Health Care Ethics: Your Rights as a Patient
The First Rule in Medicine
The first rule in the health care industry is to Do No Harm. This means protecting patients in a number of ways. In treatment, benefits must outweigh the risks.. Finding a good physician can be difficult, especially since there needs to be a foundation of trust in order to have this type of working relationship. A physician's decision, ethically, is supposed to be made in the best interest of the patient. Unfortunately, it is far too often where we see a breach in the code of ethics. One flaw with a code of ethics is that it is extremely broad. Although it is meant to outline ideal standards set by a profession, there can be gray areas.
"Law" is not the same as "Ethics". Doctors can't be persecuted in a court of law for certain things, however ethical conduct is taken very seriously. A breach of ethics can result in review by the licensing board or by your insurance company. Depending on the evidence presented poor ethical conduct can result in suspension of license.
Although some doctors are quite wonderful and can work wonders, others are not so dedicated. Many doctors are worried more about themselves than their patients. Patients have rights and doctors have ethical obligations to their patients.
Ethics in medical and other helping professions extend to themes such as:
1. Do No Harm
2. Know your limitations and practice within your area of competence
3. Protect your client's privacy and confidentiality
4. Do not exploit your patients
5. Maintain the integrity of your profession by maintaining high ethical standards
Knowing Your Rights
Your basic legal rights as a patient should be respected and presented to you before you see a new physician. These legal rights help to protect our right to choose, right to treatment, right to privacy, and more.
PRIVACY & CONFIDENTIALITY
Many of us are familiar with H.I.P.P.A. paperwork filled out prior to meeting with a physician. These documents protect your records and your privacy. Information pertaining to child abuse and contagious diseases is mandated to be reported to the proper authorities. However, patients have the right to have their information kept private. Specific details of HIPPA includes how the patient should be contacted, if messages can be left for the patient, and if there is anyone else the office may communicate with, such as an emergency contact, a loved one, or another physician's office. Furthermore, the patient has a right to view and obtain copies of their medical records.
CONSENT & INFORMED CONSENT
Consent simply means that a physician must obtain approval to treat a patient. Informed consent is being truthful about the treatment....The whole truth and nothing but the truth! A patient should not only hear what the physician is saying, but also understand in full detail what the treatment entails including not only the benefits but the side effects. A good doctor will listen to a patient's concerns and take the time to discuss them. A good doctor will weigh the benefits and risks of treatment and respect the client's decision about what treatment method to pursue.
Who can give consent? Adults of sound mind and married or emancipated minors should be given informed consent legally. So what about those who are minors or not of sound mind? There are special cases in which a minor's decision will be upheld in court. For example, if a pregnant girl who's mother opts for her to have an abortion, but the child refuses, in such an extreme case the court may decide to uphold the girl's decision to refuse termination.
There are religious reasons why individuals may refuse treatment.
In some instances, minors may be denied their decision to refuse treatment if they cannot comprehend the benefits and risks of treatment. For example, a child who hates needles and would rather refuse vaccinations and does not understand how important vaccinations really are, and why his parents brought him to the doctor in the first place. Therefore he is not able to give informed consent.
RIGHT TO TREATMENT
In an emergency situation a patient has the right to treatment regardless of whether or not the patient can pay for services. Doctors cannot refuse to treat a patient based on religion, race, origin, or with diseases such as AIDS.
Human experimentation has had many consequences throughout history and has largely shaped ethics of today's world. Experimentation was frequently found in asylums and prisons without any regards to a person's rights, physical safety, or emotional well-being. Any experiments in today's world requires informed consent and deviating away from the terms of the informed consent or through acting in any way that could cause harm or exploitation of a patient would be considered unethical and in most cases illegal. Risks must be minimal and should pose some sort of benefit to the patient. As with any research project involving human subjects, approval must be acquired through the Institutional Review Board (IRB).
Advanced Medical Directives
The use of a power of attorney and living will are ways in which patients can ensure that should they not be of sound mind or unable to make a decision, for example if they are in a coma, decisions can be made on their behalf based on written legislation created prior to such an event. These directives not only respect a patient's previously thought-out wishes, but also alleviates family members of the responsibility to make difficult decisions such as discontinuing life support. Medical directives go hand-in-hand with a patient's right to die if they require some form of life support.
Self-Awareness & Referrals
Practitioners of medicine need to have a high level of self-awareness in order to treat their patients. It is a fact of life that not every client is going to agree with a doctor, and it is also a fact that clients can come from different walks of life, religious background, and culture.
