When dealing with healthcare, ethical issues are not uncommon. Almost every decision made can have ethical implications. These implications can affect patients, providers and healthcare leaders. Below are some of the top ethical issues faced in healthcare today.
Ethical Issues and Mental Health
About one in four adults2 in the United States has a diagnosable mental illness in any given year. Despite that mental illnesses are common, many people do not get the care that they need.9 This is due, in part, to the fact that mental illnesses are viewed by many including some healthcare professionals as “taboo.” The stigma14 of mental illnesses (including addictions) prompts many who suffer mental illnesses to deny that they are ill or to talk openly about what’s troubling them. Racial, ethnic, gender, and gender-identity-based inequalities persist in general healthcare contexts and are exacerbated in mental healthcare contexts.
Christy Rentmeester, PhD
Editor, AMA Journal of Ethics
Health Disparities & Community Research
There is a growing recognition that eliminating health disparities requires research that is not just community-placed, but also community-based. Academic and other non-community investigators partner and collaborate with a goal of influencing change in community health. The parties are involved in the research process from design through conduction and dissemination of results, building community participation, trust, and communication. This type of collaboration or approach is referred to as CBPR or Community-Based Participatory Research.15
John R. Stone, MD, PhD
Changing Attitudes about End-of-Life Care
Many people believe hospice is all about a peaceful death. They are not wrong in this understanding, but they are shortsighted. Hospice is far more about helping persons with advanced illness limit the harms of excessive treatment and make the most of the critical present than ensuring peace at the end. Most people believe being certain one’s life is limited by a particular set of circumstances is not an enviable position. When the end of life experience materializes, however, it carries with it opportunities and possibilities for meaning that are unmatched by any other. At the same time, hospice’s ability to advocate for this time of life is limited by reimbursement patterns and death avoidance that is persistent and profound. Yet—could this be changing? “Death Cafés”6 are springing up in many cities in the U.S. Could fear of dying in the hospital, Advance Care Planning initiatives, and the growth of palliative care be signaling a shift in cultural attitudes about facing and making the most of our finitude? Watch this short video by Nebraska Hospice and Palliative Care.5
Non-Expansion of State Medicaid Programs
A major ethical concern in the United States in 2015 is whether or not states have passed legislation to enact Medicaid Expansion.10 This aspect of the Patient Protection and Affordable Care Act is a strategy to provide health insurance access to health care for a population of individuals with less income who otherwise cannot afford health insurance. For many stakeholders (patients, family members, health providers, health organizations, state legislators, etc.), the ethical concerns are related to non-maleficence, beneficence, and social justice. Thus far, many people have gained access because of passage of this bill in 29 states. However, populations in 22 states without Medicaid Expansion are experiencing injustice compared to those populations who have access to health insurance. People without health insurance often lack access to proper health care and are harmed by delayed diagnosis and treatment as a result.
Beth Furlong, PhD, JD, RN
Ethics in the Outpatient Setting
Though often less urgent and critical than those encountered in the hospital, ethical issues are increasing in the outpatient setting. There are several reasons that ethical problems encountered in the outpatient setting need attention. First, the sheer number of patients who presently and potentially receive care outside of the hospital or other institutional setting is rising. For example, the Medicare Payment Advisory Commission12 reported that hospitals who are paid under the Medicare prospective payment system received $167 billion for 10.1 million Medicare inpatient admissions and 196 million outpatient services in 2013. Second, ethical issues that arise in outpatient settings present unique challenges. A new model of ethical decision making will be necessary because of the lack of control that health professionals exercise in the outpatient setting, communication challenges, shorter interactions with patients and families, and geographic disbursement amongst clinicians to name a few. Bioethics Beyond the Bedside4 is a podcast series dedicated to raising awareness about the ethical issues encountered in the outpatient setting, which is the first step in identifying trends and expanding ethics resources outside the hospital context.
