Ethics law philosophy

09.06.2010

Institute of Health Management

Dow University of Health Sciences

Aewaz Abbas Rizvi

Ethics Law Philosophy

09.06.2010

09.06.2010Brief Introduction

Rules of the game

• Punctuality of time

• No use of Mobile Phone

• Resuming sessions on time as per announcement before the breaks

Total Marks 100

Final Examination 40%

Mid Term Examination 30%

Continues Evaluation 30%

Attendance / Punctuality Participation / Quizzes / Presentations

Assignments / Case study synopsis

Scope of the course

It should be matter of embarrassment for all of us that our country have impression of “Land of Corruption” and “Unethical Business Practices”

Pakistan ranks at high level in the corruption index recently surveyed by “Transparencies International”.

Competition is getting more intense compounded by globalize economy but reports indicate involvement in illegal and unethical practices.

This value base course will help students in making ethical decisions based on sound principles.

Students should be helped to acquire a clear knowledge of what is right and wrong to analyze situations from an ethical point of

view, and to make bold ethical decisions in healthcare areas.

Out Lines - Main Topics

Main Topics Main Topics Definitions Ethics Law & Philosophy

Medical ethics ?

Laws and Regulations

Ethics & Business

Major branches of ethics?

Professionalism and Ethics

Ethics & Its Relationship

Ethics in a Business Environment

Time Lines Days - Wednesday Time 06- 9 p.m.

# Date ItemsI 09 Jun 10 • Orientation / Introduction /Course Out Lines

• Definitions Ethics Law & Philosophy

II 16 Jun 10 • Quiz 1• Medical ethics ? Laws and Regulations

III 23 Jun 10 • Quiz 2 • Professionalism and Ethics

IV 30 Jun 10 • Quiz 3• Business Ethics & Its Relationship

V 07 Jul 10 • Mid Term Examination

VI 04 Jul 10 • Quiz 4 • Major branches of ethics?

VII 21 Jul 10 • Quiz 5• Ethics & Business

VIII 28 Jul 10 • Quiz 6• Ethics in a Business Environment

IX 09 Aug 10 • Quiz 7 • Preparation Guidelines for Final Term Examination

09 Aug 10 • Final Term Examination

Course is designed in a way to make it interactive and hands-on loaded with :- Presentations on core areas of Ethics Law and Philosophy. Daily Quizzes Matching understanding level of

participants. Case studies Creative exercises Brain storming sessions

Methodology

Can you see the old lady?

Can you see the young lady?

What did you do to broader your perspective?

Try to understand all perspectives

Ethics

Ethics (also known as moral philosophy)

A branch of philosophy that addresses questions about Morality—that is, concepts such as :- Good and Bad,Noble and Ignoble, Right and Wrong,Justice, and Virtue.

http://en.wikipedia.org/wiki/Philosophy

http://en.wikipedia.org/wiki/Morality

• Effects of Govt. policy on healthcare operations

• Opportunities for and restrictions on lobbying activities and other contact with Govt. officials

• Implementation of laws pertaining to healthcare

• Legal responsibilities and liabilities of organizations and professionals

• Identification of healthcare-related fraud & abuse


Ethics

Major branches of ethics include:Meta-ethics, about the theoretical meaning and reference of moral propositions and how their Truth-values (if any) may be determined; Normative ethics, about the practical means of determining a moral course of action; Applied ethics, about how moral outcomes can be achieved in specific situations; Moral psychology, about how moral capacity or moral agency develops and what its nature is; and Descriptive ethics, about what moral values people actually abide by Within each of these branches are many different schools of thought and still further sub-fields of study.

Ethics

If you are planning to infuse strong, ethical principles throughout your Co or want to change the culture • Identify the issue /crisis.• Select alternative ways to handle ethical issue /crisis.• Create inspiring examples to successfully deal with major ethical issue.• Carefully design code of ethics.• Practice ethical values in "challenge sessions“• Practice ethical values in a way that each person should be to clarify their own perspective and commitment to Co.• Select with in organization peer coaching groups a powerful, yet straightforward, means to organize, facilitate and evaluate challenge sessions.

