medical intervention to assure safety.
Other Ob/Gyn nurses
They are also responsible for assuring that Ob/Gyn patients receive appropriate and timely medical care.
re: Stakeholders in your Dilemma
Thank you for working with me on this matter.

Which option best fulfills your duties

As I’m sure you’ll agree…before making a decision, understanding who will be directly affected by your action is critical.
I used the same mark-up as was done before when critiquing your answers:
• A appears before any stakeholder you selected as being directly involved.
• An appears before those stakeholders that you did not select.
• If I disagree with your choice, these symbols are marked as and .
• For answers on which we agree, the text is highlighted in blue.
• For answers on which we disagree, the text is highlighted in yellow.
Let’s see how you did.
Who are the primary stakeholders in this problem?
The Shareholders
(Correct) Because the purpose of a company is to maximize shareholder value, they are always stakeholders.

Although originally shareholders were considered the only stakeholders, the stakeholder theory reminds us there are others whose interests should be considered.
Dr. Emerson Rogers, Chief of Staff
(Incorrect) Excluding the Chief of Staff may seem odd. However, he has delegated responsibility for the day to day running of divisions within the hospital to appropriate staff.

Remember that those who have delegated their responsibilities to others are not primary stakeholders.
Rachel Banks
(Correct) Whatever decision you make will impact her directly.

Your decision may very well affect whether she becomes a mother today as well as life-long health issues. Your decision is also likely to impact her relationship with her parents.
MORGAN, Staff Nurse
(Correct) You are always a stakeholder in the decisions you make.

How you balance your own interests with those of other stakeholders shows your level of ethical maturity. In this case, your decision will also impact several lives and an on-going family system.
Mr. and Mrs. Banks, Rachel’s parents
(Correct) They are both directly involved – legally they are responsible for their daughter – and will be directly impacted by your decision.

You will either affirm or challenge their decision about necessary medical intervention for their daughter. Thus, they are primary stakeholders.
Yvonne Napier, RN
(Correct) Because she is the person with primary responsibility in this setting for assuring that Rachel gets appropriate care, your decision will impact her directly.

She is therefore a primary stakeholder. Your decision will impact her work conditions and her future.
Lily, Rachel’s unborn child
(Correct) Although this dilemma is not about the question of broad legal rights for fetuses, this baby long ago crossed the threshold of viability and is on the edge of live birth.

The baby’s direct interests need to be protected, just as her mother’s do. Here, the baby is a stakeholder.
Other Ob/Gyn nurses
(Incorrect) Your decision will not directly impact their work.

Ultimately, depending on what you decide to do and whether the baby has a healthy delivery, they may be affected. However, this conditional and tangential potential for impact means they are not primary stakeholders.
Rights/Responsibilities Lens
Now that we’ve identified the issue and determined the stakeholders, let’s start looking at the problem through the Rights/Responsibilities Lens.
The Rights/Responsibilities Lens helps you identify your obligations – your duties – as well as your rights in this situation.

The idea is that as we think carefully about our choices we will know our rights and responsibilities, no matter what anyone else says.
The first step is to identify your duties to the various stakeholders. This lens requires that we treat people the way they have agreed to be treated…either because of our stated agreements (contracts) or our implied agreements.
Below is a list of the duties that you might owe the stakeholders. Three of the six of them are actually your responsibility.

Considering your leadership role in the company, check those which you believe apply to you in this situation.
Which duties do you owe the stakeholders?
Duty to abide by the parents’ wishes.
Duty to support your staff’s professional improvement.
Duty not to interfere with competent staff in doing their jobs.
Duty not to accommodate parents who are harming their child.
Duty to provide the best patient care possible.
Duty to make parents do the right thing for their daughter.
re: Rights/Responsibilities Lens
Defining your duties can be difficult.

Are you surprised by the answers?
People who find the focus of this lens appealing are often called idealists:
1.

Which option best fulfills your duties

each person is supposed to work to be the very best that they can be;
2. as individuals use reason, they identify the principles that all people should follow;
3. people often do not live up to the ideals and so need rules; and
4. punishment or the threat of punishment keeps people in line.
As before, I have marked your responses:
• A appears before any stakeholder you selected as being directly involved.
• An appears before those stakeholders that you did not select.
• If I disagree with your choice, these symbols are marked as and .
• For answers on which we agree, the text is highlighted in blue.
• For answers on which we disagree, the text is highlighted in yellow.
Now, let’s review your duties.
Which duties do you owe the stakeholders?
Duty to abide by the parents’ wishes.
(Incorrect) In reviewing the list of duties created by W.D.

