Managed Care Organizations

Managed care organizations provide health care to millions of people in the United States. Two private MCOs are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). These organizations have been around for decades and the HMO Act of 1973 allowed managed care to become more popular. Over the years more people have become dependent on managed care for health care needs. Although managed care has been helpful in some aspects, these organizations have been the topic of many debates.

MCOs have been stereotyped as having lower quality of care and focusing more on costs than the health care of patients. The accusation of lower quality of care could come from the idea that sometimes caregivers do not spend enough time with patients. This helps a facility see more patients throughout the day or not have enough staff to extend the amount of time with patients. Another accusation is that managed care organizations focus more on costs than helping patients. For example, there have been statements made that physicians who work in managed care organizations receive incentives for not performing certain procedures for patients. MCOs have also been known to deny claims for medically necessary treatments that could eventually lead to the further health complications or death. These are ways for MCOs to manage costs but this could cause concern for ethical issues.

It is important for MCOs to focus on the patient because these patients depend on them for health care. They want to feel that when they visit a facility they will receive good care, especially since they spend money to ensure they receive care. For those who have been treated unfairly by a MCO, these organizations have to remember their ethical practices. Patients have rights and the MCOs have keep their health the main focus. They should not put the patient's health in harm and give them the compassionate care they deserve. MCOs will be around in the future and there will be ethical issues in the future. Hopefully, they will be able to have a new approach to these issues and address them more appropriately.

And the Band Played On

HIV/AIDS began to affect our population in the 1980s and has been detrimental to our society. This illness has killed millions around the world and continues to infect individuals everyday. In a class on Community Health I watched a movie named "And the Band Played On". This movie discussed the HIV/AIDS epidemic from the beginning and gave a closer perspective to how HIV/AIDS affect individuals from a researcher, family member, infected person, and society viewpoint. One of the main issues in the movie discussed how many homosexual men were contracting the disease in bath houses. These were spa-like businesses that allowed men to have sexual intercourse.

There was one character in the movie who was a French-Canadian flight attendant. He was suspected of infecting several men with HIV. Since this was the beginning of the epidemic he was in denial that he was infected. Researchers from the CDC (Centers for Disease Control and Prevention) began to investigate him. They asked him how many sex partners did he have and he admitted to sleeping with thousands of men around the world. After conducting more research on him they found that there were at least 40 men in the United States who were infected with HIV as a result of this flight attendant.

Although this was person was not the main subject of the movie, his role was most devastating to me. It difficult to see him because there are characters like him in real life. These individuals are infecting others without any remorse. This behavior is unethical and those who knowingly infect others lack ethical moral, values, and principles. Nonmaleficence is the ethical principle that is especially disregarded because it discusses causing no harm. Infecting others with HIV is causing a lot of harm to the person who is infected. Those who participate in this behavior also violate the values of compassion, respect and honesty.

It is important that more people are educated on the topic of HIV/AIDS so that we can prevent incidents like these. Ethics can play an important role in certain individuals who contract HIV. Hopefully one day our society will be able to get some control over this epidemic. Until then preventing people from contracting the disease and helping those who are infected is imperative.

Patient Abuse

Patient abuse is an issue that is faced everyday in the United States. There have been extreme cases of patients abuse that has even resulted in death. Patient abuse is something that many people are working hard to improve. Although patient abuse affect patients in every aspect of health care, elder abuse has become a serious issue. Elder abuse can include emotional, financial, verbal, mental, sexual, or physical abuse. Many reports of elder abuse go unreported because some elders fear retaliation and the fear of no one believing them.

Elder abuse is an aspect in health care that seriously needs to be addressed. When the elderly turn to caregivers for care it is not always an easy decision. They have been used to caring for themselves and trusting others may be difficult for them. Caregivers that abuse the elderly could include employees working in the facility where the patient resides and even family members. In many cases the patients who are getting abused cannot defend themselves physically and verbally. This makes the patients more vulnerable to abuse and often prevents the patients from speaking up for themselves. It is a violation of patient rights because patients have the right to receive compassionate care from caregivers.

It is saddening that patients experience this treatment towards the end of their lives. This can also be hard for the family members who discover the abuse. Patients tend to be very trusting of those who provide care for them and abusing the patient could cause distrust. Abusing the patient could also cause more health problems and sometimes result in death which is why it is an important issue to discuss. This could eventually increase health care costs because we will have to treat patients for abuse. This problem in the United States does not seem to be improving. Hopefully more individuals will become more aware of the issues regarding patient abuse and will become more educated to prevent this in the future.

