Abstract
This paper provides a background understanding of research that is aimed at examining the legal and ethical environment restrictions and opportunities affecting health care provision at the Jackson Hospital in Miami. The literature review presents different perspectives, such as the effect of standardization, healthcare, legal issues, as well as ethical dilemmas created by the demands for compliance. The review provides different views of practitioners and patients as they interact in the legal, ethical environment of health care, leading to the question of whether it is possible to have the restrictions still and achieve universal health care objectives.
Literature Review
According to Epstein (2014), professionals are persons who can profess to know something. Going by this definition, medical professionals have a legal right to impose fees when discharging their professional services. Nevertheless, the acceptance of fee-charging behaviors by professionals can deter society from pursuing or actively enjoying the services, which professionals should provide, and instead spend much time and money on evaluating professionalism itself. In the medical fraternity, the effect of markets continues to be felt, where the various aspects of professionalism become standardized and priced.
As commodities, physician services, and other healthcare services continue to plummet in prices due to technological advances, economies of scale, and other commerce instruments. Unfortunately, when the professional service becomes a mass-market commodity, it losses reliability, and professionals are called to innovate (Mehlman, Berg, Juengst, & Kodish, 2011).
When they do so, they again increase the value of their professional services by making them unique. With standardization, there are compromises that professionals have to make. Those at the center of institutions and systems enjoy substantial rewards while the majorities who are at the periphery get low revenues despite their role as key implementers (Badzek, Henaghan, Turner, & Monsen, 2013).
Although medical professionals will not term themselves as businesspersons, business norms run them. Doctors may learn about a procedure in surgery or medicine that they can only use when they adhere to its licensing terms.
Another example provided by Epstein (2014) is that of an independent payment advisory board whose mandate is to ensure that Medicare spending reverts back to target levels. While the body’s mandate gives it immense power over the provision of health care, several clauses also affect the ability to execute the order. For example, it cannot increase Medicare beneficiary cost-sharing or try to increase the cost of healthcare to patients.
Still sticking to market ideology, Epstein (2014) explains that despite the lack of guarantees in life, monopolies will always drive up costs and reduce surpluses. Allowing firms to set prices could award them monopoly powers. On the other hand, the ability can enable them to remain innovative as they can find market justification for their innovations. However, in the health care case, hospitals can both operate as monopolies and competitors and still fail to garner adequate room for exercising their powers to innovate.
For example, public hospitals have to put up with restrictions on their funding from national or state budgets. Those subscribing to Medicare have to deal with price ceiling and standardizations that overall allow the system to function well, but for particular institutions, they restrict the abilities to innovate and offer better healthcare to patients or better payment terms to their staff.
Antitrust laws seek to protect consumers from exploitation, and in healthcare, the question is whether they can protect consumers against standardized practices that limit innovation. When a hospital has standardized practices and acts alone, there are no risks posed to the rest of society. However, when standardized practices affect all hospitals and remain unquestionable, then all beneficiaries of healthcare are in danger.
Letting less qualifies professionals to handle significant roles in hospitals as part of the standard protocol to keep costs low might save hospitals from going bankrupt. However, that does not allow the same hospitals to remain innovative. Epstein (2014) cautioned against standardization, which many healthcare institutions may seek only to find out that permitting restrictions and sticking to licensing requirements stifles their innovativeness and jeopardizes their short-term financial positions.
In addition to standardization claims by Epstein (2014) that describe a real concern, but lack adequate examples to tie them to typical hospital situations, Ford (2012) offers the same argument but from a patient’s perspective. Thus, while the Epstein (2014) account is mostly legal, the one by Ford (2012) offers an ethical dimension to the healthcare environment. Key questions that the author seeks to answer are about the qualification of individuals in publicly funded health care and the decision to provide drugs to some patients and leave out others (Randall, Curran, & Omer, 2013).
Healthcare resources remain scarce in many parts of the world, and the United States is not an exception (Moeller et al., 2012). However, many cases where patients receive less health care than they would expect have had to go to court for rulings (Dickens & Cook, 2008).
