Ethics in the Healthcare Field

Currently, I work at Disney World in Orlando, Florida. We have been known for our courtesy and for making every guest feel special. And we definitely have to have our own codes of ethics while working there. If I end up working in Healthcare, I want to be the most courteous, ethical doctor/nurse/health administrator there is! Obviously, that won't be easy.

Ethics is not something I could just sit here and write a "code" for. I could never think of every possible situation and provide a solution based on my personal moral values and ethics. That would be impossible. But I can say a few of the generalized ideas I have for ethics.

I feel that, in regard to patients, all people should be treated equally and fairly. No patient deserves more of my time than another, and no patient deserves to be turned away or not treated because of any circumstance, financial or otherwise. Too often I've seen people without insurance turned away or given minimum treatment, when others are given a week stay in the hospital for the same exact symptoms. I feel that, ethically, doctors and nurses should not be focused on the money. They should focus on the patient. It is the patient that means more, not money. A person's life is worth far more than anyone could ever pay to be seen in the hospital. So, one of my personal standards of ethics is that every patient should be treated fairly and ethically, regardless of the situation. I feel that we should do no harm, and that we should do our absolute best to treat or cure the patient of whatever their ailment is.

In church, as a teenager, we had a set of "values" that we recited every Sunday, that we took an oath to live by. These values were Faith, Individual Worth, Knowledge, Choice & Accountability, Good Works, and Integrity. I feel like these values can be used in the medical field, just as in religious settings.
-Faith: As a healthcare professional, you need to have faith in yourself, in healthcare, in your team, and in medicine. If you doubt yourself or medicine, a patient is not going to receive the best care possible, which would be unethical.
-Individual Worth: As a medical professional, you have to know your own self-worth, as well as how valuable another person's life is. Everyone is here for a reason, and everyone serves a purpose. Keeping that in mind can help you make more ethical decisions as a doctor/nurse/etc.
-Knowledge: Having the knowledge from school and knowing how to apply it to work is important. But you also learn new things everyday, especially in the medical field. Having a good working knowledge will help you act more ethically. You won't do anything that you aren't knowledgable about.
-Choice & Accountability: There are tons of choices a healthcare professional will make every single day. And they need to hold themselves accountable for their actions and choices. If you do something wrong, own up to it. It is more ethical to own up to making a mistake and learning from it, than to put the blame on someone else (the patient, another physician, etc.)
-Good Works: Always go out of your way to provide superior service to patients. They get exceptional service at Disney World when they're healthy, why shouldn't they get the same (or better) at the hospital when they're sick? Ignoring patients, not speaking to them on their level, not checking on them unless it's absolutely immediate, etc. are all examples of poor ethics. But doing good works for your patients would be very ethical and would make the patients much happier and heal quicker.
-Integrity: This one seems to be included in all ethical discussions. Always be honest, no matter what. Stealing, lying, cheating...all poor ethical decisions. Have good integrity, and you'll be much more ethical.

So, if I were to go into the healthcare field, I'd take these values with me. I'd look for another coworker to be a role model, and I'd follow my organization's code of ethics. I'd quit my job if any superior made me break any of my personal values (be dishonest, don't hold yourself accountable, just guess, etc.). Putting the patient first is a big priority for me. I will never let a patient down because of a lack of money or insurance. I definitely want to be the best professional I can be, so I'm going to stick to my values and codes of ethics.

This is my last blog entry as an HSC4652 assignment. I will probably continue updating the blog with other health-related things, so keep reading! :) Thanks for your time throughout the class, and I hope I made you think. ;)

Ethics Committees

Case for review:

Jimmy is an 11-year old boy who suffers from lymphoma.  His oncologist has indicated that without chemotherapy, he is likely to die within 6 months.  She has also indicated that in most cases, chemotherapy provides an effective cure in only 20 percent of cases like Jimmy’s; in most cases, chemotherapy produces at best an additional 3-6 month extension of life. 