Ross to flesh out Kant’s theories, we see there is no duty such as this. Indeed, due to the fact that the parents seem to be making decisions that are not in their daughter’s best interests, duties exist to go against their wishes.
Duty to support your staff’s professional improvement.
(Correct) Not only is this good professional practice in all settings, it corresponds to the duty of beneficence. This duty requires that, if you have the capacity to do so, you should improve the capacity of others for virtue, intelligence, or pleasure.

Which option best fulfills your duties

You have this capacity with your staff.
Duty not to interfere with competent staff in doing their jobs.
(Incorrect) Although a good supervisor will tend to give staff wide latitude, no duty to avoid intervening exists.

However, competing duties exist that may require you to intervene if staff who are generally competent make decisions that violate the general medical duty to do no harm.
Duty not to accommodate parents who are harming their child.
(Correct) This combines the duties of non-maleficence and justice. Justice requires a proportional response. Here the parents do not appear to have their daughter’s best interests at heart and so justice – as well as your duty to do no harm – requires that you not defer to their wishes.
Duty to provide the best patient care possible.
(Correct) This is primarily an expression of the duty of fidelity.

In part it is also an outgrowth of the duty of non-maleficence. The hospital has at least implicitly, and in many cases explicitly, promised its patients to avoid harming them and to provide the best care they are capable of providing.
Duty to make parents do the right thing for their daughter.
(Incorrect) In rare cases, you may have an obligation to comply with a court order to provide treatment against a parent’s wishes.

Which option best fulfills the duties owed the stakeholders?

However, legal obligations are not the same as the duties of the Rights/Responsibilities Lens, and the duty of beneficence only requires you to encourage parents to do the right thing, not force them.
re: Rights/Responsibilities Lens
Just to review . . .

we’ve determined that you have the following duties owed your stakeholders in this problem:
• Duty to support your staff’s professional improvement.
• Duty not to accommodate parents who are harming their child.
• Duty to provide the best patient care possible.
Now let’s take a look at your options.
I’ve made a list of what I think are the possible choices in this situation.

Considering your duties to your stakeholders, choose the option that you think is the most ethical.
Which option best fulfills the duties owed the stakeholders?
Option 1
Confront the parents about their daughter’s need for medical attention.
Option 2
Ask the nurse to do a thorough check to verify that the situation has not reached the point where intervention is necessary.
Option 3
Trust your nurse to provide sufficient care to prevent the fetus from going into medically dangerous distress.
Option 4
Call the physician on duty without seeking input from or informing the parents or the assigned nurse.
Option 5
Ask the assigned nurse to call a physician and a chaplain.

Make sure that the mother is assessed medically and that the parents are provided a ministerial response.
Option 6
Involve the assigned nurse and the parents in assessing need for medical intervention to ensure a safe delivery. Provide contacts for aftercare support and education.
re: Rights/Responsibilities Lens
Based on the duties you owe the stakeholders, you chose the following option:
Ask the assigned nurse to call a physician and a chaplain.

Which option best fulfills your duties

Make sure that the mother is assessed medically and that the parents are provided a ministerial response.
With this option you have fulfilled all your duties to the stakeholders.

You have fulfilled your own duties and have supported others in doing their duties voluntarily, which bodes well for the future of this small family system.
Well done! You chose the best option for this lens!
The Rights/Responsibilities Lens is just one of the tools at our disposal.

Let’s continue onwards and examine this problem from another perspective.
Results Lens
The Rights/Responsibilities Lens focused on your duties. Now it’s time for a change of perspective. The Results Lens is going to focus on what results will make the stakeholders happy or, in other words, what goals they want to accomplish.
Below is the list of stakeholders that you made earlier.

The first step is to decide how much each of the stakeholders will be affected by your decision on this problem, regardless of what your ultimate decision might be.
• Select “high” for those stakeholders who will be affected the most.

For instance, if a decision puts someone’s job on the line, or could drastically change their current situation, or has a serious impact on their well-being, the impact would be high.
• Select “low” for those stakeholders who will be affected the least. For instance, if a decision inconveniences a stakeholder, slightly increases their workload, or has a very remote chance of affecting them at all, the impact would be low.
• Select the middle radio button for those stakeholders where the impact will be between these extremes.

