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Description
EXECUTIVE SUMMARY
Ethical conflicts are a common phenomenon in today's healthcare settings. As healthcare executives focus on balancing quality care and cost containment, recognizing the costs associated with ethical conflicts is only logical. In this article, we present five case vignettes to identify several general cost categories related to ethical conflicts, including operational costs, legal costs, and marketing and public relations costs. In each of these cost categories, the associated direct, indirect, and long-term costs of the ethical conflict are explored as well.
Our analysis suggests that organizations have, in addition to philosophical reasons, financial incentives to focus on decreasing the occurrence of ethical conflicts. The cost categories affected by ethical conflicts are not insignificant. Such conflicts can affect staff morale and lower the organization's overall culture and profit margin. Therefore, organizations should develop mechanisms and strategies for decreasing and possibly preventing ethical conflicts.
The strategies suggested in this article seek to shift the organization's focus when dealing with conflicts, from just reacting to moving upstream--that is, understanding the root causes of ethical conflicts and employing approaches designed to reduce their occurrence and associated costs. Such an effort has the potential to enhance the organization's overall culture and ultimately lead to organizational success.
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Ethical conflicts are a common occurrence in healthcare facilities. Managing and responding to the ethical conflict can be challenging because inherent in all ethical conflicts is uncertainty or the question of what appropriate course of action to take. Ethical conflicts affect not only patients and families but also the facility's staff, culture, and overall Success.
In many healthcare facilities, conflicts are addressed by ethics committees or ethics consultation services (Fox, Myers, and Pearlman 2007; Milmore 2006). When an ethical conflict is recognized by a clinician or an administrator, the involved staff may call upon the organization's ethics mechanism to help address the situation. This reactive approach reflects the traditional manner in which ethics committees or ethics consultation services function when an ethical conflict occurs. While this approach can be helpful in complex and challenging ethical situations, it can be stressful and time consuming for members of the ethics committee or consultation service. In addition, this approach tends to accept the recurrence of ethical conflicts and, in so doing, ignores the underlying system or structure that may have caused the conflict (Forrow, Arnold, and Parker 1993; Nelson 2007).
Because addressing ethical conflicts demands investment of time and places stress on staff, such conflicts are clearly associated with financial costs. Little is known about the costs of ethical conflicts for two reasons. First, any analysis of costs associated with ethical conflicts is complex and does not have a framework that is specific to healthcare ethics. Second, historically, the costs of ethical conflicts were thought to be trivial or were simply an accepted part of the overall costs of delivering healthcare; thus, any analysis was not deemed worthy of the needed effort.
As healthcare executives and managers increasingly focus on balancing quality and cost, exploring the costs of ethical conflicts becomes a logical step in cost-control efforts. In this article, we use five case vignettes of actual ethical situations but with fictitious names to identify and categorize the costs related to ethical conflicts. We then offer recommendations for strategically decreasing costs associated with ethical conflicts in healthcare settings.
CASE VIGNETTES
Case 1
Eighty-one-year-old Mr. Stanton struggled for years with end-stage chronic obstructive pulmonary disease. Mr. Stanton was admitted to the hospital with bilateral pneumonia. Because of his compromised pulmonary function, he was placed on a ventilator and received an aggressive course of antibiotics. During his hospitalization, he became increasingly disoriented. Despite the gradual clearing of his pneumonia, the medical team was unable to extubate him. As Mr. Stanton's hospitalization continued, the medical team realized that his mental status was unlikely to change and that he had become ventilator dependent.
A week of further assessment confirmed this unfortunate prognosis. Mr. Stanton's wife indicated to the medical team that he would never want to live in such a situation and authorized the removal of the ventilator. Several family members disagreed, but Mrs. Stanton was adamant. These family members threatened to sue if the medical team removed the patient's life-sustaining treatment. The hospital's ethics committee and risk management office were consulted by the medical team because the staff did not know how to proceed. Over the next week, several meetings took place that involved the patient's wife and family members, the medical team and other staff on the case, members of the ethics committee, and the hospital's legal counsel. The decision was reached to remove Mr. Stanton from life-sustaining treatment. He died soon after being extubated.
Case 2
Mr. Larson was a 63-year-old man who suffered from small-cell lung cancer. He was admitted to the hospital after collapsing on the street. He had not been an inpatient at the hospital despite his cancer, but he had used services at one of the hospital's community clinics. Mr. Larson had received a short course of outpatient chemotherapy, but he frequently missed doctor's appointments and expressed little interest... |
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