Although doctors cannot refuse treatment of a patient based on these traits, it is important that if a doctor cannot see past certain traits or is at an impasse with a client, that they appropriately refer their client to a physician who is better equipped or more competent to work with the client. Some clients require specialized treatment which cannot be offered by their physician. Failure to refer a client under such circumstance is highly unethical and considered negligent.
One very controversial but very real example would be in Women's Health. The topic of abortion is still a heated debate, as is the topic of cohabitation and unmarried couples. In states where abortion are legal, if a doctor refuses to terminate and by an extension of that, refuses to refer the client to a doctor who will help the patient with terminating a pregnancy, the doctor's actions would be considered a clear violation of the code of ethics and is considered to be negligent. It is understandable that some doctors may not feel morally right about certain procedure, however they are ethically obligated to provide the patient with a referral to another physician.
Another example would be a psychologist treating a patient with a different culture and is not trained in understanding what is and is not acceptable in other cultures. Trying to treat a patient under this circumstance may lead to assumptions made by the counselor, or a misunderstanding between the counselor and the patient. If a psychologist feels incapable of understanding and cannot find adequate answers through researching literature and confiding in colleagues, the best approach would be to refer the client to another psychologist who can adequately help the client to progress in a manner that is considered acceptable. Failing to refer a client in such circumstances is considered negligent.
Ethics and Confidentiality for Minors
Treating minors can be a tricky business, especially in therapy. Minors have a need for confidentiality and a way to build trust with the physician or therapist. However, the parents also have a right to information regarding the child. Prior to counseling, it is important to discuss with the child and the parents about what information will be disclosed. If a counselor refused to raise awareness about a potential for the child to harm himself or herself it would be considered negligent.
The law favors the rights of the parents over the rights of the minor. Although children have an ethical right to confidentiality, this dilemma can result in problems including incidences where the child no longer trusts the therapist.
Another important thing for therapists to understand is that typically the child in question is only part of a more complex problem within the family as a unit. In many cases, discretion is wise, especially if there is suspected mental, physical, or sexual abuse in the household.
The below video contains specific details about working with minors and their rights to privacy. This video is based on practices in Australia so it is important to review state-specific laws regarding any further questions you may have about the confidentiality of minors.
Working with minors- Video
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Today, patients have more rights pertaining to involuntary commitment. Asylums and other forms of mental institutions were quite common in which patients had little or no rights and were kept as a form of punishment, away from society. In today's world, institutionalization requires a least-restrictive environment and only after other methods fail. State laws differ, but in general, danger to one's self or others is reason to institutionalize the patient.
In some cases, a patient's health may deteriorate under these circumstances and it would be wise to consult colleagues or refer the patient to another professional for a second opinion and treatment.
Other Forms of Malpractice
As we have already discussed, failure to obtain informed consent, treating a patient without competency in specific area, failing to a refer a client after denying services or after recognizing inability to properly treat the client, and failure to control a client who may cause harm to himself are all asking for a malpractice suit. There are several other things to be aware of for patients and physicians alike.
1. Client abandonment or termination of services without taking appropriate action.
2. Sexual Misconduct
3. Use of procedures which may put themselves (the physician) at risk
4. Misdiagnosis (diagnostic incompetence)
5. Repressed or false memory of a client obtained through intervention methods which are untested or have no scientific basis
6. Transference and counter-transference such as putting the physician's personal problems on the client
I highly recommend Issues and Ethics in the Helping Professions, 8th edition for further reading. It discusses everything that I have reviewed in this article and more. This includes values, morals, ethics, and legal issues in addition to specific scenarios. This book also covers additional issues not discussed in my article. It is a comprehensive piece of literature not only for professionals but for patients who are concerned about their ethical and legal rights concerning health care.
Many of us are familiar with the legal aspects surrounding the health care industry, but are not as familiar with various ethical dilemmas. At the very least it is important to know your doctor and determine if there are any red flags. Many people wish to stay with the same doctor they have had for years despite potential problems with their care. Ask yourself...
1. Does your doctor discuss all options with you honestly and respect your autonomy or right to choose as a patient?
2. Does my doctor respect my right to privacy and confidentiality including family members who may also visit the office?
3. Does my doctor have my best interests in mind and discuss my concerns with me?
4. Does my doctor give me appropriate referrals, such as a specialist for issues that cannot be addressed here?
Understand your doctor's ethical obligations and know your rights as a patient.
Thank you for reading!