If a decision causes a stakeholder to be exposed to some risk, or to suffer a temporary setback or punishment, the impact would be medium.
I think you’ll find that the stakeholders are evenly divided between these three groups.
How much will each stakeholder be affected by your decision?
Low High
The Shareholders
Actions that affect the value of the company affect their ownership interest.
Low High
Rachel Banks
She is the pregnant patient who may need more medical care than her parents want.
Low High
MORGAN, Staff Nurse
You have to make and implement the decision.
Low High
Mr.

and Mrs. Banks, Rachel’s parents
They are the patient’s legal guardians and do not appear to want additional care for their daughter.
Low High
Yvonne Napier, RN
She is the one primarily responsible for assuring Rachel has a safe delivery.
Low High
Lily, Rachel’s unborn child
This is the child who is about to be born and may need medical intervention to assure safety.
re: Results Lens
At times, this exercise takes a fair bit of thought.
People who find the focus of this lens appealing are often called realists:
• each person is basically good but sometimes misguided;
• as individuals follow their hearts and seek happiness, they will know how to behave ethically;
• people need role models and encouragement to do the right thing; and
• relationships and respect keep people in line.
Here’s how I marked up your response:
• appears wherever you noted a low impact on a stakeholder.
• appears wherever you noted a medium impact on a stakeholder.
• appears wherever you noted a high impact on a stakeholder.
• If I disagree, the annotations are marked as , , and .
• For answers on which we agree, the text is highlighted in blue.
• For answers on which we disagree, the text is highlighted in yellow.
So, let’s look at your assessments.
How much will each stakeholder be affected by your decision?
The Shareholders
The impact is LOW .

. .
This situation is unlikely to be known beyond the Ob/Gyn unit. Thus, there is little chance it will impact the value of their shares. The shareholders are always stakeholders, but in this case the impact of your decision on them is very low.
Rachel Banks, the patient
The impact is HIGH .

. .
Because of the potential your decision has for serious medical consequences, your decision will have a high impact on her. Only her child will be more greatly impacted by your decision.
MORGAN, Staff Nurse
The impact is MEDIUM .

Which option best fulfills the duties owed the stakeholders?

. .
This decision will impact you more than a little bit. However, your decision will not impact your livelihood or your health. Thus, the impact on you relative to other stakeholders is medium.
Mr.

and Mrs. Banks, Rachel’s parents
The impact is LOW . . .
The parents will certainly have a strong opinion about your decision. However, the impact on them is unlikely to be significant. In a perfect world, whatever you decide would help them re-evaluate their position, but even so, the impact on them is low.
Yvonne Napier, RN
The impact is MEDIUM . . .
Your decision will have a greater impact on her, than on you or Rachel’s parents. You can help her improve her decision-making, ride roughshod over her, or leave her to her own devices.

However, the impact on her is not as high as on others.
Lily, Rachel’s unborn daughter
The impact is HIGH . . .
Your decision may very well be the deciding factor in whether the baby suffers irreparable harm in delivery. Although many people may have an opinion about your decision, no one will be impacted more than the fetus.
re: Results Lens
Once you understand the impact your decision will have on the stakeholders, the next question is determining what is important to them.

This process is a bit tricky because each of us is an individual and has different criteria for action:
• Non-negotiable Criteria – What event would be so horrendous or outside of their personal integrity that a stakeholder would take immediate action?
• Tipping Points – What patterns of action would become so annoying that the stakeholder would eventually take action or leave?
Below is our list of primary stakeholders. For each stakeholder, choose the two items that you believe (given your knowledge of these people) are the most important for them to be happy.

In this context, happiness is a work place that supports them and enables them to contribute to the world.
What are each stakeholder’s criteria for happiness?
The Shareholders – who want to maximize their profit, are happy in this situation if…
Staff do not provoke lawsuits by clashing with patients over adequate care and religious beliefs.
The hospital provides care efficiently, ethically, and legally.
The value of their shares increases each year.
Rachel Banks – who wants her baby to be delivered safely, is happy in this situation if…
The hospital gives her medication to reduce pain or advance her labor.
The hospital staff do not make her situation with her parents worse.
The hospital provides care so that she is not in unnecessary pain and her baby is delivered safely.
You – as you have to make and implement the decision, are happy in this situation if…
Your nurses do not provoke patients to sue the hospital by giving them necessary medical care.
Your nurses give appropriate and necessary care to all patients without discrimination.
Your nurses do not provoke lawsuits because of their religious beliefs.
Rachel’s parents – who do not agree with their daughter’s choices, but do not want her or their grandchild to be harmed, are happy in this situation if…
Their daughter and their grandchild receive the care they need to be safe.
They do not have to raise their grandchild.
Their values are respected by medical care providers.
Yvonne Napier – Rachel’s nurse, who is primarily responsible for Rachel having a safe, uneventful delivery, is happy in this situation if…
She is trusted to determine when patients assigned to her need additional medical attention.
She is able to promote the safe delivery of healthy children.
She is allowed to determine when patients assigned to her should not receive additional medical care.
Lily – Rachel’s daughter, who is about to be born and may need medical attention to prevent injury, is happy in this situation if…
Her mother’s choices are validated.
Her mother gets the medical attention she needs for a safe delivery.
She is born without injury or unnecessary pain.
re: Results Lens
In applying the Results Lens, discerning what makes each stakeholder happy is critical.

