HCS 335 Week 1 Ethical Theories and Principles in Health Care Example

Three Missed Visits and You Are Out? Testing a Clinic's No-Show Dismissal Proposal Against Ethical Theories and the Four Principles

[Student Name]

University of Phoenix

HCS/335: Health Care Ethics and Social Responsibility

Week 1 Assignment

[Instructor Name]

[Date]

The clinic, its patients and its figures are composites written for a model paper; theories and principles come from the sources listed.

The four physicians at a composite family medicine clinic brought their manager a proposal: any patient who misses three appointments in 12 months will be dismissed from the practice. Last year, 11% of scheduled visits were no-shows, and each empty slot cost the clinic about $140 while other patients waited three weeks for an appointment. The proposal is legal if patients receive notice and time to find other care. Whether it is ethical is a different question, and answering it requires the theories and principles that guide health care decisions.

The Facts Behind the Proposal

Before applying theory, the manager looked at who misses visits. Of 212 patients with three or more no-shows, 64% were on Medicaid, 38% had no car and many worked hourly jobs without paid leave. Several had depression or substance use disorders. The patients most likely to be dismissed were also among those with the greatest need for care.

Consequentialism

Consequentialist theories, of which utilitarianism is the best known, judge an action by its results for everyone affected. A utilitarian manager would count the benefit to hundreds of patients who get earlier appointments against the harm to 212 who lose their medical home. The count is not simple: dismissed patients may turn up later in the emergency department sicker and costlier, and the clinic's reputation in the community could suffer. A careful utilitarian would favor whatever policy produces the most good overall, which may not be dismissal.

Duty-Based Ethics

Deontology holds that some actions are right or wrong regardless of their outcomes, because of the duties people owe one another. A deontologist would ask what the clinic owes its patients. Having accepted them, it has a duty not to abandon them and a duty to treat them as persons, not as slots on a schedule. Dismissing a patient whose bus did not come treats a barrier as a moral failure, which a duty-based view cannot accept.

Virtue Ethics

Virtue ethics shifts the question from rules and results to character: what would a clinic that is compassionate, fair and practically wise do here? Such a clinic would neither ignore the cost of empty slots nor punish patients for circumstances beyond their control. It would look for the reasons behind missed visits.

The Four Principles

Beauchamp and Childress (2019) set out four principles that have become the common language of health care ethics, namely respect for autonomy, beneficence, nonmaleficence and justice. Gillon (1994) argued that these principles can be accepted by people who hold very different moral theories, which makes them useful for a team that does not share one philosophy.

Autonomy

Respect for autonomy means honoring patients' right to make their own choices. Patients who miss visits may be choosing not to come, and the clinic cannot force attendance. But autonomy also requires that choices be informed and possible; a patient without transportation is not freely choosing to miss.

Beneficence

Beneficence is the duty to act for patients' good. Continued care for a patient with diabetes or depression is plainly in that patient's interest, which weighs against dismissal.

Nonmaleficence

Nonmaleficence means avoiding harm. Losing a primary care home can cause harm through missed screenings, uncontrolled chronic disease and lapses in medication refills.

Justice

Justice concerns fair distribution of benefits and burdens. Varkey (2021) described justice in clinical ethics as treating patients fairly and distributing scarce resources equitably. Appointment slots are scarce, so wasted slots are a justice problem. Yet a policy whose burden falls mostly on poor patients without cars is also a justice problem.

Stakeholders Beyond the Clinic

The decision reaches past the four physicians and the patients on the list. Front desk staff would have to enforce the policy and face upset patients. The Medicaid plan that pays for most of the affected patients has its own interest in keeping them connected to primary care, and the local emergency department would absorb some of those dismissed. Other patients, too, have a stake: they wait weeks for visits because of empty slots. Naming all of these parties keeps the analysis from shrinking to a contest between physicians and a few unreliable patients.

Where the Answers Diverge

The theories do not all agree. A narrow utilitarian count might support dismissal. Duty-based ethics and virtue ethics oppose it. The four principles conflict with one another: justice for waiting patients against beneficence and nonmaleficence for those who miss visits. The manager's task is to find an option that honors as many of these demands as possible.

What the Law Allows

Ending a patient relationship with written notice, an interim period of care and help transferring records is generally permitted. Legal permission sets the floor, not the answer, and the manager kept the two questions separate.

A Better Policy

The manager recommended a revised approach. Patients with two no-shows receive a call from a care coordinator who asks about barriers and offers solutions, such as ride vouchers through the Medicaid plan, evening appointments or telehealth visits. Text reminders go out two days and two hours before visits. The clinic adds same-day slots filled from a waiting list, which recovers lost capacity. Dismissal remains possible only after these steps fail and only with the physician's review of the patient's medical needs.

Measuring the Result

The clinic will track the no-show rate, third-available appointment wait and the number of dismissals each quarter. If no-shows fall below 7% within a year, the policy will have protected the schedule without closing the door on patients.

Personal Reflection

As a future manager, I hold fairness as a core value. This case showed me that fairness has two sides, to the patients waiting and to the patients missing, and that a good decision tries to serve both before choosing between them.

Conclusion

The three-strikes proposal looked like an efficiency measure but carried ethical costs that fell on the most vulnerable patients. Applying consequentialism, deontology, virtue ethics and the four principles showed those costs and pointed to a policy that addresses barriers first and reserves dismissal for last.

References

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Gillon, R. (1994). Medical ethics: Four principles plus attention to scope. BMJ, 309(6948), 184-188. https://doi.org/10.1136/bmj.309.6948.184

Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. https://doi.org/10.1159/000509119