Ethics

Let's Start With "What is ethics?“

Simply ethics involves learning • what is right or wrong, and then doing the right thing – but "the right thing" is not nearly as straightforward as conveyed in a great deal of business ethics literature.

Ethics

Many ethicists assert there's always a right thing to do based on moral principle, and others believe the right thing to do depends on the situation – ultimately it's up to the individual.)

Ethics includes the fundamental ground rules by which we live our lives. Philosophers have been discussing ethics for at least 2500 years,

Ethics

Many ethicists consider emerging ethical beliefs to be "state of the art" legal matters, i.e., what becomes an ethical guideline today is often translated to a law, regulation or rule tomorrow.

Values which guide how we ought to behave are considered moral values, e.g., values such as respect, honesty, fairness, responsibility, etc.

Statements around how these values are applied are sometimes called moral or ethical principles.

Ethics

The concept has come to mean various things to various people, but generally it's coming to know what it right or wrong in the workplace and doing what's right -- this is in regard to effects of products/services and in relationships with stakeholders.

Business Ethics

Business ethics is critical during times of fundamental change -- times much like those faced now by businesses, both nonprofit or for-profit. In times of fundamental change, values that were previously taken for granted are now strongly questioned. Many of these values are no longer followed. Consequently, there is no clear moral compass to guide leaders through complex dilemmas about what is right or wrong.

Ethics

. Attention to ethics in the workplace sensitizes leaders and staff to how they should act. Perhaps most important, attention to ethics in the workplaces helps ensure that when leaders and managers are struggling in times of crises and confusion, they retain a strong moral compass. However, attention to business ethics provides numerous other benefits, as well

Medical Ethics

Medical ethics is primarily a field of applied ethics, the study of moral values and judgments as they apply to medicine. Medical ethics tends to be understood Narrowly as an applied professional ethics, whereas bioethics appears to have worked more expansive concerns, touching upon the philosophy of science and the critique of biotechnology. Still, the two fields often overlap and the distinction is more a matter of style than professional consensus.

Medical Ethics

In the early modern period, the field is indebted to Muslim physicians such as Ishaq bin Ali Rahawi (who wrote the Conduct of a Physician, the first book dedicated to medical ethics) and Muhammad ibn Zakariya ar-Razi (known as Rhazes in the West), Jewish thinkers such as Maimonides, Roman Catholic scholastic thinkers such as Thomas Aquinas

Medical Ethics

Six of the values that commonly apply to medical ethics discussions are:

1. Autonomy - the patient has the right to refuse or choose their treatment.2. Beneficence - a practitioner should act in the best interest of the patient (duty). 3. Non-maleficence - "first, do no harm" (consequence).

Medical Ethics

4. Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality). 5. Dignity - the patient (and the person treating the patient) have the right to dignity. 6. Truthfulness and honesty – the concept of informed consent has increased in importance in recent years.

Values such as these do not give answers as to how to handle a particular situation, but provide a useful framework for understanding conflicts.

When moral values are in conflict, the result may be an ethical dilemma or crisis.

Medical Ethics

Sometimes, no good solution to a dilemma in medical ethics exists, and occasionally, the values of the medical community (i.e., the hospital and its staff) conflict with the values of the individual patient,family, or larger non-medical community.

Conflicts can also arise between health care providers, or among family members.

Medical Ethics

Non-Maleficence : The concept of non-maleficence is embodied by the phrase, "first, do no harm”. Many consider that should be the main or primary consideration (hence primum): that it is more important not to harm your patient, than to do them good.

This is partly because enthusiastic practitioners are prone to using treatments that they believe will do good,without first having evaluated them adequately to ensure they do no harm.

Medical Ethics

In practice, however, many treatments carry some risk of harm.

In some circumstances, e.g. in desperate situations where the outcome without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified, as the risk of not treating is also very likely to do harm.

So the principle of non-maleficence is not absolute, and must be balanced against the principle of beneficence.

Medical Ethics

Truthfulness and honestyInformed consent in ethics usually refers to the idea that a person must be fully-informed about and understand the potential benefits and risks of their choice of treatment.

