While ethics and law go hand in hand they both have different perspectives. Law is enforced, whether it is by the police, courts or administrators. Ethics comes from within and are inherited over time through family and the community. While both areas take a different approach, in the healthcare organizations the main purpose is to make sure that the patient safety is key and that quality of healthcare is universal. The health care industry is one the largest regulated industries in the world, this is why laws and code of ethics have been put into place to protect the patient.
Every time an organization or a healthcare professional provides services to a patient there is room for error and in return room for legal and ethical violations. Education and training in these areas for all health care personnel is pertinent since perception is a major concern. We all think and see things differently and without regulations behind us we all could look at a situation and handle it in many different ways and if that was the case then how could we hold ourselves to a high level of care if that level of care is not defined.
What is ethics?
Ethics is defined as “a system of moral principles”. As a society we are held to a high standard of ethical behavior and we are held to a higher standard when it comes to our behavior in health and human services. Ethics in the medical field traces back for many years and most of the rules and regulations that we see today are based around ethical behavior.
There are four key ethical principles that define what is expected of each person in and out of health and human services. These principals include; respect for persons, beneficence, non-maleficence and justice.
Respect for persons is compiled of telling the truth, confidentiality, fidelity and autonomy. Within the medical field it is important that people make informed decisions, always being honest is very important, this is where truth telling comes into place. Confidentiality is of up most importance, making sure that a person’s medical information is kept private is one of the most important things to remember in this profession. Also you must keep fidelity, this meaning that you keep your word.
When telling patients about their care and making plans it is pertinent that you stick to your word and follow through. Remembering that in all cases respect must be in the front of your mind as we are unaware of what is going through our patients minds. Beneficence requires doing the best one can for the recipient of ones services (Buchbinder 2007). This principal is describing that we do not discriminate against any one for any reason. This means that as medical professionals we do all that we can for each and every patients regardless of demographic or cultural indifferences.
For example, knowing that a patients is unable to pay for a life changing surgery does not mean that we do not give the patient the option to have it, we must treat every patient the same and with respect. Non-maleficence, meaning do no harm, or minimizing risk in many cases is also something that health care professionals must do. In some cases this cannot always be followed, some risks and harm to patients may need to be present in order to make the patient better but only in rare cases. In all other times medical professionals must use this principal to make sure that they are keeping their patients safe.
The last principal around ethics is justice, this is one of the hardest principals to define. Justice is meaning that everything is done is a fair way. In health and human services this can be broken down into many different areas; one being patient care, other being allocation of funds and employee fairness. All areas of justice are equally important to any health care organization and need to be upheld at all times. Ethics can be perceived in many different ways depending on the person, the organization and each individual situation.
There are many different ethical views that can be used in a number of situations these include; professional ethics, applied ethics, advocacy ethics and critical ethics. Professional ethics focuses on ethics that have been developed by a person or organization in a specific field over time. It is when these ethics are adapted and applied because of a certain profession that we use professional ethics. An example would include non-maleficence, in the medical profession this is a certain ethical behavior that we have adapted and used over many years and is mostly specific to that industry.
Applied ethics is a newer approach to ethics in the workplace, it take general ethics and makes it use in and outside of the workplace. This approach focuses on taking real-life situations and teaching people who to handle themselves in any situation that they may face. Advocacy ethics is geared toward equality and social justice. In recent years it has been shown that poverty, social deprivation and inequality has led to poor health and disease. This is showing us that the increased concern for human rights has also raised the concern for health and human services. The final division of ethics is critical ethics.
Critical ethics combines professional and applied ethics into one. Like professional ethics it is practiced by what other have taught us and like applied ethics it looks at the larger picture of society not just an organization. The best description of this type of ethics is promoting better health, not only inside the organization but outside as well. We see in many cases that organizations provide information about better health to their patients, but getting involved in the community and spreading the word not only helps the people who walk through your door but the people who surround it every day as well.
Law is a body of official rules of conduct, subject to interpretation and change over time (Buchbinder 2007). Within society there are many different types of laws and different levels of which laws are statuses in. In the hierarchy of law there are local, state and federal laws, each of which supersedes the next. Along with the different levels of which law is given there are also two different types of laws; civil and criminal. Criminal law is wrong doing against society as a whole.
In the healthcare field it is become more prominent to charge persons with a criminal offence; malpractice and unlicensed practice of medicine are a few instances where we would see a criminal case filed against someone. Civil law is concerning a specific persons or organization. Breaking contract with an organization or torts would fall under civil law. The definition of contract and torts can be misguided and the repercussion and affects that they can have on a person or organization must be understood fully.
A contract has many aspects it must follow these guidelines; it must be between two or more people, all parties must consent to the agreement, the agreement must be something of value and the agreement must be lawful. This does not always mean that a contract has to be in writing, but one should make sure that they have the necessary precautions taken in case legal matters do occur. A tort is considered a wrongful act; there are many categories that can fall under this for healthcare personnel and organizations. Negligence, intentional torts and mental distress are just a few.
Negligence involves an act that the person involved would or would not do over again in a difference circumstance. In order for negligence to be proven there are four key factors; the negligent party must have relationship to the other party, this includes professional relationships. There must also be a breach of duty, this meaning that there must have been a level of inappropriate care. The patient must also prove that they were wronged in one way or another, this must have substance and lastly there must be a just cause to why this incident occurred.