If you are wrong or don’t pay attention, your employees will either grumble or leave.
Below, you will find my analysis with the following mark-up:
• A appears before any item you selected as a primary criterion for happiness.
• An appears before those criteria that you did not select.
• If I disagree with your choice, these symbols are marked as and .
• For answers on which we agree, my analysis is highlighted in blue.
• For answers on which we disagree, my analysis is highlighted in yellow.
Now, let’s look at the criteria.
What are each stakeholder’s criteria for happiness?
The Shareholders – who want to maximize their profit, are happy in this situation if…
Staff do not provoke lawsuits by clashing with patients over adequate care and religious beliefs.
The hospital provides care efficiently, ethically, and legally.
The value of their shares increases each year.
Research shows investor tolerance for reduced or no profits when ethics are strong.

So long as the staff don’t provoke lawsuits and the hospital runs its business well, shareholders will put up with the occasional flat period or even loss in share value.
Rachel Banks – who wants her baby to be delivered safely, is happy in this situation if…
The hospital staff do not make her situation with her parents worse.
The hospital provides care so that she is not in unnecessary pain and her baby is delivered safely.
The hospital gives her medication to reduce pain or advance her labor.
She is less concerned with specifics than she is with getting the care she needs without further compromising her situation with her parents.

If medication isn’t the best remedy, she will be satisfied with what a nurse or doctor determines is the best medical care.
You – as you have to make and implement the decision, are happy in this situation if…
Your nurses do not provoke patients to sue the hospital by giving them necessary medical care.
Your nurses give appropriate and necessary care to all patients without discrimination.
Your nurses do not provoke lawsuits because of their religious beliefs.
Ideally, your nurses do not provoke lawsuits at all.

However, your interest is to make sure that the nurses in your charge provide adequate care.

If providing necessary medical care results in the occasional lawsuit, you should not quit your job – or even consider firing the nurse.
Rachel’s parents – who do not agree with their daughter’s choices, but do not want her or their grandchild to be harmed, are happy in this situation if…
Their daughter and their grandchild receive the care they need to be safe.
Their values are respected by medical care providers.
They do not have to raise their grandchild.
Their disappointment in their daughter does not make them want her or their grandchild to be harmed.

If they feel their values are respected, they are likely to trust hospital staff about medical care. Raising their grandchild is unlikely to be a factor in remaining at this hospital.
Yvonne Napier – Rachel’s nurse, who is primarily responsible for Rachel having a safe, uneventful delivery, is happy in this situation if…
She is able to promote the safe delivery of healthy children.
She is allowed to determine when patients assigned to her should not receive additional medical care.
She is trusted to determine when patients assigned to her need additional medical attention.
The difference here is between trusting her judgment and giving her control over decisions she has neither the right nor the medical training to make.

Your nurse wants to do her job without being micro-managed, not to do the doctor’s job or deny patient autonomy.
Lily – Rachel’s daughter, who is about to be born and may need medical attention to prevent injury, is happy in this situation if…
Her mother gets the medical attention she needs for a safe delivery.
She is born without injury or unnecessary pain.
Her mother’s choices are validated.
This is a tricky question: what is the tipping point for an unborn child?

The primary concern is simply to be born healthy, without permanent injury and as free of pain as possible, then to be loved and cared for. Other people’s choices are irrelevant except as they relate to these primary interests.
re: Results Lens
The final step in this lens is to determine which of the options make each of the stakeholders the happiest.

When combined with your analysis of how much each stakeholder is affected by your decision, one option should ultimately rise to the top as being the best.
Here are the ones that we are considering:
Option 1
Confront the parents about their daughter’s need for medical attention.
Option 2
Ask the nurse to do a thorough check to verify that the situation has not reached the point where intervention is necessary.
Option 3
Trust your nurse to provide sufficient care to prevent the fetus from going into medically dangerous distress.
Option 4
Call the physician on duty without seeking input from or informing the parents or the assigned nurse.
Option 5
Ask the assigned nurse to call a physician and a chaplain.

