ethics

profession

a body of knowledge shared by a group of individuals with specialized education and training and common values

Core Components of Profession:

• High ethical standards

• Disciplined

• Special skills

• Body of learning

• Education and training at a high level

• Interest of others

Professionalism

Ability to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and the community, a service orientation, and a commitment to lifelong learning and improvement

Characteristics (Professions and Professionals)

• Possessing systemic knowledge

• Adhering to professional norms

Possessing systemic knowledge

Acts, tools, and theories of a field organized into a unique body of knowledge. (ACHE, ACHE, Profession academic prep)

Adhering to professional norms

internalized standards of conduct to which professionals automatically and unconsciously 

Value

a basic and fundamental belief of the members of profession

• Public service

• Self-regulation

• Sense of calling and meaningful work

• Autonomy

Stages of Professionalism

1. Full-time occupation

2. Formal training

3. Professional association

4. Self regulation and possibly licensure 

5. Code of ethics

Ethics as a Cornerstone of Professionalism

• trust and credibility

• accountability and responsibility

• positive workplace culture

• legal and ethical obligations

• sustainability and long term success

• decision making

ethical branch

a major category of  ethics composed of clusters and families of theories that share characteristics or functions

descriptive ethics

study of people's beliefs about morality

Normative ethics

the study of ethical theories that prescribe to how people ought to act

Moral psychology

moral reasoning and judgment in decision making

Applied ethics

putting moral knowledge into practice

Applied ethics include

bioethics, business ethics and stakeholder theory, organizational ethics, profession specific ethics

Deontology (ethics of duty)

• Doing the right things for the right reasons

• We all have duty to ourselves and to others

• Only true good is goodwill

• All humans have worth

• An act is right because it is inherently honest, just or fulfills a duty, regardless of its eventual outcome 

Utilitarianism (consequential)

The right action tends to result in good consequences; the wrong action tends to result in bad consequences

• Ethical choices should be based on consideration of the consequences of those actions, not “duty”.

•  The greatest benefit to the greatest number affected.

•  Focus on the best outcome for all persons, not the individual.

Virtue ethics

Determines rightness by the quality of a person’s character rather than a person’s individual acts or their consequences, not what I should do but who should I be

Aristotle’s cardinal virtues

• Prudence (practical wisdom)

• Fairness (justice)

• Courage

• Temperance (self-control)

Person

Virtue

Action

deontological

outcome 

utilitarian

Rawls’s Principles of Justice

justice as fairness

• Liberty principle

•  Equal opportunity principle and the difference principle

Factors that affect moral behavior

• situational factors

• emotional state

• interpersonal influences

Moral courage (Rushworth Kidder)

the quality of mind and spirit that enables one to face up to ethical challenges firmly and confidently, without flinching or retreating.

ethics

a system of beliefs and behaviors that people value and use to control their

conduct

The four branches of ethics

descriptive ethics, normative ethics, moral psychology,

and applied ethics.

Healthcare managers use

applied ethics, which includes bioethics, business ethics,

organizational ethics, and profession-specific ethics.

Ethical theories in philosophy include

deontology, utilitarianism, virtue ethics, John Rawls’s principles of justice, and the ethics of caring

Professionalism

knowledge, skills, ability, and conduct expected of practitioners of a profession.

Professional role refers to

the assigned and expected functions, responsibilities, and working relationships of the person in a professional position.

Corporate social responsibility is the

context-specific organizational actions and policies that take into account stakeholders’ expectations and the triple bottom line of economic, social, and environmental performance

The role of healthcare managers in CSR initiatives is threefold

(1) Identify goals that meet the healthcare needs of the community and that fit with

the organization’s mission,

(2) motivate stakeholders to get involved in initiatives, and

(3) plan and implement actions to ensure the initiatives are successful

Stewardship

acting in the best interests of patients, providers and staff, and the community, which helps build and maintain a trust relationshi

Role of stewardship in managers duties

• Identify and prioritize stakeholders

• Support and sustain the organizations mission

• Maintain organization integrity through reciprocity

Fiduciary duty

the duty of an individual or a group to act in the best interest of another individual or group

includes:

