Whether you’re a healthcare administrator or physician, working in the field of healthcare can be highly rewarding but challenging at times. The healthcare field is complex. Each decision, from the type of care a patient receives to the resources a health unit needs, can lead to conflicts.
What choice is ethically correct will be an important question any professional in the healthcare industry will have to navigate no matter how uncomfortable the answer might be.
What are Ethical Issues in Healthcare?
High ethical standards are necessary for healthcare. These standards fall under the umbrella of health or medical ethics, the field of applied ethics that is concerned with moral decision making applied to medical practices and policies.
A standard approach to health ethics, developed by Tom L. Beauchamp and James F. Childress, often refers to the following four basic principles when evaluating the merits and difficulty of a medical procedure:
- Autonomy: Determine the wishes of the patient to protect their autonomy.
- Justice: Follow the due process to determine limits on healthcare and treat patients alike.
- Beneficence: Seek the patient’s best interest and assess what counts as goods to be pursued
- Non-maleficence: Determine what counts as harms to avoid.
These principals can help healthcare professionals identify ethical dilemmas and find solutions by having conversations with patients about their needs and desires.
What Are Some Examples of Ethical Issues in Healthcare?
When a healthcare provider oversees a patient’s health, disagreements about treatment decisions, waiting lists and access to resources can be some of the challenges that pose ethical dilemmas.
Ethical decisions don’t have the same consequences as unlawful practices. If a healthcare administrator faces the challenge of a busy emergency room, they are not lawfully required to promise people that the process will speed up. But it can be ethically responsible for them to raise the concern with the board of administrators.
Healthcare institutions may create ethical committees to facilitate reasonable decision making that respects value and concerns of patients, their families and healthcare providers.
5 Ethical Issues in Healthcare
1. Do-Not-Resuscitate Orders
A Do-Not-Resuscitate (DNR) order is written by a doctor and it instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient stops breathing or if their heart stops beating. The DNR doesn’t have instructions for any other treatment and can only be permitted after a physician speaks with the patient.
Ethical concerns can arise when it’s not clear if a patient was capacitated to choose a DNR. In 2017, the case of a Florida man who was rushed to the hospital unconsciously with a “do-not-resuscitate” tattoo across his chest rose questions amongst the hospital staff.
After questioning the seriousness of the tattoo and his critical existing medical conditions, the ICU unit decided to honor the message expressed in the tattoo, despite the man’s inability to talk. According to the ethics consultation on the case, “…the law is sometimes not nimble enough to support patient-centered care and respect for patient’s best interests.”
Hospital administrators should consider that CPR can sometimes worsen preexisting conditions. In such cases, questioning if the degree of pain is worth the benefits can help professionals navigate severe situations that involve life or death.
2. Doctor and Patient Confidentiality
Violating a patient’s confidentiality can have legal and ethical consequences for healthcare providers, according to the Health Insurance Portability and Accountability Act (HIPPA). The act requires physicians to protect the privacy and security of a patient’s medical records. HIPPA also sets forth who can see the confidential information and who cannot. Despite the law’s straightforwardness, there are some gray areas.
For example, withholding information about a patient’s condition could be unethical because it could harm the patient or someone else. The opposite can be harmful too. A health practitioner could be suspended or, in some cases, fired for posting information about cases on social media. Despite how unintentional a practice like that can be, HIPPA laws prohibit any disclosure of health information on social media channels, arguing that a patient loses their privacy immediately after the fact.
3. Malpractice and Negligence
Medical errors are the third leading cause of death in the U.S., according to a study published in the BMJ journal. Despite the decreasing rate of malpractice suits, patients who are affected by it may never recover. For others, it may take years.
The high-risk nature of the healthcare atmosphere can increase the likelihood of malpractice. Administrators, as well as physicians and nurses must cover the essential responsibilities of patient care to avoid litigation. In the case of hospitals, ordinary negligence can be due to defective medical equipment, a misdiagnosis or a delayed diagnosis.
Sometimes conditions can come up in unusual ways that wouldn’t make sense unless a doctor was looking for the symptoms. Lines can be blurred when doctors disagree about procedures or necessary tests to provide accurate treatment. In cancer cases, a diagnosis can be challenging to prove, as there is a possibility that cancer would have progressed the same way regardless of when doctors started a treatment.
4. Access to Care
In 2017, the number of people with health insurance coverage increased by 2.3 million, up to 294.6 million, according to the United States Census Bureau. Despite peak access to healthcare insurance, Americans without coverage face difficulties when accessing medical services.
A Kaiser report informs that one in five uninsured adults in 2017 did not seek medical care due to costs. With the increase in healthcare resource demands, financial costs that cover the resources are very high, and hospitals weigh down the price.
Emergency departments across the U.S. can charge a patient up to $900 for a routine medical service that doesn’t require complex treatment, according to a year-long project focused on American healthcare prices published by Vox.
The report found that insured patients can be affected too. Health administrators justify bill increases based on the need for a high quality of healthcare. But a recent JAMA article emphasizes that the “U.S. citizen is not getting good care for the money spent on healthcare.” The World Health Organization (WHO) argues that despite the demand for service, healthcare institutions should prioritize efforts to reduce prices and administrative costs if the benefits are not worth the burden.
The WHO recommends that it’s justified to shield people from health-related financial risks, too. This recommendation, as well as the debate of affordability and access, sparks difficult questions that institutions and healthcare providers must navigate.
5. Physician-Assisted Suicide
Physician-assisted suicide is the act of intentionally killing oneself with the aid of someone who has the knowledge to do so. In the most basic sense, the only person fully qualified to participate in the process is a physician. PAS is subject to criminalization by the state only. According to federal law, legalizing PAS is a matter of states’ rights.
In states where PAS is allowed, a patient who qualifies must be terminally ill, can take the assisted drug themselves and is mentally capacitated to understand what they’re doing. Actions to legalize PAS are increasing despite its ethical prohibitions, according to the American College of Physicians (ACP). PAS is currently legal in nine states and the District of Columbia. In Montana and California, the assistance is an option given to patients via court decision.
States that oppose the practice raise the following concerns:
- Legalizing PAS can cause pressure on terminal patients who fear their illness is a burden to their families
- PAS is incompatible with a physician’s roles as a healer and the American Medical Association’s Code of Ethics.
The dilemma leaves the states to reason with residents’ rights to autonomy and healthcare providers’ beliefs of what they ought to do, based on their code of ethics.
Since reforms and policies may change often, ethical applications can help set the pillars for a successful transformation in the healthcare industry.
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