healthcare communication ethics: response to file · web viewthis paper explores...

Running head: Healthcare Response 1

Healthcare Communication Ethics: Response to Healthcare Concerns

Tanisha Walker

Queens University

December 7, 2014

Healthcare Response 2

Abstract

This paper explores Healthcare Communication Ethics (HCE) and responsiveness to healthcare

concerns. To engage Health Care Communication ethics, one looks for ways to respond to the

illness in the larger context of a life, not for answers to “fix’ ill health (Arnett, R., Harden, J.M.,

& Bell, L.M., 2009). This paper will examine three articles discussing health ethic concerns and

factors considered in developing a response. Like many communication models, there is not a

one size fits all in healthcare communication ethics. However, there is one commonality which

appears in each article, the importance of finding an appropriate response to healthcare

communication ethics. Responsiveness leads to communicative action that, when directed

toward another, outlines the necessity of human care. Responsiveness is also the responsibility

for doing the task of health care communication ethics (Arnett et al., 2009).


Healthcare Communication Ethics: Response to Healthcare Concerns

Volunteers traveling abroad face challenges upon returning to the United States due to the

Ebola outbreak in West Africa. Fear of contracting the disease from others exposed to infected

people, raises a question in the United States on whether quarantines are ethical. Kaci Hickox is

a nurse who served abroad to help treat Ebola patients. Although testing negative for Ebola two

times and experiencing no symptoms of the disease, Hickox was quarantined 21 days in New

Jersey. During a recent CNN interview, Ms. Hickox expressed, “This is an extreme that is really

unacceptable and I feel like my basic human rights have been violated” (Cohen, E, Holland, L. &

Ellis, R.). Hickox continued to express her anger due to the emotional and physical stress she

suffered during her mandatory 21day quarantine (Cohen et al., 2014). In comparison, a

missionary name Allen Mann returned from a trip to Liberian and was treated with scorn and

fear in his small town. Mann imposed a self-quarantine for himself and family despite showing

no symptoms of the disease or Center for Disease Control and Prevention (CDC) requiring the

quarantine (Almendrala, A., 2014). Mann expressed to the Huffington Post, “…We wanted to

give our community peace of mind that we were not sick, not contagious, and we were not

spreading it around” (Almendrala, A., 2014). Mann also states despite ill treatment he received

by his community, he holds no ill will towards the people who criticized and threatened him.

When asked why he chose to self-quarantine, Mann states his decision was rooted in

“compassion towards his home community”(Almendrala, A., 2014). This paper examines three

scholarly articles and two news articles related to healthcare communication ethics. Each article

explores healthcare communication ethics and factors in developing responses to healthcare

concerns. The articles were chosen based on healthcare communication ethic factors such as

experiential, responsibility, and authenticity to help answer whether quarantines are ethical or


not. The news articles were chosen to provide a quarantine narrative through the lens of those

impacted by them.

Literature Review

In an article by Warren Thomas Reich, experiential ethics is used as a foundation for

dialogue between health communication and health-care ethics. The principle-based paradigm of

ethics offers a way of working out an ethic of duty or obligation. Reich mentions in the duty

based normative approach, the normative question is: “What ought to be done?” (Reich, W.,

1988). Reich also mentions this principle-based paradigm helps formulate answers of healthcare

communication in the public policy debates. The moral principle acts as a guide for public

policy. This suggests experiential ethics searches for principles such as those that mandate the

observance of the rights of others. The experiential ethic is considered a corrective paradigm.

According to Reich, two fundamental questions should be: “What is going on around me? What

is occurring in this moral world?” To answer that question is to start the process of response

ethics (Reich, W., 1988).

Reich also states experiential ethics are the models and images that guide our moral

vision and moral behavior (Reich, W., 1988). Reich does caution ethics is the study of moral

behavior more than science of moral principles and duties. There are different models such as

situation-specific action, mutual participation, and metaphorical images of healer. Reich

discusses “Arrowsmith”, a novel by Sinclair Lewis, which is a moral story about a doctor turned

hero who was completely committed to experimental biomedical science in an American cultural

context (Reich, W. 1988). According to the paper, the character-image of Martin Arrowsmith

presents a model for moral emulation or rejection. The significance of the story is based on the

ethos paradigms. Arrowsmith is founded on a spiritual idea of selfless dedication to truth-


seeking. For healthcare ethics, ethos paradigm enables us to examine the moral and social forces

that help shape our behavior and commitments (Reich, W., 1988).

