Chapter 8Chapter 8ETHICSETHICS

• Ethics has been defined in terms of Ethics has been defined in terms of what is considered right or wrong; what is considered right or wrong; also known as “morals” or “codes”. also known as “morals” or “codes”.

• Codes of ethics bring standards of Codes of ethics bring standards of moral and ethical behavior together moral and ethical behavior together in one place.in one place.

Principle-Centered Principle-Centered LeadershipLeadership

• Stephen R. Covey, author of The 7 Stephen R. Covey, author of The 7 Habits of Highly Effective People Habits of Highly Effective People and Principle-Centered Leadership.and Principle-Centered Leadership.

• Identified eight characteristics of Identified eight characteristics of leaders:leaders:

1.1. Are you continually learning?Are you continually learning?

2.2. Are you service-oriented?Are you service-oriented?

3.3. Do you radiate positive energy?Do you radiate positive energy?

4.4. Do you believe in other peopleDo you believe in other people

Principle-Centered Principle-Centered Leadership Cont’dLeadership Cont’d

5.5. Do you lead a balanced life?Do you lead a balanced life?

6.6. Do you see life as an adventure?Do you see life as an adventure?

7.7. Are you synergistic?Are you synergistic?

8.8. Do you exercise for self-renewal?Do you exercise for self-renewal?

The answers to these questions can The answers to these questions can give you insight into your ability to give you insight into your ability to function ethically and be successful function ethically and be successful in the world of medicine.in the world of medicine.

Five Ps of Ethical PowerFive Ps of Ethical Power

1.1. Purpose: Understand your objective Purpose: Understand your objective or purpose.or purpose.

2.2. Pride: Have pride in what you do.Pride: Have pride in what you do.3.3. Patience: Strive to believe that no Patience: Strive to believe that no

matter what happens, everything will matter what happens, everything will work itself out.work itself out.

4.4. Persistence: Strive to act in an Persistence: Strive to act in an ethical manner at all times.ethical manner at all times.

5.5. Perspective: Keep your life and Perspective: Keep your life and purpose in perspective.purpose in perspective.

Ethics Check QuestionsEthics Check Questions

1.1. Is it legal? Is it against the law or any Is it legal? Is it against the law or any company policy?company policy?

2.2. Is it balanced? Is this the best possible Is it balanced? Is this the best possible approach for all concerned? Does it approach for all concerned? Does it promote a win-win situation?promote a win-win situation?

3.3. How will it make me feel about myself? How will it make me feel about myself? Will I feel good if my decision is Will I feel good if my decision is published in a newspaper? Will my family published in a newspaper? Will my family and coworkers be proud of my decision?and coworkers be proud of my decision?

NOTE: ethical means determining who you NOTE: ethical means determining who you are and who you will act.are and who you will act.

BioethicsBioethics

• Defined: brings the entire focus of Defined: brings the entire focus of ethics into the field of health care and ethics into the field of health care and into those ethical issues dealing with into those ethical issues dealing with life.life.

• Examples of bioethics:Examples of bioethics:– Scarce medical resourcesScarce medical resources– Genetic engineering or manipulationGenetic engineering or manipulation– Abortion and fetal tissue research Abortion and fetal tissue research

Ethical Guidelines for Ethical Guidelines for PhysiciansPhysicians

• AdvertisingAdvertising– not illegal or unethical as long as truthful not illegal or unethical as long as truthful

and not misleadingand not misleading• ConfidentialityConfidentiality

– must not reveal confidential information must not reveal confidential information about patients without their consent about patients without their consent unless they are required to do so by law.unless they are required to do so by law.

– Patients need to feel comfortable and safe Patients need to feel comfortable and safe so they will reveal information about so they will reveal information about themselves that may be important to their themselves that may be important to their health carehealth care

Medical RecordsMedical Records

• The medical chart and the information in The medical chart and the information in it are the property of the physician and it are the property of the physician and the patient. The record is confidential.the patient. The record is confidential.– Do not reveal information without patient Do not reveal information without patient

consentconsent– records are property of physician and patientrecords are property of physician and patient– physician should provide copy or summary if physician should provide copy or summary if

patient requestspatient requests– cannot be withheld because of unpaid billcannot be withheld because of unpaid bill– transfer records to another physician if transfer records to another physician if

office closesoffice closes

Professional Fees and Professional Fees and ChargesCharges

• Illegal and excessive fees should not be Illegal and excessive fees should not be chargedcharged

• fees should be based on customary to locale fees should be based on customary to locale and should reflect difficulty of services and and should reflect difficulty of services and quality of performancequality of performance

• may charge for completing complex may charge for completing complex insurance formsinsurance forms

