Those that work in the field talk of the rights of patients, but the field has been very slow to insist on changing anything regarding its behavior and has not given any kind of accountability for the quality of their ethics practices to consumers (Hartman, 1993). Bioethics There are many aspirational standards for those in the field of bioethics, and those who work in that field usually work toward those standards instead of looking at their actual behavior from an ethical standpoint and looking for ways to change their profession so that ethics is not such a large concern as it currently is (Freedman & Combs, 1996)
This, however, often confuses the message that these individuals are trying to convey (Spencer, Mills, Rorty, & Werhane, 1999). There are many different ways that ethical obligations are communicated with different individuals and there are many ways to enforce these against professional people such as doctors, including using sanctions (Gabbard & Lester, 1995)
These are areas where ethics and accountability sometimes have problems, and where doctors that hold specific beliefs often struggle with what they feel is right and what they really should do (Hartman, 1993). Determining ethical behavior is difficult for another reason, which is that there are many different viewpoints of what is ethical, and patients that have no objection to a procedure might be followed by patients that do object (Goldstein, 1999)
Applying patients' rights and quality assessments to medical ethics and morals is something that is relatively new, but it has sprung from patients' rights complaints of the past and the concern for quality assessments and improvements of the health care system in general (Faulkner & Faulkner, 1997). Controversial Issues and Ethical Behavior Both of these causes, as has been mentioned, have their own individual degrees of importance (Hartman, 1993)
These doctors could learn much from their patients, but they choose not to, and whether their behavior is ethical or moral, it certainly does not help them or their patients to learn more about what they need to protect their health and livelihood (Faulkner & Faulkner, 1997). Coming along with the quality concerns is the issue of patients' rights (Irving & Young, 2002)
There is no way that a doctor can please everyone all of the time, even with the most polite and respectful bedside manner (Kagle & Giebelhausen, 1994). There will always be someone who is unhappy with their treatment, unhappy with their diagnosis, wants to seek a second opinion, or does not like a particular doctor because of what he or she did for another person, among many other concerns (Jacobson, 2001)
There were many others that allegedly fought for the rights of the patient, but there was little that was actually accomplished during that time, and it appeared that no one was actually stopping to ask the patients what it was that they really wanted and needed (Spencer, Mills, Rorty, & Werhane, 1999). The main goal of the grass roots movements that involved patients was to get control away from the doctors (Jayaratne, Croxton, & Mattison, 1997)
What is ethical must be determined some other way than what the patient agrees with, but how to make that determination is causing healthcare workers a great deal of stress and concern, and much of this is being transferred to the patients (Hartman, 1993). There is no way that a doctor can please everyone all of the time, even with the most polite and respectful bedside manner (Kagle & Giebelhausen, 1994)
To some degree, this is not their fault. When health care was expanding so rapidly many medical professionals put their time into research that would benefit future patients, and this was undoubtedly important (Kanuha, 2000)
This is especially true in the more developed countries where there are more options and freedoms when it comes to medical care that is sometimes not necessary but is chosen by the patient for various reasons (such as in most abortions or plastic surgery cases) (Kutchins, 1991). The Importance of Quality In addition to this quality assessment, quality improvement has become increasing important (Kleinman, 2001)
While some of these topics are more controversial than others, all of them are within the realm of concern for doctors and hospitals, and whether more guidelines for these issues are needed is a focus of concern for almost all countries of the world (Denhardt, 1991). This is especially true in the more developed countries where there are more options and freedoms when it comes to medical care that is sometimes not necessary but is chosen by the patient for various reasons (such as in most abortions or plastic surgery cases) (Kutchins, 1991)
Another concern with the health care problem is that it is arguable as to what makes something 'good quality' (Mattison, Jayaratne, & Croxton, 2002). It can be a good value for the money, lead to increased longevity, lead to a better quality of life, and many other things (Langs, 1976)
Most of those that have it are those that are retired and were fortunate enough to have good jobs through strong companies that continue to pay their insurance premiums (Cohen, 2001). There are fewer and fewer of these people every day as the populations ages and more companies stop offering these kinds of benefits to their workers and retirees (Mattison, Jayaratne, & Croxton, 2002)
Whether assessment of quality as it relates to ethics is actually feasible is another question that many individuals have addressed (Spencer, Mills, Rorty, & Werhane, 1999). The Feasibility of Ethical Accountability There are some who believe that assessing ethical behavior and accountability to various patients and consumers for health-care quality and other issues is completely impossible (Reamer, 1999; Renik, 1996)
Whether assessment of quality as it relates to ethics is actually feasible is another question that many individuals have addressed (Spencer, Mills, Rorty, & Werhane, 1999). The Feasibility of Ethical Accountability There are some who believe that assessing ethical behavior and accountability to various patients and consumers for health-care quality and other issues is completely impossible (Reamer, 1999; Renik, 1996)
Doctors are often conflicted emotionally by this because their ethics and morals conflict with what they can do for their patients (Goold, 2001). It is becoming more clear that doctors need more guidelines when it comes to delicate situations involving their patients, because they often have to go on only what they are taught in medical school and do not get to exercise their ethical beliefs as much as they would like (Rhodes, 1986)
The Strongest Cases There are many persuasive arguments made about the informed consent law and how it has never actually provided enough support for the autonomy of patients (Russell, 1984). There are many different rights that can be discussed when talking about patients and the most successful right that has been upheld within the courts is the rejection of life-sustaining treatment (Rose, 2000)
The point was not to instill morals and ethics into doctors, because most people develop those opinions themselves, but instead the point was to determine what kind of guidelines should be required to ensure that doctors, whatever their own beliefs and opinions, conformed to the rules that had been created for their profession (Bartle, Couchonnal, Canda, & Sraker, 2002; Strom-Gottfried, 2000). It was not until 1973 that anything was actually proposed that would create guidelines to protect human subjects in experimentation (Spencer, Mills, Rorty, & Werhane, 1999)
It is becoming more clear that doctors need more guidelines when it comes to delicate situations involving their patients, because they often have to go on only what they are taught in medical school and do not get to exercise their ethical beliefs as much as they would like (Rhodes, 1986). In other words, they often do not have the power to try to help their patients in the best way possible because they are unaware of some of the options that they have or are not able to find a way to get the procedure, tests, or medication covered by the health plan that the patient has (Stromwall, 2002)
While there are some that feel this is not as important as the treatment or medication that is received, it is part of the notion of quality and therefore it becomes important to the patient (Victor & Cullen, 1997). What is important to the patient should therefore be seen as something that is important to the doctor and the hospital, but this is too often not the case with many medical professionals (Taylor, 1999)