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Ethics for Allied Health Professionals 20-477052 3-hours Back to Course Index

 

Ethics for Allied Health Professionals

 

Should I?… What will happen?… What would you do?… What will people think?… What is right?… Who will know?…

 


In the broadest sense, ethics are the principles that guide an individual, group, or profession in conduct. Although health care professionals frequently do make independent decisions regarding patient care, they are still responsible to the profession of patient care, as a whole, in how those decisions are made. From the earliest concept of caring for someone who is sick or injured, the proper behavior and conduct of a medical professional has been closely scrutinized.

 

This continuing education course will discuss the basic principles of ethics as they apply to allied health professionals.  An overview of the terminology used in medical ethics texts is explored. 

We will explore:

 

    –         The difference between morality and ethics

         Normative ethics, Metaethics, and Applied ethics

         Medical issues that would be difficult to solve with virtue-oriented reasoning

         Basic terms used in the discussion of ethics

 

         Examples of situations the pose challenging ethical decisions

 

         Ethical codes for a variety of allied health professionals

 

         Solving ethical issues

 

         The American Hospital Associations The Patient Care Partnership

 

Defining Ethics 

Many of us confuse morality and ethics when we attempt to come up with a definition for ethics.  Ethics is defined as a particular system of principles and rules concerning duty.  As described by Ruth Purtilio, Ph.D., in Ethical Dimensions in Health Professions, morality is concerned with relations between people and how ultimately, they can live in peace and harmony.  Morality is defined as a system of ideas of right and wrong conduct. 

The difference between ethics and morals can seem somewhat arbitrary to many, but there is a basic, albeit subtle, difference. Morals define personal character, while ethics stress a social system in which those morals are applied. In other words, ethics point to standards or codes of behavior expected by the group to which the individual belongs.

When considering the difference between ethics and morals, it may be helpful to consider a criminal defense lawyer. Though the lawyer’s personal moral code likely finds murder immoral and reprehensible, ethics demand the accused client be defended as vigorously as possible. 

 

The Philosophical Foundation of Ethics

Ethics is traditionally subdivided into normative ethics, metaethics, and applied ethics.

Normative ethics seeks to establish norms or standards of conduct; a crucial question in this field is whether actions are to be judged right or wrong based on their consequences or based on their conformity to some moral rule. 

Theories that adopt consequences as the basis of judgment are called consequentialist.  This theory simply put means, actions should be judged right or wrong on the basis of their consequences.  Teleology is, in literal terms, the study of purposes, goals, or ends. In other words, the theory that acts, objects, states of affairs, and so on can only be justified in terms of the ends towards which they are directed, or by the functions they fulfill. Rightness is not intrinsic in an action or process, but is dependent on the consequences of the action or process.

Theories that adopt the conformity concept are known as deontological. Deontological  theories maintain that the moral rightness or wrongness of an action depends on its intrinsic qualities, and not on the nature of its consequences. Deontological ethics holds that at least some acts are morally wrong in themselves, such as lying, breaking a promise and murder. 

Another theory is virtue ethics.  This theory is primarily concerned with traits of character.  For virtue ethics the direction of explanation must be reversed, with virtue providing the concept with which to explain happiness, usefulness, duty, and practical reason. 

The difference between these three approaches to morality tends to lie more in the way moral dilemmas are approached than in the moral conclusions reached. For example, a consequentialist may argue that lying is wrong because of the negative consequences produced by lying though a consequentialist may allow that certain foreseeable consequences might make lying acceptable. A deontologist might argue that lying is always wrong, regardless of any potential “good” that might come from lying. A virtue ethicist, however, would focus less on lying in any particular instance and instead consider what a decision to tell a lie or not tell a lie said about one’s character and moral behavior.

 

Terminology of Health Care Ethics

In every study regarding health care ethics you will encounter some pretty lofty sounding terms like we just explored above.  How do these and other frequently used ethics terms relate to allied health professions?  The following will explore the seven principles that are considered to be the foundation of health care ethics.

Autonomy is the individual’s right to make decisions, free from deceit, duress, constraint, or coercion.  Autonomy works when the patient is able to make decisions based on adequate provision of information and intellectual competence.  The individual must also possess the ability to act on his/her decisions.  Without this power, autonomy is futile.  What good is it to make a decision, but not be able to carry out the actions associated with that decision?  This principle raises important questions related to informed consent, competence and an individual’s right to refuse treatment.

Competence is a challenging determination in health care decisions.  Who has the right to determine a patient’s competency in deciding his or her own course of diagnosis and treatment?  Health Care professionals may or may not be informed of the patient’s legal competency status. 

Veracity  refers to the legal principle that  states that a health professional should be honest and give full disclosure to the patient, abstain from misrepresentation or deceit, and report known lapses of the standards of care to the proper agencies.  This is very important, as the patient and the caregiver must be truthful for the outcome to be positive. 

Beneficence is the professional duty to do or produce good.  “good” is meant as the performance of acts of kindness and charity. “Doing good” is considered virtuous conduct. Ultimately, beneficence is the duty to do more good than harm through public health actions because, in practice, no action in public health will have exclusively beneficial effects.