Jimmy is also compromised by an incurable neurological disease.  This disease will eventually make it impossible for him to walk, talk or use his hands effectively.  Already, he speech is slurred and he cannot hold a pencil.  Even without lymphoma, the prognosis– because of the neurological disease– is death by the age of 18. 

Jimmy has been raised in a strong religious environment, and his belief in God has been an important comforting factor to him.  After having the facts fully explained to him, he has accepted his situation and the inevitability of his death at a young age.  He says he does not want the chemotherapy and that he is ready to “go to God.”  His parents, however, cannot reconcile themselves to losing Jimmy.  They want to override his decision/proceed with chemotherapy. 

Clergy/Chaplain: From a clergy's standpoint, I would side with Jimmy. If he is ready to "go to God" and has made peace with the strong possibility of death, then, as a clergy, I would support that decision. I would speak to the parents about his decision and explain that he is ready to return to God, and that it is part of God's will to listen to their son.

Jesus said, "Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these."-Matthew 19:14

 Also, the chemotherapy would likely cause bad side effects like anemia, fatigue, hair loss, nausea and vomiting, and appetite changes. I'd explain, if I were a chaplain that the boy has decided on his fate, and that it would be selfish of his parents to force him into chemotherapy. I'd also urge the whole family to pray about the decision, and let them know that no matter what ends up happening, it will be God's plan. 

Psychologist: As a psychologist, I would sit down with the entire family. I understand both points of view. The parents want to save their son and keep him around as long as possible. But the son wants to "go to God" and not have to suffer through chemo. So I would let the family know that I understand how each side feels. I'd have the parents explain to their son why they believe what they believe. Then, I'd have the son explain to his parents about his point of view. I'd try to urge the family to find a compromise. Maybe they try chemo for a short amount of time and see if it works, what side effects he gets, etc. If it didn't work well, maybe it's not meant to be. I'd urge the family to reach some sort of agreement so that there is no bitter feelings at all during the tough time. 

Technological Advances in Healthcare

The world is very different now. For man holds in his mortal hands the power to abolish all forms of human poverty, and all forms of human life. -John F. Kennedy

It's no secret that technology has significantly advanced in the healthcare industry. We have robots that can perform surgery. We have machines that can let us see inside the body. We don't have paperwork filling up doctors' offices; we have all the information stored inside the computers. With technological advances, there are benefits and disadvantages.

I have noticed, personally, that a lot has changed in my own healthcare experiences. When I was a child, my pediatrician always came in with a file folder full of papers. Now, when I visit my doctor, the nurse just finds my name in a computer system, enters my vital information, and leaves it for my doctor to make notes on. When I was in the hospital having my daughter, they brought me a tablet and I used a stylus to sign my name on the screen, instead of using a pen and papers. All of these things have been very interesting to see. I never know what is going to be new and exciting at my next visit.

One problem I have faced as a patient is the higher price of technology-based healthcare. Last year, I had a great primary care physician who was helping me find the right medication for my depression and ADHD. I saw her at least once a month to follow up. One day, I saw signs that said they were switching to digital health records. All of my paperwork was now in a computer, and I had to sign a form to acknowledge this change. I thought it was a great advancement for the office. My previous primary care physicians had already switched over to computer-based records and I found it to be much quicker and more convenient. However, about 2 or 3 months after my doctor's office switched to electronic records, I was informed that they would be shutting down the office in a few weeks. The costs ended up being too high, and my doctor could not keep up with the increasing costs. I was forced to find a new physician at a moment's notice. This is the only "inconvenience" I have personally faced, though. However, I can see that technology could potentially cause some other problems.

Of course advances in technology result in an increase of healthcare costs. Hospitals are faced with the need to "keep up" with all of the new technology and bring in the "latest and greatest" devices in order to compete with other area hospitals. There is also the chance of electronic devices "crashing" or losing information, as well as failure to work properly. However, I do believe that technology could bring our healthcare system to amazing advances and has the potential to do great things for the overall health of our world.

