Legal and Ethics in the Healthcare System - Essay Example

Introduction: Any discussion involving ethics can be quite complicated or complex. This is because the question of ethics in any field has to be viewed according to several viewpoints. They include policies of the government and organized bodies, statutes, religious beliefs and customs, social practices that have evolved over the years, etc. Moreover, there is also the question of diversity that may exist from country to country or region to region that further complicate matters. But in any case, the question of ethics is taken into account in practically all the fields of human endeavor in a civilized society. This paper looks at the concept of medical ethics in the area of group therapy. In this modern and highly stressful world the concept of social interaction is coming down and individual and groups have no way to deal with their problems. Hence the concept of group therapy is gaining importance. It is very important in this context to see the ethical practices that govern any such therapy sessions primarily aimed at individual members and the members of the group as a whole. Medical ethics: This concept basically means applying the above mentioned parameters in medicine. The United States has a large number of bodies representing different medical fields. Each of them has developed their own code of conduct based on ethical principles. A study of literature on the topic shows that the basis for all ethical principles is based on the Hippocratic Oath. But many more parameters have been brought in taking into consideration legal, religious, and social factors. The American Psychological Association has developed extensive a set of ethical principles to be followed by its members. According to the association, “Ethics Code applies only to psychologists activities that are part of their scientific, educational, or professional roles as psychologists” (Ethical principles of psychologists and code of conduct, 2003). They add that misuse or disregarding these principles could result in disqualification to practice and loss of membership from the APA and probable other associations as well. But this need not necessarily result in legal action since it is dependent on statutes of the state or country. Some of the more important principles that are related group therapy are given here. One important precaution to be taken by physicians is to obtain informed consent from the members of a particular group before start of therapy sessions. For this purpose, psychologists must communicate with members of the groups in a language that could be reasonably understood by them. This indicates that if a person does not understand English, communication must be made in a language that is understood by the patient. If the person or persons undergoing therapy is mentally or physically incapable, then the person in charge (e.g. family members) should be contacted and consent obtained. In case there are any conflicts with personal, organizational or legal factors, all efforts must be made to find a solution. But the APA adds that legal considerations have precedence over any other factors and can even override their own guidelines if these principles are found to be a violation of law. The therapist should not be discriminative towards group members with regard to religion, gender, race or color. Therapists must in no way perform a session if it is outside their level of competence or qualification. Another important factor is the concept of confidentiality. All information with regard to the therapy should be kept confidential. This is important since the reason for therapy may be embarrassing for the participants should it be made public. In case the results are published, then the identity of the participants must be kept secret unless they specifically agree to it. In case the therapy session is recorded (audio or video), here again, consent from the members have to be obtained. If incapable, the same principles with regard to informed consent (mentioned above) will apply. Any form of misconduct (for example, sexual misconduct) is also specifically prohibited. It may also happen that a member may be harassed or discriminated against by other members of the same or different group. It is the duty of the therapist to see that such incidences do not happen or even if they do, it is not repeated. It should be noted here (again) that most controlling bodies including the Nurses Association have their own ethical guidelines. There is the American Counseling Association and the American School Counseling Association which is strictly involved in therapy and counseling. As mentioned earlier, medical ethics in any field is influenced (and bound) by statutes. The rights of group members to sue for malpractice is also a threat that motivate the ‘less caring physicians’ and therapists into complying with ethical guidelines (Lymberis, 2007). As with most statutes in the United States, each state has their own laws regarding malpractice and ethics in medicine even though many of the areas covered were common. But in 1986, the US Congress found that that a national statute aimed at improving quality of healthcare should be enacted. It introduced the Healthcare Quality Improvement Act of 1986 with the aim of a “national need to restrict the ability of incompetent physicians to move from State to State without disclosure or discovery of the physician’s previous damaging or incompetent performance” The Healthcare Quality Improvement Act of 1986, 2008). It is assumed ethical misdemeanor will also come under the purview of this Act. As a result, the National Practitioner Data Bank is released periodically where offenders and institutions guilty under the Act are named. This public has access to this database and they can make sure that a new or old physician not guilty of any misdemeanor. Some instances of ethical practice with regard to social and religious settings are also provided here. A group may be comprised of people from different races, classes, and religions. The therapist should take care not to hurt the sentiments of group members even unintentionally. For example, if dogs are taken as a part of the therapy, it may not be acceptable to a person who is devout Muslim. All major religions of the world have the welfare of the state and those who inhabit it. But the therapist should refrain from giving religious based advice as it may again be uncomfortable to those from other faiths. In group therapies, the therapist may find it difficult to prevent members from either hurting social sentiments or using religion. This again may cause distress to other members. If such a thing occurs, the therapist should gently and firmly put a stop to it. He can be accused of unethical practice if this is not done. It would also be worthwhile to have a very brief look at ethical theories that have evolved over the years. According to one line of thought, “ethics is concerned with what we chose to do intentionally or on purpose. Ethics is not concerned with what people do accidently or unintentionally, even if these behaviors cause bad things” (Devettere, 2000, p.1). This indicates that unless an act is done intentionally, there is no question of unethical behavior, even if something bad occurs. This is also in line with the national criminal justice system, whereby two factors namely, ‘mens rea, and ‘actus reus’ are required for a person to be guilty. It means intention to commit a crime or unlawful act and the actual committing of that act. Hence an unintentional ethical lapse may be forgiven by law. There are other theories that equate ethics with morality. Any action which is moral to a person and society is ethical. Again according the concept of absolutism, physicians of the past had absolute power regarding a treatment or therapy. But according to Dr Lymberis (mentioned earlier) this no longer holds true today. The concept of utilitarianism states that any act should bring out the maximum number of benefits. The people who benefit from it should be much larger than those who are hurt by it. Conclusion: Ethics in group therapy is no longer difficult to understand, though its practice may be more difficult. This is because most associations related to the field have clearly laid down principles that need to be followed. Ethical theories can also provide guidelines. There are also statutes and laws to help in this regard. All the principles regarding general ethics can be applied to group therapy also. But since more than one person is involved in a single session, the therapist has to look at other factors also. One of the most important is ensuring behavior of other group members in a way that is within the boundaries of ethics. This could be a challenging task apart from normal ethical concerns for a therapist. References Devettere, R.J. (2000). Political decision making in healthcare ethics, Georgetown University Press. Ethical principles of psychologists and code of conduct. (2003). American Psychological Association, Retreived August 21, 2009, from http://www.apa.org/ETHICS/code2002.html#intro Lymberis, M.T. (2007). Ethical and legal issues in group psychotherapy, Retrieved August 21, 2009, from http://www.lymberis.com/ethical.html The Healthcare Quality Improvement Act of 1986. (2008). HCQIA, Retrieved August 21, 2009, from http://www.hcqia.net/ Read More