• duty of care

• duty of loyalty

• duty of obedience

duty of care

• the responsibility that requires an individual or a group to act with the care and prudence any reasonable entity would use

Duty of Loyalty

prohibits gaining advantages at organization’s expense

Duty of obedience

requires adherence to the organization’s mission

Joint Commission requires accredited healthcare organizations to

have a process for disclosing unanticipated outcomes of care

Stakeholders involved in disclosure:

• Providers

• Patients

• Public

• Board of directors

Transparency

Policy of sharing information and communicating directly, honestly, and in a timely manner

Lexington Model

• Face to face meeting with the patient and family

• Apology from those who committed the error

• Monetary compensation

• An action plan dealing how the organization will minimize the risk that the error will reoccur

Environmental sustainability

is a moral imperative because it is the right thing to do for a variety of reasons

core principles

• autonomy

• beneficence

• nonmaleficence

• justice

autonomy

• acknowledge people's right to make choices for themselves based on their own values and beliefs

Beneficence

one ought to prevent and remove evil or harm, promote good

Justice

• treat others equally and fairly

Factors influencing patient autonomy

• Level of health literacy (ability to understand and make informed decisions)

• Access to information

• Language or cultural differences

• Pressure/influence from others

Informed consent

A process by which a patient voluntarily confirms their willingness to undergo a particular medical intervention, after having been informed of all the potential risks, benefits, and alternatives

• A process and a form

Autonomy Confidentiality

The ethical principle that requires healthcare providers to keep a patient's personal health information private unless consent to release the information is provided by the patient.

Autonomy Truth telling

the ethical principle of keeping ones word to other, or promise keeping

• Trustworthiness

• Loyalty

Primum non nocere

First do not harm

Strategies to balance beneficence and nonmaleficence

• Ethical decision-making frameworks

• Involving Multidisciplinary teams

Ethical decision-making frameworks

employ structured frameworks like the Four Principles Approach (autonomy, beneficence, nonmaleficence, and justice) to guide decision-making

Involving Multidisciplinary teams

Involve a range of healthcare professionals (doctors, nurses, social workers, ethicists) to provide comprehensive care and diverse viewpoints

Justice in healthcare

• fairness

• equity

• legal and patient rights

fairness

• all patients receive equal treatment and opportunities, regardless of their background, socioeconomic status, or personal characteristics

equity

involves recognizing and addressing the different needs of individuals and group to achieve fair outcomes

legal and patient rights

• ensuring that their rights are protected and upheld

Theories of distributive justice

• Justice as fairness

• Utilitarianism 

Equal liberty principle (justice as fairness)

Each person has an equal right to the most extensive basic liberties compatible with similar liberties for others.

Original Position and Veil of Ignorance (justice as fairness

• Rawls introduces the concept of the "original position," where individuals choose principles of justice behind a "veil of ignorance," unaware of their own social status, abilities, or personal characteristics.

Professional codes of ethics principles

• Honesty

• Integrity

• Justice

• Loyalty

• Beneficence

• Autonomy

• Honor

professional associations in healthcare, such as ACHE, MGMA, and ACHCA, issue their

own codes of ethics.

Codes of ethics spell out

standards of behavior that professionals learn, follow, and internalize. Once internalized, the codes become professional norms

Codes of ethics can be applied throughout a healthcare manager’s

 career and influence behavior.

Market forces External

• Changes in the economy: employment, insurance coverage rates

• Local, state, and national political decisions: ACA, social policy

• Societal changes: globalization of healthcare, consumerism

Market forces internal

• Geography

• Medical discoveries

• Labor shortages

• Inflation

Managed care, ethical issues:

• Autonomy concerns: provider incentives and conflicts of interest, gatekeeping: consider utilitarianism vs deontology, informed consent

• Nonmaleficence concerns: cream skimming, marketing promises

• Justice concern: who deserves insurance, benefits

Clinical ethics

deal with real-world ethical dilemmas, such as those involving informed consent, patient rights, end-of-life care, and resource allocation.

managerial ethics

review and revise your organizations charity care policy

Utilitarianism often involves this type of analysis to determine most efficient allocation of resources

cost-best analysis