5 Ethical Issues in Healthcare Management
That a man considered mentally ill enough to be facing involuntary commitment was considered well enough to consent to a blinded study of antipsychotic drugs? That apparently the young man was given to understand that he could not leave the study without being involuntarily committed? That big pharma is using academic doctors to turn patients like this man into lucrative guinea pigs?
But then those people charged with watching out for the rights of patients and research subjects — people who increasingly tend to be lawyers who pragmatically treat things like IRBs as liability shields for their institutions — stick as closely to the laws and regulations as possible.
They do not worry about the gray zone of questionable practices that remains between patients and the law; they worry about following the law. They worry about protecting the institution from illegal behavior, not protecting the patients or research subjects. It seems to restrict what you can even worry about.
Now, if the systems we set up to protect people are not only inadequate to protect people, but in fact are used to constrict concerns about protection — how do we really protect people in medicine and medical research? Especially when the laws are used to protect an institution, and not a seriously mentally ill man caught in a research study, or his mother.
Who will do the real work of medical ethics, and how? The University of Minnesota has issued a statement on this story. The statement also seems to contain two basic misrepresentations. She has collaborated with Carl Elliott on various occasions.
Ethical but not Legal and Legal but not Ethical Conducts
She discusses the approaches taken by professionals to resolve conflicts between medical laws and ethics, position of medical laws and ethics in India along with landmark judgements.
How should medical practitioners react to laws that are directly interfering with their ability to do what is best for their patients? One of the most controversial subjects is the interrelationship between laws and ethics. As a long standing convention, rules of professional ethics have been imposed by professionals upon themselves and the medical profession is no exception.
These rules govern them in universal practice of their profession. It is often observed that the ethical standards of the professionals often exceed those required by law. A physician charged with ill-conduct may be held guilty or innocent in a court of law, however, along with legal proceedings, disciplinary proceedings may also be initiated against him on the basis of unethical conduct.
So, where does it leave the medical practitioners? Should they follow the law or do what is best for their patient? Is there a way to give a concrete answer to this question?
What are medical ethics? There is no universal definition of medical ethics and more often than not, it is quite difficult to explain it. A broad interpretation could mean the moral and not legal obligations that a medical practitioner is supposed to abide by. However, there are a lot of times when some of the standards known as medical ethics have legal effect as well. Medical Law is undergoing a massive change. Rapid scientific advances mean that lawyers and ethicists are constantly required to face new issues.
There have been a lot of legislations and rules pertaining to Medical Laws like Policy of Family Planning, Surrogacy Bill, laws pertaining to abortion and sex determination test, etc. It is undisputed that everyone has certain prima facie moral obligations to others that may conflict with the law. For instance — Everyone has obligations to not lie, to avoid harm, to not steal, etc. Medical professionals, however, have special moral obligations by virtue of their profession.
These obligations are tied to their roles as doctors, therapists, nurses, and others. These special obligations have been expressed through codes of professional ethics, principles of biomedical ethics, the concept of a fiduciary relationship, rich accounts of the virtues, and obligations inherent in the doctor-patient relationship. What are the various approaches?
Beauchamp and James F. Childress elaborated four principles that are now often regarded as foundational for medical ethics. The four principles are — Respect for autonomy, Non-maleficence, Beneficence and Justice.
They believe that these four principles represent a common morality and have given various arguments in support. Respect for autonomy — Respect patients as individuals e. For example — A psychologist is not to disclose the private records of a patient, it he fails to abide by the same, legal as well as disciplinary action can be taken against him.
Provide the information and opportunity for patients to make their own decisions regarding their care. An informed consent is required to be taken. However, if the patient is not in a condition to consent, then his family members can do so on his behalf. And if it is an emergency case, then the doctor can go ahead with what he thinks is right according to his experience and knowledge. In addition to having the right to refuse a diagnostic or therapeutic intervention, patients also has the right to refuse to receive information.
Beneficence — Act in the best interest of the patient and advocate for the patient. Misrepresentation of the facts or misleading the patient by giving false information or prescription is considered highly unethical. Non maleficence — Avoid causing injury or suffering to patients. The healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment. Justice — Treat patients fairly and equitably.
Distributing benefits, risks and costs fairly; the notion that patients in similar positions should be treated in a similar manner. The principle of respect for autonomy is also violated in cases wherein the physicians force a patient to listen to a fetal heartbeat or observe a fetal ultrasound before the abortion procedure is started with. The moral obligation to prevent avoidable harm to children is considered central to the ethics of pediatric medicine and if a physician fails to abide by it, there is definitely a violation of the principle.
The principle of justice is violated if some patients, because of better education or better insurance, are able to navigate around legal restrictions on the doctor-patient relationship, while other patients are left severely limited. May are propounders of this approach. Taking their inspiration from Hippocrates, Maimonides, etc. He urges the medical practitioners to focus on the well being of the patient and accept the responsibility. Following the Biblical notions, he urges powerful practitioners to help the vulnerable and powerless.
He states that medicine is a vocation as well as a profession. Basically, the covenantal approach encompasses a virtue-based description of professional ethics. Another available model for the doctor-patient relationship is that of the contract.
This model assumes obligations on both sides, but the content of the contract may be decided by the parties itself. It can be as huge as a dictionary or as small as two pages. Pellegrino criticizes the contractual model.
According to him, such a contract makes an assumption that one party to the contract is lesser than the other party and hardly has parties on equal footing. Such a disparity may lead to one party acting only out of self interest which may be unethical in nature. The Fiduciary Approach It is always observed in the society that some relationships although appear to be merely a species of business transaction or contract, require an increased ethical vigilance.
