Contents Contents Medical Ethics A Reference Guide for Guaranteeing Principled Care and Quality Medical Ethics A Reference Guide for Guaranteeing Principled Care and Quality Eldo E. Frezza, MD, MBA, FACS A PRODUCTIVITY PRESS BOOK A Routledge title, part of the Taylor & Francis imprint, a member of the Taylor & Francis Group, the academic division of T&F Informa plc Published in 2019 by Routledge Taylor & Francis Group 711 3rd Avenue New York, NY 10017 © 2019 by Taylor & Francis Group, LLC Routledge/Productivity Press is an imprint of Taylor & Francis Group No claim to original U.S. Government works Printed in the United States of America on acid-free paper 10 9 8 7 6 5 4 3 2 1 International Standard Book Number-13: 978-1-138-58107-4 (Hardback) This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Names: Frezza, Eldo E., author. Title: Medical ethics : a reference guide for guaranteeing principled care and quality / Eldo Frezza. Description: Boca Raton : Taylor & Francis, 2019. | Includes bibliographical references and index. Identifiers: LCCN 2018020483 (print) | LCCN 2018022124 (ebook) | ISBN 9780429506949 (e-Book) | ISBN 9781138581074 (hardback : alk. paper) Subjects: | MESH: Ethics, Medical Classification: LCC R724 (ebook) | LCC R724 (print) | NLM W 50 | DDC 174.2--dc23 LC record available at https://lccn.loc.gov/2018020483 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com This book is in memory of Dr Sherilyn Gordon-Burroughs and to all women who were victims of domestic violence. We trained in the same university. She called me one day and told me to write a book on medical ethics. She encouraged me to start the project and left all of us all too early. Contents Preface .............................................................................................................xvii Author ...............................................................................................................xix SECTION I PUBLIC HEALTH 1 Medical Ethics from Hippocrates to the AMA .......................................3 The Art of Medicine.....................................................................................3 History of Ethics .....................................................................................4 Ethics and Deontology ............................................................................4 Societal Values.........................................................................................6 The Search for Guidelines ............................................................................6 The Professional Code of Ethics ..............................................................7 The AMA Code of Ethics ........................................................................7 Notes ...........................................................................................................9 Suggested Reading .......................................................................................9 Ethics Summary Table ...............................................................................10 Ethics and You, The Physician ...............................................................10 2 Changes in Health Care and the Physician’s Role ................................11 First Insurance ...........................................................................................11 Cost Reimbursement .................................................................................11 First Health Maintenance Organization (HMO) and Capitation Payment ....12 No HMO Restrictions ...............................................................................12 Eight Stages of Health Care Revolution .....................................................12 Stage 1...................................................................................................12 Stage 2...................................................................................................12 Stage 3...................................................................................................12 Stage 4...................................................................................................12 Stage 5...................................................................................................13 Stage 6...................................................................................................13 Stage 7...................................................................................................13 Stage 8...................................................................................................13 How to Keep Up with the Changing Faces of Health Care .......................14 vii viii ◾ Contents Self-Determination ....................................................................................14 The Individual and the Group ...............................................................14 Safety .........................................................................................................15 The Attitude of Physicians Toward Their Profession ..............................15 Suggested Reading .....................................................................................16 Ethics Summary Table ...............................................................................16 How to Be Professional .........................................................................16 3 Ethical Issues in Health Care and Medical School Curricula ..............17 Not Only in Medical School ......................................................................17 Ethics at All Levels of Health Care ............................................................19 How to Solve Ethical Issues .......................................................................19 Medical School Curricula ..........................................................................20 Residency Program ....................................................................................20 The Future .................................................................................................20 Chapter from the Article .......................................................................22 Suggested Reading .....................................................................................22 Ethics Summary Table ...............................................................................23 How to Teach Ethics and Where ...........................................................23 4 Public Health and Professionalism ......................................................25 Health Delivery .........................................................................................25 Medical Profession .....................................................................................26 What Are the Goals? .............................................................................26 Professionalism Principles ..........................................................................26 Commitment to the Patient: Message and Trust ........................................27 Assessment of Professionalism ....................................................................28 Measures of Competence and Deterioration ..........................................29 Notes .........................................................................................................30 Suggested Reading .....................................................................................30 Ethics Summary Table ...............................................................................31 How to Reach Professionalism ..............................................................31 5 Sexual Harassment ...............................................................................33 Quid Pro Quo ...........................................................................................33 Unacceptable Accepted Practice .................................................................33 Policies ......................................................................................................34 Hostile Working Environment..................................................................34 Type of Harassments ..................................................................................35 Verbal (Spoken or Written) ...................................................................36 Non-Verbal ............................................................................................36 Who Needs to Watch? ...............................................................................36 Is There an Antiharassment Policy? ............................................................37 How To Report Harrassment .....................................................................38 Contents ◾ ix Documentation ..........................................................................................38 Conclusion .................................................................................................39 Notes .........................................................................................................39 Suggested Reading .....................................................................................39 Ethics Summary Table ..............................................................................40 How to Avoid Sexual Harassment ........................................................40 SECTION II PHYSICIAN PROFESSIONAL RELATIONSHIP 6 Patient–Physician Relationship ............................................................43 Principles of Ethics for Physicians Taking Care of Patients ........................43 Doctor–Patient Relationship.....................................................................44 Informed Consent ......................................................................................45 Patient–Physician Collaborations ..........................................................45 Continuum of Care ..............................................................................46 Relationship at the End of Life .............................................................46 Advance Directives ....................................................................................47 Family Belief and Religions ...................................................................47 Note ...........................................................................................................48 Suggested Reading .....................................................................................48 Ethics Summary Table ...............................................................................49 How to Build Patient–Physician Relationship .......................................49 7 Commitment to Honesty and Trust .....................................................51 Physician Limitations .................................................................................51 Zero Dashboard .........................................................................................52 Recognize Limitations ...............................................................................52 Engage in the Relationship ........................................................................52 Honesty .....................................................................................................53 Patient Autonomy ......................................................................................53 Global Trust ..............................................................................................54 Building Trust ...........................................................................................54 Errors .........................................................................................................55 Disclosure ..................................................................................................55 Legal ..........................................................................................................55 Transparency .............................................................................................56 Arrogance ..................................................................................................56 Suggested Reading .....................................................................................57 Ethics Summary Table ...............................................................................57 How to Commit to Honesty and Trust .................................................57 8 Disclosing Medical Errors ....................................................................59 The Impact of Medical Errors ....................................................................60