The healthcare center where I am employed is in an academic setting and we are not affiliated with another medical facility.  Recognizing the importance of an organizational code of ethics and it being my responsibility as director to implement the policy and a process to monitor compliance, where do I start?  If I include each clinical profession's code of ethics, the ACHE code of ethics, and a process for dealing with ethical issues into the existing policy and procedure manual is that enough, or is additional information needed?  What do other smaller healthcare offices do?

What do you think is the ethical duty of an HCO manager who is aware of an extramarital affair between two other HCO managers or executives?  Is the manager ethically obligated to report the affair to his/her superior?  Should the manager confront one of the people in the affair?  Or should the manager simply ignore the affair, treating it as a completely private matter?

The comments brought up are fascinating.  I wish there were answers!  It's great hearing what others are facing.  Much of my work is with patients in nursing homes.  A common scenario is the following, though sometimes the situation is infinitely more complex.  A very elderly patient is referred for evaluation after being admitted to a long term care facility.  They are agitated, depressed and somewhat paranoid.  They claim that they didn't know they were being taken to this home by the children and their children are taking their money.  The patient has some mild cognitive problems, but definitely not dementia.  The information provided by PCP indicates that these thoughts and behaviors are new.  The staff, social worker and myself have met with the family and they seem to be quite reasonable people.  However, there are certain consistencies between everyone's story and there is probably some truth to the patient's accusations.  The resident is my patient.  The family however is responsible for payment and so the customer of the home.  There's no clear neglect or abuse so Adult Protection Services won't get involved.  This scenario is played out in various forms several times a month.  I'd be curious as to your thoughts.

After reviewing the article by William Nelson, Ph.D.  on Organizational Ethics Decision Making Process, while the procedural justice process appears to be a fair process to our community, has anyone in the tutorial group ever used this process when deciding to close a program/service?  How did your community respond when asked for their input, did this lessen any ill feelings, etc?  I see the benefit with regard to community buy in and perception.  It is important to think through service/program closure s and allow time to approach stakeholders.  I like the model and will consider it as we face similar decisions at our organization.  We are seeing a decline in volume related to the economy and uninsured, etc. 

 

Jodi Beauregard

Our institution utilizes a multidisciplinary ethics committee, and has most recently developed a protocol for practitioners in assisting patients and family members with end of life decisions.  It focuses on medical end of life issues.  We have begun discussing how to approach the patients and family members with financial decisions related to end of life issues prior to "crisis" end of life decisions.  Has anyone worked with a end of life protocol that included patients and family members making and the financial aspects of end of life issues?

I know health care professionals will all soon face a huge ethical dilema.  No one issue is more devisive than abortion.  However, those people who have moral and ethical reservations about a woman's right to abort her child will no longer be given an option to not participate.  Obama's FOCA will force health care providers to fullfill without question a woman's decision to abort.

FOCA States as follows:

SEC. 4. INTERFERENCE WITH REPRODUCTIVE HEALTH PROHIBITED.

(a) STATEMENT OF POLICY- It is the policy of the United States that every woman has the fundamental right to choose to bear a child, to terminate a pregnancy prior to fetal viability, or to terminate a pregnancy after fetal viability when necessary to protect the life or health of the woman.

(b) PROHIBITION OF INTERFERENCE- A government may not--

(1) deny or interfere with a woman's right to choose--

(A) to bear a child;

(B) to terminate a pregnancy prior to viability; or

(C) to terminate a pregnancy after viability where termination is necessary to protect the life or health of the woman; or

(2) discriminate against the exercise of the rights set forth in paragraph (1) in the regulation or provision of benefits, facilities, services, or information.

(c) CIVIL ACTION- An individual aggrieved by a violation of this section may obtain appropriate relief (including relief against a government) in a civil action.

How can this law remove any consideration of the ethics process  and the moral and ethical reservations from that of the health care provider from the equation?  Nelson did state that an issue may be legal; however, it does not mean it is ethical.

I am curious what the thoughts of my collegues on both sides of the fence think of FOCA and the ethical choices it places health care workers who oppose abortion to either support it or leave your job.

Thanks

Recently, I was told this story by a colleague:  A manager had been approached by leadership to terminate an employee.  Later that week, the employee approached the manager and provided some facts about one of the leaders which, shall we say, would not read well in the headlines.  The manager was fearful that the leaders information would be smeared if the employee was terminated.  However, the other side of the story was that the manager was disgruntled, frustrated with leaderships "lack of leading effectively".  Years of being "passed over" and lack of support from leadership had the manager looking for positions elsewhere.  He had lost interest in his position and faith in the institution.  The manager struggled with providing leadership with the information, because he knew it would not make a difference.  In the end, the manager remained loyal to the institution, and informed leadership of the information he had available.  As leaders sometimes we lose focus, faith in leadership and become stagnant.  I wonder how many managers in the same position would make the ethical choice and how many others would look the other way.

 Here is a scenario:

You are a discussing difficult issues about particular physicians with your CEO.  You are talking about concerns the both of you have regarding behavior and patient care decisions by physicians.  Being lay people, these concerns are not founded by any overt mistreatment or adverse outcomes but the concern is what do you do now before a decision made by one of these physicians results in a negative outcome with a patient.  Do we get rid of them, do we sanction them somehow, and how does this play out when you do not have any specific breach of licensure or legality?  Confronting them would cause them to take the defensive immediately.  Then your CEO shifts gears and poses their concern of what do you with these two when they are contributing a substantial amount to the bottom line?  At first reaction the answer is never jeopardize your ethics.  But what do you do or where do you turn when you may be concerned that these matters may not be dealt with because of the physicians financial contribution until it is too late? 

Before answering please try and put yourself into this scenario completely as I feel there are many variables that go into the decision.