Make sure that the mother is assessed medically and that the parents are provided a ministerial response.
Option 6
Involve the assigned nurse and the parents in assessing need for medical intervention to ensure a safe delivery.

Provide contacts for aftercare support and education.
In the section below, choose the one option that will make each stakeholder the happiest. Beneath each of the stakeholders, I’ve listed the two criteria for happiness that we deduced in the previous exercise.

Please note that no single option may make every stakeholder happy — that’s to be expected.
Which option makes each stakeholder the happiest?
The Shareholders
1. Staff do not provoke lawsuits by clashing with patients over adequate care and religious beliefs.
2. The hospital provides care efficiently, ethically, and legally.
—— OPTIONS ——
1 2 3
4 5 6
Rachel Banks
1. The hospital staff do not make her situation with her parents worse.
2.

The hospital provides care so that she is not in unnecessary pain and her baby is delivered safely.
—— OPTIONS ——
1 2 3
4 5 6
MORGAN, Staff Nurse
1. Your nurses give appropriate and necessary care to all patients without discrimination.
2.

Your nurses do not provoke lawsuits because of their religious beliefs.
—— OPTIONS ——
1 2 3
4 5 6
Mr. and Mrs. Banks, Rachel’s parents
1. Their daughter and their grandchild receive the care they need to be safe.
2. Their values are respected by medical care providers.
—— OPTIONS ——
1 2 3
4 5 6
Yvonne Napier, RN
1. She is trusted to determine when patients assigned to her need additional medical attention.
2.

She is able to promote the safe delivery of healthy children.
—— OPTIONS ——
1 2 3
4 5 6
Lily, Rachel’s unborn child
1. Her mother gets the medical attention she needs for a safe delivery.
2. She is born without injury or unnecessary pain.
—— OPTIONS ——
1 2 3
4 5 6
re: Results Lens
In this lens, you have determined the impact that your decision will have on the stakeholders.

You have also assessed which option should make each stakeholder the happiest. A summary of your analysis is provided below:
Impact Happy with… Stakeholder
HIGH Option 4 Rachel Banks, the patient
HIGH Option 4 Lily, Rachel’s unborn daughter
MEDIUM Option 5 MORGAN, Staff Nurse
MEDIUM Option 3 Yvonne Napier, RN
LOW Option 5 The Shareholders
LOW Option 5 Mr. and Mrs. Banks, Rachel’s parents
Given this analysis, you must now choose the option that will create the greatest good for the greatest number.
Giving more weight to the happiness of those who will be impacted the most .

. .
which option will make the most people the happiest?
Option 1
Confront the parents about their daughter’s need for medical attention.
Option 2
Ask the nurse to do a thorough check to verify that the situation has not reached the point where intervention is necessary.
Option 3
Trust your nurse to provide sufficient care to prevent the fetus from going into medically dangerous distress.
Option 4
Call the physician on duty without seeking input from or informing the parents or the assigned nurse.
Option 5
Ask the assigned nurse to call a physician and a chaplain.

Make sure that the mother is assessed medically and that the parents are provided a ministerial response.
Option 6
Involve the assigned nurse and the parents in assessing need for medical intervention to ensure a safe delivery.

Provide contacts for aftercare support and education.Option 1
Confront the parents about their daughter’s need for medical attention.
Option 2
Ask the nurse to do a thorough check to verify that the situation has not reached the point where intervention is necessary.
Option 3
Trust your nurse to provide sufficient care to prevent the fetus from going into medically dangerous distress.
Option 4
Call the physician on duty without seeking input from or informing the parents or the assigned nurse.
Option 5
Ask the assigned nurse to call a physician and a chaplain.

Make sure that the mother is assessed medically and that the parents are provided a ministerial response.
Option 6
Involve the assigned nurse and the parents in assessing need for medical intervention to ensure a safe delivery. Provide contacts for aftercare support and education.
re: Rights/Responsibilities Lens
Based on the duties you owe the stakeholders, you chose the following option:
Ask the assigned nurse to call a physician and a chaplain.

Make sure that the mother is assessed medically and that the parents are provided a ministerial response.
With this option you have fulfilled all your duties to the stakeholders. You have fulfilled your own duties and have supported others in doing their duties voluntarily, which bodes well for the future of this small family system.
Well done!

