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THE MOST CHALLENGING HEALING:HUMAN, FINANCIAL AND ETHICAL CONSIDERATIONS
IN HEALTH CARE
Oklahoma Ethics GroupBruce Lawrence, President and CEOBeth Pauchnik, Managing Director,
Chief Legal Counsel, and CAO
INTEGRIS HEALTH OVERVIEW
MISSION
VISION
VALUES
CORE COMPETENCIES
To improve the health of the people and communities we serve
Most trusted name in health care
Love, Learn and Lead
₋ Delivering the most challenging healing through leading edge clinical care₋ Collaboration to create our future₋ Community focus
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INTEGRIS HEALTH OVERVIEW• 8 Acute Care Hospitals • 122 INTEGRIS Family Care and Affiliated Clinics• 9,590 Staff Members• 1,400 Physician Staff• 47,333 Inpatient Discharges• 640,626 Outpatient Registrations• 648,358 Physician Clinic Visits• 237,528 Emergency Department Visits• E-Health services since 1994
₋ TeleHealth₋ INTEGRIS Virtual Visit – newest access point
INTEGRIS Heart HospitalHough Ear InstituteJim Thorpe Rehabilitation HospitalNazih Zuhdi Transplant InstitutePaul Silverstein Burn Center
James R. Daniel Cerebrovascular & Stroke CenterINTEGRIS Cancer InstituteHenry G. Bennett, Jr. Fertility InstituteM.J. and S. Elizabeth Schwartz Sleep Disorders Center
CENTERS OF EXCELLENCE
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INTEGRIS HEALTH OVERVIEW
Agenda for Today
Define Health Care Ethics
Main Ethical Principles
Access to Health Care
Clinical Ethics
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DEFINITION OF HEALTHCARE ETHICS
A set of moral principles, beliefs and values that guide us in making choices about
medical care
Nicomachean Ethics - Aristotle
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MAIN PRINCIPLES
In the U.S. four main principles define the ethical duties that healthcare professionals owe to their patients:
• Autonomy: to honor the patients right to make their own decisions• Beneficence: to help the patient advance
his/her own good• Non-maleficence: to do no harm• Justice: to be fair and treat all cases alike
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IMPROVING ACCESS TO HEALTH CARE
• As the number of Americans without health care coverage continues to increase, access to care is a major political, economic and policy problem.
• Unequal access to healthcare is also an ethical issue.
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IMPROVING ACCESS TO HEALTH CARE
Three core American values are at stake:•
• Equality of opportunity• Justice• Compassion
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IMPROVING ACCESS TO HEALTH CARE
“The enjoyment of the highest standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”.
World Health Organization (1946)
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IMPROVING ACCESS TO HEALTH CARE
The Ethical Force Program four ethical obligations regarding access to health care:
• First, every member of society must have an adequate array of core health care benefits.
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IMPROVING ACCESS TO HEALTH CARE
• Second, the contents and limits of health care benefits must be established through an ethical process.TransparentParticipatoryEquitable and ConsistentSensitive to Value Compassionate
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IMPROVING ACCESS TO HEALTH CARE
• Third, the health care system must be sustainable.
• Fourth, the health care system must ensure that its stakeholders have clear responsibilities for which they are accountable.
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IMPROVING ACCESS TO HEALTH CARE
ScenarioLong Term Patients in an Acute Care Setting• Patient exhausted payor sources. • Care required does not meet criteria for inpatient
acute care. • No real options so continue as an inpatient. • Consider paying for the 24 hour monitoring the
patient needs
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IMPROVING ACCESS TO HEALTH CARE
ScenarioEmployer on Employee Benefits• You have 5,000 employees. • Seven employees who have chronic hepatitis
represent a significant percent of the organization’s health care costs due to the inordinately expensive hepatitis drugs.
• Do you stop covering these drugs next plan year? • What if you are a health care organization, does that
elevate the ethical conundrum?
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CLINICAL ETHICS
• When we think of health care ethics, most people think of: Life Sustaining TreatmentEuthanasiaAbortion
• The Role of Advance Directives
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MICRO ETHICS
Clinical ethics plays out daily in ways you may not expect.• Anesthesia informed consent for a routine low-risk
anesthesia. All anesthesia carries the risk of death. Some anesthesiologists never mention it, some always do and some customize their approach.
“Relational judgments” framed as “ethical decisions”.• Constant small ethical decisions play out every day in
clinical work.
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MICRO ETHICS
Very individual to the clinician, based on how communication occurs and how decisions made
Managing medical information. • Should information be withheld from patients for
therapeutic reasons?
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CLINICAL ETHICS
Ethics Committee - How it Functions and Ethical Framework• Core Principles: Autonomy, beneficence, non-
malfeasance, justice.• Framework: Information, identification,
clarification, assessment, recommendation and documentation.
• Increase provider awareness.
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THE MOST CHALLENGING HEALING:HUMAN, FINANCIAL AND ETHICAL CONSIDERATIONS
IN HEALTH CARE
Conclusion
Thank you
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