Volume 2 Issue 7
VOLUME 3 | ISSUE 3
Ethics & Public Trust in Healthcare
Ethical issues can arise in all areas of healthcare, but the most significant issues occur in acute care hospitals. Constraints on managed care and reimbursement methodologies can often necessitate cost reductions or the elimination of unprofitable services that can raise ethical concerns. Some physicians encounter and must manage issues such as legalized abortion, experimental treatments, and the artificial prolongation of life.
Clinicians have moral responsibilities that are guided by the principles of beneficence and nonmaleficence when delivering medical care. Beneficence refers to healthcare organizations and providers who must do all they can to alleviate suffering caused by ill health and injury. This includes providing emergency care to individuals who may not have the ability to pay for services.
Nonmaleficence simply means that healthcare professionals have a moral obligation not to harm patients… full stop. It requires physicians to use their best professional judgment when selecting interventions that can maximize the potential health benefits at the lowest risk. As a point of clarification, people often refer to the Hippocratic Oath that physicians take when choosing to render care to patients as a 'North Star' to guide ethical decisions. However, this is not required by most medical schools, and it does not explicitly contain the phrase, “first, do no harm.”
Addressing Ethical Issues
Some healthcare organizations, particularly large acute care hospitals, employ ethics committees that have the responsibility of developing guidelines and standards for ethical decision-making when delivering health care. Ethics committees appoint interdisciplinary members that typically include nurses, physicians, clergy, legal experts, social workers, administrators, and others. The Patient Self-Determination Act (PSDA) applies to all healthcare organizations that participate in Medicare and Medicaid. It requires facilities to provide all patients, upon admission, with pertinent information on their rights.
Informed consent requires physicians to provide all requested information by a mentally capable patient to make properly informed decisions relative to their care. Patients also have the right to formulate advance directives that allow them to express their wishes in advance regarding the continuation or the withdrawal of treatment in the event they become incapacitated or incompetent. When advance directives are not available, the burden of ethical decision-making for patients' care falls on medical providers.
Communities place a high degree of trust in healthcare organizations and medical providers. Occasionally, the behaviors of those organizations and providers call that trust into question. Hospital administrators have a fiduciary responsibility to act prudently in managing the affairs of their facilities. Because a hospital’s mission is to benefit the community it serves, the hospital or healthcare organization should be viewed as a community asset regardless of whether it is a for-profit or non-profit institution. When this perspective is lost, and a hospital’s board and its executives begin to place other priorities before their primary responsibility to serve the community, a breach of public trust may occur.
While hospitals must maintain their financial and operational integrity, a real danger arises when financial concerns are placed above a genuine concern for the welfare of patients and the community. Because hospitals form the institutional hub of healthcare delivery, their integrity within the system is crucial. Public trust is a precious commodity in any industry, but in healthcare, it represents life and death.
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