This can be true for the acting party and the organization in which the person is employed; both parties are responsible for negligent behavior. Intentional tort must show that harm was done deliberately. A few examples of intentional tort would be; assault and battery, false imprisonment, defamation of character and invasion of privacy. All of these could involve to a civil case if there is proof of wrong doing. In some cases there may be a reason to break a law and this is only if the well-being of the patient is at stake.
If a patient was being abused, by telling another person this would be considered as an invasion of patient privacy but when their life is in danger it is important to make others aware so that they are able to help the patient in need. These cases can happen and should be treated with caution, making sure that only the people who are needed to help the patient are involved and that the information is not wide spread. Now that the understandings of ethics and law have been established, what are the concerns that we are facing in managed care? By definition, managed care imposes limits on patient and provider choices (Buchbinder 2007).
Managed care was developed to avoid unnecessary care and to make sure that preventive care was the primary care given to patients. This has become a concern for many physicians over past years, striking conflict when it comes to the care that is being given to their patients. When a patient is in a managed care program there are limitations that are set; the physician must be approved by their charges and treatment plan. Once within those guideline the physician must follow strict rules when prescribing medicine and go through certain channels to provide referrals to specialists.
This is ultimately to save time and money and to keep within the managed care’s good graces. This is where the conflicts arise, by setting goals and regulations around cost, the patient care that is given decreases and causes major concern for the physicians and the patients. Biomedical concerns are also on the rise. While healthcare managers and administrators do not have a direct decision making when it comes to life and death, the decisions that they make for their organization can have an impact on how others make these decisions.
Areas like allocation of funds and resources have a large impact on how physicians and other medical staff make decisions on a daily basis and while there is not a level of equal care these problems will continue to exist. The three largest area of concern within in these guidelines are beginning of life care, end of life care and human subject research. Beginning and end of life care take a special precedence in most cases. With the medical technology that continues to grow there are many complex decisions that are needed to be made.
Beginning of life care is a subject that everyone had opinions about, contraceptives, abortions and in vitro fertilization are all more commonly discussed and seen. The battled that is places upon patients and physicians is their ethical and moral views about these procedures and the funds that an organization gives to each area. Social, parental, and physician’s rights and responsibilities are of major concern and doing what is right is in the eyes of the beholder. End of life care has also become more complicated over time.
The balance between decision-makers, providing ethical care, giving life-sustaining treatment and rights and responsibilities is a hard battle. Making sure that you are carrying out the patient’s wishes is always of the upmost importance but if the patient is unable to make those decisions then the choices for their care fall upon family members and guardians. Organizations have the option to make their own decisions when it comes to what limitations they will treat their patients in these circumstances.
Some organizations will take a more extreme approach when it comes to beginning and end of life care while others will do more moderate procedures. All of this important information is usually guided through the organizations mission and religious values. Human subject research has a lot of ethical and lawful concerns that is why it is of great importance that there are many people involved in all aspects of this research. Institutional Review Boards (IRB) is the committees that are dedicated to oversee the patients’ rights.
Along with the IRB there are other codes of ethics that one must follow, each organization holds a code of ethics as well as following the American College of Healthcare Executives Code of Ethics for administrators. In addition to the code of ethics that an organization has in effect there are also federal laws and regulations that a healthcare professional must adhere to at all times. A few of these regulations would include HIPPA and PSQIA. HIPPA, the Health Insurance Portability and Accountability Act of 1966, was created to make sure that our personal medical files and information are to stay private.
This gives all control to the persons of which the file is contained; only he or she can designate the people who are able to know this information. HIPAA applies to all types of medical communication including electronic and written files as well as oral communications. It also pertains to all information in the file including doctor-patient conversation, billing and/or insurance information, and all information that doctors, nurses and medical administrative staff put into your file. All medical personnel must adhere to the HIPPA law.
This regulation was originated to protect patient’s privacy and since there is a thin line for some peoples ethical and moral values, even when a regulation is put into play, laws will continued to be broken. Some people will choose not to follow this regulation and will have to be prosecuted. This is one of the many reasons why medical ethics and law continue to go together, hand in hand. PSQIA, the Patient Safety and Quality Improvement Act of 2005, is a voluntary reporting system to enhance data that can help resolve patient safety and health care quality issues (US Department of Health and Human Services).
This regulation was created to make it so that providers would be able to access patient safety events without the increased liability. In some situations ethical and moral incidents could not get reported in fear of what may happen to the person or the people who are involved. While if this does happen there is not a way to prevent this same occurrence from happening again in the future. This is one of the greatest reasons why PSQIA is now around. The greatest improvement is that we can see is what is going on in a larger picture in health care organizations.
If any incidents happen in an organization they would be taken care of on a local level and while now we can see things that are happening all over, this will minimize incidents of recurring numerous times. Now there may be many cases where a health care professional will receive reprimanding for the behaviors that they did this is including, termination, disbarment, and other legal matters, which maybe appropriate depending on each situation. As we look into the future medical law and ethics will continue to evolve as we do.
The more technology and advanced research that is done to expand our quality of life will just continue to bring additional rules and regulations that we must follow. It is important that we continue to strive for the best and make it so that others are held accountable to do the same. In a world where there are no ethics and law there will only be ciaos. It is important to remember why these regulations are put into place and has a health care professional if you were on the outside looking in wouldn’t you want someone there to protect you and give you the highest quality of care.
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