Expert Comments on Ethics in Health Care

Patient confidentiality is an anticipated right that dates back to the Hippocratic Oath … What I may see or hear in the course of the treatment … I will keep to myself … However, on any given television channel we can follow reports of a pop star’s mental status or an actor’s autopsy report and use of medications. Furthermore, whether you are in a 21st century tertiary university hospital or a rural doctor’s office, medical and health information is collected, analyzed, stored and shared through a variety of distribution methods from telemedicine to elevator conversations.

What kinds of ethical challenges does this instantaneous communication present for health care professionals concerned? How are clinicians and administrators able to balance the need for access against the right to privacy in today’s world? Do governmental mandates and regulatory guidelines or agencies such as HIPAA or JCAHO insure patient privacy?

Ethics was around before current social methods to ensure compliance and enforcement, according to Kenneth Goodman, Ph.D., Co-director of University of Miami Ethics Programs and an expert in bioethics and information technology. Dr. Goodman is an associate professor in the university’s Department of Medicine and routinely wrestles with these ethical dilemmas. His U.M. program has received a Robert Wood Johnson Foundation grant for work on ethical and legal issues related to the use of personal health records (PHR), devices that allow patients and clinicians to collaborate in the collection and review of health data.

“Doing the right thing needs to be part of the institutional and professional culture,” he said, “even though policies and procedures are vital to help guide best practices and maintain compliance with all regulatory directives.”

Given that, he notes three must-haves for 21st century health care professionals as outlined in numerous courses, seminars, conferences and campus-wide ethics discussions:

1. adequate security and safeguards
2. policies and procedures to guide behavior and interpret and measure compliance
3. ethics education and modeling to teach that privacy is not a courtesy but rather a guarantee.

In clinical settings, safeguards include everything from physical locks on the doors and computer passwords to administrative policies, procedures, and training on how to share medical information and maintain confidentiality.

Health workers need broad access to a patient’s record, and safeguards may, at first glance, be relegated to the purview of physical security officers and computer technicians. However, Goodman advises that a sense of ethical stewardship is essential for anyone working in a health care environment.

Ethics Education and Modeling

Clinicians need to take a leadership role and set the professional tone for others. Goodman notes that while you can’t necessarily train someone to act ethically, what you can do is cultivate the recognition that ethics should be pivotal in their decisions, so they become ever-conscious of it.

For example, routine habits, such as hospital conversations promote ethical ramifications.

“If professionals are casual about privacy, such as holding loud conversations about patient outcomes in the cafeteria, that sets the standard for others to adopt, no matter what the policy states. Clinicians cannot ignore the benefits of shared communication; however, they need to take reasonable steps to minimize incidental disclosure,” he explains.

South Florida Sets the Pace for Ethical Modeling

South Florida is ahead of the curve regarding ethical discussion because it is an incubator for sizeable and juicy ethical challenges. As a result they have fostered a robust ethical mediation resume designed to help solve clinical problems.

Dr. Goodman notes that demographics and location provide for a variety of ethical challenges for health care professionals. South Florida is home to a large elder population which presents a plethora of end-of-life issues to tackle. It also has a significant indigent demographic which raises access-to-care issues and it hosts an increasingly diverse population which poses cultural and/or religious differences in health care delivery. Finally, geographically it provides opportunity as a port of entry for pandemics and bioterrorism with questions of quarantine, rationing and allocation of health resources in a disaster.

Hospital Ethics Committees

Goodman views the functionality of a hospital’s ethics committee as an important metric in determining the intrinsic value of ethics within the organization. Evidence suggests that if the ethics committee is sanctioned to engage the board, managers, medical staff and employees to foster ethical clinical and business decision making, there will follow an attending incidence of reduced compliance risks.

“When hospitals make an across-the-organization commitment to invest in ethics, it becomes everyone’s responsibility – from boardroom to bedside – to incorporate ethical values into professional practice,” he summarized.

If hospitals create and promote ethical cultures within their walls they protect the wellbeing of patients, foster the healing process, and help patients and families cope with disease.

“A well-oiled ethics committee provides a fundamental forum for reflection on important moral dilemmas that arise in modern life and promotes the incorporation of ethical values in personal life, professional practice, and community development,” Goodman said, “A happy residual is reduced liability.”

Dr. Goodman, who chairs the adult Ethics Committee at Jackson Memorial Hospital, as well as the ethics committee for the American Medical Informatics Association, directs the statewide Florida Bioethics Network and has written numerous articles in bioethics, the philosophy of science, and computing.