You chose the best option for this lens!
The Rights/Responsibilities Lens is just one of the tools at our disposal. Let’s continue onwards and examine this problem from another perspective.
Results Lens
The Rights/Responsibilities Lens focused on your duties.

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Now it’s time for a change of perspective. The Results Lens is going to focus on what results will make the stakeholders happy or, in other words, what goals they want to accomplish.
Below is the list of stakeholders that you made earlier. The first step is to decide how much each of the stakeholders will be affected by your decision on this problem, regardless of what your ultimate decision might be.
• Select “high” for those stakeholders who will be affected the most.

For instance, if a decision puts someone’s job on the line, or could drastically change their current situation, or has a serious impact on their well-being, the impact would be high.
• Select “low” for those stakeholders who will be affected the least.

For instance, if a decision inconveniences a stakeholder, slightly increases their workload, or has a very remote chance of affecting them at all, the impact would be low.
• Select the middle radio button for those stakeholders where the impact will be between these extremes. If a decision causes a stakeholder to be exposed to some risk, or to suffer a temporary setback or punishment, the impact would be medium.
I think you’ll find that the stakeholders are evenly divided between these three groups.
How much will each stakeholder be affected by your decision?
Low High
The Shareholders
Actions that affect the value of the company affect their ownership interest.
Low High
Rachel Banks
She is the pregnant patient who may need more medical care than her parents want.
Low High
MORGAN, Staff Nurse
You have to make and implement the decision.
Low High
Mr.

and Mrs. Banks, Rachel’s parents
They are the patient’s legal guardians and do not appear to want additional care for their daughter.
Low High
Yvonne Napier, RN
She is the one primarily responsible for assuring Rachel has a safe delivery.
Low High
Lily, Rachel’s unborn child
This is the child who is about to be born and may need medical intervention to assure safety.
re: Results Lens
At times, this exercise takes a fair bit of thought.
People who find the focus of this lens appealing are often called realists:
• each person is basically good but sometimes misguided;
• as individuals follow their hearts and seek happiness, they will know how to behave ethically;
• people need role models and encouragement to do the right thing; and
• relationships and respect keep people in line.
Here’s how I marked up your response:
• appears wherever you noted a low impact on a stakeholder.
• appears wherever you noted a medium impact on a stakeholder.
• appears wherever you noted a high impact on a stakeholder.
• If I disagree, the annotations are marked as , , and .
• For answers on which we agree, the text is highlighted in blue.
• For answers on which we disagree, the text is highlighted in yellow.
So, let’s look at your assessments.
How much will each stakeholder be affected by your decision?
The Shareholders
The impact is LOW .

. .
This situation is unlikely to be known beyond the Ob/Gyn unit. Thus, there is little chance it will impact the value of their shares. The shareholders are always stakeholders, but in this case the impact of your decision on them is very low.
Rachel Banks, the patient
The impact is HIGH . . .
Because of the potential your decision has for serious medical consequences, your decision will have a high impact on her. Only her child will be more greatly impacted by your decision.
MORGAN, Staff Nurse
The impact is MEDIUM .

. .
This decision will impact you more than a little bit. However, your decision will not impact your livelihood or your health. Thus, the impact on you relative to other stakeholders is medium.
Mr. and Mrs.

Banks, Rachel’s parents
The impact is LOW . . .
The parents will certainly have a strong opinion about your decision. However, the impact on them is unlikely to be significant. In a perfect world, whatever you decide would help them re-evaluate their position, but even so, the impact on them is low.
Yvonne Napier, RN
The impact is MEDIUM . . .
Your decision will have a greater impact on her, than on you or Rachel’s parents. You can help her improve her decision-making, ride roughshod over her, or leave her to her own devices.

However, the impact on her is not as high as on others.
Lily, Rachel’s unborn daughter
The impact is HIGH . . .
Your decision may very well be the deciding factor in whether the baby suffers irreparable harm in delivery. Although many people may have an opinion about your decision, no one will be impacted more than the fetus.
re: Results Lens
Once you understand the impact your decision will have on the stakeholders, the next question is determining what is important to them.

This process is a bit tricky because each of us is an individual and has different criteria for action:
• Non-negotiable Criteria – What event would be so horrendous or outside of their personal integrity that a stakeholder would take immediate action?
• Tipping Points – What patterns of action would become so annoying that the stakeholder would eventually take action or leave?
Below is our list of primary stakeholders.

