An Introduction to Ethics in Healthcare

An Introduction to Ethics in Healthcare

Over the past 30 years, the field of medical ethics has become increasingly important in both medical education and clinical practice. Manifestations of the increasing role and presence of medical ethics can be found not just in the escalating number of books and journal articles on this topic, but in the percentage of medical schools in which training in medical ethics is now part of the standard curriculum and the growing number of hospitals nationwide in which ethics committees regularly meet to help resolve perceived ethical dilemmas. Healthcare as a microcosm of society reacts and responds to societal events. The task of medical ethics is to analyze and hopefully resolve ethical dilemmas that arise in medical practice and biomedical research. Medical ethics is not a static, rigid entity; on the contrary, it is a field where disagreements among acknowledged experts are far from uncommon. Much of medical ethics has concerned itself with end-of-life issues and discussions related to medical decisions making in the case of incapacitated patients. Healthcare managers are usually acutely aware of their ethical responsibilities to patients, clients, the organization, and the community. For the most part, they are aware of what are considered ethical business practices. Too often, however, they may overlook their ethical responsibilities to the people they manage. Continual advances in technology, changes in healthcare financing, increasing consumer needs and expectations, the ever expanding public scrutiny and litigation all contribute to the significant complexity of healthcare. On a fundamental level, people need and want guidance and standards to help them “do the right thing.” Most of the time, unconsciously, the manager will make the right decisions and will “do the right thing.” Healthcare managers will be confronted with ethical dilemmas on a daily basis. For the most part, those involved in healthcare are decent, because they wish to contribute something of value to society.

The decision-making process in healthcare management has become more complicated and it is especially difficult for healthcare executives to feel confident that they are making ethically responsible decisions. Caution must be exercised, however, to avoid the assumption that if no law or rule or regulation or policy addresses an action, then the action must be ethical. This is not true. The healthcare manager is expected to know the answers, to make decisions quickly and authoritatively, and to lead the staff with a moral integrity.

Laura Nash in her article, “Ethics Without the Sermon”, offers the following twelve questions for examining the ethics of a business decisions:

1. Have defined the problem accurately?
2. How would you define the problem if you stood on the other side of the fence?
3. How did the situation occur in the first place?
4. To whom and to what do you give your loyalty as a person and as a member of the corporation?
5. What is your intention in making this decision?
6. How does your intention compare with the probable results?
7. Whom could your decision or action injure?
8. Can you discuss the problem with affected parties before you make your decision?
9. Are you confident that your position will be as valid over a long period of time as it seems now?
10. Could you disclose without qualm your decision or action to your boss, your CEO, the board of directors, your family, society as a whole?
11. What is the symbolic potential of your action if understood? If misunderstood?
12. Under what conditions would you allow exceptions to your stand?

The key to ethical decisions is an awareness on the part of the healthcare manager of the necessity of asking thoughtful questions and taking the time to formulate ethically sound answers. Regardless of which strategy the healthcare manager uses to arrive at a sound ethical decision, the manager must examine all of the consequences of each action considered. John Worthley offer the following ten ethical principles that can be used to help healthcare executives determine an ethical course of action:

1. Never take any action that is not in the long-term self-interests of yourself and the healthcare organization to which you belong.
2. Never take any action that is not honest, open, and truthful.
3. Never take any action that is not kind, and that does not build a sense of community.
4. Never take any action that violates the law.
5. Never take any action that does not result in greater good than harm in your healthcare facility.
6. Never take any action that you would be unwilling to see another healthcare professional take in similar situations.
7. Never take any action that bridges the agreed upon rights of others.
8. Always act to maximize profits subject to legal and market constraints and with full recognition of external costs.
9. Never take any action in which the least among us are harmed in any way.
10. Never take any action that will interfere with the rights of others for self-fulfillment.

Ethical dilemmas all have one thing in common-they all deal with the interrelationships of people and the different values, special interests, and goals that each person brings to the workplace. Above all, a wise manager never underestimates the power of example. The ethical manager will consistently practice the standards of conduct that the manager wishes all employees to emulate. And we always say that Ethics applies to all situations and to all relationships.