Similarly, Arnett, Harden-Fritz, & Bell mention health care communication ethics is a

response of hope in the ongoing meeting of questions of human health (Arnett, R., Harden-Fritz,

J.M., & Bell, L.M., 2009). Arnett et al. discusses the meaning of health care communication

ethics which is to protect and promote a sense of gratitude and knowledge of a final freedom—

our response to health, its absence, and the eventuality of death (Arnett et al., 2009). Healthcare

communication ethics rest in the response. Arnett mentions health care ethics is a call to

responsibility defined not by demand or acquiescence, but by responsiveness. Responsiveness in

turn is the responsibility for doing the task of health care communication ethics (Arnett et al.,

2009). Reference of final freedom is seen as a response to health care communication ethics

throughout the chapter. According to the text, final freedom is to find a way to build when life

before and around you refuses to conform to demands. It’s through human tenacity responsive

understanding of health care communication ethics springs forth (Arnett et al., 2009). Arnett

ends this section of the chapter reflecting on responsiveness as one of the final freedoms. It is

the active reaching out to another and to one’s own problems. Responsiveness leads to

communicative action that, when directed toward another, outlines the necessity of human care

(Arnett et al., 2009).

In contrast, Petraglia studied the importance of authenticity as a means to persuade,

narrate, and promote dialogue in health communication and education. Presentation and

application of healthcare information are equally important in persuading others. Petraglia

outlines the significance of not just learning knowledge but also applying what is learned. It may

be easy to learn facts, but without the ability and willingness to apply information to the contexts


in which the information is relevant, knowledge is wasted (Petraglia, J., 2009). Petraglia does

mention how widely health information is circulated and publicized impersonally. For many

public health target audiences, information and messages about illness and disease and

exhortations to change risky behavior can easily become white noise—droning buzz in the

background that only occasionally reaches consciousness (Petraglia, J., 2009). Petraglia does

build his theory from progression of constructivism as the theoretical perspective to authenticity

leading persuasion as a means to convince individual’s information is authentic. Petraglia (2009)

mentions persuasion is the core of authentication. Authenticity is not an intrinsic property

possessed by information; it is a judgment, a decision made on the part of the learner based on

prior experience and sociocultural context.

Petraglia introduces several approaches to contextualization appearing in education.

Problem-based learning in which Dewey’s theory of learning-by-doing is made operational. The

subfield of educational technology extends problem-based learning with variations such as

anchored instruction and goal-based scenarios (as cited in Petraglia, J., 2009). The relevance of

authenticity in public health is evaluated through constructivism methodology. Constructivism

in contrast to positivism increases emphasis on the learner’s relationship to his or her social and

material environment (Petraglia, J., 2009). Petraglia uses his personal experience with

organizations such as MARCH (Modeling and Reinforcement to Combat HIV/AID) and RAMP

(Reflection and Action Within Most-at-Risk Populations) as a reference for narrative, dialogue,

and authenticity messaging. The Pathways to Change tool was developed to assist with

structuring stories using behavior change theory and site-specific research on behavioral risk

(Petraglia, J., 2009). The tool was designed to describe key characteristics that slowly change

specific attitudes and behaviors. Subjects face both positive and negative influences, experience


setbacks, and seek support in various ways to achieve specific behavior goals (Galvatotti et al.,

2005). Study results are inconclusive, however, Petraglia states the dialogic aspects of public

health communication and education is difficult, labor-intensive, and costly from an

administrative perspective. In the case of MARCH and RAMP, each project encouraged

dialogue in the service of promoting perceptions of authenticity from the individual who needs to

apply information and guidance relating to behavior change to their circumstances Petraglia, J.,

2009).

The Huffington Post interviewed a missionary named Allen Mann who imposed a self-

quarantine for himself and family upon returning from a trip to Liberian, capital of Monrovia.

Mann mentions some people in his small town in Arizona treated his arrival with scorn and fear

(Almendrala, A., 2014). Mann was not part of a health care team and took precautions to refrain

from physical contact with pastors and community members he served in Monrovia. Despite not

showing any symptoms of Ebola or the Center for Disease Control and Preventions requiring a

quarantine, Mann decided a self-quarantine was the best option. During this time, Mann

mentions his community turned on him by communicating threats such as, “…we should torch

his house” and called him names such as “idiot” or “irresponsible” (Alemendrala, A., 2014).

Mann felt a personal responsibility or duty to protect his community by self-quarantining for 21-

days.

