1. Ethical Decision-Making

2. What is Ethics? Ethics is the formal process of intentionally and critically analyzing, with respect to clarity and consistency, the basis for one’s moral judgments. Ethical reasoning is necessary to resolve the potential conflicts between personal values and professional values. Ethical decision making requires everyone to consider the perspectives of others, even when they have different values.

3. Addressing Ethical Issues Many people may want to answer questions of professional ethics according to their own personal morality. However, resolving conflict depends on the more formal mechanism of ethics. Most of the time people do not make a distinction between morality and ethics, however, there is a difference. Morality refers to your own personal moral choices. Ethics refers to the formal process of intentionally and critically analyzing the basis for your moral judgments for clarity and consistency and considering other’s views. HIA professionals must go beyond the right or wrong moral perspective and evaluate the many values and perspectives of others who are engaged in the decision to be made.

4. Addressing Ethical Issues (cont.) People need ethics to help resolve conflict Ethics provides a formal way to step back from the conflict. Important because you are held accountable for your actions as a professional Patients do not know your personal moral values, but they have expectations of your professional conduct (e.g.- the ethical dilemma of the pharmacist who will not dispense “morning after” pill). They expect you to be able to act professionally. Ethics helps search for reasons to support once choice over the other. Ethics helps apply this reasoning in future situations.

5. Addressing Ethical Issues (cont.) Consider the opinion of others Individuals as professionals

6. Three components of an Ethics Curriculum Knowledge: The HIM professional needs to be aware of the standards set forth in the professional Code of Ethics. Development: The moral maturity of the HIM professional needs to be nurtured and reinforced so that it can be applied in professional settings. Skills: HIM professionals need practice in identifying ethical issues and applying a process of ethical decision making to ethical issues that arise in the practice of HIM (e.g. ROI, Coding, QM,etc.).

7. Seven Steps in Ethical Decision Making Step 1: Identify the ethical question (i.e.- what is the ethical question?). Look for the “shoulds”- normative questions about what ought to happen according to norms and standards.

8. The Process of Ethical Decision Making Step 2: What are the facts? (good ethics begins with good facts) Known facts Facts to be Gathered It is always tempting to avoid ethical discussion by claiming that there are not enough facts to make the decision.

9. The Process of Ethical Decision Making Step 3: What is the perspective of all stakeholders (i.e.- values at stake) ? A stakeholder is someone who will be affected by the decision to be made The patient: values accurate medical record that will be the basis of quality care. The HIM Professional: integrity is at stake if the professional is willing to violate core values for the sake of reimbursement Other health care professionals: obligations to promote welfare of patients (accurate medical records) Hospital Administrators: Should optimize reimbursement without compromising truth-telling. Society: People pay for health care and want costs controlled

10. The Process of Ethical Decision Making Step 4: What are the options in the case? Determine possible actions or strategies, alternatives, choices… Seek more information

11. The Process of Ethical Decision Making Step 5: What should I do? - Consider the best option based on core values - Seek more information: base your choice on the best available data

12. The Process of Ethical Decision Making Step 6: What justifies your choice? Provide reasons to support choice based on the values at stake

13. The Process of Ethical Decision Making Step 7: How could this ethical problem have been prevented? Are there any systematic changes that could have been made to prevent the problem from happening again?

14. Recap of Seven Steps in Ethical Decision Making 1. Identify the ethical question 2. Determine the facts in the case 3. Determine what values are at stake from the perspectives of all stakeholders 4. Identify the available options in the case 5. Determine what you should do 6. Justify your choice 7. Explore how this ethical problem might have been prevented

15. Justification in Ethical Reasoning: How do you know what is best? Most difficult aspect of ethics is deciding what you think is the best course of action and providing good reasons to support your choice. What choices are better or worse? How do you justify your actions? Ethical reasoning: apply ethical theories, and approaches.

16. Two (2) Classical Theories 1. Utilitarian Theories Jeremy Bentham and John Stuart Mill Considers the consequences of an action (or failure to take action) in terms of how the action promotes happiness Actions are right to the extent that they tend to promote happiness and wrong to the extent that they tend to promote the reverse of happiness Judges the rightness and wrongness of an action by its consequences Advantages Simplicity: only one thing needs to be considered - happiness

17. Two (2) Classical Theories  2. Deontological Theories Theories are based on the calculation of duties rather than the consequences Considers whether it is one’s duty to perform or not perform an action Immanuel Kant (famous deontological moral theorist)- If you want to know a proposed action is morally acceptable, the right question is not “What are the consequences?” but “Can I, as a rational person, consistently will that everyone in a similar situation should act in the same way?”

18. Deontological Theories (cont.) Advantages in that it supports common moral intuitions Disadvantages Inability to decide among duties when they conflict Inability to take some considerations of the consequences Seems important to break a promise if it will save them from severe harm

19. Applications of More Than One Theory Many philosophers have come to doubt that there can only be one correct theory Many philosophers believe we should use them as a guide Partial contributions to a comprehensive, although necessarily fragmented, moral vision Utilitarianism examines consequences Deontological analyzes the duties involved, the duty to tell the truth, and the accuracy and integrity of the medical record

20. Four (4) Current Ethical Approaches # 1. Principle-based Analysis Four core ethical principles Beauchamp and Childress’s Principles of Biomedical Ethics (1994) Respect for autonomy (means self-determination) Nonmaleficence (not harming others) Beneficence (promoting good) Justice (treating others fairly)

21. # 1. Principle-based Analysis (cont.) -- Principles are helpful in understanding ethical issues in professional practice and drafting policies regarding ethical issues. -- Strong reliance on rules and duties and dealing with patients and other strangers More important to avoid harm than it is to promote good

22. # 2. Analysis of Rights Based on the consideration of whether an action affirms or violates human rights Moral Discussion, especially in the U.S., occurs using the language of rights A right is an especially powerful moral claim that others are obligated to respect In health care scholars debate a right to die, a right to life, and a right to health care

23. Analysis of Rights (cont.) Advantage Rights-based approaches are simple to apply Disadvantage People disagree about which claims are determined “basic human rights” Causes much debate: some people believe there is a certain right to choice and another party believes that there is a certain right to life

24. # 3. Ethics of Care Based on what action best supports the relationships of the parties involved Emphasize the importance of focusing on the patient and the professional in context of his or her relationships Considers the emotional commitment and willingness of individuals in relationships to act unselfishly for the benefit of others Values sympathy, compassion, fidelity, discernment, and love Has lack of a well developed basis for providing justification for courses

25. # 4. Virtue Based Ethics Emphasizes how the action expresses and shapes the character of the person who performs it Closely associated with ethics of care A virtue is a habit of behavior in a good way Emphasizes the agents who perform actions and make choices What would the good HIM professional do? It looks at feelings, motivations, duties, and not only actions but at character as well

26. When confronted with an ethical dilemma …… 1. Talk with trusted colleagues and get advice. 2. Approach the problem through the proper channels and document your efforts. 3. Frame issues for the institution in terms of shared values and the AHIMA Code of Ethics. 4. Appeal to professional sources as necessary. 5. Address the issue in some way rather than letting it go on unaddressed. Apply 7 steps of ethical decision making. Justify ethical reasoning through theories and approaches.