Ch. 20 Healthcare Ethics

Provision of competent medical care

Physicians have the responsibility of providing competent medical care. They also need to show compassion to all and uphold human rights and dignity.

Access to medical care

Physicians must provide and ensure access to medical care to all those who need it.

Standards of professionalism and honesty

A physician is required to conduct all duties with honesty and comply with all professional standards. Any physician who is dishonest or incompetent, or engaging in fraud or deception, should be reported.

Respect for law and rights of other individuals

Physicians should show respect for the law and strive to attempt to modify those aspects of the law that are not in accordance with the patient’s health interests.

Respect for rights of other individuals and patient confidentiality

All physicians are required to respect the rights of other individuals: patients, colleagues, and other professionals in the field of healthcare. Physicians are also required to uphold patient confidentiality norms and requirements in accordance with federal, state, and local laws.

Advancement of learning and skills

Physicians should strive to learn and apply their knowledge to different and challenging situations. They must also strive to advance scientific knowledge and show a strong commitment to medical education.

Freedom of choice

Except in emergencies, a physician has the freedom (provided there is appropriate patient care) to choose their patients and associates. They can also choose the environment in which to provide medical care.

Prioritization of patient care

While providing medical care, the physician needs to prioritize patient needs and regard their responsibility to the patient to be of the highest importance.

Participation in the betterment of the community

Physicians have a responsibility to help others and work for the betterment of the community and public health in general.

Abortion

a physician can perform an abortion in circumstances that are in accordance with all applicable laws and good medical practice.

Surrogate motherhood

when a woman conceives a child through artificial insemination and surrenders her parental rights after delivering the child, usually in return for payment. In this case, the child’s father is the biological parent and his wife is the adoptive mother.

Surrogacy laws

the surrogate mother has the right to void the surrogacy contract after giving birth to the child. This means the surrogate mother has the right to change her mind and refuse to give away her child.

Artificial fertilization (known donor)

It is preferred for the donor and recipient to provide a complete medical history and undergo diagnostic screening. Individuals going through this process should receive information on all infections (communicable or not) and genetic disorders for which the donor and recipient can undergo screening.

Artificial fertilization (unknown donor)

• It is important to screen donors for infections or genetic disorders that could affect the recipient or the child.

• The husband provides consent to become the child’s legal father.

In vitro fertilization

The process of in vitro fertilization and embryo transplantation is useful for couples who were previously incapable of conception. It is also useful for research focused on studying the occurrence, transmission, and treatment (or prevention) of genetic defects.

Genetic counseling

When there is an increased risk of genetic disorders based on medical histories or family backgrounds of couples attempting to conceive, prenatal genetic testing is suggested.

Types of prenatal genetic testing

1. Diagnostic screening of parents

2. Pre-embryo analysis

3. Post-conception in utero testing

Physician role in capital punishment

• Prescribing or administering tranquilizers and medications used in executing the condemned prisoner

• Witnessing or observing an execution

• Giving technical advice specific to the needs of the execution

• Monitoring vital signs at the execution site or from a remote location

Physician assisted suicide

Instances in which a physician helps a patient in a life-ending act by providing necessary means or information. Some patients suffering from terminal and debilitating illnesses may feel the need to end their lives.

Stem cell research

Participation in stem cell research requires respect for embryos and all persons involved in the research, which includes all participants, donors, and recipients. Physicians and other team members involved in research should have evidence that justifies the risks, showing the potential of the research to contribute significantly to the advancement of medical science and commitment to patient welfare.

Health resource allocation

While allocating health resources, the criteria that should be considered include urgency of need, likelihood of benefit, duration of benefit, amount of resources for successful treatment, and possibility of a change in the quality of life.

Life-prolonging treatment

Physicians are responsible for saving lives and relieving patients from suffering. In some situations, it may be difficult or impossible to achieve these two goals.

Organ donation

Organ procurement is done immediately after a person dies or when the patient is kept alive artificially for a certain amount of time. Organs should be considered a national resource rather than a regional or local resource.