In contrast, Kaci Hickox, an epidemiologist, worked to help treat Ebola patients in Sierra

Leone. Upon returning to the United States, she was immediately placed in a mandatory 3 day

quarantine in a tent behind a New Jersey hospital. Hickox expressed outrage over the mandatory

quarantine and felt it was unacceptable and a violation of her human rights (Cohen, E.,

Holland,L. & Ellis, R., 2014). Hickox mentions politicians have no right to make those type of


decisions and considered it unacceptable. Hickox attorney Steven Hyman states, “She went and

did a magnanimous thing and deserves to be treated with respect and dignity, not put in isolation

because some political leaders decided it looks good to do that” (Cohen et al., 2014).

Methodology

I chose to use responsiveness as a lens for healthcare communication ethics to review

each literature. Arnett (2009) mentions responsiveness leads to communicative action that, when

directed toward another, outlines the necessity of human care. Each literature was examined for

characteristics important to healthcare communication ethics. There are other tools which could

apply, however, responsiveness proved to be the best methodology to explore healthcare

communication ethics and its determinant factors which influence it. Many scholars have used

the behavior change narrative, as seen in Petraglia’s journal, to help frame responsiveness in

healthcare communication ethics. The behavior change narrative also help determine how

certain situations could influence individuals, in this case, as it pertains to health care concerns.

Media interviews, polls, and literature review of relevant scholar articles pertaining to

healthcare communication ethics were assessed in order to evaluate how healthcare issues are

communicated, received, and possibly impact behavior change. Responsiveness allows

evaluation of healthcare communications ethics from a constructive view of learning.


Data

The question of whether healthcare quarantines are ethical in response to the recent

Ebola outbreak in West Africa needs to be addressed. Two polls were reviewed and analyzed to

determine the general consensus towards quarantines in the United States. According to a NBC

poll, the question of whether mandatory quarantines for health professionals who have treated

Ebola patients in West Africa, even if they have no symptom, to be enforced showed 71 percent

agreed health workers should be subjected to a 21-day quarantine. The poll showed 24 percent

disagreed with imposing mandatory quarantines. The poll did suggest support for quarantines

varied by political party, age, and education level. Eighty-five percent Republicans say they

think quarantines should be enforced, versus 65 percent of Democrats and 60 percent of

independents. Ninety-one percent of Tea Party backers also believe quarantines are necessary

(as cited in article by Dann, C., 2014). Older Americans are more likely to support mandatory

isolation of health workers versus a third of those 18-34 year olds who oppose such requirement.

Interestingly, those with lower level of education are more likely to support quarantines (80

percent with a high school education or less) versus those with a college or post-graduate

education (63 percent are in favor).

A second poll conducted in US News Report was ask the question of “Should returning

health care workers be quarantined? Although there were no mention of symptoms of Ebola or

not, 75 percent agreed there should be a quarantine, while 24 percent disagreed. There weren’t

specific timeframes given as part of the survey nor symptom status a requirement. Interviews

from two individual with personal experience of quarantines (voluntary and involuntary) allows

further insight of responses to healthcare concerns from a narrative perspective. Each interview


presented another perspective from the voice of the individuals subjected to the quarantines in

contrast to public opinion.

Review of three scholar articles and two news articles regarding healthcare

communication ethics were reviewed. The literature review outlines the premise of each study

and how each aids in formulating healthcare responses. Each review assisted in generating

additional questions for further consideration. For example, what’s the impact on healthcare

communication ethics when media provides healthcare information? How does authentic

persuasion impact messages when communicated to the public as a response to healthcare

concerns? How does responsibility or the moral compass impact response to healthcare

concerns?

Petraglia’s article on authentic persuasiveness as a healthcare communication ethic

response was evaluated to provide insight to some of these questions mentioned. Petraglia’s use

of narrative formats provide rich contextualization. Petraglia examined John Dewey’s

perspective of constructivism learning viewpoint. Dewey argued education should be less

artificial and abstract and, instead, draw more from learners’ experience (Petraglia, J., 2009).

Experimentation within a behaviorist framework is best for constructivism study. Petraglia does

express concerns regarding constructivism posing serious methodology challenges for

educational researchers. However, a widely accepted theory of contemporary constructivist

focuses on cognition because it’s embedded in our everyday interactions with the world, in turn

are mediated by language or symbols. Everyday activity is the source of information and allows

others to not only inform our cognition but also extend it.


