ETHICAL CONDUCT FOR HEALTH CARE INSTITUTIONS

American Hospital Association

1992

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In 1973, the American Hospital Association (AHA) developed its Guidelines on Ethical Conduct and Relationships for Health Care Institutions, the precursor to the present document, as a complement to the preceding code of ethics for health-care executives. This AHA code of ethics for health-care institutions, which addresses the major areas affecting their ethical conduct, is different because it is written for institutions, that is, their "mission, programs, and services," rather than for people.

Points of interest include (1) responsibility for "fair and effective use" of available resources and helping to resolve the problem of providing care to medically indigent individuals; (2) respect for the spiritual needs and cultural beliefs of patients and families; (3) accommodation, to the extent possible, of "the desire of employees and medical staff to embody religious and/or moral values in their professional activities"; and (4) sensitivity to "institutional decisions that employees might interpret as compromising their ability to provide high-quality health care."

Introduction

Health care institutions, by virtue of their roles as health care providers, employers, and community health resources, have special responsibilities for ethical conduct and ethical practices that go beyond meeting minimum legal and regulatory standards. Their broad range of patient care, education, public health, social service, and business functions is essential to the health and well being of their communities. These roles and functions demand that health care organizations conduct themselves in an ethical manner that emphasizes a basic community service orientation and justifies the public trust. The health care institution's mission and values should be embodied in all its programs, services, and activities.

Because health care organizations must frequently seek a balance among the interests and values of individuals, the institution, and society, they often face ethical dilemmas in meeting the needs of their patients and their communities. This advisory is intended to assist members of the American Hospital Association to better identify and understand the ethical aspects and implications of institutional policies and practices. It is offered with the understanding that each institution's leadership in making policy and decisions must take into account the needs and values of the institution, its physicians, other caregivers, and employees and those of individual patients, their families, and the community as a whole.

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Community Role

• Health care institutions should be concerned with the overall health status of their communities while continuing to provide direct patient services. They should take a leadership role in enhancing public health and continuity of care in the community by communicating and working with other health care and social agencies to improve the availability and provision of health promotion, education, and patient care services.
• Health care institutions are responsible for fair and effective use of available health care delivery resources to promote access to comprehensive and affordable health care services of high quality. This responsibility extends beyond the resources of the given institution to include efforts to coordinate with other health care organizations and professionals and to share in community solutions for providing care for the medically indigent and others in need of specific health services.
• All health care institutions are responsible for meeting community service obligations which may include special initiatives for care for the poor and uninsured, provision of needed medical or social services, education, and various programs designed to meet the specific needs of their communities.
• Health care institutions, being dependent upon community confidence and support, are accountable to the public, and therefore their communications and disclosure of information and data related to the institution should be clear, accurate, and sufficiently complete to assure that it is not misleading. Such disclosure should be aimed primarily at better public understanding of health issues, the services available to prevent and treat illness, and patient rights and responsibilities relating to health care decisions.
• Advertising may be used to advance the health care organization's goals and objectives and should, in all cases, support the mission of the health care organization. Advertising may be used to educate the public, to report to the community, to increase awareness of available services, to increase support for the organization, and to recruit employees. Health care advertising should be truthful, fair, accurate, complete, and sensitive to the health care needs of the public. False or misleading statements, or statements that might lead the uninformed to draw false conclusions about the health care facility, its competitors, or other health care providers are unacceptable and unethical.
• As health care institutions operate in an increasingly challenging environment, they should consider the overall welfare of their communities and their own missions in determining their activities, service mixes, and business. Health care organizations should be particularly sensitive to potential conflicts of interests involving individuals or groups associated with the medical staff, governing board, or executive management. Examples of such conflicts include ownership or other financial interests in competing provider organizations or groups contracting with the health care institution.

Patient Care

• Health care institutions are responsible for providing each patient with care that is both appropriate and necessary for the patient's condition. Development and maintenance of organized programs for utilization review and quality improvement and of procedures to verify the credentials of physicians and other health professionals are basic to this obligation.
• Health care institutions in conjunction with attending physicians are responsible for assuring reasonable continuity of care and for informing patients of patient care alternatives when acute care is no longer needed.
• Health care institutions should ensure that the health care professionals and organizations with which they are formally or informally affiliated have appropriate credentials and/or accreditation and participate in organized programs to assess and assure continuous improvement in quality of care.
• Health care institutions should have policies and practices that assure that patient transfers are medically appropriate and legally permissible. Health care institutions should inform patients of the need for and alternatives to such transfers.
• Health care institutions should have policies and practices that support informed consent for diagnostic and therapeutic procedures and use of advance directives. Policies and practices must respect and promote the patient's responsibility for decision making.
• Health care institutions are responsible for assuring confidentiality of patient-specific information. They are responsible for providing safeguards to prevent unauthorized release of information and establishing procedures for authorizing release of data.
• Health care institutions should assure that the psychological, social, spiritual, and physical needs and cultural beliefs and practices of patients and families are respected and should promote employee and medical staff sensitivity to the full range of such needs and practices. The religious and social beliefs and customs of patients should be accommodated whenever possible.
• Health care institutions should have specific mechanisms or procedures to resolve conflicting values and ethical dilemmas as well as complaints and disputes among patients their families, medical staff, employees, the institution, and the community.

Organizational Conduct

• The policies and practices of health care institutions should respect and support the professional ethical codes and responsibilities of their employees and medical staff members and be sensitive to institutional decisions that employees might interpret as compromising their ability to provide high-quality health care.
• Health care institutions should provide for fair and equitably-administered employee compensation, benefits, and other policies and practices.
• To the extent possible and consistent with the ethical commitments of the institution, health care institutions should accommodate the desires of employees and medical staff to embody religious and/or moral values in their professional activities.
• Health care institutions should have written policies on conflict of interest that apply to officers, governing board members, and medical staff, as well as others who may make or influence decisions for or on behalf of the institution, including contract employees. Particular attention should be given to potential conflicts related to referral sources, vendors, competing health care services, and investments. These policies should recognize that individuals in decision-making or administrative positions often have duality of interests that may not always present conflicts. But they should provide mechanisms for identifying and addressing dualities when they do exist.
• Health care institutions should communicate their mission, values, and priorities to their employees and volunteers, whose patient care and service activities are the most visible embodiment of the institution's ethical commitments and values.