Patients have to qualify as exceptional cases for them to access specific drugs offered in hospitals. Their physicians have to prove beyond doubt that their patients trained for a particular procedure (Gaudine, Lamb, LeFort, & Thorne, 2011). Pressure comes from both the funding agencies that seek to implement standards to keep the costs manageable and agencies or administrators seeking to keep resources manageable and to stretch them as far as possible (Førde & Hansen, 2014).
Health bodies have to approve drugs for them to be included in standard treatment for particular diseases. Hospitals can only include drugs in their subsidized payment plans when they have the approval of the relevant medical bodies governing them. The challenge is for public authorities to avoid fettering the exercising of their decisions (Ford, 2012).
When weighing priorities, different authorities will exercise diverse judgments as long as they meet reasonable requirements. In many cases, organizations leave out exceptions to their standard as undefined, which then raises a legal question of what qualifies as exceptional. Legal battles can ensure unless the special terms or circumstances are at least vaguely identifies to facilitate future interpretation (Marchetti et al., 2013).
Doctors act according to standards approved by their hospitals and their governing medical bodies. They provide treatment or arrange for it based on the assessment they make, the needs of the patient, and the available treatment options. Unethical practices arise when doctors discriminate patients based on personal views. The same argument would be advanced to a hospital when one patient receives different treatment from the rest. The patient could be exceptional, thus qualifying for a different protocol, but the same procedure would be violating standard guidelines and thus raise an illegality question (Ford, 2012).
Within hospitals and other healthcare institutions, there are departments working on different agendas, but with standard views or objectives. Based on the organization theory, the different departments serve as independent units of production (Perera & Peiro, 2012). However, in healthcare provision, it is hard to assign individual units of production because many services are interdependent. There are hospital administrators in charge of the provision of the relevant working environment for healthcare providers like nurses and doctors within institutions. In many cases, the administrators also serve as providers.
The person in charge of making standards and enforcing them would be ideal at the apex of the organization (Chiarello, 2013). On the other hand, with the need to tailor strategic plans to the needs of hospitals, it is important to involve the primary stakeholders, and with the government being the biggest stakeholder of public institutions, decision-making ends up taking place beyond the apex of the system (Perera & Peiro, 2012).
Moreover, organizations create lists of services that they offer to clients, and they mostly gloss over the details. Patients end up expecting services from a hospital-based on what they get in the list of services. In many cases, the creation of the list follows demand and habit instead of critical review. Therefore, patients may not expect to get a particular car from a hospital because it is not availed as part of the routine. It is the hospital’s duty to inform patients of available care.
Tiedje and Plevak (2014) offer reconciliatory remarks that explain the source of inequalities in the healthcare environment. Hospitals are restricted to patients who qualify for their medical services. They can only treat patients with adequate medical covers when that is a condition for treatment. In such arrangements, patients who lack protection have to find somewhere else.
The hospital will be performing an illegal act if it proceeds to treat uninsured patients with the funding it receives from insurance companies or government insurance agencies. In this regard, health care institutions governed by financing standards can only offer limited healthcare and have to go against their wishes to provide care for all. Such is the consequence of operating healthcare institutions in a market-based society (Tiedje & Plevak, 2014).
The recurring question at this stage is whether it is possible to act within the market system and still be able to honor both legal and ethical requirements and expectations of healthcare provision.
Many people who opt to join the medical field as professionals or volunteers do so because they are advocating the rights to health, yet the systems in place limit their participation and actualization of their goal (Larsen, 2012). They remain unable to meet the needs of patients, who may not have anything to do with political, legal, and religious aspects that cause standardization challenges (Tiedje & Plevak, 2014). The human experience is an amalgamation of biological, psychological, ecological, and spiritual paradigms.
Moreover, it is only by looking at the interconnection of these paradigms that an effective healing intervention can occur (Butler & Zamora, 2013). Patients expect confidentiality when they are receiving health care. In therapy, patients may reveal intricate details about their habits, and the same can happen when physicians are making a diagnosis. However, the information collected by staff in a health care institution needs to remain private as a right to the patient. Both the formally recorded data and the informally collected data need protection and proper handling.
