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Clinical Ethics, Personal Ethics and Managed Care

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1. What are some of the goals associated with clinical ethics?

2. How do your values/ethics influence the care that you give or your actions in the work environment?

3. What is your understanding of the effects of managed care on health care resources in your environment?

List references.

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Good questions! Let's take a closer look. I also provided an article at the end of this response, some of which this response is draw.


1. What are some of the goals associated with clinical ethics?

This relates to the ethical code and principles that guides the clinical practices. Each profession (e.g., nursing, physician, psychologist, etc.) adhere to a different code of ethics and different ethical principles, although there are some common goals. One goal of clinical ethics is guide all professional behavior, which first mandates "to do no harm" called in ethics "the principle of nonmaleficence. Clinical ethics also has principles intended to direct behavior in a positive direction, such as showing respect for the human dignity and autonomy of the client/patient e.g. the right to make her or his own decisions, the right to be informed about treatment option, and so forth. In other words, the goal is to provide principles to cover most professional situations concerning the principles of autonomy, beneficence, nonmaleficence, and fidelity. Clinical ethics often deals with principles and values directed beyond the patients, to colleague, the profession and the community at large. Another goal is to provide a 'COMMON' framework to help professionals make clinical decisions with conflicting principles. In fact, "a number of conflicting ethical principles may be relevant and applicable to any difficult medical situation. How patients, physicians, staff and family rank and value these principles and how conflicting rankings are resolved constitutes the main work of clinical ethics (http://xnet.kp.org/permanentejournal/sum97pj/principles.html).

Can you think of other goals? Please see article at the end of this response, some of which this answer drew on.

2. How do your values/ethics influence the care that you give or your actions in the work environment?

Values guide all behavior, including professional behavior. Values are also embedded in each ethical principle. Indeed, personal values need to be subordinate to professional values, especially where they differ to any large extend. This is because personal values can bias treatment and clinical decisions, and that is one reason why clinical ethics emerged, to provide a framework of ethical principles to guide and analyze all professional behavior, which are intended to override personal values, at least in the workplace. For example, because of autonomy, patients may refuse any proffered procedure, treatment, or even the advice of a health care professional. Even though at the personal value level, this refusal is seen as ill-advised or even irrational, you would not counter the clinical principle of autonomy, which reflects the moral, social, and legal norms that hold that competent patients have the right to determine their destinies (http://xnet.kp.org/permanentejournal/sum97pj/principles.html).

For example, if a patient decided to have an abortion, even though your personal value was pro-life, the professional principle of autonomy would have to override your person value that "abortion is wrong or immoral." However, a health professional is not expected to perform abortions if it is unconscionable, and something that the person could not live with. However, the health professional still needs to treat the person with respect and refer the patient to a health professional that can help.

3. What is your understanding of the effects of managed care on health care resources in your environment?

Managed Care Organization is an entity, whether it is public or private, which exercises overall management of the service delivery process (http://www.allenshea.com/careconcepts.html).

This integrated approach is about cost containment to some extent, and it has been argued that it is done at the expense of quality. In other words, health care resources are stretched and patients suffer because of it. For example, human resources, such as physicians are forced to work longer hours and see more patients in a hour, so the quality of care. Nurses and their time are also stretched to save money, and there is a shortage of nurses due to the negative working environment and making fewer nurses handle a more and more work leading to being overworked, fatigue and stress, which also impacts performance negatively. In fact, the number of medical errors has risen due to the stretching of health care human resources beyond human capacity without making errors and impacting overall performance negatively. Medical supplies and their distribution is another example of health care resources which are expected to be used sparingly. This too can compromise quality care. It is all about maximizing profit, and a system that is focused on profit, puts quality care on the back burner. However, others argue that managed care is more than cost containment, and done right, it is a highly effective system of delivery, which fails when HCOs implement only isolated techniques that part of managed care. This courts disaster. Unfortunately, mixing and matching these techniques--especially as implemented by different vendors--can result in complications and cross-purposes sufficiently dire to negate any cost or quality benefits. In such an environment, says Gould, managed care principles that are sound in themselves can begin to work against each other. Integrated management care can also delivery programs effectively and efficiently. Services and programs can also be considered health care resources. In terms of financial resources, however, there seems to be less and less, even though one goal of managed care is cost containment, but other factors come into play (e.g. aging population, etc.) (see http://findarticles.com/p/articles/mi_m0903/is_nSPEISS_v9/ai_11098640)

What do you think about managed care and its effect on health care resources?

