Chapter 8
Ethical Considerations
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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?
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Ethics
• Please refer to the video “Intro to
Ethics” through the instructor
companion site.
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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
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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
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Ethics
• Five Ps of ethical power
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Purpose
Pride
Patience
Persistence
Perspective
• From The Power of Ethical Management by Kenneth
Blanchard and Norman Vincent Peale
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Ethics
• Ethics check questions
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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.
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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
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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
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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
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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
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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
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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
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Ethical Guidelines for
Health Care Providers
• Medical records
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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
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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
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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
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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”
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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
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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
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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
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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
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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
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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
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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?
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or duplicated, or posted to a publicly accessible website, in whole or in part.
Bioethics
• Health care–right or privilege?
– Examples
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•
•
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Available kidney
Next available pediatric appointment
Artificial insemination
Referral to a mental health specialist
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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
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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
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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
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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
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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?
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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
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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
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