Ethics is a hot topic these days. There is a deluge of input. Home care managers do not need to be ethicists. They need to be able to identify problems quickly, and know how to prevent them. They need to understand the tools available, and to recognize the areas of risk.
Bioethics guides caregivers. It uses principles for framing ethical issues in any case. These are:
1. Autonomy - Individual dignity, self-determination, and rights. Will a particular course of action lead to anyone being used as a means to an end without regard for their individual rights?
There are two approaches in bioethics. Deontology is concerned with duty and the use of principles, especially beneficence, non-maleficence, and justice, to deal with problems. Teleology or utilitarianism is concerned with consequences and uses beneficence in seeking optimal outcomes. Bioethics asks: What should I do in regard to a patient or patients for which I have some responsibility?
Administrative ethics is concerned with how providers influence the ethics of their members, how the members influence each other and the organization, and how the members and organization deal with the community and government. It is a new branch of bioethics addressing the corporate context in which decisions are made by providers. It asks: How can a provider assure compliance with its values and ethical behavior by its members? The distinction between bioethics and administrative ethics is shown below:
* Duty to specific patients
* Duty to those served
Administrative ethics at work: There are three ways that organizations influence ethical behavior: (i) requiring performance of unethical or illegal acts; (ii) unrealistic performance expectations; and (iii) being unclear about what is ethical and offering little guidance. Administrative ethics is a framework for producing outcomes that ethically empower stakeholders and deter illegal behavior. It provides instruments to accomplish this goal. These include:
* Value statements and philosophies
An administrative ethics conflict: It is a situation in which an individual is faced with a decision that is incongruent with the provider's values or constitutes a possible violation of the law. The conflict can be the result of a policy, plan, or up-line mandate. It is an sign of an underlying ethics issue in the organization. An ethics issue can arise in the form of an ethics problem or an ethics dilemma.
An administrative ethics problem: It is a matter of "right and wrong." There is clarity and certainty about the individual choices. "Wrong" is: (i) breaking the law (administrative, civil, or criminal); (ii) violating an organizational policy; (iii) failing to fulfill a responsibility; (iv) being dishonest (lying or withholding information); or (v) breaching a value or ethical principle. An individual faces an ethics problem when he or she is put in the position of having to do any one, some, or all of these things as a result of their place in an organization.
An administrative ethics dilemma: It is a situation in which (i) any possible action would involve harm or (ii) the decision maker must choose from two or more options, all of which may be inconsistent with personal values as well as the agency's or company's values, or (iii) the only available course of action involves unethical and/or illegal activity. Ethics dilemmas tend to involve such choices as:
* Honesty versus loyalty
1. Determination and acknowledgment of the conflict
Administrative ethics problems tend to be non-routine, diffuse and nebulous. Administrative ethics belongs in every manager's resource inventory.
From: Bioethics
2. Beneficence - Doing the greatest good and balancing the risks and benefits. Caregivers have an obligation to benefit the patient.
3. Non-maleficence - Minimizing harm ("primum non nocere"). Caregivers must avoid causing harm and strive to protect the patient from harm.
4. Justice - Fairness, equitable use of resources and equal access to care. Individual need justifies who gets what and how much. Individuals or groups are similarly treated.
Administrative Ethics
Bioethics
* Rights of specific individual patients
* Caregiver duty to professional competence
* Caregiver compliance with professional codes
Administrative Ethics
* Patient rights and provider rights
* Provider commitment to quality and standards
* Provider compliance with values and laws
* Ethics codes
* Ethics education and training
* Ethics committees
* Staff ethicists and consultants
* Individual need versus organization need
* Short-term versus long-term gain
* Justice or fairness versus compassion or caring
Steps in resolving an ethics conflict
An administrative ethics conflict is a problem within an agency or a company. Its cause may be motivated by outside factors (e.g., competition), but it is an internal matter. We proposes a six step process for use in resolving such conflicts:
2. Definition and documentation of the conflict
3. Clarification of the nature of the conflict (i.e., ethics problem or ethics dilemma)
4. Identification and verification of the process responsible
5. Identification of alternatives for resolving the cause
6. Selection and implementation of a course of action
Administrative Ethics: A Guide for Home Care Providers
HCMA, Ltd.
1. You give your patients a standard unit of service (e.g., two hours of skilled HHA care, supplies, etc.) because that is what "everybody else does?"
2. You accept referrals regardless of the availability of qualified staff to provide timely service.
3. You or others sign orders or certifications that have not yet been returned by the physician because an external surveyor is due to visit your office.
4. You unquestioningly implement policies or procedures developed by your agency or company even though you personally consider them to be wrong.
5. You or others with your knowledge spend evenings updating records and QI reports to demonstrate "compliance" rather than fostering consistent documentation practices.
6. The "numbers" (i.e., sales objectives) are the dominant factor in your decision-making in regard to the care, services, or products provided to patients.
7. You overlook actions of a superior which you feel may be at odds with agency or company policy rather than risk reprisals.
8. You feel that it really does not matter what you do because your agency or company is too small for anyone to be concerned about.
9. You seek the advice of others when you encounter a decision or issue that you feel may conflict with agency or company values, or may be unethical or illegal.
10. You compel staff to do things that they may individually consider to be unethical.
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