professional and business ethics in health care
DESCRIPTION
HOW CAN WE EXPLAIN THIS PHENOMENA? Background Medical professional is facing a decreasing professionalism and increasing ethical problems around the globe Charles Dougherty: “General features of the pervasive hold of commercialism in medicine include an increase in competition and decline in professionalism among physicians, a view of health care as commodity and patients as consumers, and a general depersonalization of doctor-patient relationship including dilution of the tradition of physician as patient advocate” HOW CAN WE EXPLAIN THIS PHENOMENA?TRANSCRIPT
Professional and Business Ethics in Health Care
dr. Nur Azid Mahardinata Center for Bioethics and Medical
Humanities Faculty of Medicine, Universitas Gadjah Mada HOW CAN WE
EXPLAIN THIS PHENOMENA?
Background Medical professional is facing a
decreasingprofessionalism and increasing ethical problemsaround the
globe Charles Dougherty: General features of the pervasive hold of
commercialismin medicine include an increase in competition and
declinein professionalism among physicians, a view of healthcare as
commodity and patients as consumers, and ageneral depersonalization
of doctor-patient relationshipincluding dilution of the tradition
of physician as patientadvocate HOW CAN WE EXPLAIN THIS PHENOMENA?
FIRST: The Theory of Market
Developed by Adam Smith: Economic man, self-interested, and
fundamentallyasocial, motivated by an insatiable desire to improve
hismaterial condition, is the model that explains humanmotivation
and action The special characteristics of healthcare market isboth
Private as well as Social/Public domain Therefore, health care
business is unique. It mustbalance the obligation to care for
others with thenecessity of making a profit as a business.
Pharmaceutical Industry
Patient Care Profit Making Hospital Pharmaceutical Industry
Physician Government Patient and Families What is profitable to
Businesses in the Healthcare industry:
Selling Medicine/Drugs Selling Medical Supplies Hospital equipment
Lab equipment Selling Medical Services Patient care Nursing home
care Home care New Health Care Technology Market Driven Care
Advantage Disadvantage Incentive for innovation
Incentive for efficiency Less governmentintervention Alienate
physicians Undermine patient trustof physicians Hurt academic
medicalcenters and theresearch establishment More patients
withouthealth care coverage. Public Cost of Poor Health
Higher disease burden Longer time to recover from sickness Shorter
time to work (become productive economically and socially) Lower
life expectancy What is not as directly profitable is: PreventionAn
ounce of prevention is worth a pound of cure
But companies cant make much money from preventing diseases
Therefore, healthcare should be managed by the people and for the
people How Market Driven Healthcare Cuts Costs
recruit the healthiest patients excluding the sickest rationing
care by making it inconvenient to obtain denying care by a variety
of mechanisms. Physicians Dilemma in Market Driven Healthcare
As Caregiver: provide a wide range of services, recommend the
besttreatments improve patients' quality of life As Efficiently
keeping expenses to a minimum: limit the use of services increase
efficiency shorten the time spent with each patient use specialists
sparingly Managed healthcare plans Good of Patient vs ..
(1) the good of all the other patients served by the plan (2) the
good of the plan and the organization themselves (3) the
self-interest of the physician. from Edmund Pellegrino Second:
Stakeholder Theory:
Who are the Stakeholdersfor a HealthcareOrganization? From Pat
Werhane: Business Ethics, Stakeholder Theory, and the Ethics of
Healthcare in Organizations The Investor: Pharmaceutical
Industries
The pharmaceutical industry in 2006 was worth US$ 643 billion.
Total pharmaceutical sales from the top 10 companies accounted
formore than 40% of the total market (see table). Pharmaceutical
Industry as Investors
Irrational Use of Drugs In 2005, the Indian NationalCommission on
Macroeconomicsand Health labeled 10 out of 25top selling brands of
medicinesin the country as being eitherirrational or non-essential
orhazardous. Pharmaceutical Industry as Investors
Questionable New Drugs A survey in April 2005 by the French journal
La Revue Prescribeconcluded that 68 per cent of the 3,096 new
products approved inFrance between 1981 and 2004 brought nothing
new to existingtreatments. A breakdown of more than 1,000 new drugs
approved by the USFood and Drug Administration between 1989 and
2000 revealed thatmore than three-quarters had no therapeutic
benefit over existingproducts. Pharmaceutical Industry as
Investors
Advertising with Incomplete Information 2005 study of Psychobiology
of the Paulista Medical Schoolof the Federal University of So Paulo
Brazil Analysed 24 Brazilian advertisements for the
samepsychoactive drugs as advertised in American and/or
Britishpublications from the same period. Observed that Brazilian
advertisements omittedinformation on usage restrictions, such as
contraindications,adverse reactions, interactions, warnings and
precautions,and that such information was present in American
andBritish advertisements. How They Do It? --- Drug Promotion is
the Key
Increasing the perceived frequency and/orseverity of the
indications. 2.Widening the indications to include more people.