Reich’s article on experiential ethics was analyzed to review the impact of ethos or morals

on healthcare communication ethics. Reich mentions contemporary “applied” ethics is a

framework for this type of study which analyzes dilemmas and resolved in a deductive fashion

through application of already established principles. In short, contemporary applied ethics is a

good starting part in developing responses by decision-making and action. Reich refers to the

principle-based paradigm of ethics as a way to work out an ethic of duty or obligation. The

normative question in principle-based paradigm is “What out to be done?” (Reich, W., 1988).

Arnett’s discussion of responsiveness to communication ethics as an outline to the

necessity of human care was reviewed to determine if quarantines do meet the definition of

human care and for whom? Arnett uses response as an outline for care and labor of care in

healthcare communication ethics. Arnett did not have particular technique to use for his study, it

was based off the work of others such as Nel Nodding and Julia Wood work on caring. Also,

Hannah Arendt’s perspective of caring defining three major characteristics of the human

condition: labor, work, and action (Arnett et al., 2009).

Analysis

The objective of this paper is to help answer the question if quarantines are ethical from

a healthcare communication ethic perspective. Review of polls indicate a large percentage of the

general public considers quarantines to be ethical. However, the polls reviewed provide a narrow

view based on the types of questions asked. The NBC poll was more detailed in regards to

length of quarantines as well as symptom requirements. It provided additional information such

as differences in political party, age, and education level as possible factors impacting response

to the Ebola healthcare issue. This poll exposed additional considerations regarding how

healthcare communication is disseminated and processed based on those factors. Petraglia


mentions in his paper the importance of being able to apply knowledge. He also warns of the

danger of information becoming inert with little connection to application (Petraglia, J., 2009).

The poll also shows how social norms plays a part in how they interpret information and apply

knowledge. However, there are negative side effects when social norms are used as a framework

for health care communication. Social norms theory have many assumptions, the main of which

assumes actions are based on misfortune or misperception of others attitudes and/or behavior

(Nazione, S. & Silk, K., 2011).

In contrast, a CNN poll was conducted based on one question, “Should returning health

care workers be quarantined?” This was a general poll providing limited details on

demographics of those taking the poll, making it difficult to determine what additional factors

could aid their response. Determining if fear was a motivation behind the response was difficult

to deduce. Misconceptions about Ebola and contraction of the disease could have aided the

responses in both surveys, however, further study is recommended to find out if those factors

were the reason by similar percentages in both polls. Unfortunately perception is not always

aided in facts. Instead of feeding into the fear and discriminating against others, we need to

come together in solidarity as we grapple with this terrible disease (Lacey-Bordeaux, E., 2014).

Arnett mentions the importance of responsiveness points to a particular view of caring.

A labor of care requires even when the demands of the inconvenient or frightening are before us

that we must keep going (Arnett et al., 2009). Arnett’s argues healthcare communications ethics

not only stems from responsiveness to healthcare concerns but also responsibility of humans

caring for one another. Even when it is inconvenient to do so, it is important to find the tenacity

to do so. Human beings find the reason to respond from many sources, each giving a sense of

energy (Arnett et al., 2009). Arnett’s goal was not to examine the factors of the human response,


only acknowledge the importance of finding a way to assist oneself and others. Healthcare

communication ethics centers on a good that gives us a “why” for seeking information, for

seeking help, for a reason to fight, and a reason to think about others in the final moments of our

own lives (Arnett et al., 2009). Reference of work by others such as Nel Nodding and Julia

Wood work on caring was helpful in determining the importance of response to healthcare

concerns. Also, Hannah Arendt’s definition of three major characteristics of the human

condition: labor, work, and action was appropriate for this study since it help bridge labor of care

and care as a responsiveness to the world before us and helps define humanness. To be human is

to care; the labor of care is a necessity of our identity (Arnett et al., 2009).

Similar to Arnett, Reich explores applied communication through experiential ethics as a

foundation for dialogue between health communications and health care ethics. The question of

the moral experience is an integral starting point for ethics. Reich describes several models such

as situation-specific action (analytic criteria for the physician-patient relationship), mutual

participation (patients are mutual participates in therapeutic process, and metaphorical images of

the healer (images relying on metaphor for their meaning) (Reich, W.T., 1988). Reich adequately

describes in detail each of the models, however, does mention there are some drawbacks with

experiential ethics. One of the difficult questions regarding interpretation of the models and

images are: “Whose experience should count?” “Which models or image, in preference to others,

should be normative for human behavior?” Such questions present challenges in determining if

quarantines are ethical.

