(Part 2 of an ongoing series)
In speaking to groups of healthcare professionals, there is a general consistency in response. As a healthcare ethics speaker, healthcare ethics consultant and author, the top seven areas of concern include:
Creating a balance between quality of care and the competency of staff; addressing difficult end-of-life decisions; provider and patient confidentiality; equitable access to treatment; the allocation of limited resources; organ donor allocation and reporting unethical behaviors to authorities.
Not surprisingly, the breakdown in terms of percentage of provider concerns is rather flat suggesting relatively equal weight to the issues.
To answer the question of what are some examples of ethical issues in healthcare? is relatively easy; to examine the reasons behind each concern is relatively complex. If, for the sake of this ethical discussion, I was to single out but one issue: reporting unethical behaviors to authorities, it would be the equivalent of writing a book. Nevertheless, let me probe the topic a bit. Not unexpectedly, fear is involved.
A menu of unethical behaviors
As a healthcare ethics speaker, healthcare ethics consultant and author I know the fears behind reporting. As excellent background material, let me recommend a somewhat dated (but still relevant) study from Annals of Family Medicine (2015). I am afraid (and I have heard this from many healthcare providers) the pattern is set in medical schools. From the study:
“First, there are barriers to reporting unprofessional behavior within medical schools including fear of retaliation and lack of mechanisms to ensure anonymity. Second, deans and directors do not want to look for unethical behavior in their colleagues. Third, most of us have learned to take disrespectful circumstances in health care institutions for granted. Fourth, the accreditation of medical schools around the world does not usually cover the processes or outcomes associated with fostering ethical behavior in students.”
Sadly, the patterns follow healthcare professionals out into practices, healthcare systems and hospitals. When unethical behavior is ingrained, everyone suffers. Again, not surprising, the reasons for not reporting are remarkably similar to business ethics behaviors in many other fields from accounting to manufacturing to nonprofit associations.
It is not so much a question of citing ethical issues in healthcare, but breaking the cycles.
There have been studies done on gender discrimination and sexual harassment in medical schools. It should be the last thing a medical student needs to worry about, but it often isn’t. The same discriminatory patterns have also been noted on issues of race and religion and again, it is underreported for fears of retaliation and a lack of respect for the privacy of the student making the complaint.
Why bother?
An unintended side effect of fears of reporting unethical healthcare behaviors is often a lack of empathy. It is human nature. A healthcare provider might believe that because they were never listened to or respected, why respect other colleagues, subordinates or even patients in the “real world?”
It is easy to shut down, easy to judge and mock, and quite easy to be less compassionate and more detached. We are not talking about mechanics or carpenters here, but healthcare professionals who shrug off other professionals or individuals seeking their help. They distance far beyond professional detachment into a realm of disinterest.
The “cure” to this is a shift in ethical training and a demand for ethical accountability throughout the system. As a healthcare speaker who is in the trenches, so to speak, I am privy to the confidences of professionals from medical schools to researchers at Big Pharma who crave – and need – backup from those in authority.
There is no end to brain numbing classes and yammering, required podcasts. What is needed is more training to allow professionals to stand up for themselves and a mechanism to replace those who stand in their way.
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