An uninformed person is at risk of mistakenly making a choice not reflective of his or her values or wishes.

The value of informed consent is closely related to the values of autonomy and truth telling.

Medical Ethics

Confidentiality is commonly applied to conversations between doctors and patients.

This concept is commonly known as patient-physician privilege.

Legal protections prevent physicians from revealing their discussions with patients, even under oath in court.Traditionally, medical ethics has viewed the duty of Confidentiality as a relatively non-negotiable tenet of medical practice.

Medical Ethics

Bioethics is an especially difficult field because it regularly Concerns some of the most troubling topics: the nature of life, the nature of death, what sort of life is worth living, what constitutes murder, how we should treat people who are in especiallyvulnerable and painful circumstances, just what sort of responsibilities any of has to other human beings, and so on. Bioethics is not a wholly independent field – it must, obviously, draw a great deal from other ethical discussions.

Medical Ethics

Perhaps the most fundamental principle of all medical ethics is the idea that for anyone who presumes to be involved in the treatment of disease or illness, their primary and overriding duty is to their patient.There are a variety of ways in which this basic principle can be expressed. One of the oldest comes from Hippocrates, an early Greek physician.

Medical Ethics

Many believe that his Hippocratic Oath mandates that doctors "first do no harm," but that doesn't actually appear in the oath (although it does seem to be present in other writings of his). Instead, he wrote "I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice."

“Law is a system of principles and rules devised by organized society for the purpose of controlling human conduct.”

– Southwick, A.F. The Law of Hospital and Health Care Administration (2nd ed). 1988 page 3.

Laws and Regulations16.06.2010


Know the trends and pitfalls in legal fields:• Criminal law• Contracts• Antitrust• Negligence• Fraud & abase• Taxation• Administrative Law• Law of Corporations• Environmental regulation• others

Criminal Law

Prosecution and conviction for:AssaultFalse imprisonmentViolation of civil rightsDefamation (libel and slander)Environmental pollutionmurder



Contract Law• Private agreements give rise to certain duties

that are enforceable in a public forum (court system)

• All physician-patient and institution-patient relationships are founded in contract – the patient requests treatment and the provider agrees to provide it in return for payment

• This establishes certain legally enforceable duties and expectations


Contract Law•Contractual aspects exist in relationships between a healthcare organization and

–Physicians–Nurses–Other employees–Suppliers–Payors–Government–others


Corporation Law

Because a corporation has a charter from the state, it receives certain benefits:

Perpetual existenceLegal personality“corporate veil” that shields the individual who created it and those who operate it


Corporate charters also create

• legal obligations• Government licensure• Regulation• Oversight merely to virtue of its corporate status


Negligence/Tort LawViolation of some proven “standard of care” or failure to exercise due care under the circumstances.

Alleged medical malpracticeHealthcare organizations were once protected by the doctrine of “charitable immunity”, this is no longer the case

Negligence – failure to:• Determine the qualification of a physician prior to

granting or renewing staff privileges• Failure to monitor the qualifications of nurses or

healthcare workers• Failure to maintain and implement adequate

institutional policies• Failure to follow the organization’s own bylaws• Failure to maintain adequate facilities and

equipment• Failure to comply with “anti-dumping” laws

regarding emergency room patients



Negligence – failure to:• Supervise the performance of contractors

(including hired physicians)• Maintain appropriate peer review and quality

assurance functions• Prevent the unauthorized disclosure of

information from patient records• Protect patients from healthcare workers who

carry communicable or infectious diseases• Protect the identities of AIDS or substance

abuse patients

16.06.2010


Negligence – failure to:

• Follow standard orders and protocols

• Inform the patient or family when injuries result from known deviations from the standard of care

• Counsel persons regarding known or knowable genetic conditions that would affect their children


Negligence – failure to:

Fraud and Abuse

• False claims

• “Kickbacks” for referrals or Medicare patients

• Physician self-referrals

Hugh potential for penalties – fines and expulsion from the Medicare program

Antitrust Laws• Physicians and healthcare organizations were

once exempted from antitrust statutes because of their “learned profession” status

• However we are now subject to antitrust laws of both federal and state governments.

• Mergers• Consolidations • Acquisitions• Reduction of services• Joint Ventures


Antitrust Laws

• The incentives of antitrust laws (to preserve and promote competition) seem counter to the policy imperatives of healthcare reform (efficiency, lower cost, reduction of duplication of services).


Antitrust Laws• Litigation is brought by:

– U.S. Department of Justice– Federal Trade Commission– State antitrust agency

• Antitrust action:– Can take years to litigate– Cost millions of dollars to defend– Can cost millions or more in damages and

penalties


Tax Laws• Tax-exempt organizations must comply

with tax laws’ limitations and requirements regarding:– Lobbying activities– Political campaigning– Community benefits– Charitable purposes– Private inurement– Unrelated business income


Other Legal Obligations

• Admission and discharge procedures

• “Hill-Burton Act”

• EMTALA – Emergency Medical Treatment and Active Labor Act

• Involuntary Commitment of Mentally Ill persons


Informed Consent• Know the circumstances when consent

can be refused• Procedures needed to secure and

document informed consent• Legal aspects of medical records

– Forms and consents– Standards for retention/disposal– Rights of ownership and control– Use as evidence in litigation


Informed Consent

• Know the legal principles affecting consent for treatment of: – incompetent adults– Young minor children– Mature minors– Pregnant minors– Seriously ill newborns whose parents refuse

to consent to care


Informed Consent• Know the legal principles affecting consent

for: – Abortion– Sterilization– Euthanasia– Genetic therapies– Other procedures having religious or ethical

overtones

• Potential liability for “wrongful life” or “wrongful birth”


Professionalism and Ethics23.06.2010

The American College of Hospital Administrators (ACHA) was established in 1933 for the following hallmarks:– Public service orientation– Self-regulation– A code of ethics– Expectations, such as assuring competence of

members through continuing professional education– Samaritanism– Charity

These hallmarks can be found in the ACHE Code of Ethics


• Ethical Policy Statements have also been developed by ACHE to address specific concerns of healthcare executives

• These are published on the ache.org website, and included in the annual report.


Ethics is often defined as a formal study of morality.

Sociologists – mores, customs and behavior found in a culture

Physicians – meeting the expectations of their profession and society and acting in certain ways towards patients


Ethics to Healthcare Executives – special charge and responsibility to:

• patient• client• others served• The organization• Its personnel• Themselves• The profession• And ultimately, but less directly, to society


Ethics to Healthcare Executives – special charge and responsibility to:

• patient• client• others served• The organization• Its personnel• Themselves• The profession• And ultimately, but less directly, to society


In the Code, special attention is given to such issues as:

• Responsibility to those served by the organization

• Obligations to the profession and the organization

• Roles in providing health services to the community and those in need of services

• Conflicts of interest


The Code encompasses the concept of moral agency (or advocate) which holds that healthcare executives are morally accountable for the implications of their:

Malfeasance (wrongdoing or misconduct, especially by a public official)

Nonfeasance (failure to do what ought to be done) and

Misfeasance (the performance of a lawful action in an illegal or improper manner)


• ACHE affiliates are obliged to bring to the attention of the ACHE Ethics Committee any information that reasonably causes them to believe there has been an infraction of the Code.

• Alleged infractions of the Code are reviewed by the Ethics Committee, with the help of other elements of the ACHE governance structure.

• The Ethics Committee makes a recommendation to the Board of Governors, which has final authority.

• The Code includes appeals and reviews, which provide for substantive and procedure due process.


American Medical Association’s Principles of Medical Ethics

• Based on work of a 19th century English physician, Sir Thomas Percival.

• Subsequent revisions continue to incorporate portions of the Hippocratic philosophy governing physician-patient relationships.

• The Principles were last revised in 1980 – which moved away from previous emphasis on benefits and harms, and adopted the language of rights and responsibilities.

• The Principles direct members to “strive to expose those physicians deficient in character or competence, or who engage in fraud or deception”.


American Nurses Association’s Code for Nurses• Philosophy is that the goal of nursing is to

support the client’s responsibility and self-determination to the greatest extent possible.

