© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 1 Chapter 6: Ethical Decisions and Challenges

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2 Introduction Challenges confronting the HIM professional are almost limitless Study of ethics can be applied to everyday situations Focus of this chapter: –Recognition of ethical challenges and learning how to address them –Application of ethical reasoning and decision making to resolve issues

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3 Ethical Decision Making We all face ethical dilemmas in life Decisions are made –Individual level: affecting personal life –Organizational level: affecting others No one right answer that applies to every situation Decision maker must consider: – Factors that influence decision making – Process to be followed

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4 Ethical Decision Making: Influencing Factors Numerous factors may influence the decision maker: –Professional code of ethics –Ethical concepts or theories –Patients rights –Religious beliefs –Personal experience

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5 Influencing Factors: Codes of Ethics Written list of a profession’s values and standards of conduct Embody professional concepts –Differentiate members from other occupations and careers –Present professional as autonomous decision maker –Endorse promise of loyalty to clients and fellow professionals –Elevate the client above the interests of self or fellow professionals

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 6 Influencing Factors: Codes of Ethics Codes are open to change over time Historically: –Were more a statement that limited competition and promoted image –Imposed restrictions Modern codes of ethics –Statements of ethical and moral principles –Govern the conduct of the profession’s members Almost every professional association has an ethics code –For example, AOA, AHIMA, medical associations, nursing associations, etc.

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7 Influencing Factors: Codes of Ethics Physician code of ethics –Obligation to provide competent medical service –Confidentiality of communication with patient –Duty to study and advance scientific knowledge –Recognize patient’s right to chose a physician –Must not discriminate

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8 Influencing Factors: Codes of Ethics Health information manager –Ethics are a cornerstone of the profession. –AHIMA has promulgated the code of ethics. HIM has ethical obligations –To the patient –To other members of the health care team –To her professional association –To the public –To herself

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9 Influencing Factors: Codes of Ethics Effective communication is key Professional education –Applicability of code in workplace –Consequences of unethical behavior –Case-by-case analysis Successful approach stresses need to think for oneself

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10 Influencing Factors: Codes of Ethics Ethics committee –Group within an organization –Establishes, evaluated, and enforces ethics code and related corporate policies –Addresses ethical issues that arise In health care organization, may consult on bioethical issues –End-of-life decision making support –Treatment of seriously ill newborn –Procedures for organ procurement –Medical research, new treatments, or equipment

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11 Influencing Factors: Patient Rights Role of patient in treatment has changed Limitations on patient participation in care –Physician must approve admission to hospital –Insurance may require pre-approval for treatment and/or physician –Third-party payer controls funding for care Expanded recognition of rights of patient –Rise in consumer activism –Move away from paternalism in medicine

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12 Influencing Factors: Patient Rights Recognition that patient is entitled to decide for herself –Consent to treatment –Refuse care Patient’s Bill of Rights (1970s) –Privacy, confidentiality and informed consent Patient care partnership (today) –Expanded to cover what to expect in hospital –How and where to express concerns

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13 Influencing Factors: Patient Rights as Law Incorporation of ethical concept into laws May be penalties for breach of patient right that are enforced by law Patient Self Determination Act (PSDA) –Right to determine extent of care –Right to make advanced directives (per state law) –Right to accept or refuse care –Hospitals must inform patients of rights –Hospitals must have related policies and procedures

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14 Influencing Factors: Patient Rights as Law Health Insurance Portability and Accountability Act (HIPAA) of 1996 –Federal law that protects health information Under HIPAA patient has a right to: –Access, inspect, maintain copies of PHI –Notified of privacy practices –Limit use or disclosure of PHI –Request that steps are taken to keep communication confidential –Request and accounting of disclosed PHI –File a complaint concerning privacy practices

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 15 Influencing Factors: Patient Rights as Law American Recovery and Reinvestment Act of 2009 (ARRA) Federal law Patient right to obtain copies of PHI in electronic format –If health care entity used an electronic health record –At patient direction, entity must transmit information to another as requested

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16 Influencing Factors: Other Factors Religious beliefs Advances in science and technology –Embryonic stem cell research –Scarce resources Legal factors –Civil rights transformed into legal protections –Law may address ethical concern but serves as minimum standard

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 17 Ethical Decision Making Process Different aspects of ethical problems

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 18 Ethical Decision Making: Steps 1.Clearly define the issue 2.Determine the facts of the situation 3.Identify stakeholders –Values at stake –Obligations and interests of each stakeholder 4.Determine available options –Evaluate each option

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 19 Ethical Decision Making: Steps Evaluating options –Compare each against an ethical theory Which option presents greatest good for greatest number? –Utilitarianism Which option supports one’s duty? –Deontology Which option promotes rights and dignity? –Social equality and justice

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 20 Ethical Decision Making: Steps 5.Decide what should be done Do analogous situations exist? What was done? What was the outcome? Are there legal implications? What option makes the most sense? Will option stand up to scrutiny? Can you sleep at night with choice? Are you comfortable if others know?

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 21 Ethical Decision Making: Steps 6.Justify the decision Identify reasons that support decision 7.Implement decision 8.Evaluate the outcome Compare what actually occurs to predicted outcome 9.Examine how to prevent recurrence of this ethical problem

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 22 Ethical Challenges Difficult choices with no clear “right” answer General challenges in work place –Conflict of Interest –Impaired colleague –Disparagement –Truth telling and disclosure

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 23 Ethical Challenges Conflict of interest –Self interest versus obligation to group –Use of position to promote self interest –Appearance of impropriety –Examples Accepting favors from a vendor Second job with a competitor

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 24 Ethical Challenges Impaired colleague –Impede performance and safety risks –Balance between no-tolerance and support person with disease of substance abuse Disparagement –Criticizing skills of another professional –Codes of ethics consider such personal attacks to be professional misconduct –Focus should be on merits of issue

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 25 Ethical Challenges Truth telling –Lack of full disclosure versus protecting trade secrets or security –Deceptive communications versus puffery –Copy of another’s work (plagiarism) –Unethical practices lead to erosion of trust

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 26 Role of Ethics in Supervision Role model –Set a good example –Accept responsibility for mistakes Encouraging ethical behavior –Communicate ethical standards clearly –Enforce standards fairly –Respect, rewards, and punishment Monitoring employee conduct –Review compliance with policies and procedures –Explicit part of performance evaluation

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 27 Health Care Challenges Conflicts of interest –Joint ventures and self-referral practices –Inappropriate relationships with patients Substance abuse/impaired colleague –Increased risk to patient safety –Situation must be addressed properly Financial issues –Third-party payer affecting medical decisions Bioethical issues

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 28 Health Information Management Challenges Changes in care environment –Accreditation critical Pressure to “fudge” statistics to reflect compliance or excellence –Sensitivity of information Genetic Drug and alcohol and mental health Abuse Documentation, access to, and release of information –Access to sensitive patient information –Celebrity patients –Demands from third parties: insurers, vendors

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 29 Health Information Management Challenges Technology developments –Data resource management –Audit trails Changes in reimbursement systems –Coding properly –Pressure for maximum reimbursement –Standards for ethical coding (AHIMA)