3.Increasing the perceived likelihood andmagnitude of benefits.
4.Decreasing the perceived likelihood andmagnitude of harms.
5.Increasing the use of the drug for longerdurations.
Pharmaceutical Gifts in Pakistan
Low cost: pens/pads/diaries/calendars. Medium cost:
stethoscope/books/briefcases. High cost: air
conditioners/laptops/desktop computers/club membership. The latest
practice is: For writing 200 prescriptionsof the companys high
priced drug, a doctor isrewarded with the down payment on a brand
newcar. What about in Indonesia?? Doctors Biased Behavior
Evidence shows that biased doctors are more likely to: Prescribe a
drug if they had recently attended a sponsored eventby the
manufacturer. Prescribe a drug that is not clinically indicated.
Have a drug placed on a hospital formulary. *Governments Key
Recommendations:
Implement, improve and monitor legislation in line withthe WHO
Resolution on the Rational Use of Medicines andthe WHO Ethical
Criteria for Medicinal Drug Promotion. Support the provision of
independent information ondrugs for consumers and health
professionals. Implement and enforce a ban on gifts to doctors.
Enforce strict sanctions that will deter poor corporatepractice in
drug promotion. Take measures to improve the transparency of
drugcompanies marketing activities and seriously address
theconflict of interest encountered in drug companiesfunding of
medical education. **Key Recommendations at the Company
Level:
1. Stop the practice of gifts to doctors 2. Implement rigorous
policies on vetting of drug promotion materials and adherence to
existing codes of conduct 3. Provide transparent and verifiable
information on the precise nature of relationships and associated
funding for all stakeholder groups, including health professionals,
pharmacists, students, journalists, clinical research organizations
and patient groups. **Industry-Wide Level:
1. Ensure codes of conduct on drug promotion extend to interactions
with health professionals AND consumers. 2. Invest in innovative
partnerships with government and civil society organizations so
that corporate funding of disease awareness campaigns, and CME may
be channeled via blind trusts in line with specific health
priorities of consumers at a community or national level.
Bibliography Drugs, Doctors and Dinners: How drug companies
influence health inthe developing world Managed Care and the
Morality of the Marketplace(NEJM, 333:50-52, 7/6, 1995) How to
maintain the humanitarian aspects of health care?
Professionalism and ethics are the key to maintain humanitarian
aspects of healthcare How to Execute Ethical Principles in an
Organization?
Organizational Goals Approach The Stakeholder Analysis Approach
Ethical Justifiable Decision Organizational Goals Approach
Institutional mission statements are commonly expressed
thedevelopment and implementation of organizational goals An
ethical analysis of organization behavior can be conceived as
ameans of ensuring that an appropriate mission statement is
adopted,kept up date, and put into effect The J&J case (1982) a
350 words credo First, responsibility of the company is to
healthcare professionals andcustomers who use its products Useless
mission statement:
To improve the total health of our communities, working
inpartnership with the people we serve A hospital has ethical
responsibilities deriving from its organizationalroles as employer
and business entity Institution Its physician Other care givers
Employers Individual patients and families Community as a whole The
Woodstock Ethical Framework
Compassion and respect for human dignity Commitment to professional
competence Commitment to a spirit of service Honesty
Confidentiality Good stewardship and careful administration Model
Hospital Mission Statement (1)
It is the goal and mission of general hospital to: Offer care to
all without regard to race, religion,or ethnic identity and to the
extent thatresources permit, irrespective of the ability to pay
Offer health and wellness programs and healtheducation to the
people of our service area Provide the best available medical care
to ourpatients honoring their rights to determine thecourse their
treatment Model Hospital Mission Statement (2)
Employ open and ethical business practices in ourdealings with
patients, professional associates, alliedservice providers and
business partners Provide a fulfilling place of employment to
ourprofessional staff and employees including
appropriatecompensation, healthful working conditions,
andopportunities for education and advancement Use the resources
provided by benefactors, foundations,and public entities as
efficiently as possible in the pursuitof these goals Stakeholder
Analysis Any group or individual who can affect or is affected by
thecorporation (Evan and Freeman, 1988:100) Primary stakeholders:
groups whose continued participation isnecessary to the survival of
the organization (e.g. shareholders,employees, customers,
suppliers, creditors, and governments) Secondary stakeholders:
groups whose participation is not essentialto the organization,
although they are affected by organizationalactivities (e.g. media,
community, and other business) Remember the Formula Organizational
Goals Approach
The Stakeholder Analysis Approach Ethical Justifiable Decision
Thank You for your kind attention