Physician Assisted Suicide and Euthanasia
Physician assisted suicide (PAS) and euthanasia are hotly debated topics in bioethics. Ever since Oregon1 legalized PAS in 1994, Washington7 and Vermont11 followed suit and Montana13 decriminalized PAS by judicial verdict. The Canadian Supreme Court16 did the same earlier this year. In 2014, Quebec3 legalized both PAS and euthanasia. Many US states are presently debating similar bills. While differing significantly in terms of the conditions set for legalized PAS, these bills all restrict the practice to physicians. And yet it is not at all self-evident that physicians are the only ones competent to provide such assistance. Moreover, why is it that physicians are so readily entrusted by the public at large with this awesome power?8 Conversely, the World Medical Association17explicitly prohibits its members from engaging in PAS and euthanasia, considering them incompatible with the physician’s role. It is a topic that merits much more research and reflection.
Find Out How You Can Influence Ethical Outcomes
Creighton University’s Online Health Care Ethics programs admit highly accomplished practitioners from across the globe looking to expand their area of competency to include medical ethics and to enhance their ability to make informed decisions in complex situations. Do you want to make a difference in today’s healthcare and address the ethical issues discussed above? Request more information or call 866.717.6365 to speak with a Program Manager and learn more about our online graduate programs.
1"Annual Reports." Annual Reports. N.p., n.d. Web. 06 May 2015. http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ar-index.aspx.
2"Any Mental Illness (AMI) Among Adults." National Institute of Mental Health. N.p., n.d. Web. 05 May 2015.
3"Bill N°52 : An Act Respecting End-of-life Care - National Assembly of Québec." Bill N°52 : An Act Respecting End-of-life Care - National Assembly of Québec. Aseemblee National Du Quebec, n.d. Web. 07 May 2015. http://www.assnat.qc.ca/en/travaux-parlementaires/projets-loi/projet-loi-52-40-1.html.
4"BIOETHICS BEYOND the BEDSIDE:." Podcasts. N.p., n.d. Web. 06 May 2015. http://www.creighton.edu/chpe/podcasts/.
5"Community Outreach Video | Nebraska Hospice Palliative Care." Nebraska Hospice Palliative Care. YouTube, n.d. Web. 06 May 2015.
6Death Cafe. N.p., n.d. Web. 06 May 2015. http://deathcafe.com/.
7"Death with Dignity Act." Washington State Department of Health. N.p., n.d. Web. 07 May 2015. http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct.
8Have, H. Ten., and Jos V. M. Welie. Death and Medical Power: An Ethical Analysis of Dutch Euthanasia Practice. Maidenhead, England: Open UP, 2005. Print.
9Horwitz, Allan V. "The Epidemic in Mental Illness: Clinical Fact or Survey Artifact?" Contexts 5.1 (2006): 19-23. Web.
10"An Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion." An Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion. N.p., n.d. Web. 06 May 2015. http://kff.org/medicaid/fact-sheet/an-overview-of-actions-taken-by-state-lawmakers-regarding-the-medicaid-expansion/.
11"Patient Choice and Control at End of Life." Vermont Department of Health, n.d. Web. 07 May 2015. http://healthvermont.gov/family/end_of_life_care/patient_choice.aspx.
12"Report to the Congress Medicare Payment Policy." Executive Summary. N.p., n.d. Web. 6 May 2015. http://www.medpac.gov/docs/default-source/reports/mar2015_entirereport_revised.pdf
13"State Of Montana and Steve Bullock." In The Supreme Court of The State of Montana, N.D. Web.
14"Stigma of Mental Illness." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 04 Oct. 2013. Web. 06 May 2015.
15Stone, John R., PhD. "Ethics and Community-Based Participatory Research." Focus 32.118 (2011): 9-16. Center for Health Policy & Ethics. Creighton University. Web. http://www.creighton.edu/fileadmin/user/CHPE/Focus_pdfs/spring-2011.pdf.
16"Supreme Court Judgments." Carter v. Canada (Attorney General). Judgements of the Supreme Court of Canada, n.d. Web. 07 May 2015. https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do.
17"WMA Resolution on Euthanasia." WMA Resolution on Euthanasia. World Medical Association, Inc., n.d. Web. 07 May 2015. http://www.wma.net/en/30publications/10policies/e13b/index.html.