Chapter 8 Ethical Considerations © 2014 Cengage©Learning. 2014 Cengage All Rights Learning. Reserved. All Rights May not Reserved. be scanned, May not copied be scanned, copied or duplicated, or or posted duplicated, to a publicly or posted accessible to a publicly website, accessible in wholewebsite, or in part. in whole or in part. Ethics • Defined in terms of what is considered right or wrong • Sometimes referred to as “morals” – Would you agree that everyone has their own moral compass? © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethics • Please refer to the video “Intro to Ethics” through the instructor companion site. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethics • Professional organizations often identify their ethics in “codes” • Code of ethics bring standards of moral and ethical behavior together in one place – Principles of Medical Ethics from American Medical Association (AMA) – Medical assistants have AAMA code of ethics and a creed – American Hospital Association (AHA) Hospital Patient Bill of Rights – More than 50 differing codes of ethics for professional organizations – Seven ethical codes that relate to the entire world © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethics • Principle-centered leadership – Guidelines to how you might perform ethically in medical setting – Adapted from Stephen R. Covey’s The 7 Habits of Highly Effective People and Principle-Centered Leadership © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethics • Five Ps of ethical power – – – – – Purpose Pride Patience Persistence Perspective • From The Power of Ethical Management by Kenneth Blanchard and Norman Vincent Peale © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethics • Ethics check questions – – – – Is it legal? Is it balanced? Is it the best approach for all concerned? How will it make me feel about myself? • If a procedure is a bioethical issue, you are allowed to remove yourself from participation but you must allow the patient’s right to treatment. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Keys to the AAMA Code of Ethics • Render service with full respect for the dignity of humanity • Respect confidential information • Uphold honor and high principles of the profession and accept its disciplines © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Keys to the AAMA Code of Ethics • Seek to improve knowledge and skills of medical assistants • Participate in additional service activities to improve health in community © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • AMA’s Code of Medical Ethics • American Osteopathic Association Code of Ethics • American Chiropractic Association’s Code of Ethics © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Advertising – Legal and ethical for providers to advertise if claims made truthful and not misleading – May include credentials of providers, description of practice, services rendered, how fees determined – Managed care agencies may advertise services and participating providers © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Confidentiality – Must not reveal information without consent unless required by law – Patients must feel comfortable revealing information – Some incidents must be reported • Patient threatens another person • Certain injuries and illnesses • Subpoenaed information © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • HIPAA – Care must be taken to protect confidentiality – Only authorized individuals should be permitted to add or alter data – HIPAA has specific guidelines for computer privacy © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Medical records – – – – Records are property of provider and patient Do not reveal information without patient consent Record confidential Transfer records to authorized provider if requested – Provider should provide copy or summary if patient requests – Cannot be withheld because of unpaid bill © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Professional fees and charges – Illegal or excessive fees should not be charged – Based on fees customary to locale – Reflect difficulty of services and quality of performance – Fee splitting unethical © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Professional fees and charges – Providers may charge for missed appointments if that office policy known by patient – Providers may charge to complete complex insurance forms – Bill only treatments documented on patient’s chart © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Professional rights and responsibilities – May choose whom to serve – May not refuse patient on basis of race, color, religion, national origin, or any other illegal discrimination – Cannot deny treatment of HIV-infected patient – Cannot neglect or refuse patient treatment unless withdrawn from case – Patients have right to know their diagnoses © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Professional rights and responsibilities – Only providers should inform families of patient’s death – Should expose incompetent, corrupt, dishonest, and unethical conduct by other providers – May not treat patients if under influence of controlled substances or alcohol – Must take precautions if HIV positive – Must avoid “conflicts of interest” © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Disaster response and emergency preparedness – Care of sick and injured is primary concern – Providers should consider seeking training in emergency preparedness and disaster response © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Treatment for culturally diverse clientele – Same quality of care to all patients regardless of race or ethnicity – Eliminate biased behavior toward any individuals different from themselves – Encourage diversity when hiring © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Care of the poor – Should be regular part of every provider’s practice – Encouraged to take certain number of patients on reduced-cost basis or provide free services – Volunteer their time to lobbying and being advocates for those without medical coverage © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Abuse – Neglect, physical, emotional/psychological/mental injury, sexual – Child, elder, intimate partner violence (IPV) – All 50 states mandate reporting of child abuse – Most states have legislation regarding elder abuse – Reporting abuse of IPV varies by state • Stalking: reportable crime in some states • Rape: reportable criminal act © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Ethical Guidelines for Health Care Providers • Abuse – Protect and care for the abused – Treat abuser as victim also – Provide safe environment for abused seeking treatment – Seek treatment for abuser and abused © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • Allocation of scarce medical resources – 2011: 59 million people without health insurance coverage – Health Care Reform Act of 2010 – Hispanic and non-Hispanic black children more likely to have no health care – Elderly have difficulty finding providers who take new Medicare patients – Macroallocation and microallocation © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • Allocation of scarce resources – Who should receive benefits and treatments? – How much money should be spent and distributed? – Who will make decisions for allocation of resources and services? © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • Health care–right or privilege? – Examples • • • • Available kidney Next available pediatric appointment Artificial insemination Referral to a mental health specialist © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • HIV and AIDS – Confidentiality must be safely guarded – Unethical to deny treatment to individuals because they test positive for HIV – If patient refuses to notify persons that they have put at risk • The physician should encourage them to do so • In some cases, the physician can make contact • Authorities can be contacted to take action © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • Reproductive issues – Female genital mutilation • Illegal in the US • Can cause infections and pregnancy complications – Contraception – Sterilization • Tubal ligation • Vasectomy – Assisted reproduction • Artificial insemination • In vitro fertilization • Surrogacy © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • Abortion and fetal tissue research – Constant court challenge to validity of Roe v. Wade – States’ restrictions vary, but abortion in first trimester is legal without interference – Health care professionals cannot be forced to perform or participate in abortions – Many unanswered ethical questions related to abortion © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • Abortion and fetal tissue research – Use of fetal tissue to benefit patients with lifethreatening diseases – Some states ban research using aborted fetuses – Federal law prohibits sale of fetal tissue – Fetal tissue research is not to be used to encourage abortion – Stem cells in umbilical cord blood shown to be beneficial treatment for sickle cell anemia and Type 1 diabetes in children © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • Genetic engineering/manipulation – Used in diagnosis of disease, production of medicines, forensic documentation, research – May be able to create custom-made organs to replace those that are defective or diseased – Where does cloning stop? © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • Dying and death – Patients making more choices • Advance directive specifies end-of-life wishes – Examples seen in Karen Ann Quinlan and Terri Schiavo cases – Physician-assisted suicide legislation in Oregon – Other states considering similar action – Quality-of-life issue © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Bioethics • Hospice – Make patients comfortable and as free from pain as possible and allow them dignity in their deaths – Death treated as natural end-of-life experience – Death neither hastened nor prevented – Often covered by insurance and less expensive than inpatient hospital care © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.