Ethics usually deals with questions of right and wrong, good or bad at all levels. Its subject constitutes key issues of practical decision making, with the inclusion of the nature of ultimate values and principles by which human actions can be determined whether to be right or wrong (Boylan, 2014). Medical ethics, on the other hand, incorporates taking a closer look at specific issues, usually clinical cases, and utilizing sense, values, and facts to choose the best course of action. A few ethical issues tend to be quite straightforward, but others can prove to be rather complicated, for instance, choosing between two rights, or choosing between two distinct value systems (Grainger & Ozolins, 2015).
According to a recent Medscape research, a number of issues were identified where some doctors held differing opinions. These were getting romantically involved with a family member of a patient or the patient themselves, not revealing mistakes, prescribing placebos, dropping insurers, and reporting impaired workmates (Goetz, Rotman & Bishop, 2015). Other cases included not providing treatment to meet a company’s budget, and taking money from device manufacturers or pharmaceuticals. Although expert principles are considered a way of providing some guidance in terms of ethical issues, they cannot always address every single problem. They may also not be able to address troubling nuances, such as bringing together two disagreeing values (Boylan, 2014).
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Discussion
Basic principles to deciding ethical issues
It is common for some physicians today to think of medical ethics as a mysterious field which is separate from the practical considerations in clinical practice. However, there are some very practical relevance and implications. Medical ethics should, therefore, be taken seriously because it would help uphold a clear conscience, resolve disagreements between physicians, patients, and families, uphold respectful associations with other clinicians, ad uphold the respect of one’s patients (Grainger & Ozolins, 2015). In deciding ethical issues, most experts generally recommend 4 main principles or values which are non-malfeasance, beneficence, autonomy, and justice. Beneficence is whereby procedure is provided with the aim of doing what is best for patients involved. It also demands that healthcare providers uphold and create knowledge and skills, regularly update training, strive for net gain, and consider personal circumstances of all patients (Grainger & Ozolins, 2015).
Under autonomy, patients have the independence of action, intention, and thought while making decisions about healthcare practices. This means that the decision making process must be free of coaxing or forcing Goetz, (Rotman & Bishop, 2015). It is important that patients understand all the advantages and risks involved before making a complete informed decision, in addition to the possibility of success. Non-malfeasance requires that a process does no harm to the patient involved or those in society. In some instances, it is hard for physicians to victoriously apply the ‘do no harm’ principle (Boylan, 2014). On the other hand, the notion that the advantages and burdens of experimental or novel treatments must be dispersed evenly among all groups in society is what is referred to as justice. It requires that processes maintain the spirit of present laws and are fair to all persons involved. Health care providers must keep in mind four main regions when assessing justice, and these are competing needs, possible disagreements with created legislations, rights and obligations, and equal dispersion of scarce resources (Grainger & Ozolins, 2015).
It should be noted that medical ethics is not restricted to these 4 principles. Others such as honesty, showing respect for patients’ own values, and showing respect for families and patients, are also values for deciding ethical problems (Goetz, Rotman & Bishop, 2015). Additionally, medical ethics is not simply a thought procedure but incorporates individuals’ skills. From what has recently been observed listening skills are an important part of medical ethics, especially since a majority of ethical disagreements stem from not knowing all facts or not providing the relevant facts to patients. If doctors go through proper ethical thought procedures, they tend to have greater certainty that what they are doing is actually the right thing. As the healthcare system changes, ethical decisions are more challenging. That is why making ethical decisions should take more time and a more deliberative style (Boylan, 2014).
Medical ethics, religion, and morality
Medical ethics is quite different from morality in that while the former utilizes convincing methods to get its message across, the latter follows a particular belief system or code of conduct (Grainger & Ozolins, 2015). Morality also depends on authorities such as the Bible, to rationalize its message, but does not only involve religion. It can also be personal or political. Medical ethics, on the other hand, has an adjustable set of solutions and is founded on sense and facts, not religious doctrines. It is possible to have religious faith and political ideas, but physicians will need to put them aside when offering and creating ethical opinions to patients who are not of the same notion of personal morality (Goetz, Rotman & Bishop, 2015). Ethical choices must respect the attitudes and principles of patients.
Fulfilling a patient’s wishes tend to have a practical outcome. Physicians who generally overrule patients end up witnessing their treatments fail since the patients fight them the whole way. Notably, patients who are overruled do not often tell the truth. It is common or patients or their families to come into conflict with the doctor when an ethical decision is not considered the right one (Boylan, 2014). A good illustration is when, say, a patient from Southeast Asia has a clubfoot that can easily be managed, but the family members do not allow treatment because they believe God has ordained the condition. The healthcare providers are right to prioritize the patient’s health, and so may go to court to get an order for the operation.
