Ethical conflicts are inescapable in today’s healthcare setting. There are ethical implications in every aspect of the systems that affect healthcare and the way clinicians, patients and family members interact with it. Healthcare systems have a wide range of stakeholders, all with differing interests that can conflict. Political systems, economic factors, demographic changes, the influence of a culturally diverse world, and the clinical transformation that regulatory changes such as the Affordable Care Act imposes in the U.S. are just some of the factors that present challenges as well as opportunities to administrators and clinicians alike to provide ethical leadership. Diverse situations such as outbreaks of contagious diseases, decisions
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health care delivery system does not lend itself to complete autonomy on almost any facet. Beauchamp and Childress describe autonomy as “self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice, such as inadequate understanding” (Childress, 2013). The U.S. health system is the most complex in the world. Insurance coverage can be provided by an incredible number of sources. Medicare with multiple parts, Medicare Advantage plans, Medicare supplemental insurance coverage, 50 different state Medicaid plans, the Children’s Health Insurance Plan, the Women, Infants and Children Program, the Veterans Administration, the Federal Employees Health Benefits Program, the Department of Defense healthcare programs for the military, scores of employer-provided plans and their insurance companies, or by the individual insurance market. Insurance may be paid for by the federal or state governments, by employers, labor unions, or individuals. Some employers’ plans cover retirees, others do not. Some offer health savings accounts and then there are private pay patients “The result is that the system is pluralistic, mysterious, capricious and impossible for most patients and providers to understand” (Morrison, 2011). Patients do not have access to all necessary information either financial or medical or many times, even the ability to make an informed decision. The price that hospitals charge for a particular service is obfuscated. Payment methodologies, insurance contracts, and hospital cross-subsidization for the indigent all contribute to distort the amount the health services costs much less what is paid. Asymmetric information also exists from a clinical perspective. Many patients do not have the clinical background necessary to determine whether a medical procedure or test is necessary, whether defensive medicine is being practiced or whether the provider is just capitalizing on the payment
health care delivery system does not lend itself to complete autonomy on almost any facet. Beauchamp and Childress describe autonomy as “self-rule that is free from both controlling interference by others and limitations that prevent meaningful choice, such as inadequate understanding” (Childress, 2013). The U.S. health system is the most complex in the world. Insurance coverage can be provided by an incredible number of sources. Medicare with multiple parts, Medicare Advantage plans, Medicare supplemental insurance coverage, 50 different state Medicaid plans, the Children’s Health Insurance Plan, the Women, Infants and Children Program, the Veterans Administration, the Federal Employees Health Benefits Program, the Department of Defense healthcare programs for the military, scores of employer-provided plans and their insurance companies, or by the individual insurance market. Insurance may be paid for by the federal or state governments, by employers, labor unions, or individuals. Some employers’ plans cover retirees, others do not. Some offer health savings accounts and then there are private pay patients “The result is that the system is pluralistic, mysterious, capricious and impossible for most patients and providers to understand” (Morrison, 2011). Patients do not have access to all necessary information either financial or medical or many times, even the ability to make an informed decision. The price that hospitals charge for a particular service is obfuscated. Payment methodologies, insurance contracts, and hospital cross-subsidization for the indigent all contribute to distort the amount the health services costs much less what is paid. Asymmetric information also exists from a clinical perspective. Many patients do not have the clinical background necessary to determine whether a medical procedure or test is necessary, whether defensive medicine is being practiced or whether the provider is just capitalizing on the payment