Confidentiality

Disclosing patient information to others is considered an unethical practice. A breach of confidentiality often occurs accidentally in places such as elevators, hallways, waiting or reception areas, break rooms, and lunch rooms.

Advertising

Medical practices have the right to advertise their services, and the AMA has no restrictions on advertising by physicians. However, advertising must be accurate and not misleading.

Media communication

The provider should not discuss the patient’s health information with the press or news media without approval from the patient or the patient’s legal representative. The provider can only offer information that is authorized to be released.

Fees and charges

The physician’s fee should depend on the service provided to the patient and must be considered fair. Providers are ethically obligated to order diagnostic tests for patients, regardless of how much money the test costs to the patient, or what kind of insurance the patient has.

Fee splitting and contingent fees

fee splitting is the act of sharing fees for patient services, and most often occurs when a provider refers a patient to a specialist. This is considered unethical because it means providers are acting in their own self-interest, instead of in the best interest of patients. It is also unethical to collect fees that are contingent on the success of therapy. These are known as contingent fees.

Waiver of insurance co-payments

However, some insurance company policies may be violated when physicians waive co-payments. Providers should make sure co-payment policies are within the legal boundaries. 

Professional courtesy

When a provider offers care to other physicians, staff, or family members at no charge or at a reduced rate, it is called professional courtesy. This practice is not deemed unethical.

Conflicts of interest

A conflict of interest may occur if the provider acts as a spokesperson on behalf of medical device companies, or if the provider has financial interest in a medical product company whose products they prescribe and recommend.

Unethical conduct

MAs also have the legal and ethical right to report unethical conduct to law enforcement agencies or a local medical society.

Therapeutic privilege

When a provider withholds medical information from the patient due to believing that the disclosure of the information is contraindicated, it is known as therapeutic privilege. But this decision may create a conflict between the patient’s autonomy and welfare, and the physician’s obligations.

Informed consent

It is the responsibility of the physician to present accurate medical facts to the patient or patient’s legal representative. Informed consent originates from the ethical and legal right of the patient, in which the provider discloses medical information

Ethics

feelings, judgments, and actions that are associated with concepts of right and wrong. something may be legal, but not ethical.

2250 BCE

The Babylonians created the earliest documented code of ethical conduct (Code of Hammurabi) for medical practice. The code did not survive through different successive periods since it was very lengthy.

400 BCE

Hippocrates developed statements of the principles of medical ethics that continue to inspire the physicians of today.

1803

Thomas Percival made the most significant contribution to medical ethics: the Code of Medical Ethics.

1846

The American Medical Association (AMA) was established in New York City. At this time, medical education and medical ethics had been inherently vital components of the healthcare profession.

1847

A Code of Ethics was established for the use of medical practitioners at the first annual AMA meeting. Percival’s code was acknowledged as the Code’s foundation.

Duties

obligations that people think or feel they must perform.

Nonmaleficence

a healthcare professional is duty-bound to avoid intentionally harming anyone.

Beneficence

acting in a manner that benefits others (e.g. patients and physicians). Healthcare professionals are morally obligated to help others.

Fidelity

refers to the health professional’s obligation to follow through with responsibilities and uphold the promises made to others.

Veracity

the duty to speak truthfully and act with honesty.

Justice

the duty to right the wrongdoings or provide benefits to whom they are owed.

Rights

The claims made on individuals, groups, or society such as citizens of a democracy having the right to vote. To uphold ethics, rights must be applied equally and without prejudice.

Character traits

Individuals tend to act in definitive ways, known as character traits. Those who place value on honesty choose to conduct themselves (personally or professionally) in that manner.

Ethical distress

Occurs when a healthcare professional knows the ethically appropriate action to take but is unable to act due to institutional, legal, or other constraints.

Ethical dilemmas

Occurs when there are two or more conflicting ethical choices, and it is unclear which is the right decision.

Justice related dilemmas

A situation involving fairness in the distribution of healthcare resources, benefits, or burdens among patients.

Locus of authority issues

A situation in which there is uncertainty or conflict about who has the legal or ethical authority to make a healthcare decision (e.g., patient, family member, or provider).