The outcome is considered horrendous, and the family members feel that the patient has lost favor with God, thus end up abandoning him/her. In such cases, the healthcare providers will have won, but lost favor, trust, and respect with the family (Grainger & Ozolins, 2015). Even though doctors need to respect their patients’ beliefs, their own values should not influence or affect their decisions. This means that they should not allow the religious faith and conscience to automatically overrule a patient’s need to get the most appropriate treatment possible (Goetz, Rotman & Bishop, 2015). Notably, the patient’s needs should be a priority before the physician’s principles. Therefore, healthcare providers are expected to put aside their beliefs and concentrate on the greatest interests of the patient. Where a doctor cannot bring themselves to treating a patient, they must find another doctor capable of doing it.
Medical ethics and effects on cost control
Cost control need to take a central place in daily healthcare ethics program. The regularly rising cost of healthcare also needs to be controlled if people are to have a sustainable system of superior quality healthcare for all (Boylan, 2014). The level of healthcare spending particularly in America is continuously dragging the nation’s economy while threatening future development in health costs. Healthcare prices tend to be rather opaque, and both doctors and patients are in the dark about them. Furthermore, the cost of delivering healthcare is hidden in layers of terminology and complicated accounting. The cost to healthcare providers is usually calculated with the inclusion of costs from groups like equipment and personnel that may appear not linked to an individual patient’s care Goetz, (Rotman & Bishop, 2015).
In healthcare organizations, experts, and American culture, the health risks and waste incorporated in doing more than necessary is not highlighted. There are no guidelines with a firm enough logic and with enough clarity to help healthcare providers, payers, and patients in comprehending the distinctions between what is extra and what is actually needed (Grainger & Ozolins, 2015). There is also no regular emphasize on control of healthcare costs as an important ethical responsibility. The ability of individuals to receive the necessary care and treatment is closely linked to the cost of healthcare. Notably, if the cost of healthcare increases rapidly, more and more individuals will no longer be able to afford the treatment they need. (Boylan, 2014).
Nothing in medical ethics has received more focus in the last 4 decades than patient rights. The ethical responsibility to control costs in treatment of individual patients does not necessarily mean withholding treatment that would otherwise provide real advantage to the patient for the simple reason that it is costly, or to save resources (Grainger & Ozolins, 2015). Doctors and healthcare organizations in general should realize that the medical ethics of controlling cost of treatment starts with the pointless expansive treatment and needless treatment. Any belief that treatments are a waste of resources should not be founded on the cash involved in a course of treatment, but rather on a consideration of the association of the cost to the anticipated medical gain (Goetz, Rotman & Bishop, 2015).
In order to contain increasing healthcare costs, doctors need to participate in bedside allocation. This refers to a doctor’s actions to hold back advantageous care from a patient that doctors were free to offer them (Boylan, 2014). However, most doctors together with ethicists have rejected this particular reasoning in the belief that doctors must support the individual patient even if it means going against the obvious interests of society as a whole. They argue that it will disrupt the main trust between doctors and patients. Although this particular word is avoided, the healthcare organizations do not have implied rationing in the healthcare system, and that is why controlling increasing costs is significant. And as stated earlier, better health care does not necessarily imply the least costly care. Providing patients with the necessary care may require advance investments.
It is unfortunate to realize that most doctors do not really know the cost of the treatment alternatives they discuss with their patients. Humane, ethical patient care can be effective business and there need be no actual disagreement between the two (Grainger & Ozolins, 2015). Most research indicates that cost effective systems usually have positive outcomes. However, it is difficult to make a case that physicians are being unethical to families and patients if they put into practice a more proportional research-based care and effectiveness (Goetz, Rotman & Bishop, 2015). Doctors who are educated in identifying marginally advantageous services are able to make ethical and informed choices about how best to treat their patients (Boylan, 2014).
Conclusion
Health organizations today must acknowledge that improvements in healthcare make it possible to provide chances for all individuals to lead healthier, better lives. This makes the rate of increase in healthcare spending the single most significant factor which undermines long lasting financial conditions. Increasing pressures to control costs tends to necessitate that restricted healthcare resources be utilized judiciously and fairly. Healthcare costs must be correlated with superior quality and effectiveness in service delivery so as to improve health results. Therefore, healthcare organizations must understand the efficiency and advantages of clinical processes, acknowledge key drivers of healthcare costs, and determine how best to achieve savings without ethically offending anyone. Healthcare providers should also consider the four main principles to deciding ethical issues.
References
Boylan, M. (2014). Medical ethics . 2 nd Edition. Malden, Mass.: John Wiley & Sons.
Goetz, C., Rotman, S.R., & Bishop, T.F. (2015). “The effect of charge display on cost of care and physician practice behaviors: A systematic review.” J Gen Intern Med ., 30(6). Pp. 835 – 842.
Grainger, J., & Ozolins, J. (2015). Foundations of healthcare ethics: Theory to practice . Cambridge: Cambridge University Press.
