THE MOST CHALLENGING HEALING:
HUMAN, FINANCIAL AND ETHICAL
CONSIDERATIONS IN HEALTH CARE
Oklahoma Ethics Group
Bruce Lawrence, President and CEO
Beth Pauchnik, Managing Director,
Chief Legal Counsel, and CAO
INTEGRIS HEALTH OVERVIEW
MISSION
To improve the health of the people and communities we serve
VISION
Most trusted name in health care
VALUES
Love, Learn and Lead
CORE COMPETENCIES
₋ Delivering the most challenging healing through leading edge clinical care
₋ Collaboration to create our future
₋ Community focus
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INTEGRIS HEALTH OVERVIEW
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CENTERS OF EXCELLENCE
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8 Acute Care Hospitals
122 INTEGRIS Family Care and Affiliated Clinics
9,590 Staff Members
1,400 Physician Staff
47,333 Inpatient Discharges
640,626 Outpatient Registrations
648,358 Physician Clinic Visits
237,528 Emergency Department Visits
E-Health services since 1994
₋ TeleHealth
₋ INTEGRIS Virtual Visit – newest access point
INTEGRIS Heart Hospital
Hough Ear Institute
Jim Thorpe Rehabilitation Hospital
Nazih Zuhdi Transplant Institute
Paul Silverstein Burn Center
James R. Daniel Cerebrovascular & Stroke Center
INTEGRIS Cancer Institute
Henry G. Bennett, Jr. Fertility Institute
M.J. and S. Elizabeth Schwartz Sleep Disorders Center
INTEGRIS HEALTH OVERVIEW
Agenda for Today
Define Health Care Ethics
Main Ethical Principles
Access to Health Care
Clinical Ethics
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DEFINITION OF HEALTHCARE ETHICS
A set of moral principles, beliefs and values
that guide us in making choices about
medical care
Nicomachean Ethics - Aristotle
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MAIN PRINCIPLES
In the U.S. four main principles define the
ethical duties that healthcare professionals
owe to their patients:
• Autonomy: to honor the patients right to
make their own decisions
• Beneficence: to help the patient advance
his/her own good
• Non-maleficence: to do no harm
• Justice: to be fair and treat all cases alike
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IMPROVING ACCESS TO HEALTH CARE
• As the number of Americans without health
care coverage continues to increase, access to
care is a major political, economic and policy
problem.
• Unequal access to healthcare is also an ethical
issue.
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IMPROVING ACCESS TO HEALTH CARE
Three core American values are at stake:
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• Equality of opportunity
• Justice
• Compassion
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IMPROVING ACCESS TO HEALTH CARE
“The enjoyment of the highest standard of
health is one of the fundamental rights of
every human being without distinction of
race, religion, political belief, economic or
social condition”.
World Health Organization (1946)
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IMPROVING ACCESS TO HEALTH CARE
The Ethical Force Program four ethical
obligations regarding access to health care:
• First, every member of society must have an
adequate array of core health care benefits.
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IMPROVING ACCESS TO HEALTH CARE
• Second, the contents and limits of
health care benefits must be
established through an ethical process.
Transparent
Participatory
Equitable and Consistent
Sensitive to Value
Compassionate
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IMPROVING ACCESS TO HEALTH CARE
• Third, the health care system must be
sustainable.
• Fourth, the health care system must ensure
that its stakeholders have clear responsibilities
for which they are accountable.
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IMPROVING ACCESS TO HEALTH CARE
Scenario
Long Term Patients in an Acute Care Setting
• Patient exhausted payor sources.
• Care required does not meet criteria for inpatient
acute care.
• No real options so continue as an inpatient.
• Consider paying for the 24 hour monitoring the
patient needs
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IMPROVING ACCESS TO HEALTH CARE
Scenario
Employer on Employee Benefits
• You have 5,000 employees.
• Seven employees who have chronic hepatitis
represent a significant percent of the organization’s
health care costs due to the inordinately expensive
hepatitis drugs.
• Do you stop covering these drugs next plan year?
• What if you are a health care organization, does that
elevate the ethical conundrum?
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CLINICAL ETHICS
• When we think of health care ethics, most
people think of:
Life Sustaining Treatment
Euthanasia
Abortion
• The Role of Advance Directives
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MICRO ETHICS
Clinical ethics plays out daily in ways you may
not expect.
• Anesthesia informed consent for a routine low-risk
anesthesia. All anesthesia carries the risk of death.
Some anesthesiologists never mention it, some
always do and some customize their approach.
“Relational judgments” framed as “ethical
decisions”.
• Constant small ethical decisions play out every day in
clinical work.
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MICRO ETHICS
Very individual to the clinician, based on how
communication occurs and how decisions
made
Managing medical information.
• Should information be withheld from patients for
therapeutic reasons?
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CLINICAL ETHICS
Ethics Committee - How it Functions and Ethical
Framework
• Core Principles: Autonomy, beneficence, nonmalfeasance, justice.
• Framework: Information, identification,
clarification, assessment, recommendation and
documentation.
• Increase provider awareness.
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THE MOST CHALLENGING HEALING:
HUMAN, FINANCIAL AND ETHICAL
CONSIDERATIONS IN HEALTH CARE
Conclusion
Thank you
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