Any sufficiently advanced technology is indistinguishable from magic.-Arthur C. Clarke

Sick Around America

This week I had the opportunity to watch a video for the second time around, PBS Frontline's "Sick Around America". The more times I watch this particular episode, the more frightened I am about the current state of our health care system. The stories that you hear from patients and families really make you think about what needs to change in our current system.

In my opinion, the health insurance companies in our country today, are incredibly unethical. Personally, I feel that they are more concerned about profits than they are about people who really need them to survive.  Karen Pollitz describes the current health insurance system: "like having an airbag in your car that's made out of tissue paper: I'm so glad that it's there, but if I ever get in a crash, it's not going to protect me." 

These days, without a good job, it's insanely hard to get good health insurance. Without health insurance, healthcare is very expensive and many times impossible to receive. How is this ethical? 

I'd like to share a personal story about my fiancé. His name is Daniel, and since he graduated high school, he hasn't had any health insurance. In 2009, he fell down the stairs in our apartment and broke his neck. Because he didn't have insurance, he decided to just deal with it through the day. He did not know at the time that his neck was broken, just that he was really sore and had a terrible headache. After working all day, I finally called my friend to take him to the hospital. When he arrived, they were very concerned and put a neck brace on him immediately. After several tests they determined that he had a grade 3 concussion and a broken neck. He was very lucky to have survived. The hospital bills were insane, though, and we couldn't pay. A few months later, he started having seizures, major mood changes, and terrible headaches. After a few more hospital visits, he found out he had developed epilepsy as a result of multiple head injuries. Now, he has a chronic condition. He worked from 2009 until this year with a company who didn't offer any health insurance. Since his injury, he has built up thousands, maybe even millions, of dollars in medical bills. There's no way he can pay for these. And because of his chronic condition, no individual insurance companies will help him. Now, he is looking for a new job with a reputable company so he can receive a good health insurance package. But, because of the state of the economy, and the high costs of healthcare, there are far fewer companies offering full-time employment with health insurance. I work for Disney, and they've even stopped hiring full-time employees for many positions. The only reason I get full-time hours there is because I am an intern, and they don't have to offer me health insurance. 

Our health insurance system is failing us, and we need a change immediately. 

Euthanasia

This is probably the hardest topic to write about. Is it right to say when a patient should die? Is it okay to give consent to taking a family member off of life support? Is it okay to "play God" in these situations? It's a really hard thing to think about. Decisions like these are made everyday, but I honestly have no idea how I'd ever make such a decision. 

I feel that we're all here for a reason, and that we'll die when the time is right. I agree with many of the doctors in the Frontline video-that we should always offer treatments. At the point where there's nothing left to do, except keep the patient on a ventilator and/or feeding tube, that's the time when the family needs to make a decision. Personally, if I were in the situation, I'd want every treatment done. No matter how much it hurts, no matter how much pain or agony it causes, if there's any sort of chance that I'll improve afterward, I want it done. At the point where the doctors say, "She's going to be on life support. There's no further treatments we can do.", that's when I'd give the okay to let me die. But never before. I feel that allowing someone to die, without doing something that might have a chance of helping, is unfair. There are so many instances in which someone who's given 2 months to live makes it  several more years. The advances in medical technology are moving so quickly! If we were to allow everyone to die after we try one thing, we wouldn't learn much about medicine. It's those people who defeat the odds that help us advance medicine. As Jerome Groopman, M.D. said, "There's very stark and important advances that have occurred by very much chasing that tail end of the curve. Severe diseases like leukemia, initially treated with chemotherapy, might have a 5 percent or a 10 percent improvement. Some people might say, "Well, that's meaningless." Of course for the individuals in that 5 or 10 percent, it's 100 percent. But it's not only to help patients, which of course is the primary goal, but it's to learn from that and try to build on it and expand, and then move to 15 percent or 20 percent, because generally in medicine, progress, advances occur incrementally, in small steps. There's rarely a eureka moment with this dramatic breakthrough that just shifts the paradigm." 

