PRESIDENT'S LETTER
Ethics in Health Care Anthony M. Zacharek, MD MHA
W
e all deal with ethical dilemmas in our daily lives, whether as a physician or as a parent or a spouse. According to Filerman et al, “ethics is discussion, questioning, reasoning, or debate about morality (the right thing to do), and the terms (ethics and morality) are often used interchangeably. … More often, morally or ethically problematic situations or events are murky and have no unequivocal yes or no answer” (Filerman et al, Managerial Ethics in Healthcare, 2014). In other words, ethical issues require communication and debate in order to reach a reasonable conclusion to the issue. Imagine a patient being admitted to your hospital who is receiving a lifesaving treatment that costs thousands of dollars, and after a lengthy hospital stay, the patient
cannot afford the treatment and has no health insurance. What should the hospital do in this situation, especially if the patient needs to be admitted periodically in order to receive lifesaving care? The hospital has to try to stay financially viable in order to continue to operate, but at the same time, has the obligation to serve its community. This is just one of many examples of how ethical dilemmas arise in healthcare. In order to provide some guidance on ethical decision-making, the ACHE (American College of Healthcare Executives) has provided a six step process for approaching an ethical issue in healthcare. The six step process is the following: • Step One - recognize the background (the circumstances leading to the ethics conflict) • Step Two - identify the specific ethical question that needs clarification
• Step Three - consider the related ethical principles or organizational values • Step Four - determine the options for response • Step Five - recommend a response • Step Six - anticipate the ethical conflict This six step process is a logical way to approach any ethical dilemma. Hospital ethics committees use this process to come up with responses to ethical issues, and as Step Six suggests, there will always be ethical conflicts no matter what response you take. My challenge to our Medical Society is to incorporate ethics in your day-to-day routine of patient care and in your interaction with your colleagues. I believe an ethical approach to any healthcare issue should involve open communication with those people involved, listening, respect and a good heart.
In other words, ethical issues require communication and debate in order to reach a reasonable conclusion to the issue.
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The Bulletin | October 2021