For each stakeholder, choose the two items that you believe (given your knowledge of these people) are the most important for them to be happy. In this context, happiness is a work place that supports them and enables them to contribute to the world.
What are each stakeholder’s criteria for happiness?
The Shareholders – who want to maximize their profit, are happy in this situation if…
Staff do not provoke lawsuits by clashing with patients over adequate care and religious beliefs.
The hospital provides care efficiently, ethically, and legally.
The value of their shares increases each year.
Rachel Banks – who wants her baby to be delivered safely, is happy in this situation if…
The hospital gives her medication to reduce pain or advance her labor.
The hospital staff do not make her situation with her parents worse.
The hospital provides care so that she is not in unnecessary pain and her baby is delivered safely.
You – as you have to make and implement the decision, are happy in this situation if…
Your nurses do not provoke patients to sue the hospital by giving them necessary medical care.
Your nurses give appropriate and necessary care to all patients without discrimination.
Your nurses do not provoke lawsuits because of their religious beliefs.
Rachel’s parents – who do not agree with their daughter’s choices, but do not want her or their grandchild to be harmed, are happy in this situation if…
Their daughter and their grandchild receive the care they need to be safe.
They do not have to raise their grandchild.
Their values are respected by medical care providers.
Yvonne Napier – Rachel’s nurse, who is primarily responsible for Rachel having a safe, uneventful delivery, is happy in this situation if…
She is trusted to determine when patients assigned to her need additional medical attention.
She is able to promote the safe delivery of healthy children.
She is allowed to determine when patients assigned to her should not receive additional medical care.
Lily – Rachel’s daughter, who is about to be born and may need medical attention to prevent injury, is happy in this situation if…
Her mother’s choices are validated.
Her mother gets the medical attention she needs for a safe delivery.
She is born without injury or unnecessary pain.
re: Results Lens
In applying the Results Lens, discerning what makes each stakeholder happy is critical.

If you are wrong or don’t pay attention, your employees will either grumble or leave.
Below, you will find my analysis with the following mark-up:
• A appears before any item you selected as a primary criterion for happiness.
• An appears before those criteria that you did not select.
• If I disagree with your choice, these symbols are marked as and .
• For answers on which we agree, my analysis is highlighted in blue.
• For answers on which we disagree, my analysis is highlighted in yellow.
Now, let’s look at the criteria.
What are each stakeholder’s criteria for happiness?
The Shareholders – who want to maximize their profit, are happy in this situation if…
Staff do not provoke lawsuits by clashing with patients over adequate care and religious beliefs.
The hospital provides care efficiently, ethically, and legally.
The value of their shares increases each year.
Research shows investor tolerance for reduced or no profits when ethics are strong.

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So long as the staff don’t provoke lawsuits and the hospital runs its business well, shareholders will put up with the occasional flat period or even loss in share value.
Rachel Banks – who wants her baby to be delivered safely, is happy in this situation if…
The hospital staff do not make her situation with her parents worse.
The hospital provides care so that she is not in unnecessary pain and her baby is delivered safely.
The hospital gives her medication to reduce pain or advance her labor.
She is less concerned with specifics than she is with getting the care she needs without further compromising her situation with her parents.

If medication isn’t the best remedy, she will be satisfied with what a nurse or doctor determines is the best medical care.
You – as you have to make and implement the decision, are happy in this situation if…
Your nurses do not provoke patients to sue the hospital by giving them necessary medical care.
Your nurses give appropriate and necessary care to all patients without discrimination.
Your nurses do not provoke lawsuits because of their religious beliefs.
Ideally, your nurses do not provoke lawsuits at all.

However, your interest is to make sure that the nurses in your charge provide adequate care. If providing necessary medical care results in the occasional lawsuit, you should not quit your job – or even consider firing the nurse.
Rachel’s parents – who do not agree with their daughter’s choices, but do not want her or their grandchild to be harmed, are happy in this situation if…
Their daughter and their grandchild receive the care they need to be safe.
Their values are respected by medical care providers.
They do not have to raise their grandchild.
Their disappointment in their daughter does not make them want her or their grandchild to be harmed.

If they feel their values are respected, they are likely to trust hospital staff about medical care. Raising their grandchild is unlikely to be a factor in remaining at this hospital.
Yvonne Napier – Rachel’s nurse, who is primarily responsible for Rachel having a safe, uneventful delivery, is happy in this situation if…
She is able to promote the safe delivery of healthy children.
She is allowed to determine when patients assigned to her should not receive additional medical care.
She is trusted to determine when patients assigned to her need additional medical attention.
The difference here is between trusting her judgment and giving her control over decisions she has neither the right nor the medical training to make.