Nonmaleficence derives from the ancient maxim primum non nocere, which, translated from the Latin, means “first, do no harm.”

Both beneficence and nonmaleficence have become very complicated ethical principles because of the rapid technological developments in health care.  Many treatments that benefit patients also have adverse effects that may harm the patient.  Health care professionals are constantly weighing the pros and cons of the treatment they choose for their patients.  We are always trying to utilize therapies that have maximum benefits and minimal risk. 

Beneficence and nonmaleficence are also at the heart of the debate over physician-assisted suicide and euthanasia, as well as many other issues.  Who decides what will help a terminally ill patient in extreme pain?  How can we make sure that patients requesting assistance in committing suicide are competent?  Are individuals in extreme pain able to make rational decisions?  No doubt, physician assisted suicide, euthanasia, abortion, cloning and many other ethical topics will continue to be debated in our society for many years to come, if not forever.

Confidentiality refers to the authorized or unauthorized disclosure of information.  Patients have the right to expect that their health information will not be disclosed without their permission.  Health care professionals should only discuss a patient’s case with other practitioners when they are in need of a consultation.  These conversations should take place in a private setting and health care providers should maintain professional demeanor during these conferences.  Discussing a patient in the elevator, in the cafeteria or outside of work may result in a breach of confidentiality, a violation of trust.

More and more health information is being kept and shared online.  Many health care consumers are concerned about maintaining the confidentiality of their medical records largely due to the use of computers in health care.  The amount of documentation required by insurance companies and managed care companies, so they can review the data to ensure that claims are based on medical necessities can jeopardize confidentiality.  Where is all of this information stored, who has access to it and how much can we protect patient data in the computer and internet age?  Some of these questions have been addressed by a series of federal regulations designed to protect patient privacy and the confidentiality of their medical records.  The law designed to protect this information is known as the Health Insurance Portability and Accountability Act of 1996 or HIPAA.

-HIPAA was first developed to make sure that people could not lose their medical coverage when they changed jobs even if they had a pre-existing  medical condition.  As with many federal laws the bill grew larger and larger.  HIPAA today affects almost all health care providers or anyone who is employed anywhere where patient information may be located, including hospitals, clinics, radiologists and more.

The first goal of the law is to improve the portability and continuity of an individual’s health exempt pre-existing conditions as long as the insured’s previous health coverage has not lapsed more than 60 days before any new plan takes effect.  This part of the legislation became effective in late 1996.

The second goal is to improve health care’s administrative efficiency and effectiveness by standardizing electronic transaction processes and setting standards for the major health care code sets.  The regulations also define and establish standards and national databases for health care providers, health plans and employers.

The third goal of HIPAA is to strengthen the health care industry’s ability to combat waste and fraud while protecting and securing patient confidentiality.  You are surrounded by patient data information and it is your responsibility to keep it private and confidential.  If not, your employer and you can face financial and criminal penalties.

      

– –How the HIPAA Privacy Rule Affects You?

 

The HIPAA Privacy Rule, the first major HIPAA regulation, became effective       

April 14, 2003. It requires that almost all healthcare providers who file claims for reimbursement meet this required date or face significant fines and other penalties.

 

As the original HIPAA regulations to assure patient insurance portability were developing, congress urged healthcare organizations to become more

efficient through computerization. But, before doing so, they expanded the

regulations to make sure that legal safeguards were added to protect patient information from prying eyes. This is the basis of the privacy rule.

 

–A Covered Entity

Basically, any organization covered by HIPAAs regulations is a Covered

Entity. You see HIPAA regulations cover much more than healthcare

providers.  In fact, all health plans and payers of healthcare services are also covered by HIPAA. 

 

Covered Entities include hospitals, clinics, dentists, laboratories, mental health providers, medical imaging services, and just about everyone that delivers any form of health care then files a claim electronically and gets paid or reimbursed for their services.

 

HIPAA is quite serious about these regulations. The penalties for violating the Privacy Rule can range from a simple fine all the way up to 10 years in jail plus a $250,000 fine.

 

–Protected Health Information

HIPAA Privacy requirements are based on the concept of Protected Health Information or PHI. This is medical information that contains any data element that can be used to link a past, present or future medical condition to an individual. The regulation lists 19 such elements and includes items such as a patient’s name, address, birth date, telephone or fax number, employer, license number, etc.

 

–Do You Know Your Organizations HIPAAs Policies and Procedures?

Section 164.530 of the Privacy regulation makes it clear that a covered entity must implement policies and procedures with respect to PHI (Personal Health Information) that are designed to comply with the standards. In other words, your organization must have a set of written policies and procedures when it comes to protecting PHI (Personal Health Information) and you need to read them. 

