As a health care and medicine ethics keynote speaker and consultant, I have been told on what seems like a thousand occasions that there is no such thing as ethical based healthcare. I completely disagree.
When speaking on the topic of ethical based health care/medicine to physicians, nurses, therapists, paramedics, administration and many others, I have met hundreds of incredible, dedicated medical professionals who always strive to do the right thing.
It’s been a bad time
However, ethical based health care and medicine have lately taken some serious twists and turns as of late.
The FBI keeps a running “tab” of health care and medicine fraud and the result of their investigations are not pretty. To give you an example, the last 10 cases they prosecuted included:
Medical billing fraud; prescribing medically unnecessary equipment; genetic cancer screening fraud; Medicaid home healthcare fraud; medical kickback fraud; pharmaceutical fraud; North Carolina medical fraud case; opioid fraud; home patient brokering fraud and telemedicine fraud.
The acts of fraud were committed by everyone from physicians and pharmacists to nursing care facilities, clinics and hospitals.
The health care and medical ethics list above, does not include the billions stolen during the pandemic nor the billions ascribed to pharma price gouging and bribes. As a health care and medicine ethics keynote speaker, author and healthcare ethics consultant, I have seen far too many frauds and scams that could have been prevented with ethics training and follow-up refreshers – at all levels on the health care and medical spectrum.
What is ethical based health care/medicine?
Before going any further, as a medical ethics speaker, I feel it is important to find a workable definition of what constitutes ethical based healthcare. The “go-to” definition is a 2016 paper entitled: Utilitarian and deontological ethics in medicine. I will admit that it’s a mouthful.
According to the author, Jharna Mandel et. al.:
“Two strands of thought exist in ethics regarding decision-making: deontological and utilitarian. In deontological approach, outcomes/consequences may not just justify the means to achieve it while in utilitarian approach; outcomes determine the means and greatest benefit expected for the greatest number…Ethics is a crucial branch in medicine guiding good medical practice. It deals with the moral dilemmas arising due to conflicts in duties/obligations and the faced consequences. They are based on four fundamental principles, i.e., autonomy, beneficence, nonmaleficence, and justice.”
The problem with academic discussions of ethics is that if we get too wrapped up in principles and “moral dilemmas,” and not on the laser sharp focus of knowing that every choice made will inevitably result in a consequence, healthcare will continue to wallow in one scandal or fraud after another.
If healthcare is honest about “what is” a good ethical code, what constitutes proper medical ethics, my guess is that overwhelmingly providers, their support teams and the facilities in which they work, already know the best road to take. While I would agree that there are indeed circumstances around patient care that require thoughtful, nuanced ethical discussions, those situations are few and far between.
Returning to the ethical truth
Examining just two of the 10 fraud cases from the FBI list provided above, the practice “prescribing medically unnecessary equipment,” resulted in unneeded Medicare over-billings of $8.8 million and the unnecessary “genetic cancer screening” fraud over-charged hundreds of thousands. In both situations, the healthcare professionals who committed the activities knew they were being unethical.
They didn’t need complex guidelines to understand it no more than pharma companies bribing physicians for prescribing opioids or nurses filling out fake COVID vaccination cards. Despite legal wranglings, all of the parties in these cases pled guilty and are serving sentences and/or facing stiff penalties.
In every case the FBI adjudicated, the healthcare professionals were undoubtedly exposed to large doses of ethics classes. They did not work or were never seriously taken. The courses and materials gave the “students” the deontological and utilitarian choices. What is ethical based health care/medicine? It is understanding the consequences of those choices. We cannot forget that truth.
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