Medical ethics

Fear of legal action may also cause healthcare administrators and clinicians to engage in defensive medicine.

Cost pressures and changes in the healthcare environment pose ethical challenges and hard choices for patients, physicians, healthcare administrators, policymakers and society.

Health care resources are limited or restricted. Their allocation requires hard choices. Hard choices are at the heart of ethics. Ethical challenges posed by limits often must be addressed with or jointly among patients, families, clinicians and providers such as health insurers.

Financial decisions can impact both the healthcare organization and the quality of care delivered. It can be very challenging to balance competing demands, and it sometimes pits budget, quality and ethics against each other. For example, administrators often must choose between hiring more staff to decrease nurse-to-patient ratios.

Medical lawsuits can be devastating to any healthcare organization or medical practice. Health administrators work with staff to resolve complaints before these issues escalate to the point of legal action or media attention, and to help ensure the organization’s providers are basing their decisions on patients’ needs over other factors. Appropriate actions may include disciplining or terminating a member of a healthcare team.

Fear of legal action may also cause healthcare administrators and clinicians to engage in “defensive medicine.” This may mean departing from normal medical practice as a safeguard from litigation. It occurs when a clinician performs treatment or a procedure to avoid exposure to a malpractice lawsuit. Balancing legal issues requires careful ethical analysis of all the issues.

One important ethical principle is maintaining the right to privacy. Healthcare organizations are increasingly reliant on technology, such as Electronic Medical Records for recording, storing and transmitting sensitive health information. A healthcare organization’s administrative group plays a role in ensuring that these systems adhere to all the relevant laws and regulations to ensure and protect a patient’s privacy. However, there are circumstances under which confidentiality must be broken, for example, as is explained in a case in the Psychiatry Journal, to prevent harm to a patient or outside party. A thorough understanding of such rules and ability to analyze the ethical principles involved is important for professional leadership.

Healthcare administrators may work to manage relationships with many stakeholders, including external vendors who provide products and services such as brand-name medications, diagnostic equipment and software solutions. This attention is necessary to ensure that staff members are making decisions in the patients’ best interests without outside influence. One example to avoid is a doctor or nurse prescribing medication — even if it is not medically necessary or there are other alternatives — to obtain a benefit promised from a pharmaceutical sales representative.

Health care decisions are not always simple or easy to make. Physicians and nurses can try to provide information as clearly and sensitively as possible and can even make recommendations about what to do. Still, patients have decisions to make, in accordance with their values and convictions. Patients may accept or refuse any or all tests and treatments that are offered or recommended by clinicians.

It is not enough, however, to simply obtain the patient’s consent. That consent must be informed. This raises questions about how much information should be provided and how this can best be presented in a way that the patient understands.

Sometimes it may be hard to decide what choice is truly in the patient’s best interest, or what course of treatment best reflects what the patient wants. Uncertainty can make choices difficult.

Medical ethics means going through the process of determining what is the “best” or “right” thing to do when uncertain, when the choices and their consequences are not evident — and when those involved disagree about what to do.

Administrators play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected.