An understanding of a few of the elements of ethics, the different types of ethical problems, and how a good ethical decision is made is important before we discuss the opinions of the CEJA. Then, as some of the opinions are presented in this text, students can begin to evaluate their own positions on each issue. This section enables the medical assistant to recognize the types of ethical problems that might arise in the physician’s office and provides a pattern to follow in making an ethical decision.
Elements of Ethics
Dr. Ruth Purtilo, an authority on ethics in medicine, has written a book on the subject, Ethical Dimensions in the Health Professions. She presents three general elements of ethics: duties, rights, and character traits. A duty is an obligation a person has or perceives himself or herself to have. A daughter may feel the obligation to care for her elderly parents, or a husband who has hurt his spouse may feel an obligation to somehow make up for his act.
Purtilo mentions several types of duties related to the medical profession. Nonmaleficence means refraining from harming oneself or another person. Beneficence means bringing about good. Fidelity is the concept of keeping promises, and veracity is the duty of telling the truth. Justice, in relation to medical ethics, deals with the fair distribution of benefits and burdens among individuals or groups in society having legitimate claims on those benefits. When a person has wronged another, he or she has a duty to make reparations, or right the wrong. Last, a person should feel grateful if he or she is a beneficiary of someone else’s goodness. This also is a type of duty.
Rights are defined as claims a person or group makes on society, a group, or an individual. The Bill of Rights appended to the U.S. Constitution guarantees certain liberties that we enjoy as American citizens. However, some individuals think that they have rights, but those rights are actually privileges. For instance, Americans do not have the “right” to healthcare services. Individuals may expect to be cared for when sick, but this is not a right guaranteed to anyone in America. Some countries provide medical care to all their citizens, but the United States is not one of those countries. A right applies to all people within a group, without prejudice.
Purtilo defines character traits as a disposition to act a certain way. A person who believes that honesty is an important character trait usually can be trusted to speak the truth. One who feels comfortable with taking small items from work for use at home may not be able to resist an opportunity to take something more valuable. Character traits certainly do not always indicate how a person will react in all situations. No human being is perfect, and we sometimes are unpredictable. Stress also can interfere with our normal reactions, and other factors, such as depression or anger, influence how we act. The phrase that someone is acting “out of character” usually means that the person is deviating from his or her normal behavior patterns.
With an understanding of these basic elements of ethics, we have a good foundation to help us look more objectively at ethical problems and solve them to the best of our ability.
Ethics plays a role in the decisions and actions of medical assistants while caring for patients. Patients have certain rights that a medical assistant must adhere to. These patient rights include the right to life, right to privacy, right to autonomy, and right to the means to sustain life. The medical assistant also has duties to uphold while administering patient care. These ethical duties include do no harm, do the best possible, be faithful to reasonable expectations, be a patient advocate, tell the truth, and give each person a fair share. The medical assistant will need to adhere to professional ethics and know that professional ethics supersede personal ethics and morals. However, some conflicts may arise between a medical assistant’s religious or personal beliefs and what science deems is needed. Through a medical assistant’s career, their ethical and moral decisions will evolve, but should not supersede patient’s basic rights.
Patient Rights
A right is a claim that is expected to be honored. In respect to medical assistants, a patient has the right to life, right to privacy, right to autonomy and the right to the means to sustain life. These rights should be in the forefront of all actions and decisions made by the medical assistant.
Right to Life - For medical assistants, they may not harm patients as this may threaten their lives. However, we must consider that advances in medical care have helped keep people alive who could not recover their health. This sustaining of life can come at the cost of prolonged suffering. Each medical professional has their version of ethics when it comes to a patient’s right to life however a medical assistant can leave this ethical dilemma up to the patient to decide about their own body and their reproductive decisions.
Right to Privacy - The fourth amendment of the Bill of Rights assures the patients right to privacy from search and seizure without a warrant. HIPPA also offers patients the right to privacy and was established to offer patients’ personal protection of health information. All information held in any form, including digital, paper or oral must be kept private for patient confidentiality. This information includes:
- The patient’s name, address, birth date and Social Security Number
- The patient’s physical or mental health condition
- Any care provided to the patient
- Any information concerning the payment for the care provided to the patient or any information that could be used to identify the patient.