Euthanasia in the United States

Until this year, Oregon was the only state in the United States to legalize Euthansia. This pass November, Washington was the second state to make this procedure legal as well. This procedure allows patients to have a physician assist in suicide. Dr. Jack Kevorkian was a famous physician known for conducting physician-assisted suicide. He was convicted when he conducted one of his procedures on television. Prior to his conviction in 1999, Oregon legalized physician assisted suicide with its Death with Dignity Act.

Euthanasia has been a controversial topic in health care as well as ethics for years. Some support euthanasia arguing that it is the patient's choice and it could be good economically which could save on costs of keeping a patient alive. Physician assisted suicide has both pros and cons. Patients who are terminally ill may not want to continue to live in painful conditions and opt for physician assisted suicide. Patients have to go through a rigorous process to qualify for the procedure. Although it may be a hard process for patients to go through, patients may see this as the best option for them. Some also argue that if patients are now allowed to participate in physician assisted suicide, they may commit suicide on their own. This could relate to the ethical principle of autonomy which gives patients the right to make their own decisions as well as the right of self-determination.

Other issues concerning euthanasia includes that this act should not be legal and is not considered ethical for a physician to conduct this procedure. Physicians are expected to cause no harm to patients and assisting the the suicide could be considered as harm. Physicians have been stereotyped as the person that helps to keep people alive and not to cause their death. This is one reason people may have an issue with physicians participating in euthanasia. Others may disagree because they do not believe in any form of suicide.

The citizens of the United States do not have to accept euthanasia but the reality is there are two states where it is legal. The choice lies between the physician and the patient. Not to say that citizens do not have a voice but patients have the right to choose this procedure. It is available to truly believe this is something they want and negative interference could cause other issues with the patient and could lead to patients committing suicide alone. There may be other states who choose to legalize it in the future.This could cause more issues in regards to euthanasia or it could cause more people to become more accepting of the procedure.

Doctor Holds Patient in Room

While watching the news one day I saw a story about a physician who refused to let a patient leave until payment was made. The patient said that she called her physician and asked how much a specific service would cost and he explained the costs to her. Once she went to the office he changed the price of the service. The patient informed him that she only had the amount he originally stated and he told her that she could not leave until she made that payment. The physician blocked the door to prevent patient from leaving. One of the assistants in his office assisted in restraining the patient as well.

This behavior was unethical in many situations not only health care. Holding a patient against their will due to nonpayment was not right. There are many individuals in the United States who cannot afford healthcare and they deserve the right to receive services without feeling that they will be harassed for not being able to make payments. In the book discussing Legal and Ethical Issues, it states that a patient has the right to discharge. Patients should not be detained because of the inability to pay for services rendered. This could be considered false imprisonment. This was evident in this particular case. The physician was reprimanded for his behavior which was deserved. Caregivers have the responsibility to exercise good judgment which was not used by the physician or his assistant at this particular clinic. It would have been extremely uncomfortable as a patient to have to experience this behavior by someone I trust.

It is important for physicians to remember the focus of their jobs which is to help the patient. False imprisonment is no form of helping the patient and does not demonstrate any positive ethical principles such as beneficence and nonmalficence. These principles are always important to remember when giving care to patients and in my opinion are two of the most important principles in health care ethics. Although this was an unfortunate event, there are similar cases that have occurred. If more patients are informed of their rights, maybe situations like these would happen less often.

Doctors giving Patients Placebos

This morning I read a survey online that over of the 679 physicians surveyed gave their patients placebos. These doctors were treating arthritis patients and 60 percent of the physicians felt that giving patients placebos were ethically permissable. Some of the physicians did not disclose to the patients that they were receiving placebos and sometimes the patients were given these medications 2 to 3 times per month. It is hard to understand how these physicians felt that this type of treatment was ethical.

In the article it states that under the standards of the American Medical Association, it is unethical which states that patients should have full knowledge of treatment they are receiving. It is not fair to give patients treatment that is not helping their condition. They are paying for and taking medication that is doing no good to their health. This could eventually cause financial hardship to a patient. It is similar to buying a car and not knowing that the motor is not included. The car will not work without the motor. These placebos are not working and helping the patient. I would be skeptical receiving care from a physician who thought this aspect of their practice was ethical. This is apparently unethical because it is a violation of patient's rights. Patients have the right to know the type of medications they are receiving especially if the are placebos. This issue is also a violation of the AMA Code of Ethics which states that physicians should be honest in all professional interactions and make relevant information available to patients.

Deontological Ethics involves telling the truth. These physicians cannot consider themselves honest if they are giving patients medications and the patients feel these medications will be used to help their conditions.The patients had arthritis and this is a very painful condition. Which makes the circumstances of this issue worse. Giving the patients the placebos 2 to 3 times per month does not seem to be conscientious behavior as well. Hopefully with this article patients will take a closer look at the behaviors of their caregivers and will encourage other physicians to not take on the practices of their fellow colleagues.

