Bioethical Issues in Health Care Management

Posted June 2, 2017 | By Tricia Hussung

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As medical technology advances at a rapid pace, health care professionals are tasked with examining the resulting ethical dilemmas. This is where bioethics comes in. By applying the principles of ethics to the field of medicine, bioethics aims to investigate and study how health care decisions are made. It is a core component of ensuring that medical practices and procedures benefit society as a whole.

According to the Center for Practical Bioethics, those who are concerned with bioethics ask questions such as the following, within the context of modern medicine and health care:

  • What is the right thing to do?
  • What is worthwhile?
  • What are our obligations to one another?
  • Who is responsible, to whom and for what?
  • What is the fitting response to this moral dilemma, given the context?
  • On what moral grounds are such claims made?

Bioethics is a multidisciplinary field, combining philosophy, theology, history and law with medicine, nursing, health policy and the medical humanities. Because the health care system is so complex, it is important to consider relevant issues from multiple points of view.

The term “bioethics” was first introduced in 1971 to reference “the combination of biology and bioscience with humanistic knowledge,” the Center for Practical Bioethics explains. However, its application has become much broader today, including clinical decision-making, controversial new research, the implications of emerging technologies, global concerns, public policy and more. In fact, bioethics has played a central role in influencing policy changes and legislation in recent years. Its relevance for medical professionals is difficult to overstate, as the modern health care system continues to change at a rapid pace.

Bioethics has applications ranging from birth to the end of life, and it directly affects both patients and care providers. “Bioethics has an impact on every level of human community from the local nursing home to the huge international conferences on issues like the Human Genome … [It] is full of difficult ethical questions for everybody: families, hospitals, governments and civilization,” the Adelaide Centre for Bioethics and Culture explains.

The following are some of the most relevant bioethical issues faced by the health care industry.

End-of-Life Care

Elderly individuals and their families face a variety of difficult decisions as they near the end of life. Whether legal, practical, spiritual or medical in nature, the American Psychological Association notes that health care professionals overseeing these decisions “should ideally [consider them] in terms of the relief of suffering and the values and beliefs of the dying individual and his or her family.”

Advancements in medical treatment may prolong life, but quality of life can decrease once an individual becomes too ill. Then it is time to consider the level of pain management offered, whether to deliver care at home or in a hospital setting, what kind of caregiver is needed and more.

Medical Resource Allocation

When medical resources are limited or scarce, it is difficult to meet all health care needs due to a limited supply. This is why, in some cases, there is some degree of rationing in the health care system. One good example of this is intensive care units (ICUs). Patients might need to be transferred out of the ICU when they could still derive a small amount of benefit from ongoing monitoring, according to “The Ethics and Reality of Rationing in Medicine.” Decisions like this might be made to accommodate the needs of more seriously ill patients who need access to limited space in the unit.

Resource allocation could also apply to something as simple as physician time. Leaders and other stakeholders must determine which patients should be seen first and how much time should be dedicated.

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Eugenics

With modern advances in technology, it is possible to improve genetic quality through selective reproduction, gene selection and gene manipulation. But just because more choice exists, does that mean we should take advantage of it? That’s the ethical question behind eugenics. Options like embryo selection can allow parents to choose the sex of their child, for example. “Such possibilities raise important ethical questions – questions about which of these choices, if any, are morally wrong – along with closely related questions about the extent to which law and regulation should restrict these areas of medicine,” according to Eugenics and the Ethics of Selective Reproduction.

Euthanasia

One of the most controversial topics in bioethics is euthanasia. According to the BBC, “Euthanasia is the termination of a very sick person’s life in order to relieve them of their suffering. A person who undergoes euthanasia usually has an incurable condition.” In some cases, it may be done at the patient’s request, but when a patient is incapacitated, the decision can be made by others, such as family members or medical professionals.

In the medical community, there are two categories of euthanasia. Active euthanasia occurs when a medical professional does something that allows the patient to die. Passive euthanasia occurs when “medical professionals either don’t do something necessary to keep the patient alive, or when they stop doing something that is keeping the patient alive,” according to the BBC. It is important to note that in both cases this is done at the patient or family member’s request. The American Medical Association Code of Ethics makes a distinction between “withdrawing life-sustaining treatment” and euthanasia, which indicates just how complex this issue is.

Organ Donation

The importance of organ transplantation in modern medicine can’t be overstated. It helps patients by prolonging their lives after the failure of vital organs. For organ transplantation to work, of course, it requires donation from deceased or living individuals. According to “Ethical Issues in Organ Transplantation,” “The increasing incidence of vital organ failure and the inadequate supply of organs … has created a wide gap between organ supply and organ demand.” This means that patients often have long wait times before they receive an organ — and this can result in death. The ethical questions surrounding this issue are complex, including whether organ donation should continue to be voluntary and whether minors should be allowed to donate organs.

Bioethics and Health Care Management

For leaders in the health care field, it is important to create an ethical environment in which to deal with the daily challenges that arise. According to the National Center for Ethics in Health Care (NCEHC), ethical leadership can be achieved when managers prioritize ethics, communicate clear expectations to their employees and practice ethical decision-making.

According to the NCEHC, ethical health care organizations create a culture where individuals:

  • Appreciate the importance of ethics
  • See ethics as part of quality
  • Recognize and discuss ethical concerns
  • Understand what is expected of them
  • Seek consultation on ethics cases when needed
  • Feel empowered to behave ethically
  • Work to resolve ethics issues on a systems level
  • View organizational decisions as ethical

When managers are able to foster a culture of ethics, employee behavior is more likely to follow suit. This is one of the many important responsibilities of professionals in health care management roles.

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