Blog 8: Legal Perspectives

As a business student, the topic of legal vs. ethical is not lost on me, as it is a very important topic in both the business world and the medical world. There is no clearly drawn line between the two, and this is where the problem arises. There are many activities that are completely legal, but are probably not considered the ethically correct thing to do. This is a particularly touchy subject in healthcare, as many choices a physician makes have an ethical position behind them.

Consider this: a doctor is brought up on a criminal charge of negligence, but is found not-guilty. In most cases, once the not-guilty verdict is read, the case is over. But for a doctor, the person who was allegedly harmed may turn to the civil courts to sue, saying that his unethical (but not quite illegal) actions caused the injury. A doctor is held to a much higher standard of ethics than you and I are, and for this reason, acting within the law with no regards for the morality of the decision is impossible. There are ethical codes in place at most medical institutions, and as such, doctors and healthcare administrators must research both the legality of their actions as well as the ethicality of them.

The textbook offers the case of the drunken surgeon, and the legal responsibility to remove him from the operating room. It also, however, deals with the ethical responsibility of the administrator to report this behavior, as it is very dangerous in the healthcare field. She is most likely not legally bound to report the incident, but ethically, she should.

This will continue to be a big problem as technology increases and the boundaries between legality and ethicality are blurred further.

Blog 7: Physician-Assisted Suicide

I came across an article entitled “Push for ‘death with dignity’ in Massachusetts picks up steam,” and was immediately intrigued, as this has been a hot topic for a long time. The article discussed the upcoming vote on whether or not physician-assisted suicide should be legal in the state of Massachusetts.

 

There are many people who find the topic of physician-assisted suicide a very unethical situation. They believe that no one should “play God” and that every time a physician decides to partake in this act, they are behaving unethically. These people also tend to believe that they are not doing everything in their power to sustain the patient’s life when deciding to help end the patient’s suffering. The American Medical Association is vehemently against this “death with dignity bill”, quoting the Code of Medical Ethics: “Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer. Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life … in order that these patients continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy and good communication,” (O’Reilly, 2012).

 

On the other hand, some believe that they are committing the ultimate sacrifice by helping the patient end their suffering. I tend to fall on this side of the argument; if a patient is terminally ill and is suffering all of the time, I have no problem with physician-assisted suicide. It is not something the patient can do on their own, and it is their body, and therefore their decision. From this side of the argument, one could also look at the Medical Code of Ethics, as it is more-or-less about putting the patient’s needs first. It appears that a majority of residents of Massachusetts support the “death with dignity” bill, and they are hoping to follow behind Oregon and Washington.

 

Again, I support the idea of physician-assisted suicide, in that it is the patient’s decision to make, and they cannot do it themselves. It is not fair that they have to live in agonizing pain with no control over what happens to them.

 

References:

 

http://www.ama-assn.org/amednews/2012/07/16/prsc0716.htm

Blog 6: Continuance of Mini Paper 1: Human Experimentation

This week's blog post will be an addition to my first mini paper on the topic of human experimentation, with respect to drug trials. I came across an article that was similar to what I discussed in the paper, titled “Drug Trial Participants Not Fully Informed About Placebos,” which discussed one of the topics I covered in the paper. In this article, the author argues that patients should be informed about the placebo, as well as the trial drug. He stated that in most cases, the placebo is overlooked altogether, even though they often have some side effects. The “placebo effect”, as it is often referred to, can indeed change people’s symptoms, and sometimes they go away altogether. According to medical researchers at Southampton University, “they recommend that different ways of describing placebos and their potential effects should now be tested, not only where such information appears in leaflets, but also in how it is communicated by researchers and administrators who have personal contact with participants in drug trials.” 

I think this is an important distinction to make, as the “placebo effect” does exist. The doctors are so interested in promoting the trial drug and making sure the patient is fully informed that they tend to overlook what the placebo can do. These patients may believe they were on the drug the whole time, when in reality their body was reacting to the psychological effect of taking the placebo. Informed consent must go both ways; the patient should know when there is a trial drug that has some potentially negative side effects, but they should also be aware of what might come from taking the placebo, if that is the case.

Source:

http://www.medicalnewstoday.com/articles/247233.php

Blog 5: Conflict of Interest in the Workplace

While watching an episode of House today, the topic of conflict of interest came up. Dr. Cuddy, Dean of Medicine, was in the process of adopting a baby. Upon meeting the mother of the baby, she discovers she has a medical condition, so Dr. Cuddy admits her to the hospital. Once they determine what is wrong with the mother, they have to make a dramatic decision: deliver the baby prematurely and risk its health or wait for the baby to get closer to term and risk the mother’s health. Because Dr. Cuddy was invested in the health of the baby, her “medical” opinion was to monitor the mother but leave the baby for now. This, however, posed serious risks to the life of the mother. The obvious solution was to deliver the baby prematurely, as that was what the mother wanted to do, and the ethically correct thing to do. This showed a real-world example of conflict of interest, which I mentioned in a previous post.

In this case, it was inappropriate for Dr. Cuddy to be passing off her advice as “medically” relevant. Because she had a personal stake in the decision, she should have bowed out and allowed the rest of the doctors to make the correct decision.