Data privacy is a good thing; it allows patients to receive care without fear of stigma. However, hospitals also need to make decision-based on patient information, and physicians will often share patient data within the process of treatment. The legality of sharing, which exposes patients’ private condition to other people, is a matter requiring legal interpretation. While most patients will not mind the sharing of their personal information, such as the display of patient information on publicly viewed documents besides their hospital beds, some can raise legal and ethical concerns and put a hospital in the defensive position.
On one part, there is the patient’s right to privacy. On the other hand, there is the hospital’s obligation to offer care and provision to gather patient information (Williams, Skirton, & Masny, 2006). Acknowledgment of this gap has been made by scholars, with suggestions to resolve it, but a solution is yet to be found (Butler & Zamora, 2013).
Another environmental challenge for hospitals is the legality of the patient. Immigrants lack the necessary documents to allow them to buy health care; thus, they remain at the mercy of institutions and state authorities. Without abilities to navigate the healthcare bureaucracy, they are unable to pay for care given that hospitals do not have provisions for reporting care provided to illegal immigrants who lack necessary documentation.
Thus, while the hospital can obtain money and offer treatment, its obligation to report expenditures forces its staff to decline caregiving to avoid a documentation nightmare and legal hurdles (Marrow, 2012). Hospitals cannot avoid reporting immigrants to authorities. Resultantly, immigrants will not go to hospitals when they need treatment because they fear deportation; therefore, the promise of universal health care remains false in such cases (Wike, 2013).
The last factor of review in this paper is the cost of health care. In the United States, as it is with many other developed countries, the cost does not reflect patient and public health outcomes. The cost reflects the availability of healthcare, where high cost compels insurers to opt-out of some markets while employers reduce the cover for their employees.
According to Kaplan and Babad (2011), despite the constraints of available resources, various actions, when taken, can lead to a maximum population health improvement (Bengtsson, 2011). Governments have to act as public advocates against the harmful effects of market orientation and standardization that many scholars have explored (Kaplan & Babad, 2011).
Problem Statement
Hospitals continue to face difficulties related to standardization of practices and reliance on market-based systems that are not reflective of the healthcare environment that is needed to facilitate maximum public and patient care gains. Hospitals involved directly with research such as Jackson Hospital in Miami have to navigate legislative provisions and restrictions that govern both researchers and participants. Many scholars look at the problems facing trouble with legal and ethical environments of healthcare operations independently.
They do not develop a holistic outlook that can assist in gaining practical insight that individual institutions can embrace without having to succumb to long wait periods for relevant authorities to make changes. For example, if hospitals could understand and find ways of circumventing the ethical and legal restrictions to procurement, storage, and transfer of tissues and cells to aid their research activities, then such hospitals would be able to remain innovative and contribute to the overall development of healthcare.
Legal and ethical aspects affect patient care, hospital policy formulation, property rights exercising and protection, as well as right and entitlements of patients, doctors, institutions, research materials, and other healthcare assets. The challenge is to not only understand the challenges but also define mechanisms that help to solve them and improve universal health care access.
Research Question
The study aims to find out the impeding factors to universal health care providers that affect Jackson Hospital. In doing so, the research shall examine the legal and ethical environment restrictions and opportunities affecting health care provision at the institution.
