Basics of Ethics and Law for The Health Industry
Please write a discussion and respond to this 2 peers’ Discussion Prompts
Discussion: In this course, you have learned the basics of ethics and law for the healthcare industry. Now that you have a solid foundation of knowledge on the subject, evaluate a healthcare law and its related policies. Analyze the impacts of these policies on public health and health equity. Provide ethical ramifications for each chosen policy. Include any insights that you gained from your research and postings or from responses of peers or the instructor that helped shape your thinking on these issues. (200-300 words)
When you respond to your classmates, thoroughly analyze the examples and evidence cited and expand on their posts by providing your own perspectives. (50-100min words each)
ALL citations and references needs to be APA 7th edition format.
My law of choice this week is the Emergency Medical Treatment and Active Labor Act (EMTALA). This law, enacted in 1986, is part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (ACEP, 2021). This act “forbids Medicare-participating hospitals from ‘dumping’ patients out of emergency departments” (Pozgar 2016). According to the American College of Emergency Physicians (ACEP), “anyone coming to an emergency department [needs] to be stabilized and treated, regardless of their insurance or ability to pay” (2021). In addition, if the facility has reached capacity and cannot “handle” the patient, the next step in order would be to transfer the patient to another facility (ACEP, 2021). But in order to do so, a medical screening must be provided by the original emergency facility to “ensure they are stable for transfer” (ACEP, 2021). Penalties of this law include “hospital fines up to $104,826 per violation” (dependent on hospital capacity), and “physician fines up to $50,000 per violation” (ACEP, 2021).
From an ethical viewpoint, I definitely think they deserve the treatment. We learned in this course that there are four ethical principles, and two of those are directly applicable to this situation: beneficence and justice (Pozgar, 2016). Beneficence simply means to “demonstrate kindness,” and “justice is the obligation to be fair” (Pozgar, 2016). One may even stretch to a third principle, nonmaleficence, as this means that physicians are required to “avoid causing harm” (Pozgar, 2016). This is practiced by treating the patient, versus turning them away at the emergency room door.
Of the ethical theories, there are two that directly applicable here as well. Normative ethics simply means “to do what is right” (Pozgar 2016). Consequential ethics applies because treating a patient would “lead to the maximum balance of good” (Pozgar 2016).
But from a business perspective, this is very alarming to me. Apparently, there are no repercussions for the patient who seeks treatment with no health insurance. Perhaps this is why emergency rooms still have a wait time—everyone is able to go there, but there is still an unequal ratio of patients to hospital beds (and physicians). If the emergency department is consistently accepting more patients with no insurance than those with, how is the department going to stay open? The emergency department does not receive funds to compensate for the patient’s treatments from the government or any other source. “Emergency physicians provide the most charity care of all physicians” (ACEP, 2021). According to a May 2003 American Medical Association study, “emergency physicians on average provide $138,300 of EMTALA-related charity care each year, and one-third of emergency physicians provide more than 30 hours of EMTALA-related care each week” (ACEP, 2021). To reiterate, I am not advocating that the patient be responsible for the emergency treatment they needed, but there does need to be a protocol in place for funding the emergency treatment. I also read that “some health insurance plans deny claims for legitimate emergency department visits, based on a patient’s final diagnosis, rather than the presenting symptoms (ACEP, 2021). So, if someone goes into the emergency department with chest pains (thinking they’re having a heart attack) but it turns out to be heartburn, some insurances will deny the payment on the patient’s behalf. But this is not correct—the insurance should cover the claim per EMTALA and the initial symptoms.
The Patient Self-Determination Act of 1990 (PSDA) was authorized to ensure that patients are informed of their right to execute their rights to implement advance directives and accept or refuse medical care. An Advance Directive is a legal document that contains information on one’s medical decisions and is only put into effect if one is incapacitated and unable to speak for themselves (Advance Care Planning: Health Care Directives, 2018). The PSDA impacted hospitals, skilled nursing facilities, home health agencies, hospice organizations, and health maintenance organizations serving Medicare and Medicaid patients back on December 1, 1991. Health care organization that participates with the Medicare and Medicaid reimbursement programs must address patient rights reading life-sustaining decisions and other advance directives. Healthcare organizations also have the responsibility to explain to staff, patients, and families that the patient has the right to direct their medical and nursing care, including the right to die directive. The patient also has the right to refuse any medical treatment when their mental or physical status has not been impaired. When the patient is no longer competent to exercise their right to self-determination, the right still applies, but the decision must be delegated to a surrogate decision-maker. If a healthcare organization failed to comply with the patient’s medical directives or the legally authorized decision-maker, it is at risk for a lawsuit. The PSDA required each state to describe the law regarding advance directives to providers (Pozgar, 2016).
The Patient Self-Defemination Act of 1990 is based on the ethical principle of respect for autonomy. Autonomy is the patient’s right to accept, refuse, or terminate treatment without any influence, coercion, or prejudice. When practicing autonomy, nurses are obligated to ensure health decisions are made freely. Patients must have accurate and understandable information and time to process the data (Roscoe, n.d.). While nurses need to respect the patient’s autonomy and practice the ethical principle of nonmaleficence, their health decision will not put others and the community in harm’s way (Pozgar, 2016).