In recent years, this has become a larger problem amongst nurses and doctors alike, often when meeting with pharmaceutical companies. One article outlines two main issues: giving out free samples to patients that have limited financial resources and attending conferences and lunches held by the companies to promote their product. In the first situation, the nurse is conflicted between helping patients and setting appointments with reps under false pretenses to obtain the drugs. While the idea is to help patients, her actions are unethical. She is taking free medication for the wrong reasons. In the other case, a doctor goes to many different pharmaceutical presentations for free lunches and enjoyable “breaks and training” from work. In both situations, the person is acting with a conflict of interest; one to help the patient, one to help himself. Either way, they are both acting unethically. Watching House made me realize that conflicts of interest probably arise often in the healthcare industry, just as this one did in the episode today.  

Source:

http://www.nursingcenter.com/pdf.asp?AID=783434

Blog 4: Sexual Harassment

The reading this week dealt with sexual harassment in the workplace, and when it interferes with people's future careers. While reading the Rolling Meadows Community Hospital, I was taken aback by some of the actions taken by the CEO, such as trips to attractive locations as a guise to spend time with the fellow. 

One thing that I wondered while reading the case was whether or not the act of sexual harassment actually occurred. This is because the legal definition of sexual harassment is “unwelcome verbal, visual, or physical conduct of a sexual nature that is severe or pervasive and affects working conditions or creates a hostile work environment.” While there is no question that there certain improprieties going on at the hospital, there is no clear reason to label is sexual harassment. There has been no relationship, physical or sexual, there had been no advances, unwelcome or otherwise, and there had been nothing to hinder their working relationship, until the end of her fellowship. Not until this point was there any sign of sexual harassment, and I don’t think this would qualify as a sexual harassment case whatsoever.

There were, on the other hand, ethical issues raised in this case. I believe these issues are what should be examined, such as spending lots of money on trips to conferences in expensive locations, fine dining, and upscale accommodations. He was spending unwarranted amounts of company money to satisfy his interest in spending more time with her, when their relationship should never have been more than mentor/mentee.

The CEO is being morally and ethically irresponsible on both a personal and professional level, and it should have been dealt with far before it came to this point. Still, the facts being as they are, I believe this is more of a gender discrimination case than it is a sexual harassment case, because had the fellow been male, this kind of situation would never have happened. It is ridiculous that he would jeopardize his career to protect himself from making poor decisions. What makes this particular case worse is that the CEO admitted that she was an outstanding fellow, and that she wasn’t being hired because a relationship might develop.

Sources:

http://www.equalrights.org/publications/kyr/shwork.asp

Blog 3: Conflicting Moral Demands

I find the topic of conflicting moral demands very interesting, as it pertains to nearly all aspects of business. When a conflict of interest arises, it can be very awkward and uncomfortable for those in charge to step in and remedy the situation. In this case presented by Perry, the administrator has no support in dealing with what appears to be a blatant violation of the ethical code. Unfortunately, the company and CEO have more-or-less fostered an environment of less-than-ethical behavior. It astounded me that everyone the COO asked for help dismissed him, as though it was too much of a bother to take on the board. It is also unfortunate that oftentimes, the person witnessing the ethical breach is not in a position to do anything about it. They are often in jeopardy of losing their jobs or being shunned by their coworkers. This makes doing the right thing very hard to actually do.

This case helps to emphasize how important ethics committees are, especially in the healthcare industry. Conflicts of interest can arise in so many different ways in that industry. They can range from what treatment to advise to which doctor should perform surgery on a patient. In this case, the ethics committee would oversee both the board and the CEO, ensuring that they are not abusing their positions. There is no reason the CEO should be able to take vacations whenever he likes at other people’s expense, and he should not use company money to hire a personal assistant.

The reading about managed care also ties into the topic of conflict of interest, as sometimes physicians will choose the more cost-effective treatment to better suit the hospital, even though the more expensive treatment option may be more beneficial to the patient. Conflicts also arise in managed care situations when doctors are financially rewarded for choosing the cost-effective method as opposed to the more appropriate method. Patients rely on their trust of the doctor, and if they were to find out that bonuses were driving the amount of time spent with them, they may begin to lose faith in their level of competence. This can be very damaging for the entire healthcare industry.

Blog 2: Paradise Hills Dilemma

As I read the case about the situation at Paradise Hills, I, too, found myself unsure of the "right" thing to do. Obviously, patients have the right to know what is going on with their treatment. On the other hand, however, if learning about a mishap like this could be detrimental to their health, maybe it should be withheld. The problem that I found to be the most concerning was the reasons some of the hospital staff gave as to why they should withhold the information regarding the radiation overdose. If the doctors made the decisions solely on the basis of protecting their patients, both physically and emotionally, this could be justified choice. This also assumes that the patients really would be harmed by learning of the accident, the way the doctors have proposed. Unfortunately, the doctors and administrators were looking out for more than just their patients; they were looking out for the reputation of the hospital and the potential loss in revenue if this were to get out. They even went as far as to joke about the potential for litigation if the patients found out.

This brings up an interesting case: supposing the decision had been made solely to protect the patients, would it still have been unethical to withhold the information? This is another question I hope to be able to answer once this class is complete. It seems to me that the hospital should have reported the misstep immediately, and been ready to handle whatever happens in response. As a physician, you are ultimately responsible for the health of the patient, and if they are unaware that they were put at risk in your care, they can’t do anything to potentially correct it. As we’ve seen in the past, high exposure to radiation can cause problems well into the future. If the patients never knew about what happened, what would they do when/if these medical issues did arise? This case is a good example of both good and bad intentions, where the bad intentions unfortunately outweighed the good.