The role of ethics in health care

There are many ways in which one can view safety and quality in consumer-centred health care.

It may be judged on the degree of information shared between clinicians and patients, or in any number of other ways.

I want to focus on the need for an ethical approach to this important relationship between the patient and their clinician – whether GP, specialist, nurse, pharmacists or allied health professional.

Consumer-centred health care is given to meet the needs of the patient, as defined by them, their carers, family, and their clinician collectively. The decisions, design and implementation of the care must be led by the patient, guided by the clinician.

Whilst acknowledging the importance of the conversation, and that frequently the desire is to put the patient at the centre of the discussion, there is clearly an imbalance between the medical knowledge of the clinician and the consumer’s own understanding.

As the community becomes more health literate and aware of what is happening to their bodies, there is a growing need for detailed discussions to explain the proposed treatment, the intended outcomes, possible risks, the side effects, the alternatives, what will happen if the suggested treatment is not followed and, of course, how much experience the clinician has had with the proposed procedure, what their success/failure rate is, and the total cost (including hospital costs, additional clinicians, medications, equipment charges).

Unfortunately, there are frequently gaps in this process – either by accident, ignorance, or design.

What does all this mean to the patient, carer, family member, and community in general?

The manner in which the clinician conducts the conversation with the patient is extremely important in obtaining a good outcome for the patient. Patients have a right to ask questions about the proposed care. They should then discuss the information with family, friends, and carers; and if necessary with other health professionals and/or review a reputable website such as Choosing Wisely Australia or Better Health Channel.

Whilst acknowledging the importance of the conversation, and that frequently the desire is to put the patient at the centre of the discussion, there is clearly an imbalance between the medical knowledge of the clinician and the consumer’s own understanding. This can lead to miscommunication, misunderstanding, and often confusion.

We must be aware that this can be used by some clinicians to take advantage of their patients, and it is here that we encounter ethics.

What are ethics? Ethics are professionally accepted standards of personal and business behaviour, values and guiding principles. Codes of professional ethics are often established by professional organisations to guide members in performing their job functions according to sound and consistent principles.

Is it acceptable to tell a patient that there is a small risk of a complication when statistically it is 1 in 20?

Can a surgeon say an operation will cost $x and there is a rebate of $y, and then not mention additional charges like anaesthetist, hospital stay, theatre fees, medication costs?

These are just two common ways in which unethical practices creep into health care and are clearly not centred on the best interests of the patient.

Most specialist colleges have Codes of Conduct which spell out, amongst other things, what is, and is not, appropriate ethical behaviour.  If you have concerns, it is a good idea to ask your treating clinician if they are a member of their professional college or other body and to remind them of the need to follow its ethical standards.

Let us look at two examples of potentially unethical behaviour.

Case 1

Mr Jones is referred to Audiologist, Susan by his GP, as he is having some difficulty hearing.

Susan works for a large national chain of clinics and part of her salary is based on the profit from sales she makes.

After conducting a basic test, Susan tells Mr Jones that he needs a very sophisticated hearing aid in his left ear – the price is quoted at $7,700.  Mr Jones inquires whether there is something else suitable for a lower price. Susan tells him this is the best option for him, but she will give him a 20 per cent discount reducing the price to $6160 if that will help him decide.

To try and ascertain if she has an incentive to sell him this particular device, he asks whether the manufacturer pays a commission.  Susan honestly tells him “No”.  Somewhat reassured he agrees to buy the aid. What she has not told him is that the profit margin on this unit is 53 per cent compared to other devices with only a 25 per cent margin.

Has Susan behaved ethically towards Mr Jones ?

Case 2

Mary Brown visits a cardiologist Dr Smith, who after performing a number of tests determines that she needs a pacemaker.

Dr Smith explains that this is now a fairly common and minimally invasive operation and she can be booked in two weeks. He asks her if she wants to go ahead and she responds by saying that her friend had a number of problems after she had her pacemaker implanted. Dr Smith says: yes that can happen, but I’ve done 200 of these procedures in the past year. Reassured Mary books the surgery.   What Dr Smith has not told her is that in 40 of these cases there have been complications.

Has Dr Smith behaved ethically towards Mary?

From these two case studies, we can see that not all clinical consultations are conducted in an ethical manner allowing the patient to give genuine informed consent.

If you are concerned that your practitioner has not behaved ethically with you, then you should take action.

Firstly, if you feel comfortable, try to resolve the matter directly with the clinician. If you don’t obtain a satisfactory response, then report the clinician to the Australian Health Practitioner Regulation Agency, or to the relevant professional college or association or to the health complaints authority in your State or Territory.

Consumers need to be alert and be prepared to stand up for their rights in obtaining safe, high-quality, and ethical health care.