Your nurse wants to do her job without being micro-managed, not to do the doctor’s job or deny patient autonomy.
Lily – Rachel’s daughter, who is about to be born and may need medical attention to prevent injury, is happy in this situation if…
Her mother gets the medical attention she needs for a safe delivery.
She is born without injury or unnecessary pain.
Her mother’s choices are validated.
This is a tricky question: what is the tipping point for an unborn child?

The primary concern is simply to be born healthy, without permanent injury and as free of pain as possible, then to be loved and cared for. Other people’s choices are irrelevant except as they relate to these primary interests.
re: Results Lens
The final step in this lens is to determine which of the options make each of the stakeholders the happiest.

When combined with your analysis of how much each stakeholder is affected by your decision, one option should ultimately rise to the top as being the best.
Here are the ones that we are considering:
Option 1
Confront the parents about their daughter’s need for medical attention.
Option 2
Ask the nurse to do a thorough check to verify that the situation has not reached the point where intervention is necessary.
Option 3
Trust your nurse to provide sufficient care to prevent the fetus from going into medically dangerous distress.
Option 4
Call the physician on duty without seeking input from or informing the parents or the assigned nurse.
Option 5
Ask the assigned nurse to call a physician and a chaplain.

Make sure that the mother is assessed medically and that the parents are provided a ministerial response.
Option 6
Involve the assigned nurse and the parents in assessing need for medical intervention to ensure a safe delivery. Provide contacts for aftercare support and education.
In the section below, choose the one option that will make each stakeholder the happiest.

Beneath each of the stakeholders, I’ve listed the two criteria for happiness that we deduced in the previous exercise. Please note that no single option may make every stakeholder happy — that’s to be expected.
Which option makes each stakeholder the happiest?
The Shareholders
1.

Staff do not provoke lawsuits by clashing with patients over adequate care and religious beliefs.
2. The hospital provides care efficiently, ethically, and legally.
—— OPTIONS ——
1 2 3
4 5 6
Rachel Banks
1.

The hospital staff do not make her situation with her parents worse.
2. The hospital provides care so that she is not in unnecessary pain and her baby is delivered safely.
—— OPTIONS ——
1 2 3
4 5 6
MORGAN, Staff Nurse
1.

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Your nurses give appropriate and necessary care to all patients without discrimination.
2. Your nurses do not provoke lawsuits because of their religious beliefs.
—— OPTIONS ——
1 2 3
4 5 6
Mr. and Mrs.

Chapter 16

Banks, Rachel’s parents
1. Their daughter and their grandchild receive the care they need to be safe.
2.

Their values are respected by medical care providers.
—— OPTIONS ——
1 2 3
4 5 6
Yvonne Napier, RN
1. She is trusted to determine when patients assigned to her need additional medical attention.
2. She is able to promote the safe delivery of healthy children.
—— OPTIONS ——
1 2 3
4 5 6
Lily, Rachel’s unborn child
1. Her mother gets the medical attention she needs for a safe delivery.
2. She is born without injury or unnecessary pain.
—— OPTIONS ——
1 2 3
4 5 6
re: Results Lens
In this lens, you have determined the impact that your decision will have on the stakeholders.

You have also assessed which option should make each stakeholder the happiest. A summary of your analysis is provided below:
Impact Happy with… Stakeholder
HIGH Option 4 Rachel Banks, the patient
HIGH Option 4 Lily, Rachel’s unborn daughter
MEDIUM Option 5 MORGAN, Staff Nurse
MEDIUM Option 3 Yvonne Napier, RN
LOW Option 5 The Shareholders
LOW Option 5 Mr.

and Mrs. Banks, Rachel’s parents
Given this analysis, you must now choose the option that will create the greatest good for the greatest number.
Giving more weight to the happiness of those who will be impacted the most . . .
which option will make the most people the happiest?
Option 1
Confront the parents about their daughter’s need for medical attention.
Option 2
Ask the nurse to do a thorough check to verify that the situation has not reached the point where intervention is necessary.
Option 3
Trust your nurse to provide sufficient care to prevent the fetus from going into medically dangerous distress.
Option 4
Call the physician on duty without seeking input from or informing the parents or the assigned nurse.
Option 5
Ask the assigned nurse to call a physician and a chaplain.

Make sure that the mother is assessed medically and that the parents are provided a ministerial response.
Option 6
Involve the assigned nurse and the parents in assessing need for medical intervention to ensure a safe delivery. Provide contacts for aftercare support and education.