copyright 2009 pearson education, inc. publishing as prentice hall 6-1 chapter 6 health care ethics...

Copyright © 2009 Pearson Education, Inc. publishing as Prentice Hall 6-1

Chapter 6Health Care Ethics

Understanding Business EthicsStanwick and Stanwick

1st Edition


Ethical Thoughts

• “Preserving health by too severe a rule is a worrisome malady.”– Francois de La Rochefoucauld, French writer

and moralist


$50,000 A Day, Not A Bad Payday

• Medtronic: accused of offering ‘excessive’ compensation to doctors in return for using their medical devices

• Medical devices are used in certain types of back surgeries – spinal fusion



• A former Medtronic employee filed suit against the company alleging that the company paid millions of dollars to surgeons in return for ensuring that Medtronic’s devices would be used

• Lawsuit accused Medtronic of offering excessive remuneration, bribes, illegal perks, other illegal financial incentives for using certain medical devices



• Doctors – Payments were legitimate and fair compensation for work done

• Medtronic – Defended the allegations by saying that the consulting agreements were legal and valuable – Estimated that Medtronic paid more than $50

million from 2001 through 2005 for these consulting services



• Payments:– Considered illegal if tied directly to the specific

use of one product– Cannot be used to encourage a doctor to

select one product over another based on a financial incentive

• Medtronics lawyer warned about the apparent unethical behavior by breaking their own ethical rules by using these payments


Role of Ethics – Six Underlying Values

• Beneficence: belief that the best interests of the patient should be first

• Nonmalfeasance: belief that every action taken by the health care worker should not cause any harm to the patient

• Autonomy: freedom of every patient to either accept or reject the treatment offered

• Justice: belief that the decisions made by the health care workers are fair

• Dignity: belief that all patients have the right to be treated with dignity when they are in the health care system

• Truthfulness and honesty: belief that the patient is aware of all benefits and risks of all treatments being offered


Checklist for making ethical decisions in the medical field

(Office of Public Policy and Ethics at the Institute for Molecular Bioscience at the University of Queensland, Australia)

• Ability to identify and understand the impact of all the issues that are potentially related to the incident/issue/dilemma

• Ability to separate and consider the morally relevant issues as compared with the morally irrelevant issues for any given set of circumstances

• Ability to untangle and separate the critical elements of the morally relevant information

• Ability and commitment to gather research on relevant facts pertaining to the issues and examine how they impact the overall decision making process


Checklist for making ethical decisions in the medical field

(Office of Public Policy and Ethics at the Institute for Molecular Bioscience at the University of Queensland, Australia)

• Ability and courage to seek outside advice when necessary

• The ability to formulate and present a rational, unbiased, and morally defensible conclusion given the facts for any set of circumstances

• The ability to justify and defend one’s decision and subsequent ability to implement the decision

• The ability to revise and question one’s moral framework based on past experiences

• The ability to develop and maintain a consistent moral framework


Ethical Decision Making

• Nelson’s approach uses a procedural justice approach:– Looks at the rights, values and interests of

variety of groups – Much like stakeholder theory


Steps in Nelson’s Procedural Justice Approach

1. Clarify the ethical conflict2. Identify all of the affected stakeholders and their values3. Understand the circumstances surrounding the ethical

conflict4. Identify the ethical perspectives relevant to the conflict5. Identify the different options for action6. Select among the options7. Share and implement the decision8. Review the decision to ensure it achieved the desired

goal


Questions to Ask Related to Bioethics

• Prenatal genetic testing, alternative reproductive methods, stem cell research, cloning, banking of DNA– Value– Interests– Ownership– Commodification– Dignity– Reductionism– Justice


Doctor-Patient Relationship

• Four models to describe the doctor-patient relationship

1. Engineering model: doctor carries out the patient’s wishes

2. Priestly model: assumes that the doctor will always do what is in the patient’s best interest

3. Collegial model: assumes the doctor and patient participate equally in decisions based on trust

4. Contractual model: enters into an agreement in which both parties assume they are pursuing mutual goals


Doctor-Patient Relationship

• Nontraditional treatments• Internet solutions

– Is additional guidance needed in the form of laws and regulations?