This is not exhaustive, but should give you an excellent starting point.


Davenport, J. (n.d.). Ethical principles in clinical practice. Retrieved June 25, 2008, from http://xnet.kp.org/permanentejournal/sum97pj/principles.html.

Health Care Industry. (n.d). Retrieved June 25, 2008, from ...

Solution Summary

This solution discusses the goals associated with clinical ethics and how personal values/ethics influences personal actions and the care given to others in the work environment. It also discusses the effects of managed care on health care resources in the work environment. Supplemented with a highly informative article, about the ethical principles in clinical practice.

See Also This Related BrainMass Solution

Ethical Violations

Case Study

Ethical Pitfalls in Managed Care

After completing his master's degree in counseling, Martin worked at the Family Service Center, an agency where he received 3,000 hours of supervised practice required for licensure in his state. He passed the state board examination and became a licensed professional counselor. Only then, in accordance with state licensing regulations, did Martin hang out his shingle and open his independent private practice
Martin wanted to provide the best possible counseling services to his clients. He also wanted "and needed- to earn a good living. During the first few months he struggled, unaware of the extent to which managed care had affected the private practice of counseling. He placed ads in the yellow pages and local telephone directories, gave free talks at PTA meetings and to various civic clubs, invited referral sources out to lunch, and attempted several other strategies to build a client base. Very few referrals came.
Martin pursued an opportunity to become a network provider with HealthCo, a managed care company. He accepted the company's $50 per hour payment, although it was considerably less than his usual fee, and agreed to comply with HealthCo's approach to managed care. He was delighted when HealthCo referrals began to come in on a regular basis.
In some respects, Martin was pleased with the service provided by the managed care company. When he ascertained that a client who presented with depression was also suffering from anorexia, he realized that he needed to refer clients because he lacked training and supervised experience with this disorder. He called his HealtCo case manager, who arranged a psychiatrist in the network who specialized in eating disorder.
However, there were some aspect of the relationship with HealthCo that worried Martin. He was required to get telephone authorization for clientsâ?? sessions, but it seemed that whenever he called, he was connected to a different case manager who identified him- or herself only by first name. The case managers began the telephone conferences by keying in Martin.s client's Social Security number to gain access to the client's computerized file. Before he began to work with HealthCo, Martin had been required to give diagnosis when completing paperwork for third-payers, and he was comfortable with giving that information. But these case managers insisted that if they were going to manage, they needed much more information. They inquired about client's childhood traumas, marital problems, addictions, and other matters. Martin realized that this questioning was legal because the client had signed Health Co disclosure form. But he wondered, was it ethical? He became concerned about just what happened to the information he disclosed over the telephone.
Soon after these concerns began to emerge, one of Martin's clients ran out of insurance benefits. The case manager suggested that Martin space out the last 3 of the 20 allocated visit over a period of several months or arrange a referral to a community mental health center. Martin did not feel that these options were acceptable. The client needed weekly sessions, and considerably more than the 3 that remained. He also believed that she needed continuity of care, and that a transfer t a new counselor was not in her best interest. Martin attempted to explain his concerns to the case manager but was unsuccessful in convincing her to alter her decision. Because he could not consider abandoning a client and would not make a referral, he decided, with some resentment toward HealthCo, to continue to see the client pro bono. This interaction caused Martin to wonder what professional credentials HealthCo's case managers possessed. Were they qualified to make decisions about psychotherapy?
Soon thereafter, an 11-year-old boy named Joshua was referred to Martin under the boy' father's company insurance plan administered by HealthCo. Joshua was getting in fights at school. It quickly became clear to Martin that Joshua's parents were in conflict, so Martin recommended marital counseling. However, this particular HealthCo plan didn't cover marital counseling. Martin, beginning to feel frustrated with managed care, saw the parents in counseling and billed the sessions under Joshua's name. He justified his decision to himself by reasoning that; after all, gains in the marital relationship should surely yield benefits for Joshua.

Give a brief description of two ethical violations from this case study . Evaluate the consequences (e.g., sanctions) of engaging in each violation. Finally, analyze and explain what a counselor would do to safeguard against such situations in a counseling practice

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