Chapter 8
ETHICS
• Ethics has been defined in terms of what is
considered right or wrong; also known as
“morals” or “codes”.
• Codes of ethics bring standards of moral and
ethical behavior together in one place.
Principle-Centered Leadership
•
•
Stephen R. Covey, author of The 7 Habits of
Highly Effective People and PrincipleCentered Leadership.
Identified eight characteristics of leaders:
1.
2.
3.
4.
Are you continually learning?
Are you service-oriented?
Do you radiate positive energy?
Do you believe in other people
Principle-Centered Leadership
Cont’d
5.
6.
7.
8.
Do you lead a balanced life?
Do you see life as an adventure?
Are you synergistic?
Do you exercise for self-renewal?
The answers to these questions can give you
insight into your ability to function ethically
and be successful in the world of medicine.
Five Ps of Ethical Power
1. Purpose: Understand your objective or
purpose.
2. Pride: Have pride in what you do.
3. Patience: Strive to believe that no matter what
happens, everything will work itself out.
4. Persistence: Strive to act in an ethical manner
at all times.
5. Perspective: Keep your life and purpose in
perspective.
Ethics Check Questions
1.
Is it legal? Is it against the law or any company
policy?
2. Is it balanced? Is this the best possible approach for
all concerned? Does it promote a win-win situation?
3. How will it make me feel about myself ? Will I feel
good if my decision is published in a newspaper?
Will my family and coworkers be proud of my
decision?
NOTE: ethical means determining who you are and who
you will act.
Bioethics
• Defined: brings the entire focus of ethics into
the field of health care and into those ethical
issues dealing with life.
• Examples of bioethics:
– Scarce medical resources
– Genetic engineering or manipulation
– Abortion and fetal tissue research
Ethical Guidelines for Physicians
• Advertising
– not illegal or unethical as long as truthful and not
misleading
• Confidentiality
– must not reveal confidential information about
patients without their consent unless they are
required to do so by law.
– Patients need to feel comfortable and safe so they
will reveal information about themselves that may be
important to their health care
Medical Records
• The medical chart and the information in it are
the property of the physician and the patient.
The record is confidential.
– Do not reveal information without patient consent
– records are property of physician and patient
– physician should provide copy or summary if patient
requests
– cannot be withheld because of unpaid bill
– transfer records to another physician if office closes
Professional Fees and Charges
• Illegal and excessive fees should not be charged
• fees should be based on customary to locale and
should reflect difficulty of services and quality
of performance
• may charge for completing complex insurance
forms
• may charge for missed appointment
• bill only treatments documented in patient’s
chart
Professional Rights and Responsibilities
of a Physician
• may choose whom to serve
• may NOT refuse patient on basis of race, color, religion,
national origin, or other illegal discrimination
• cannot deny treatment of an HIV patient
• cannot neglect or refuse treatment of their patient’s unless
withdraw from case
• Financial interests are not to influence
• Avoid “conflict of interest”
Abuse
Physicians and employees must:
• Report ALL cases of suspected child abuse
• Protect and care for the abused
• Treat the abuser (if known) as a victim
Bioethical Dilemmas
• Harder to define than are guidelines for ethics,
because each of the bioethical issues calls on us
to make decisions that directly affect a person’s
life.
• In some instances, the bioethical issue requires a
choice about who lives and requires a definition
of the quality of life.
Allocation of Scarce Medical
Resources
• Medical resources not available to everyone
– Appointment selection being made on availability to pay
– Patients turned away because they have no insurance or
financial resources to pay
– Decisions made by Congress, health systems agencies and
insurance companies is called macroallocation
– Decision made by physicians and members of health care
team is called microallocation.
Abortion and Fetal Tissue Research
• Roe v. Wade
– Continual challenge in the courts of its validity.
– Law stipulates that a woman has a right to an
abortion in the first trimester without interference
from regulations in any state.
– State restrictions vary in second and third trimester.
– Health care professionals are not forced to perform
abortions
– Use of fetal tissue to benefit patient with various
diseases and medical conditions.
Genetic Engineering Manipulation
• New discoveries are increasingly being seen.
• Biotechnology is being used in the diagnosis of
disease, production of medicines, forensic
documentation (DNA), and research.
• Continuous study may aid in the prevention or
cure of various genetic disorders and major
diseases.
Artificial Insemination Surrogacy
• Only way for some individuals to conceive a child
• Recommends the signed consent of each party be
obtained
• Recommends that meticulous screening be performed
prior to the insemination
• Surrogate (substitute) mothers and fathers
Dying and Death
• Patients are making more choices regarding their
health care and death.
• Via a Living Will or Physician’s Directive,
patients can mandate life support systems be
removed.
• Oregon is the only state to pass physicianassisted suicide.
• What is “quality of life?”
AIDS and HIV
• Confidentiality essential and must be protected as much
as possible
• Unethical to deny treatment to individuals with HIV or
test positive for HIV.
• Encourage HIV person to cease endangering others
• Physicians can notify authorities
• Partner Notification Programs (anonymously notify the
patient at risk, keeping source confidential)
• Physician can notify person at risk