 

 

Justice is the sixth ethical term of discussion and consists of the concepts of fairness and entitlements. Health care is a limited resource.  The concept of distributing health care across the population fairly is referred to as distributive justice. Many issues affect this distribution, such as insurance benefits, wealth and location.  As we all know, there are many citizens who do not have health insurance, and as a result do not receive the same amount or quality of health care as those with benefits. Rural areas of the U.S. do not have the same health care resources as an urban setting.  Large teaching hospitals are located in large cities, not out in the rural sections of the country.  Another issue that is related to the concept of justice and how to fairly distribute health care is organ and tissue transplantation. There are a limited number of organs available for transplant.  Who will receive the organ that they so desperately need? How do we establish a waiting list for organs? This is a very complex issue, and the experts in this field have worked very hard to create a fair system for the distribution of organs. 

 

 

Role fidelity is the final principle that contributes to the foundation of health care ethics. Role fidelity refers to the scopes of practice of the many allied health professions.  We each have a specialty and need to practice within our knowledge and experience base.  

 

 

Patient Rights 

 

Patients are health care consumers. They are more knowledgeable about their rights than in the past. As allied health professionals, we should be familiar with patient rights, and abide by them in our everyday practice.

 

In 2003, the American Hospital Association replaced its aging Patient Bill of Rights with a new series of guidelines on how patients are to be treated while in the health care system. These guidelines are available as a brochure, entitled The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities. 

 

Professional Codes

 

Codes of ethics are documents created by professional organizations to provide their members with values and standards of behavior for their discipline.  These codes are based on the seven ethical principles discussed in The Terminology of Health Care Ethics. Each professional should make themselves knowledgeable of the codes pertaining to their profession. 

 

Solving Ethical Problems 

The first step in analyzing moral issues is obvious but not always easy: Get the facts. Some moral issues create controversies simply because we do not bother to check the facts. This first step, although obvious, is also among the most important and the most frequently overlooked.

But having the facts is not enough. Facts by themselves only tell us what is; they do not tell us what ought to be. In addition to getting the facts, resolving an ethical issue also requires an appeal to values. The following are a few approaches to solving ethical issues created by philosophers.

The Utilitarian Approach
Utilitarianism was conceived in the 19th century to product the greatest balance of good over evil.

To analyze an issue using the utilitarian approach, we first identify the various courses of action available to us. Second, we ask who will be affected by each action and what benefits or harms will be derived from each. And third, we choose the action that will produce the greatest benefits and the least harm. The ethical action is the one that provides the greatest good for the greatest number.

The Rights Approach
According to this approach, what makes human beings different from mere things is that people have dignity based on their ability to choose freely what they will do with their lives, and they have a fundamental moral right to have these choices respected. People are not objects to be manipulated; it is a violation of human dignity to use people in ways they do not freely choose.

Of course, many different, but related, rights exist besides this basic one. These other rights (an incomplete list below) can be thought of as different aspects of the basic right to be treated as we choose.

  •          The right to the truth: We have a right to be told the truth and to be informed about matters that significantly affect our choices.
  •          The right of privacy: We have the right to do, believe, and say whatever we choose in our personal lives so long as we do not violate the rights of others.
  •          The right not to be injured: We have the right not to be harmed or injured unless we freely and knowingly do something to deserve punishment or we freely and knowingly choose to risk such injuries.
  •          The right to what is agreed: We have a right to what has been promised by those with whom we have freely entered into a contract or agreement.

In deciding whether an action is moral or immoral using this approach, then, we must ask, does the action respect the moral rights of everyone? Actions are wrong to the extent that they violate the rights of individuals; the more serious the violation, the more wrongful the action.

The Fairness or Justice Approach
The basic moral question in this approach is: How fair is an action? Does it treat everyone in the same way, or does it show favoritism and discrimination?

The Common-Good Approach
This approach to ethics assumes a society comprising individuals whose own good is inextricably linked to the good of the community. Community members are bound by the pursuit of common values and goals.

In this approach, we focus on ensuring that the social policies, social systems, institutions, and environments on which we depend are beneficial to all. Examples of goods common to all include affordable health care, effective public safety, peace among nations, a just legal system, and an unpolluted environment.

Appeals to the common good urge us to view ourselves as members of the same community, reflecting on broad questions concerning the kind of society we want to become and how we are to achieve that society. While respecting and valuing the freedom of individuals to pursue their own goals, the common-good approach challenges us also to recognize and further those goals we share in common.

What do these mean in application?
These approaches suggest that once we have ascertained the facts, we should ask ourselves five questions when trying to resolve a moral issue:

  •          What benefits and what harms will each course of action produce, and which alternative will lead to the best overall consequences?
  •          What moral rights do the affected parties have, and which course of action best respects those rights?
  •          Which course of action treats everyone the same, except where there is a morally justifiable reason not to, and does not show favoritism or discrimination?
  •          Which course of action advances the common good?
  •          Which course of action develops moral virtues?

 

Conclusion

So, what is the answer to solving ethical problems in the allied health field?  There is no definitive answer, but if we use the knowledge we have acquired from studying medical ethics, and mix that knowledge with a little experience, we should have a good recipe for making the best ethical decisions in difficult situations.  Always keep in mind, if you wouldn’t want all of your friends, neighbors and colleagues to read about you doing whatever action you are contemplating doing on the front page of tomorrow’s newspaper, it is likely that you shouldn’t do the behavior.

 

 

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