• may charge for missed appointmentmay charge for missed appointment• bill only treatments documented in patient’s bill only treatments documented in patient’s

chartchart

Professional Rights and Professional Rights and ResponsibilitiesResponsibilitiesof a Physicianof a Physician

• may choose whom to servemay choose whom to serve• may NOT refuse patient on basis of race, color, may NOT refuse patient on basis of race, color,

religion, national origin, or other illegal religion, national origin, or other illegal discriminationdiscrimination

• cannot deny treatment of an HIV patientcannot deny treatment of an HIV patient• cannot neglect or refuse treatment of their cannot neglect or refuse treatment of their

patient’s unless withdraw from casepatient’s unless withdraw from case• Financial interests are not to influenceFinancial interests are not to influence• Avoid “conflict of interest”Avoid “conflict of interest”

AbuseAbuse

Physicians and employees must:Physicians and employees must:• Report ALL cases of suspected child Report ALL cases of suspected child

abuseabuse• Protect and care for the abusedProtect and care for the abused• Treat the abuser (if known) as a Treat the abuser (if known) as a

victimvictim

Bioethical DilemmasBioethical Dilemmas

• Harder to define than are guidelines Harder to define than are guidelines for ethics, because each of the for ethics, because each of the bioethical issues calls on us to make bioethical issues calls on us to make decisions that directly affect a person’s decisions that directly affect a person’s life.life.

• In some instances, the bioethical issue In some instances, the bioethical issue requires a choice about who lives and requires a choice about who lives and requires a definition of the quality of requires a definition of the quality of life.life.

Allocation of Scarce Allocation of Scarce Medical ResourcesMedical Resources

• Medical resources not available to everyoneMedical resources not available to everyone– Appointment selection being made on Appointment selection being made on

availability to payavailability to pay– Patients turned away because they have no Patients turned away because they have no

insurance or financial resources to payinsurance or financial resources to pay– Decisions made by Congress, health systems Decisions made by Congress, health systems

agencies and insurance companies is called agencies and insurance companies is called macroallocationmacroallocation

– Decision made by physicians and members of Decision made by physicians and members of health care team is called microallocation.health care team is called microallocation.

Abortion and Fetal Tissue Abortion and Fetal Tissue ResearchResearch

• Roe v. WadeRoe v. Wade– Continual challenge in the courts of its Continual challenge in the courts of its

validity.validity.– Law stipulates that a woman has a right to an Law stipulates that a woman has a right to an

abortion in the first trimester without abortion in the first trimester without interference from regulations in any state.interference from regulations in any state.

– State restrictions vary in second and third State restrictions vary in second and third trimester.trimester.

– Health care professionals are not forced to Health care professionals are not forced to perform abortionsperform abortions

– Use of fetal tissue to benefit patient with Use of fetal tissue to benefit patient with various diseases and medical conditions.various diseases and medical conditions.

Genetic Engineering Genetic Engineering ManipulationManipulation

• New discoveries are increasingly New discoveries are increasingly being seen. being seen.

• Biotechnology is being used in the Biotechnology is being used in the diagnosis of disease, production of diagnosis of disease, production of medicines, forensic documentation medicines, forensic documentation (DNA), and research.(DNA), and research.

• Continuous study may aid in the Continuous study may aid in the prevention or cure of various genetic prevention or cure of various genetic disorders and major diseases.disorders and major diseases.

Artificial Insemination Artificial Insemination SurrogacySurrogacy

• Only way for some individuals to conceive Only way for some individuals to conceive a childa child

• Recommends the signed consent of each Recommends the signed consent of each party be obtainedparty be obtained

• Recommends that meticulous screening Recommends that meticulous screening be performed prior to the inseminationbe performed prior to the insemination

• Surrogate (substitute) mothers and Surrogate (substitute) mothers and fathersfathers

Dying and DeathDying and Death

• Patients are making more choices Patients are making more choices regarding their health care and death.regarding their health care and death.

• Via a Living Will or Physician’s Via a Living Will or Physician’s Directive, patients can mandate life Directive, patients can mandate life support systems be removed.support systems be removed.

• Oregon is the only state to pass Oregon is the only state to pass physician-assisted suicide.physician-assisted suicide.

• What is “quality of life?”What is “quality of life?”

AIDS and HIVAIDS and HIV

• Confidentiality essential and must be protected Confidentiality essential and must be protected as much as possibleas much as possible

• Unethical to deny treatment to individuals with Unethical to deny treatment to individuals with HIV or test positive for HIV.HIV or test positive for HIV.

• Encourage HIV person to cease endangering Encourage HIV person to cease endangering othersothers

• Physicians can notify authoritiesPhysicians can notify authorities• Partner Notification Programs (anonymously Partner Notification Programs (anonymously

notify the patient at risk, keeping source notify the patient at risk, keeping source confidential)confidential)

• Physician can notify person at riskPhysician can notify person at risk