Caring about patients and caring about money: the American Psychiatric Association code of ethics meets managed care

Patients’ rights and professional conduct issues in hospitals’ codes of ethics

Purpose

The purpose of this study is to explore the presence of ethical standards in the content of international hospitals codes of ethics disclosed in their websites.

Design/methodology/approach

Firstly, the focus is on developing an integrated framework of universal values and hospital responsibilities for the content of hospitals’ codes of ethics documents. A list of key ethical issues was determined through an examination of the American Medical Association Code of Medical Ethics (2016), the WAMA (2017), International Code of Medical Ethics and relevant peer-reviewed journal articles (Finseschi, 1997; Vergallo, 2016; Suhonen et al., 2011; Reader et al., 2014). Based on the detailed literature review, 48 concepts, which were evenly, classified under two groups; professional conduct issues and patients’ rights. In the second stage, the issues were ranked related to professional conduct and patients’ rights from most to least frequent for the proposed conceptual framework, using World Global Hospitals codes of ethics.

Findings

It was found that only 62% of the top 100 hospitals have an ethics code report in their websites. The findings of the study have significant theoretical and practical implications. First, most of the hospitals’ ethical codes extensively emphasize professional conduct and patients’ rights, whereas they differ in what they include or exclude from their codes and the wording used. The number and frequency of the professional conduct issues is higher than patients’ rights. Emerging ethical issues, such as physicians’ and patients’ freedom of choice, sperm donation and artificial reproduction, were not widely mentioned, whereas abortion, euthanasia, human rights and transplantation issues were disregarded entirely.

Practical implications

This study provides a benchmark for hospitals to assess their codes against other hospitals’ codes in terms of the specific items they address.

Social implications

The results of this study provide a benchmark for evaluating and developing ethical codes for hospitals in light of the international health standards and norms.

Originality/value

To the best of the knowledge, no previous study has theoretically or practically analyzed hospitals’ codes of ethics.

Sensitivity to isoflurane anesthesia increases in autism spectrum disorder Shank3+/∆c mutant mouse model

Autism is a heterogeneous developmental disorder characterized by impaired social interaction, impaired communication skills, and restricted and repetitive behavior. The abnormal behaviors of these patients can make their anesthetic and perioperative management difficult. Evidence in the literature suggests that some patients with autism or specific autism spectrum disorders (ASD) exhibit altered responses to pain and to anesthesia or sedation. A genetic mouse model of one particular ASD, Phelan McDermid Syndrome, has been developed that has a Shank3 haplotype truncation (Shank3^+/Δc). These mice exhibit important characteristics of autism that mimic human autistic behavior. Our study demonstrates that a Shank3^+/ΔC mutation in mice is associated with a reduction in both the MAC and RREC50 of isoflurane and down regulation of NR1 in vestibular nuclei and PSD95 in spinal cord. Decreased expression of NR1 and PSD95 in the central nervous system of Shank3^+/ΔC mice could help reduce the MAC and RREC50 of isoflurane, which would warrant confirmation in a clinical study. If Shank3 mutations are found to affect anesthetic sensitivity in patients with ASD, better communication and stricter monitoring of anesthetic depth may be necessary.

Ethical Issues with Managed Care

With the advent of managed care, counseling psychologists are encountering vexing ethical issues. These issues arise not only for practitioners but for researchers, educators, and trainers as well. In this article, the authors briefly describe the evolution of managed care and review basic biomedical ethics and ethical decision-making models. The authors then examine specific ethical issues and offer suggestions for practice, research, and education and training. This article concludes with a research agenda, a review of projected general trends in health care delivery, and a discussion of counseling psychology’s role in addressing current concerns as well as influencing the future evolution of health care delivery.

Psychiatry in the Nazi era

OBJECTIVES

To update Canadian psychiatrists on recent information from newly discovered Berlin archives about the actions of physicians, especially psychiatrists, during the era of National Socialism in Germany and to encourage introspection about the role of the medical profession, its relationship with government, and its vulnerability to manipulation by ideology and economic pressures.

METHOD

This is a selective review of the literature on the collaboration of physicians, especially psychiatrists, in the sterilization, experimentation, and annihilation of patients with mental illness before and during World War II.

RESULTS

Directed to value the health of the nation over the care of individual patients and convinced that a hierarchy of worth distinguished one person from another, German psychiatrists were enlisted to commit atrocities during the Nazi period.

CONCLUSIONS

The values of care and compassion can be eroded; this knowledge demands constant vigilance.

The managed care experience: the social worker's perspective

The noise surrounding managed care is deafening. Clinicians all over America are gearing up for the worst. But what are the implications for social workers? A survey drawn from the NASW Clinical Social Worker Registry reveals that the influence managed care practices have on social work activities is perceived to be increasing and that social workers are experiencing ethical conflicts when dealing with primary insurers. This article explores the experience of managed care in a sample of 442 social worker clinicians and discusses the implications for ethics and social work.

Moral judgments in the rationing of health care resources: a comparative study of clinical health professionals

Social workers, physicians, and nurses from a major urban teaching hospital were assessed and compared regarding their attitudes toward the rationing of health care. Responses to eighteen statements of considered moral judgments in the rationing of health care resources were analyzed in terms of levels of agreement with each. All three professional groups rejected rationing based on patient age and socioeconomic worth. However, social workers and physicians were more likely than nurses to consider such factors as cost-benefit ratios, quality of life, relative strength of a patient's moral claim, and scarcity of resources in rationing decisions. Study findings appear to portray social workers and physicians as being more utilitarian and nurses more egalitarian in rationing decisions. Implications for practice in a managed care environment are presented.

General hospital psychiatry and the ethics of managed care

Managed care programs come in many stripes, and the field is evolving with bewildering rapidity. In order to be effective advocates and critics, clinicians need a vision of ethical managed care practice, to use as a standard for judgment and quality improvement. This paper presents four principles that I believe capture the essential stance of an ethical clinician in managed care. The central challenge for creating ethical managed care systems is integrating stewardship (communitarian) and fiduciary (patient centered) values. Because general hospital psychiatrists treat individual patients in a "communal" (institutional) setting in which issues of resource use stand out with great clarity, they will play a central role in developing ethical guidelines for managed care practice. This paper considers issues in general hospital psychiatric practice--determining hospital length of stay, deciding how much suicidal risk is tolerable in a treatment plan, and the problems that arise when patients prefer valid but less cost-effective treatments--as examples of the kinds of questions a clinically relevant set of ethics must address.

Managed care in mental health: the ethical issues

Praise and blame of managed mental health care are on the rise on many fronts, including allegations that it could adversely affect quality of care, access to care, the physician/patient relationship, and informed patient choice. Given the heterogeneity among managed mental health care organizations--each with differing practices--it is difficult to sift the ethically defensible concerns from the indefensible ones. In this paper we identify and examine the different moral concerns about managed mental health care and mark which problems have been addressed or are in need of resolution. We also identify which problems are unique to managed mental health care.