In contrast to Arnett and Reich, Petraglia suggest authentic persuasion is the core to

establishing health care communication ethics. A non-narrative (polls, surveys, etc.) technique

may attract attention and also deliver information, however, it will fail to offer people


opportunities to engage in authenticating information. According to Petraglia, the best strategy

to authenticate ideas about health and behavior change is the narrative strategy contextualizes

information in the form of stories, anecdotes, and cases (Petraglia, J., 1988). Petraglia’s argument

is that health care ethics should have a starting point as knowledge of moral reality based on

experience. Interviews of the individuals quarantined due to visiting West Africa during the

Ebola outbreak is a good example of the narrative strategy.

Although Petraglia did express using a “crab-like” transition through models, images,

paradigms to help link health-care ethics and health communication, it was difficult connecting

his original objective of knowledge as the starting point of moral reality. He mentions there were

methodology and disciplinary constraints preventing a cohesive notion of authenticity with both

the public and health practitioners. Many health messages are not so much incomprehensible or

imprecise as they are inauthentic—they do not agree with what people know about themselves

and the world they live (Petraglia, J., 1988).

Discussion

During this study I recognized many opportunities for future research. One of the

challenges in healthcare communication ethics is addressing who voice should be center. Arnett

mentions the importance of recognizing the needs of oneself and others. Finding the appropriate

response is the essence of caring. However, questions of what is considered “appropriate” and

for whom arise. Reich mentions during his study, two difficult questions to address in order to

interpret models are, “Whose experience should count?” “Which models or image, in preference

to others, should be normative for human behavior?” (Reich, W.T., 1988). There are other

factors to consider such as morals, compassion, responsibility, and sense of duty.


Does the benefit of the whole outweigh that of a few? When considering health care

communication ethics, this has to be taken into consideration. The need to treat people with

compassion and do what is morally right may not be sufficient to solve problems. Compassion

is grounded in the awareness that all living things suffer, it bypasses—although it need not

displace—all judgments, including those of justice (Hariman, R., 2009). Treating people

humanely when exposed to health care issues offers additional opportunities in healthcare

communication and ethics. Determining how healthcare concerns are communicated to the

public is important for further study. The role of media in communicating health concerns is

worth exploring for future research.

Conclusion

The objective of this paper was to determine if quarantines are ethical from a healthcare

communication ethics perspective. Responsiveness as the lens was appropriate to help answer

this question. Arnett (2009) mentions responsiveness leads to communicative action that, when

directed toward another, outlines the necessity of human care. This study does not prove a clear

answer of whether it is ethical to quarantine due to additional considerations raised during

evaluation of the factors which impact healthcare communication ethics. Originally the study

was leaning against quarantines, viewing them as unethical. Now I am not too sure. Each factor

had me question what voice is important to consider during a health crisis. A natural response to

display compassion for others, especially in their time of need, was one factor I questioned as

part of my evaluation. Questions regarding who is considered “others”, such as the general

public or those subject to quarantines, and who “needs” are important in evaluating healthcare

ethic started to change my way of thinking. If response equates to caring and shouldering the

labor of caring, I believe quarantines regardless of self or mandatory, are good precaution


measures to protect the general public. Although one can conclude precautions taken are

humane, the ultimate goal is to ensure all parties are protected.

Proper education of healthcare concerns should be facilitated by the health professions with

careful monitoring of the media. This may help reduce unnecessary fears which can cause

negative impacts to those quarantined for helping others less fortunate. Concern over reduction

in volunteerism due to quarantines has to be considered when crafting healthcare communication

and staying within healthcare ethics. For future study, I recommend use of the Protective

Motivation Theory (PMT), based on the work of Lazarus (1966) and Leventhal (1970). PMT

describes adaptive and maladaptive coping with a health threat as a result of two appraisal

processes (threat and coping appraisal). There are four factors considered during the appraisal:

1. The perceived severity of a threatened event

2. The perceived probability of the occurrence or vulnerability

3. The efficacy of the recommended preventative behavior

4. The perceived self-efficacy

Proper assessment of each factor could aid in appropriate responses to health care threats in the

future.


Reference

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WHO: Ebola Toll Leaps Higher to Nearly 7,000 in West AfricaFrom <http://www.nbcnews.com/storyline/ebola-virus-outbreak/who-ebola-toll-leaps-higher-nearly-7-000-west-africa-n258321>

http://www.nbcnews.com/storyline/ebola-virus-outbreak/who-ebola-toll-leaps-higher-nearly-7-000-west-africa-n258321First published November 30th 2014, 3:38 am Reuters--

http://www.nbcnews.com/storyline/ebola-virus-outbreak/who-ebola-toll-leaps-higher-nearly-7-000-west-africa-n258321




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