Because of the amount of sensitive patient information at healthcare facilities and the life-or-death gravity of medical treatments, the healthcare industry should hold itself to the highest ethical standards.
A primary ethical challenge concerns the financial aspects of care. Administrators have to balance the costs and effectiveness of treatments with the quality of care. The issue also has to take into account how the facility addresses the needs of economically disadvantaged patients, distributing scarce resources as fairly as possible to as many people as possible.
Healthcare providers, particularly doctors and administrators, also should safeguard the personal autonomy of their patients, ensuring that they are able to make decisions regarding their care without external influence.
Administrators also face the connected issues of mercy and harm – beneficence and non-maleficence – especially in day-to-day interactions with patients. Beneficence means that healthcare professionals should act toward their patients with charity, mercy, and kindness. Non-maleficence refers to doing no harm, which provides the backbone of the Health Insurance Portability and Accountability Act (HIPAA) and medical oaths.
Finally, medical professionals must avoid misconduct, which can involve any form of dishonesty, insubordination, or behavior not befitting an ethical healthcare professional.
Students pursuing an online Master of Health Administration should be thoroughly familiar with the rules governing ethics in the healthcare industry.
1. Cost Of Resources Vs. Quality Of Care
The newest medical treatments and devices tend to be more expensive than ones that have been around for a while and are a mainstay of contemporary medicine.
As a result, administrators may face situations where a given medication or procedure is not covered by insurance. Patients and their families may feel frustrated by the lack of coverage or neglected and discriminated against because of their financial situation.
Wasteful and unnecessary treatment contributes to escalating healthcare costs. Medical resources are not unlimited, and facilities should consider that healthcare can only be available to everyone if expenditures are balanced with restraint and resources are spread out as fairly as possible among the population.
“Any judgment that treatments are ‘unnecessarily expensive’ or a ‘waste of resources’ should not be based simply on the dollar amount involved in a course of treatment, but, rather, on a consideration of the relationship of the cost to the expected medical benefit,” explains healthcare ethics consultant Leonard J. Webber in his 2011 article, “The Ethics Of Cost Control,” on the Catholic Health Association of the United States website. “This means high cost for a major expected benefit is normally an appropriate use of resources, but high cost for no real expected benefit is a waste of resources. Indeed, minor cost for no real expected benefit is a waste of resources.”
Healthcare administrators should carefully weigh the costs with expected benefits to allocate the use of resources as fairly as possible.
2. Struggling With Autonomy
Autonomy means patients have the right to make their own decisions without interference from outside influences. Healthcare professionals should protect patient autonomy and treat it as sacred as they do their own.
Part of making decisions depends on having the right information and knowledge at one’s disposal. Problems arise when, in some cases, a physician has a better command of the variables of a case than the patient does. For instance, doctors may advise taking a driver’s license away from a dementia or Alzheimer’s patient. A bariatric surgeon may refuse to do lap band surgery until a patient loses weight through diet and exercise.
Non-Western cultures tend to view the concept of decision-making, specifically medical decision-making, differently.
“In some non-Western societies the family has a dominant role in decision-making,” write medical law authorities Jose Moila and Roy Gilbar in their 2014 paper, “One Size Fits All? On Patient Autonomy, Informed Consent, And The Impact Of Culture,” in the University of Leicester School of Law Legal Studies Research Paper Series. “A key difference between Anglo-American and the East Asian bioethical approaches is that the East Asian approach provides the family rather than the individual patient the authority in medical decision making.”
Doctors could face a dilemma when family members, not understanding the Western system of doctor/patient confidentiality, try to intervene in their loved one’s care. Patients may need to be made fully aware that their family does not have to be involved, and that medical decisions lie solely with the patient. If necessary, a nurse or doctor can sit down with the patient alone, ahead of time, and explain why doctor/patient confidentiality exists in the United States.
3. Beneficence Vs. Non-Maleficence
In the field of medicine, beneficence refers to positive, compassionate actions taken to help patients in need. From beneficence, modern medicine derives practices that are seen as a standard procedure, such as giving pain medication as soon as possible to an emergency patient with a broken arm.
Non-maleficence means avoiding doing harm to others. The Hippocratic Oath reinforces a medical professional’s promise to help patients in every possible way, and is perhaps the oldest continuing practice in medicine, dating back to ancient Greece.
“All healthcare professionals are constrained by the principles of professionalism in honoring and upholding the interests and well-being of their patients,” claims chiropractic researcher Frank Stuart Kinsinger in the National Center for Biotechnology Information (NCBI) article, “Beneficence And The Professional’s Moral Imperative.”
“This embodies the concept of the fiduciary relationship; work performed that always and without exception favors the client and not the professional performing the work. The responsibility for maintaining these high professional standards rests exclusively with the party holding the position of trust, power, and authority. The client is in the weak and vulnerable position entirely due to the client’s real or perceived unmet needs, with these needs not being able to be ameliorated by the client on his or her own.”
4. Maintaining Professional Conduct
Misconduct can take many different forms, from unprofessional interactions with employees, patients, or third-party vendors to violating HIPAA and confidentiality regulations to discrimination, theft, and insubordination.
Theft has a broad definition in the medical ethics field. According to business ethics writer Shelley Kilpatrick’s 2016 blog article, “5 Types Of Unethical Employee Misconduct In The Workplace,” theft can include:
• Working on a side business while on the clock
• Using a company vehicle for personal reasons
• Taking intellectual property without permission
• Padding expense reports with extra charges
• Stealing company supplies
Insubordination can include:
• Excessive tardiness
• Talking back to supervisors
• Ignoring requests
• Taking excessive breaks
• Using profanity
Finally, misconduct can take place online if medical professionals exceed the limits of patient/doctor confidentiality in a visible way on social networks or elsewhere online.
“Physicians should be cognizant of standards of patient privacy and confidentiality that must be maintained in all environments, including online, and must refrain from posting identifiable patient information online,” the American Medical Association (AMA) details in an article, “The AMA Code Of Medical Ethics’ Opinions On Observing Professional Boundaries And Meeting Professional Responsibilities,” in the May 2015 edition of the AMA Journal Of Ethics.
Maryville University’s Master of Health Administration
Maryville University’s online MHA program helps prepare students for careers in healthcare management. Training in healthcare business ethics is an important part of Maryville University’s curriculum.
The MHA program offers four concentrations – Data Management, Healthcare Strategies, Population Management, and Senior Services – as well as a General MHA. Contact Maryville University to learn more.