Legal Implications

A simple definition of ethics, in any field, is what should be done. Law is the established social rules for conduct; a violation of law may create criminal or civil liability. While sometimes the two cross paths they are not always interchangeable. For example Law is derived and expressed through:

·         federal and state constitutions

·         federal and state statutes

·         federal and state regulations

·         federal and state case law

While on the other hand Medical Ethics is derived and expressed through:

·         law

·         institutional policies/practices

·         policy of professional organizations

·         professional standards of care, fiduciary obligations

Quite often ethical decisions are not enforced by legal actions and matters.  For example, in a case involving Paradise Hill Medical Center, 22 oncology patients received excess radiation treatment, the board, CEO, physicians, and management had to discuss whether to inform those patients of the error or not. In this case the decision was not going to result in a legal matter but is definitely testing the ethics and morals of those in charge of making the decision. By choosing not to inform the patients would be unethical but these doctors are not going to go to jail or lose their licenses. On the other hand, because they did not adhere to the ethics committee decision regarding this matter, they could potentially be held responsible and be punished by the hospital or even lose their jobs.

While legal decisions are not always ethical decision, ethical decisions are most often legal. This separation puts those with high responsibility in positions held up by higher standards than just legal standards and forces them to act ethically as well.

Patient’s Perspective

In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other treatment such as surgery. Adverse events can be either clear cut errors or minor errors that may never have any effect. The perspective of the patient is absolutely not important when it comes to determining whether an adverse event has occurred to a patient. Physicians usually know when something has gone wrong or an adverse event has taken place. In this case, patient perspective is only important and necessary when considering the magnitude of this event.

Quite often, a patient can be unaware of an adverse event occurring. It may be because of the patient being impaired by drugs or having a late reaction to some negative treatment.  Many times patients could go days if not weeks without noticing any problems, which could turn into a major problem down the road for not only the patient by for the physician as well.

Physicians should always be aware of any possible human errors when treating a patient, whom they should take into consideration anytime that treatment has been given. They should make the patients aware to look out for any possible side effects that could result from these errors and be prepared to treat them if they were to occur. Often times, the error could be so blatant that both parties would know right off the bat. While the patient’s perspective is not important that the error has been made, in this case the outcome will always be a result how extreme or negatively the patient feels about the error.

Quality in Truth

In a case study of the Paradise Hill Medical Center, where 22 oncology patients received excess radiation treatment, the board, CEO, physicians, and management had to discuss whether to inform those patients of the error or not. Without even going into detail about the discussion, my only thought while reading this chapter was of course you have to tell them, because it’s the right thing to do!

The physicians’ first argument was that these cancer patients did not want or need any more bad news. They also said “Informing the patients of this error will only confuse them and destroy their faith and trust in their physicians and in the hospital. Yet they also agreed that they did not know what kind of effects would come from the excessive radiation. In my mind, how does anyone have the right to assume they know how a patient will react or what they will think from the news they are given, especially when the hospital does not even know whether negative results will occur from the excessive radiation or not? Every patient should be given the right whether to trust their physician and hospital or not and should be fully informed while making that decision. No patient should be deceived into trusting anyone, especially someone in charge of their health. Maybe this specific hospital has had a string of errors or has been found negligent in similar instances. These patients should be able to decide whether to continue with them or not based on all of the information.

In another argument, by the chairman of radiology, was that informing the patients would just be asking for malpractice litigation. But to counter this, in a recent article in the Annals of Internal Medicine, they cite a study who found that of 127 families who sued their healthcare providers after perinatal injuries, 42% were motivated by suspension of a cover-up or revenge. With the amount of healthcare member of the hospital that may come into contact with any of the patients who received the excessive radiation, deciding to keep this information a secret from them may become more likely to receive malpractice litigation then an honest truthful mistake that has been communicated to the patient.

In conclusion, I think the act of keeping the error information from the patients who received the error is a hospital that is only trying to look out for itself, which is extremely unethical in a field built so much on trust between physicians and patients. Not only do I think hiding the truth is unethical but I don’t think it will benefit anyone in the long run.

What is Quality?

The definition of quality is the standard of something as measured against other things of a similar kind.  I agree with this as increased quality is basically an improvement or a better version of what is being referenced to. Many people base quality off of how much something cost or the value of it, but as you can see from our PowerPoint lecture the U.S. spends more per capita than any other country and still receives the worst scores on many of the “true” measures of quality. Those measures we scored the worst on as a country are:

·         Satisfaction with system

·         Continuity of care

·         Access to primary care at weekends/holidays

·         Out-of-pocket costs (i.e. highest)

·         Not getting necessary care and non-compliance because of costs

·         (Dis)Satisfaction with emergency room care

·         Doctor-patient relationships

·         Also relatively long waiting times for primary care appointments

In my line of work, working in the restaurant industry, a quality experience for a guest is comprised of many things. Guests are not receiving quality just by going to an expensive restaurant. Every guest need to be treated with a great deal of respect, and their service has to be received at the proper pace for them as well. Once the exceptional service is given, then you would add a nice atmosphere and excellent, fresh, high grade food and any person in any restaurant paying any price would be receiving a “high quality” dining experience

It’s just the same in the health care industry. I know anytime that I am a patient, I consider myself receiving quality care when I am treated in an appropriate time, given increased effort, given good service and treated with care and respect. I think the major problem causing the lack of quality to be laziness or un-supervision. Professionals showing these characteristic are usually the ones making the errors and causing the lack of quality in our U.S. healthcare system.