University of Kentucky

During one of my classes, Health Care Needs of the Elderly, we had a guest speaker who was the CEO of Winter Park Memorial Hospital. He told us the story of a physician in Kentucky who branded "UK" for his alma mater (University of Kentucky) onto a patient. This seemed to be very unethical and inappropriate so I wanted to do more research on the topic. I found an article going into more detail about that the guest speaker told us. A woman went to the physician to have a hysterectomy and allowed the physician to videotape the surgery in 2002. The physician branded "UK" on the uterus of the patient during her surgical procedure. In the article I read, there was a picture of the brand which was very disturbing (picture is listed above). It is not understandable why a physician would act in this manner. He was aware that the procedure was being videotaped but continued to brand the patient. It is not understood if he felt that this would be amusing to the patient or if the patient would disregard this immature behavior.

When patients put their lives into the hands of a caregiver they expect to receive the best of their care and the physician who degraded his patient in this manner should have been heavily reprimanded. This was a violation of patient rights. Normative ethics relates to this story because this type of ethics is designed to determine what moral standards should be followed so that human behavior and conduct may be morally right. The physician also did not demonstrate what most would consider good moral judgment in this case. Branding a patient does not appear to be good moral judgment on the physician's behalf. This leads to a violation of Code of Medical Ethics. This code states that " A physician shall be dedicated to providing competent medical care with compassion and respect for human dignity and rights." The patient's human dignity was not treated with respect and there is no way to justify the behavior of this physician. Another Code of Medical Ethics that was violated was maintaining standards of professionalism and respecting the rights of the patient.

It is saddening that events such as this one occur in health care. Having a procedure that the patient had, was a very serious procedure and having the physician violate her rights was very depressing. If I am placing my care into the hands of a caregiver I was superior service and with a hysterectomy, this could also be a very difficult procedure for some women. Hopefully the patient feel as if justice has been served and the physician has learned his lesson in ethics.

John Q

I had to watch John Q for another class and saw that the movie embraced a huge ethical dilemma. For those who are not familiar with the movie. It is the story of a working class family (The Archibalds) whose life is about to change with an unexpected health tragedy. The son of the Archibalds is about 9 years old and while playing baseball one day he collapsed. He was taken to the hospital and the family was told that he needed a heart transplant but his insurance was not going to cover it. The heart transplant would cost $250,000 but in order to place the son on the list to receive a heart the family would have to pay $30,000 cash. The son did not have long to live and after coming up short on the deposit, the hospital decided to release the son.

Situations like this occur everyday in the United States. Families are not able to pay for health care and they are placed in situations such as this. Ethics is questioned when asking a family to make a cash payment to save the life of a child. This was a working class family who did not have the $30,000 to pay for the heart transplant deposit. They sold almost everything they had and still was not able to come up with the money. To add to the turmoil the hospital tried to release the child knowing he was not in good condition and would not live much longer without the transplant. The hospital should have had more alternatives for the family besides telling them to make a cash payment. I feel it is the responsibility of the hospital to help everyone especially those who need life saving treatment. One of the principles of ethics is beneficience which stands for the act of doing good. In this case, the hospital was not acting on this principle of ethics. In my opinion, asking a family to pay $30,000 and trying to release a dying child is not beneficience.

The principle of human dignity was also questioned in this dilemma. Human life is very significant and sending someone home to die does not constitute the right of human life. The hospital took away the child's right to live by refusing to place him on the list to receive a heart and trying to release him to go home. If the child only had a short time to live with the help of the hospital, imagine what would have happened if he would have went home without any medical treatment or support. The hospital did not consider this because receiving money seemed to be most important.

In the movie, the Archibalds had an HMO and one of the employees said that HMO receive incentives for not offering treatments to patients which raises another ethical dilemma. The father said that the child receives a check up every year and no doctor every said that he was healthy and had no conditions. The dilemma here is clear, if the doctors would have ran tests prior to the incident, they could have seen that the child did not have a healthy heart and could have possibly treated him. There have been many speculations that HMOs do not offer treatments and in return receive incentives at the end of the year. This is unethical because the job of the physician is to maintain the health of the patient. If the physician does not give all of the treatments they are reducing the quality of care as well as the health of the patient.

These were two ethical dilemmas in the movie John Q that I felt should be pointed out. It is important for health facilities to realize their responsibilites and react ethically and lawfully. It is unfortunate that these events do occur often. Which is why ethics and law play significant roles in regards to the care of patients and health care organizations.