• Asked to play a ‘higher being’– When to cut off life support – legal system

may have to intervene


Health Care Codes of Ethics

• Many different codes of ethics from many different sources– Health care providers may have to reconcile,

sometimes in their own minds, the differences in the codes of ethics

– Must make the best decision under unique, individual circumstances with patients


Consumer Rights and Responsibilities Concerning Healthcare (United States)

1. Information disclosure2. Choice of providers and plans3. Access to emergency services4. Participation in treatment decisions5. Respect and nondiscrimination6. Confidentiality of health information7. Complaints and appeals8. Consumer responsibilities


Good Medical Practice (United Kingdom)

1. Make the care of your patient your first concern.

2. Protect and promote the health of patients and the public.

3. Provide a good standard of practice and care4. Treat patients as individuals and respect their

dignity5. Work in partnership with patients6. Be honest and open and act with integrity


Health Insurance Portability and Accountability Act (HIPAA)

• Passed by the US Congress in 1996; fully implemented in 2003

• Attempts to protect the privacy of patient’s medical data

• Attempts to protect health insurance coverage for those who change or lose their jobs

• Requires protection of personally identifiable information from intentional or unintentional misuse or disclosure


Noncompliance Penalties under HIPAA

• Civil Monetary Penalties– $100 per violation– Capped at $25,000 for each

calendar year for each requirement or prohibition that is violated

– Enforced by the Office of Civil Rights

• Criminal Penalties for Certain Violations

– Greater penalties for knowing violations of rule

– Up to $50,000 fine and one year’s imprisonment for knowingly obtaining or disclosing information

– Up to $100,000 and 5 years imprisonment if done under false pretenses

– Up to $250,000 and ten years’ imprisonment if done with intent to sell, transfer or use for commercial advantage, personal gain or malicious harm

– Enforced by the US Department of Justice


Information may be disclosed under HIPAA for certain reasons

• Oversight of health care system, including quality assurance activities

• Public health• Research• Judicial and administrative proceedings• Limited law enforcement activities• Emergency circumstances• For identification of the body of a deceased person or

the cause of death• For facility patient directories• For activities related to national defense and security


Pharmaceutical Issues

• Pharmaceutical companies provide financial incentives to doctors who prescribe their drugs

• Pharmaceutical companies spend millions of dollars advertising directly to consumers


The Rise of E-Drugs

• Issue of safeguarding consumers from fraudulent pharmacies selling online prescription drugs


Using E-Drugs• Advantages:

– Open 24 hours – seven days a week

– Reduced intimidation when patients obtain embarrassing or sensitive medications

– Patients may be allowed to check medication profiles online

– Price comparisons easier– Delivered directly to home– May be considered more

convenient – Persons with disabilities

may find the process easier

• Disadvantages:– Third party payers may

limit participation in internet pharmacies

– May not be a pharmacist to answer questions

– Concerns about privacy of patient information

– Concerns about financial information that is transmitted in transactions

– Questions about integrity of the drugs shipped to patients

– Quality of drug information that is provided


Stakeholders and the Healthcare System

• Patient’s family and friends• Health insurance companies• Hospitals and other healthcare providers• Pharmaceutical companies• Government Medicare and Medicaid• Doctors’ union• Managed care


Accountability of the Physician• Patient• Government• Private payers• Investors• Managed-care plans• Hospitals• Professional associations• Employers• Lawyers and courts


Questions for Thought

• Comment on the stakeholders in Figure 6-1. Are any of them more important than another group?

• Do codes of ethics work in the health-care industry? Explain.

• Is there a difference in ‘health-care’ ethics versus ‘business’ ethics? Explain.


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copyright 2009 pearson education, inc. publishing as prentice hall 6-1 chapter 6 health care ethics...

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