References
Badzek, L., Henaghan, M., Turner, M., & Monsen, R. (2013). Ethical, legal, and social issues in the translation of genomics into health care. Journal of Nursing Scholarship, 45(1), 15-24. doi: 10.1111/jnu.12000
Bengtsson, B. O. (2011). Promote the general welfare to ourselves and our posterity: the founding documents of the United States and the nation’s health care debate. Medicine, Health Care, and Philosophy, 14(3), 249-255. doi: 10.1007/s11019-010-9288-6
Butler, M. H., & Zamora, J. P. (2013). Ethical and legal concerns for MFTs in the context of clergy-collaborative care: Is what I share really confidential? The American Journal of Family Therapy, 41(2), 85-109. DOI:10.1080/01926187.2012.677713
Chiarello, E. (2013). How organizational context affects bioethical decision-making: Pharmacists’ management of gatekeeping processes in retail and hospital settings. Social Science & Medicine, 98, 319-329. doi:10.1016/j.socscimed.2012.11.041
Dickens, B. M., & Cook, R. J. (2008). Multiple pregnancy: Legal and ethical issues. International Journal of Gynecology and Obstetrics, 103(3), 270-274. doi:10.1016/j.ijgo.2008.08.006
Epstein, R. A. (2014). Big law and big med: The deprofessionalization of legal and medical services. International Review of Law and Economics, 38(Suppl), 64-76. doi:10.1016/j.irle.2013.09.004
Ford, A. (2012). The concept of exceptionality: A legal farce? Medical Law Review, 20(3), 304-336. doi: 10.1093/medlaw/fws002
Førde, R., & Hansen, T. (2014). Do organizational and clinical ethics in a hospital setting need different venues? HEC Forum, 26(2), 147-158. doi: 10.1007/s10730-014-9237-5
Gaudine, A., Lamb, M., LeFort, S., & Thorne, L. (2011). The functioning of hospital ethics committees: a multiple-case study of four canadian committees. HEC Forum, 23(3), 225-238. doi: 10.1007/s10730-011-9151-z
Kaplan, R. M., & Babad, Y. M. (2011). Balancing influence between actors in healthcare decision making. BMC Health Services Research, 11, 85. doi:10.1186/1472-6963-11-85
Larsen, A.-C. (2012). Trappings of technology: casting palliative care nursing as legal relations. Nursing Inquiry, 19(4), 334-344. DOI: 10.1111/j.1440-1800.2011.00568.x
Marchetti, D., Spagnolo, A., Cicerone, M., Cascini, F., Monaca, G., & Spagnolo, A. (2013). Research ethics committee auditing: the experience of a university hospital. HEC Forum, 25(3), 257-268. doi: 10.1007/s10730-013-9210-8.
Marrow, B. H. (2012). Deserving to a point: Unauthorized immigrants in San Franscisco’s universal access healthcare model. Social Science & Medicine, 74, 846-854. doi: 10.1016/j.socscimed.2011.08.001
Mehlman, M. J., Berg, J. W., Juengst, E. T., & Kodish, E. (2011). Ethical and legal issues in enhancement research on human subjects. Cambridge Quarterly of Healthcare Ethics, 20(1), 30-45. doi: 10.1017/S0963180110000605.
Moeller, J., Albanese, T., Garchar, K., Aultman, J., Radwany, S., & Frate, D. (2012). Functions and outcomes of a clinical medical ethics committee: a review of 100 consults. HEC Forum, 24(2), 99-114. doi: 10.1007/s10730-011-9170-9
Perera, F. P. R., & Peiro, M. (2012). Strategic planning in healthcare organizations. Revista Espanola de Cardiologia, 65(8), 749-754. DOI: 10.1016/j.rec.2012.04.004
Randall, L. H., Curran, E. A., & Omer, S. B. (2013). Legal considerations surrounding mandatory influenza vaccination for healthcare workers in the United States. Vaccine, 31(14), 1771-1776. doi:10.1016/j.vaccine.2013.02.002
Tiedje, K., & Plevak, D. J. (2014). Medical humanitarianism in the United States: Alternative healthcare, spirituality and political advocacy in the case of Our Lady Guadalupe free clinic. Social Science & Medicine, 120, 360-367. doi: 10.1016/j.socscimed.2014.05.018
Wike, V. (2013). Where should they go? undocumented immigrants and long-term care in the United States. HEC Forum, 25(2), 173-182. doi: 10.1007/s10730-012-9183-z
Williams, J. K., Skirton, H., & Masny, A. (2006). Ethics, policy and educational issues in genetic testing. Journal of Nursing Scholarship, 38(2), 119-125.