And medicine is undoubtedly one of them. A fiduciary relationship can be simply defined as a relationship based on trust. A fiduciary relationship describes a situation of heightened trust and confidence between the parties. Some of the common examples are of the relationship between a teacher and a student, the relationship between an attorney and a client. Physicians have strong fiduciary duties towards patients and it can not be neglected.
Propounders of this approach propose that the interest of the patient is to be placed above any other competing factor. What is the position of medical laws and ethics in India? The Medical Council Act, looks over the wrongdoings of medical practitioners in India. This Act was highly criticised resulting in repealing of the entire Act.
A new Act called the Indian Medical Council Act, was formed and passed which is the current law of the land. Mittal and Another v. State of U. General Medical Council acting at State level is the apex body to manage the misconduct of the medical practitioners. Some additional powers to expel and suspend medical practitioners if required have been given to the State Medical Council. They are also empowered to enlist the medical practitioners who have faced disciplinary actions. Indian Medical Council Professional Conduct, Etiquette and Ethics Regulations, amended upto 8th October, indicates the duties and responsibilities of the registered medical practitioners.
These regulations enforce certain standards which medical practitioners are required to follow. If they fail to do so, legal action can be taken against them and they can be penalized as well. Some of the duties and responsibilities of the physician are — Maintaining good medical practice Highest quality assurance in patient care Patience, delicacy and secrecy Patient should not be neglected Unnecessary consultations should be avoided Punctuality in Consultation Not to conduct sex determination test Advertising is not allowed Contravening cosmetics and drugs act are not allowed Reporting to call for emergency, military situations Reporting of suspected causes of death There should be informed consent of the patient Running an open medical shop is not allowed Ban on practice of euthanasia Medical Practitioners are required to follow the standards set in the Code.
The Code also states acts of commission or omission on the part of a physician which shall constitute misconduct rendering him liable for disciplinary action. What are the specific laws governing the medical profession in India?
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The death penalty is also legal in many states, but a multitude of individuals consider it unethical. Smoking cigarettes in public is legal in some places, but some may find it disrespectful and unethical.
Abortion is legal in some places, but many consider it unethical.
5 Unethical Medical Billing Practices
Ethical but not Legal and Legal but not Ethical Conducts Ethical but not legal Five controversial examples are ethical but not legal.
When a child is hungry and he stole a loaf of bread from a shop to feed. This action is ethical because a child is hungry and he wants something to eat but this is illegal because stealing is illegalized throughout the world. The transformer gives us electricity.
Double billing is not uncommon in the medical field.
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Since the billing and claiming process is not always smooth, there are bound to be few mistakes along the way. However, those who intentionally double bill or more for the same medical procedure might face criminal and civil penalties. If you are a healthcare service provider, double billing might seem easy to fix because it would only impact your revenue.
However, its true cost goes beyond fines and fees. Patients might be hesitant to receive any medical services from the same healthcare provider because they were double-billed before. Aside from that, patients might also call the insurance company in order to remedy the situation. This, in turn, would result in more scrutiny and eventually damage the trust between the insurance company and the healthcare provider. So if you are a medical service provider, you should not be resubmitting duplicates without further studying them.
7 Common Unethical Medical Billing Practices
Misrepresentation This billing practice can come in many forms such as Misrepresentation of locations of service Some patients are often billed for services that are not exactly consistent with what they receive. For example, a clinic worker might have handed the patient a syringe that was told to be administered at home. Misrepresentation of dates Claims submitted by healthcare service providers are often not consistent with the date of service it was rendered. For example, a healthcare service provider has only visited or seen the patient for one day.
But instead of reporting it as it is, they instead stated in their claim that they visited and treated the patient for two days. Misrepresentation of the provider of service This might seem far-stretched, but some clinics or facilities do hire and let unprofessional, unqualified, and untrained staff do medical procedures and services. Phantom Charges This billing practice is a blatant fraudulent claim and it is also the most common one because it is so easy to carry out.
Phantom invoicing is an unethical billing practice for a medical service or procedure that was never rendered. It can also happen when a medical service provider submits a claim for medical procedures that are completely unnecessary.
This means that the treatments were only administered based on profit. For example, a healthcare service provider submitted a claim for wheelchairs that a patient neither needed nor received.
Phantom billing or invoicing becomes a burden in our healthcare system because resources are fraudulently spent and unnecessarily utilized.
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This could result in backlogs and the people who actually need the medical services might find it difficult to obtain or receive one because resources have already been drained and depleted. It is worth noting that healthcare service providers are not the only ones who can commit this kind of fraud, patients can also be part of this scheme.
Some healthcare providers might offer monetary compensation to the patients in exchange for their cooperation. So whether you are a patient or a healthcare service provider, always be on the lookout for these unethical medical billing practices.
Laws like the one in Arkansas open up the healthcare system to abuse by conspiracy theorists, and it is already the case that many wellness providers are basing their advice and services on QAnon falsehoods. The health tech community is not just developing medications and devices for patients whose beliefs are similar to their own.
Equally, medical professionals should not be making it harder for people to get needed medical care based on personal feelings. On the contrary, the ultimate goal of health tech businesses and healthcare providers alike should be a singular focus on improving the quality of care for all.
The Arkansas law — and others like it — place the burden of finding appropriate care on the patient instead of on the medical community, where it belongs.