Right to Autonomy - The patient has the right to make independent decisions about their health care based on their values and concerns, without constraint or coercion by others. Informed consent is needed by a patient or their family based on the understanding of a medical procedure and the possible outcomes. However, the patient must have the mental capacity to reason and consider alternatives.
Right to the Means to Sustain Life - At a minimum, every person should have access to goods and services that are necessary to sustain life and preserve human dignity.
Medical Assistant Duties
A duty is a commitment to act in a certain way based on moral principles or a professional code of conduct. With regard to the medical assistant, their duties include doing no harm, doing the best possible, being faithful to reasonable expectations, being a patient advocate, telling the truth, and giving each person a fair share.
Do No Harm - This is found in the Hippocratic Oath, and is taken to mean that medical benefits should outweigh adverse effects.
Do the Best Possible – the concept of beneficence or doing the best possible for the patient.
Be Faithful to Reasonable Expectations – Patients can reasonably expect to be treated with dignity, treated by medical professionals who honor their agreements and treated by competent providers.
Be a Patient Advocate – an advocate is someone who intercedes on behalf of another. A medical assistant should suggest appropriate referrals to the physician. They should make sure that all insurance forms are complete and follow up if additional insurance information is needed.
Tell the Truth – medical assistants and other medical professionals should proactively provide truthful information.
Give Each Person a Fair Share – The medical assistant should offer medical supplies and education to all. However, when considering an emergency room, serious conditions take precedence.
Professional Ethics
While medical assistants are working, professional ethics should supersede personal ethics and morals. The process of making ethical decisions can be broken into steps.
Step 1: Gathering Information – the medical assistant needs to gather information about the situation’s background, the facts related to the problem, who is involved and the laws or policies that relate to the situation.
Step 2: Identify Conflicting Values – conflicts may involve high values, or the conflict may be that a person wants to save time or avoid a hassle. The medical assistant should not just go with the flow, not following established procedures because they don’t want to step on any toes. The reasonable expectations of the patient should be first and foremost in the medical assistant’s actions.
Step 3: Determining Relative Importance of Conflicting Claims – the medical assistant will need to get clarification of the goals and weigh the conflicting values.
Step 4: Exploring Alternatives – if the medical assistant has established that the values are more important, they should consider the possible outcomes. The medical assistant should identify as many alternatives as possible, predict the consequences of each action and project whether the goals will be met.
Step 5: Choosing and Justifying One Alternative – the medical assistant can analyze different hypothetical situations and come to a personal framework for ethical decisions, so they are not left to analyze each situation individually. There are a few ways to justify a decision by:
- Presenting Logical Arguments – deductive or inductive reasoning based on facts.
- Social Justification – the consideration of the larger consequences to society.
- Projection of Consequences – what will happen given the alternative chosen
- Refuting Alternative Claims – explaining why the decision was made rather than an alternative.
Step 6: Implementing the Decision – the final step is to put the ethical decision into practice. However, the medical assistants’ ethical framework can evolve over time based on real world situations.
Ethical Conflicts
Many medical assistants may have personal codes of conduct or religious beliefs that contradict the ethics and morals set forth by traditional medical practices.
Reproductive Issues – Religion and personal morals play a role in the ethical decisions about birth control and abortion.
Stem Cell Research – in this research, cells are taken from fetal tissue and are able to mature into different types of tissue. Ethics is considered during stem cell research because live human embryos may parish during research activities.
Genetic Engineering and Cloning – genetic engineering is the making, altering or repairing of genetic material whereas cloning is the reproduction of genetically identical cells. The ethics behind this practice include the argument that we may not know all the side effects of manipulating genetic material.
Refusing or Withholding Treatment – The 1990 Patient Self-Determination Act puts forth that the duty of the hospital, nursing homes and HMOs need to inform patients of their right to request refusal of treatment. This act also gives a patient the ability to create an advanced directive of requested treatment if they are not able to make these decisions.
Does this discussion about medical ethics interest you? Ready to start your new and exciting career as a medical assistant? The &Medical Assisting program at Daymar College is designed to prepare current and future employees for the fast-paced changes encountered in the health care industry, and to help develop training, skills and attitudes necessary to excel in medical assisting. This medical assisting program is appropriate for entry-level positions in doctor’s offices, hospitals, home health agencies, and other allied health organizations.