1. ETHICS AND THE CTRS HPR 453 Chapter 18

2. Ethics in Life and Practice  When there is no right or wrong answer that is clearly evident  How should I behave?  Would my profession support my behavior?  Is my behavior consistent with other practitioners?  Why explore ethics and professional conduct?  It’s the right thing to do!

3. What shapes our ethics?  Family Values  Education  Government and Judicial Systems  Religious Beliefs  Cultural Heritage  Personal and Professional Peers  Business Values and Corporate Culture  Personal Experiences

4. VA Center for National Ethics Model Figure 18.1 pg 300  Integrative Perspective for Ethics in Healthcare  Internal and External Factors  Comprehensive view  Ethics in professional practice is not simple  Today tremendous focus on healthcare fraud and abuse  In a study ¼ of public sector employees identify their work environments as conducive to misconduct  Enron as an example

5. HIPAA  Health Insurance Portability and Accountability Act (1996)  One aspect is fraud and abuse – Federal, State and Local law enforcement programs work together  Since inception in 1997 $8.85 bil turned over to Medicare Trust Fund

6. Sarbanes-Oxley Act of 2002  Repercussion of Enron scandal  CEOs and CFOs of all publicly traded companies certify that financial reports are accurate  Strict Conflict of Interest rules  Protects Whistle Blowers

7. Implications for Ethics and TR  Billing for tx and services not provided  Providing unnecessary services  Substandard quality of care in nursing homes  Submitting false claims or false cost reports  Being in violation of scope of practice or state licensure laws

8. ATRA Code of Ethics  Guides our ethical behavior  Ethics defined as principles or standards of human conduct (morals), character, values  Moral philosophy  Human actions in respect to right or wrong

9. History  5 th Century B.C. – Hippocratic Oath  “I will use tx to help the sick according to my ability and judgment, but never with a view to injury or wrongdoing”  Latin principle of medical practice – Primum non nocere – “First, do no harm” (beneficence and non- maleficence)  Ethics have been a part of medical practice for hundreds of years

10.  Until WW II the physician was the authority  Due to experimentations gradual shift of decision- making from physician to patient (autonomy) – patient-based self-determination  Right and Good may not always be the same

11. Ethics in Healthcare Today  We are capable of acting toward others in such a way as to increase or decrease the quality of their lives  We experience ethics on personal, professional, and organizational levels  Ethical dilemmas occur when a decision/action must be made/taken that has 2 or more competing courses of action based on different value sets, moral frameworks, or varying or inconsistent organizational philosophy

12.  The decision should be the “best possible” because there is no right or wrong answer  Law is a minimal standard of morality established by society  4 quadrants  Legal and ethical  Unethical and legal  Unethical and illegal  Ethical and illegal

13. What helps you make the decision?  ATRA Code of Ethics (to be distributed)  Ethical Decision-Making Model pg 304 in book