• Specific provisions set out the relationships among nurses, and with nursing, clients, employers and the public.

• Nurses are expected to act when healthcare and safety are affected by the incompetent, unethical or illegal practice of any person.


Codes of Ethics for professional groups• Provide for self-regulation• Must be sufficiently precise so that guidance is

meaningful, both to the members of professional groups and societies and to those who are charged with enforcing the code.

• Must be living documents that provide meaningful guidance to individuals who want to do the right thing, but who are uncertain as to what that is.

• Education about its ethical code and expectations should be a part of any continuing education development program undertaken by a profession


Codes of Ethics for professional groups• Provide for self-regulation• Must be sufficiently precise so that guidance is

meaningful, both to the members of professional groups and societies and to those who are charged with enforcing the code.

• Must be living documents that provide meaningful guidance to individuals who want to do the right thing, but who are uncertain as to what that is.

• Education about its ethical code and expectations should be a part of any continuing education development program undertaken by a profession


Four principles that can be used to guide healthcare executives in developing a personal ethic:

• Respect for persons (which incorporates autonomy, confidentiality, fidelity and truth telling)

• Beneficence• Nonmaleficence• Justice


Principles guiding personal ethics should:• permeate an organization’s philosophy• be reflected in its mission statement and

other written expressions of values• be reflected in all the policies, procedures

and rules used by the organization• be part of the healthcare executive’s

personal ethic, as well as part of all decision making


Institutional Ethics CommitteesInterdisciplinary teams to provide• advice• Consultation• Education• Analysis for physicians, patients, staff and healthcare

executives.Focused on biomedical ethical issues and

administrative ethics.


Infant care Review Committees (ICRC) are established in response to the Federal Child Abuse Amendments of 1984.

1. Educate hospital personnel and families of disabled infants

2. Recommend institutional policies and guidelines as to withholding medically indicated treatment

3. Offer counsel and review in such cases


Institutional Review Board• Established to meet the requirements of

the department of Health and Human Services, and other federal and state agencies in various types of research.

• Prospectively review proposed research that involves human subjects to determine whether research subjects will be at risk of harm and to ensure that legally effective informed consent will be obtained


Types of research in healthcare organizations• Clinical trials – primarily performed in academic

health centers and other teaching hospitals• Practice of Medicine research – performed in

larger hospitals and HMOs – use of previously collected data and survey research to evaluate the practice of medicine

• Patient satisfaction• Outcomes measurement


Patient Bill of Rights• Suggest appropriate ethical relationships

between the patient and the organization and its employees

• Emphasize maximization of patient autonomy while recognizing the needs of the health services organization

• Responsibility of patients in the care process


Expectations of Ethical Conduct• Statements or guidelines established by trade

associations• Set out expectations for ethical conduct and

relationships with the community, and those served, and organizational conduct in general.

• Health care providers are expected to accommodate the religious and social beliefs and customs of patients whenever possible.


Cultural and Spiritual DiversityEqual Employment Opportunity CommissionCreate protected classes of persons against whom

it is illegal to discriminate• Unlawful discrimination• Sexual harassment• Intimate or romantic relationships in the

workplace• Sexual orientation• Affirmative action• Diversity programs


Conflicts of InterestOccur when one has conflicting duties or

responsibilities and meeting one of them makes it impossible to meet the other

Example: a decision maker (manager or corporate director) is also a decision maker for an organization with which business is done.


Conflicts of InterestOccur when one has conflicting duties or

responsibilities and meeting one of them makes it impossible to meet the other

Example: a decision maker (manager or corporate director) is also a decision maker for an organization with which business is done.


ACHE Code of EthicsACHE affiliates are expected to accept no

gift or benefit “offered with the express or implied expectation of influencing a management decision”.

An organizational policy that no gratuities can be accepted is the cleanest and clearest approach and leaves nothing to the potential recipient’s judgment.

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Business Ethics & Its Relationship

Business and Customers

Business and Long Term Considerations

The Company and the Customers

Criticisms of Advertising

Ethical Problems in Advertising

Product Safety and Product Liability

IFPMA Code of Ethics

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Business and Long Term Considerations

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Technology

Ethics law philosophy