What do you think are 5 ethical issues facing physicians today? From an ethical standpoint, there has probably never been a more difficult time to be a physician than in today’s climate of rising insurance costs, malpractice claims, end of life matters, elective 
surgical procedures, social media and pharmaceutical advertising. Numerous surveys and articles have been written on what are considered the most important ethical dilemmas.
We have reviewed several reports on these ethical dilemmas and matched the more important items that they seem to have in common.
- Avoiding Conflicts of Interest – Physicians have become wary of pharmaceutical and medical equipment attempting to influence their decisions through giving gifts. Some felt they should avoid temptation altogether. In a survey conducted by Medscape Multispecialty Survey (copyright 2015), as to whether they should refuse to accept “perks” because they may affect their medical decisions, 46.8 percent of physicians would refuse or said “yes,” 36.8 percent said “no,” it would not affect them in any case and 16.4 percent said it would depend on the situation.
- Managing Issues of Moral Distress – It is a tough thing to sit at the bedside of a terminal patient and weigh whether or not to intervene in an end-of-life situation. This issue deeply affects both physicians and nurses and causes great moral distress. Physicians, after all, take an oath to preserve life and do no harm. In a survey of more than 10,000 physicians, 23.6 percent said they would give a treatment even if to prolong a hopeless case for a brief time; 37 percent said they would not; 39.4 percent said it would depend on the situation.
- Protecting an incompetent or incapacitated physician – This is a very general issue and may include situations where a physician knows of another medical professional who may be a substance abuser or physically unable to perform up to standards to due a physical or mental health ailment. In all cases, the overwhelming majority of physicians would report a colleague who fails to report him/herself. This would be true in a hospital setting where the complaint could be directed to the administration or outside of that setting where a complaint could be registered to the state board. It was agreed that the preference was that the physician who was incompetent would self-report.
- Fights over continuing care – Ethical fights frequently take place between physicians and families as to whether care should be continued in cases where the patients themselves are incapable of making a decision. This frequently occurs in situations involving the very young or the very elderly, but can apply to anyone who is incapacitated. It is an especially tough issue in the case of an incapacitated patient; for example, a young mother who has gone into a deep coma following a terrible automobile accident. In the Medscape Multispecialty survey, physicians reacted to families wanting to “prematurely” stop treatment in what appears to be a hopeless situation. About 16 percent of the physicians felt they would acquiesce to family wishes and end treatment; about 55 percent said “no,” that if they felt it was premature to end treatment they would fight the family on the matter and about 29 percent said it would depend on the situation.
- Patient Confidentiality – The one ethical issue about which every article or survey on the topic of physician’s ethical discussions includes are issues of patient confidentiality. The discussions take several forms. For example, should physicians discuss a patient’s confidential issues among one another in a non-clinical setting (For example, a casual luncheon, a golf outing or at a dinner with spouses)? Not surprisingly, if a physician determines that a patient’s health status could be harmful to those around her or him, about 63 percent would convey that patient’s condition to others, including family members.
In every one of the ethical issues confronting the physician in today’s medical landscape, it is generally agreed that the most valuable asset in helping to deal with situations is to have set policies and procedures in place. For larger offices and healthcare facilities, regular ethical training along with serious role playing is a wise way to anticipate serious situations. While no practice or facility can foresee all exegeses before they occur, having an ethical blueprint can be a tremendous help.
The question that few address in ethics or compliance training is the human motivation to make a decision that falls outside of the ethical norms. It’s easy to say how you might respond in the examples listed above, but what might cause one to change their mind or make a decision that later they might regret?
Here’s a simple example. Recently a radiation oncologist shared an ethical issue in treating a patient with lung cancer. Traditional radiation treatment (approved by his insurance), while potentially effective on the cancer, would have the negative impact of destroying a substantial portion of his remaining functioning lung leading to diminished quality of life. A more focused (higher cost treatment) would destroy less functional lung capacity and lead to improved quality of remaining life. The physician requested approval from the patients insurance for approval of the more focused treatment. Insurance reply – DENIED.
The physician then suggested that he perform the more focused treatment and bill the insurance for the traditional treatment – accepting that he and the treatment facility would eat the cost overage.
QUESTIONS: What do you think the response was from the insurance company regarding the treatment proposal? Was it ethical for the doctor to make the offer that he made? If the doctor performed the more focused treatment and billed the insurance company for the traditional treatment, would that be ethical? What do you think the outcome was?
Share your comments below and I’ll share the outcome…