I'd have to say that I agree very strongly with what David Muller, M.D. said in the interview on the "Big Issues" page of the website (Link below): "So that if you take someone who's 20 and has acute leukemia and is going to die, and you've got to look at them in the face and say, "Look, I've got a therapy, but it's very, very dangerous, and the percent of people who die from it is a high percent, 10 to 20 percent, which is very, very high," I think that's an easier discussion for doctors to have, and for many patients, an easier decision to make, because they've got a shot and they've got a long life ahead of them, and in a sense, the potential benefit is worth the risk.

If you have someone who's 70 or 80 or 90, and it's not just age that has to do with it; it's everything that we talked about that comes with it -- chronic illness, frailty, dependence in a lot of different ways -- and that person has leukemia, maybe not acute leukemia, maybe it's chronic, and they need to have an intervention that's very, very aggressive and might bring them to the brink of death, it's a different kind of discussion to have. But I don't think that it's about the therapy and how dangerous it is. I think it's about the context in which you have that discussion." 

So, basically, I feel that we have a responsibility as health care providers to offer any treatments necessary. But when you get to a certain point, where there are no other options, that's when it's time to discuss with the family what to do.

To me, this topic could go so many different ways. I don't have a strong opinion one way or another. It is really dependent on a case-by-case basis and what the individual wishes. It's ultimately up to the patient or the family members to make decisions. It is up to the health care provider to offer any available treatments. Personally, as a health care professional, I would never EVER give someone a lethal injection or push them to the point of death for any reason. I would take them off life support at the wishes of the patient or family, but I would never push that point of death on purpose. 

"This life in us; however low it flickers or fiercely burns, is still a divine flame which no man dare presume to put out, be his motives never so humane and enlightened; To suppose otherwise is to countenance a death-wish; Either life is always and in all circumstances sacred, or intrinsically of no account; it is inconceivable that it should be in some cases the one, and in some the other." -Malcolm Muggeridge


Links:
http://www.pbs.org/wgbh/pages/frontline/facing-death/interviews/
http://www.pbs.org/wgbh/pages/frontline/facing-death/

Blog #1: Chapter 1

Assignment: For BLOG #1, identify a theorist from Chapter 1 who you most resonated with. Provide specific examples, from your life and/or job, that mimic your theorist's basic concepts. Additionally, how can your theorist's ideas be used in healthcare?

Out of the theorists described in Chapter 1 of Ethics in Health Administration, I feel that I most resonate with Victor Frankl. Frankl believes that as humans, we are comprised of mind, body, and spirit. He also believes that each person is unique with their own unique purpose. Decisions are based upon the things you believe, are committed to, love, or because of your relationship with God. Frankl also stated that if one doesn't feel a sense of purpose, he or she will have a feeling of emptiness that they may feel the need to fill with things like alcohol, drugs, work, food, or power; but this emptiness can be resisted by a lively conscience. Your conscience, according to Frankl, does not have absolute knowledge, but tries to find the best action to take in a particular situation. I agree with all of these things.

I suffer from depression, and much of the reason is that I don't feel that I know my purpose. Not feeling like you have a purpose really does leave you feeling empty. I have started attending therapy, where I've learned how to resist the empty feeling by using my conscience. Through applying these concepts from Frankl, I've actually started to feel a lot better. I feel that I have a unique purpose, and that everything I do happens to achieve this purpose. I may not have completely been able to align with Frankl's beliefs if I hadn't had this experience with depression.

Frankl's ideas can also be applied to a career in healthcare. As healthcare providers or administrators, we should treat each person as more than just a body; they should be treated as a unique mind, body, and spirit. If you treat people as they are (mind, body, and spirit), and not just a body in your practice, they will leave with a much better attitude toward you. I know I hate to be treated as just another body coming through a doctor's office. If I'm treated with respect, I tend to be much happier as a patient. Frankl's ideas are also used in holistic healthcare. Holistic health is a concept of healthcare delivery in which a person's psychological, physical, and social health are all taken into account. To a holistic healthcare provider, people are not just bodies, but also have a mind and spirit to treat and examine. The mind, body, and spirit are all connected. This follows Frankl's idea of ethics.