Term Paper on "Healthcare -- Legal Issues Medical Ethics"

Term Paper 7 pages (2029 words) Sources: 3 Style: APA

[EXCERPT] . . . .

Healthcare -- Legal Issues

MEDICAL ETHICS and Management ISSUES

The National Practitioner Data Bank (NPDB) collects information regarding the professional competence and conduct of physicians, dentists, and other health care providers. The Fourth Amendment to the United States Constitution limits unlawful search and seizure. Aren't these two laws in conflict? Take a position either for or against the NPDB and support your rationale.

The NPDB is not in conflict with constitutional principles or with Fourth

Amendment protections against unlawful search and seizure. The Fourth Amendment protects the personal papers and effects of individual citizens, not information maintained by others relating exclusively to professional competence in regulated industries. There is no constitutional right to practice medicine; it is a privilege requiring specific academic credentials and satisfaction of state and federal licensing standards.

Provided the privilege is administrated and regulated impartially and without violations of other constitutional protections, (such as racial discrimination), there is nothing unconstitutional about regulatory entities ensuring the competence of professional medical service providers by maintaining information relevant to their competence to do so. The nature of medicine is that the industry absolutely requires efficient regulation and oversight for the health and safety of patients. That concern outweighs any privacy issues with respect to information relevant to a physician's competence and ability to treat patients safely.

2.The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has required that organizations that have a sentinel event conduct a root cause analysis to identify the basic or causal factors of the sentinel event. Explain how a root cause analysis helps resolve this issue.

Whether in healthcare or any other field involving multiple disciplines, responsibilities, and technologies, sentinel events must be analyzed to identify the root causes of failure and negative outcomes. The JCAHO performs a function analogous to that performed by the Federal Aviation Administration (FAA) in its forensic examination of aviation crashes.

Root cause analyses can disclose design flaws in surgical equipment and materials, procedure, contraindicated medicines and other forms of therapeutic intervention, as well as help refine and improve unanticipated complications and interrelationships between factors not expected to impact the success of medical treatments and follow-up care. Without a root cause analysis, mistakes and negative outcomes are destined to be repeated; with a root cause analysis, future incidents of the same kind and cause can be prevented by appropriate investigation of a single sentinel event.

3. Individuals have a right to refuse to participate in abortions and can abstain from involvement in abortions as a matter of conscience or religious or moral conviction. Should this premise be expanded to include participation in stem cell research? Take a position either pro-or con and clearly support your rationale.

Allowing individuals licensed by the government to refuse to participate in routine procedures within that practice based on their religious beliefs is a dangerous idea. One could also argue that where the industry is one that requires practitioners to be licensed by the state, allowing religious beliefs to interfere with their duties is unconstitutional. Whereas it might be understandable to allow Jews and Muslims (for example) to avoid procedures requiring them to touch porcine products (such as certain types of implantable heart valves), that is very different from allowing them to impose their philosophical objections by boycotting participation in medical procedures on others who do not share their religious beliefs.

This premise should not be expanded to stem cell research or to any other medical area. Perhaps medicine is not an appropriate career choice for people whose religious beliefs oppose certain medical procedures just as military or law enforcement careers may be inappropriate career choices for pacifists.

4.Insurance companies and major organizations are limiting health insurance coverage because of lifestyle issues, such as smoking. Should treatment for AIDS be limited because of the same issues? Take a position either pro-or con and clearly support your rationale.

Smoking is not a lifestyle issue; neither is skydiving or speedboat racing. They are choices whose consequences are known to increase the risk of serious injury, traumatic death, or deadly disease. Sexual transmission of AIDS is a natural risk associated with one's sexual preference, which is not a matter of choice. As such, it is much more comparable to obesity in that certain individuals are naturally predisposed to eating less healthily than recommended for optimum health. Limiting treatment for AIDS is no more justified than limiting treatment for diabetes among the clinically or morbidly obese.

In the case of transmission of AIDS by drug use, the activity of drug use, rather than the resulting disease (AIDS) is an appropriate criteria for coverage exclusion just the same as other dangerous choices like smoking and skydiving.

5.Compare and contrast the differences between allowing a patient the right to die and physician-assisted suicide?

Most importantly, the right to die necessarily involves patients who are already dying; physician-assisted suicide is not necessarily limited to patients who are already dying. Second, the right to die entails passive removal or discontinuation of medical treatments prolonging life; suicide (with or without the assistance of a physician) entails an affirmative act or series of acts intended to end life rather than termination of processes prolonging life.

Beyond this distinction, the Hippocratic Oath would seem to prohibit any physician involvement in assisted suicide. However, many physicians also recognize that modern technology may require a reevaluation of principles established to govern the profession long before anyone could have envisioned the degree to which quality of life issues would arise (Humphry 1991).

6. Numerous lives would be saved if more organs would be donated. Explain how this could be accomplished in the healthcare setting.

The most obvious way of increasing participation in organ donation programs would be to provide meaningful incentives, such as subsidizing some of the costs of other medical treatments in life, or subsidizing the costs of medical treatments for the family members of the deceased donor after his or her death. Similarly, tax breaks and other government benefits for organ donors could provide additional incentives for program participation.

Ethical considerations prohibit incentives for organ donation by living donors, because the economic realities of our society would quickly result in a situation where the poor would supply the wealthy with organs, as demonstrated in countries like China where such practices are allowed. However, no such ethical violations result where donor organs are provided by the deceased, particularly in connection with tangible benefits provided in return, during life.

7. Should management have the right to hire replacement workers during a strike? Take a position either pro-or con, and defend it.

As a matter of public policy, certain essential services should be protected from work stoppages caused by striking workers. Those industries would include law enforcement, military service, and other essential services such as those with the capacity to disrupt interstate commerce or travel, because the effects of work stoppages in those areas have such widespread effects on society.

The medical services industry should be protected from work stoppages for precisely this reason. In fact, this is the same rationale for requiring medical facilities with emergency departments to treat all incoming patients. The consequences to society of allowing work stoppages in contract disputes in the healthcare industry are potentially too devastating to allow.

8. Describe what should be included in a management-training program to assist managers in preparing fair and objective performance appraisals?

One of the most essential components of a management-training program is the use of objective performance criteria. Objective criteria serve several functions: they ensure that managers will conceptualize the operational requirements for success; they also help minimize the impact of personal issues on fair and objective performance appraisals.

Management-training programs often include role-play exercises as well, to further highlight the distinction between personal likes and dislike of certain employees and an objective assessment of their actual performance.

9.Much has been written about the advantages and disadvantages of Managed-Care Organizations. Take a position, either for or against the following statement: managed-care organizations have helped to control medical costs.

In principle, managed-care organizations could help to control medical costs by standardizing costs and amortizing the costs of medical treatments against the collective revenue of large numbers of plan participants exactly the way the casualty insurance industry has operated since its inception. However, the current incarnation of managed care has had the opposite effect because for-profit manufacturers of medical equipment and materials, and many service providers set prices much higher than they could ever hope to justify were individual patients responsible to pay for services. The current culture in the industry has allowed manufacturers of surgical materials and everything from bandages to therapeutic pillows to set prices so high that the effect to undermine any concern for cost by virtue of the fact that expenses are administrated by computer- assigned codes not subject to audits for reasonableness or the amount of profit those prices represent in relation to their actual value and cost.

10.Explain how a CQI process should be selected and implemented within a healthcare setting.

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