V.I.P. care: Ethical dilemmas and recommendations for nurses

Abstract

Background: Not all patients are considered equal. For patients who are considered to be “very important persons,” care can be different from that of other patients with advantages of greater access to resources, special attention from staff, and options for luxurious hospital amenities. While very important person care is common and widely accepted by healthcare administration, it has negative implications for both very important person and non-very important person patients, supports care disparities and inequities, and can create serious ethical dilemmas for healthcare professionals. Very important person care can also result in negative care outcomes for its recipients. Objective: This article sought to explore the implications and ethical considerations of very important person care within the context of United States healthcare system, and integrate bioethical principles and American Nurses Association Code of Ethics for Nurses to influence recommendations for managing ethical dilemmas associated with very important person care. Method: A synthesis of the literature on very important person care was undertaken for this article. Ethical considerations: Ethical conduct was considered and respected when performing the literature review, referencing sources, and establishing authorship. Findings: According to the published literature, very important person care bares both positive and negative implications for patients, and negative implications for nurses. Nurses are the most affected by the demands from their administrators to provide special care and attention to patients in the “very important person” category and their families. Very important person care can be disruptive, disorienting, challenging, and stressful to nurses. Conclusion: While physicians and other healthcare professionals have commented on very important person care, limited work has been done in nursing. There have not been any empirical studies on very important person care. Therefore, in order to minimize the negative implications of very important person care, studies of this phenomenon are warranted. Exposing very important person care is important in the development of an ethical healthcare system. Moreover, understanding the ethical principles surrounding the concept of very important person care will empower nurses to effectively manage conflicts and ethical dilemmas that arise with very important person care.

VIP Patients in Interventional Radiology: Do Some Patients Deserve “Better” Care?

“…12,13 For example, age is a feature universal to all, and as such may be a justified consideration, whereas gender, race, socioeconomic, and, arguably, VIP status are all aspects of being that may unjustly affect allocation of resources. 5,11,13 IRs must often triage patients according to acuity, medical necessity, and the availability of finite human and technological resources. This case exemplifies how the choices and accommodations made in designating priority can significantly affect other patients whose care was altered because of an index decision.…”

“…VIPs often receive greater access to resources and attention from healthcare professionals, and yet, paradoxically, their care often inadvertently deviates from standard practice, which may confer poorer outcomes. 1,[4][5][6][7][8]10,15 The "spotlight" that accompanies high-profile VIPs or the pressure of caring for an influential patient can incite self-doubt that destabilizes our trained judgment and abilities. 8 This makes it easy to worry we are "not doing enough," and to overinvestigate or intervene on an issue in effort not to miss anything, as a result.…”

“…Eleanor Roosevelt too was "saved" from the discomfort of a bone marrow biopsy, and, as a result, was diagnosed and treated only for aplastic anemia while she had disseminated tuberculosis, which was realized only at her autopsy. 5,21 Michael Jackson requested and was prescribed propofol to mitigate his insomnia, which ultimately claimed his life. 3,11,22 Although these tendencies are likely rooted in compassion for VIP patients in need of our assistance, ironically, they bias us into providing them with inferior care.…”

“…These "well-known" patients (celebrities, benefactors, CEOs, administrators) or "well-connected" patients (family members, colleagues, healthcare providers) are often referred to as "influential" or even "intimidating" because of their status. [1][2][3][4][5][6][7] The "VIP" designation may be context and clinician-dependent and can extend further to include anyone for whom we have special interest. As such, VIPs are those who have been deemed important by the healthcare institution in which they are seeking care, and whose status may influence their providers.…”

“…1,8 When this influence causes undue deviation in clinicians' trained judgment and in standards of care, the outcome is not always superior for the VIP or for the system; this is termed the "VIP syndrome." 5,9,10 There are some potential positive effects of VIP care. The current medical system can be rather byzantine and difficult to navigate, and VIPs may be able to circumvent unnecessary roadblocks.…”