Ch 13-17 Flashcards
Ethics
Character/customers- a field of study that helps “define what is good for the individual and for society and established the nature of duties that people owe themselves and one another.”
Medical ethics
Most informative when collaborative, drawing from Sociology, History, Anthropology, Theology, Philosophy and the clinical studies
An example of applied ethics
Truth-telling
As far back as the Hippocrates oath, but once again at the forefront of medical ethics; has long been a complex decision for doctors
Proponents of truth-telling
Demonstrates respect for the patient and lying would undermine trust and rapport
Opponents of truth-telling
Argue that patients really “don’t want to know,” especially about serious illness; thus they are against it because they believe its the patients’ interest.
Lying to/deceive patients is justified on the grounds of
Discretion - doctors shouldn’t be forced to “just report the facts.”
Lying- may benefit the patient
Patients can’t always fully understand the truth.
Truth supports argue that…
Patients know themselves better than their doctors, and truth helps in planning —> law suites could occur when truth isn’t told
Truth-telling enhances the doctor-patient relationship (trust/legitimacy)
What mandates truth-telling
Patient bill of rights & AMA
Landmark California Case: The Tarasoff Case
Rules that doctors have a duty to break confidentiality in order to protect innocent third parties
Confidentiality is a ____ issue, especially with __________ and _____
Critical; electronic records; hacking
Patients count on their _______ to not share their _____/_____ information with others
Physicians; personal/private
Confidentiality dates back to ______
Hippocrates
Protecting Confidentiality is beneficial bc
1) people needing treatment will seek it
2) people will provide maximum information
3) trust with physician in enhanced
Physicians have a ____ to care for people, even if they have ______ _______.
Duty; contagious diseases
Recently, there has been a push by some to _____ __ _____ on the basis of: ________, ___________, ________________
Refuse to treat; excessive risk (for doc); questionable benefits; obligations to other patients/self/family
Proponents of Treating Regardless of Risks argue that…
- is inherent part of being a doctor— their profession
- its part of the social contract between society — medical institution
- patients are dependent on their doctors
____ policy has changed over time; now it expresses
both ________ and ________
AMA; duty to treat; easy exemptions
Patients want _______ info from physicians
Full/accurate
Physicians use ____ based on communication
Discretion
Cultural differences in communication about diseases
Some cultures say disease name while others avoid it (better for psychosomatic health)
In terms of _____&______, US health care is _______________
Access; outcomes; less than effective
The US health care system is ________ ($)
Profit-based
The US spends _____ than any other country on health care
More
Before ACA/Obama care, there were >_______ people without health insurance; after _____ don’t have health insurance
47 million; 26 million
Social medicine
Government pays for health care
US is not socialized medicine (individuals or employers pay for insurance)
Healthcare costs are covered by
- employers
-individuals/families (pay what insurance doesn’t cover) - government (medicare/Medicaid)
The __________ is the #1 payer for health care because of ____ & ______
Federal government; medicare/Medicaid
Medicare
A federal insurance program that helps pay for medical care for people ≥ 65 years old, permanently disabled workers, their dependents, and people with end-stage renal disease
- recipients must qualify according to income
- no deductibles/co-pays
- lower expenditures in the last 20+ years
Part D added to Medicare
G.W. Bush (2003) Bush/Congress passed the Prescription Drug Coverage for Medicare
Medicaid
A jointly-funded federal-state-local program designed to make health care available to the poor
- eligibility reqs and program benefits vary from state-to-state
- majority of funds provide service for the elderly, blind, and disabled
- 2/3 of Medicaid recipients are members of an AFDC (aid to families with dependent children)/ welfare family
______ health care costs ________ for decades (accounting for _____)
Increased; escalating; inflation
Why are health care costs increasing
- new medical technologies
- people living longer & needing more care for chronic & acute illnesses (older population growing)
- medical wastes
- enormous corporate profits
- exorbitant salaries & compensation packages (CEOs, CFOs, advertisement $)
- high administrative costs
- medical fruad
Even as a % of _____: the US has much ____ costs than ANY OTHER country
GDP/gross domestic product; higher
The US is #__ in health care spending
1
__________ accounts for most increases in Health Care costs
Hospital care
Past 3 decades: Health care in US has gone from ___________ to __________ & __________ “out of pocket” expenditures
Reliance on private sources; increased dependence on public sources; declining
Some companies ______ public health care (________)
Want; to reduce production costs
Private business - health care expenditures
1) primarily spent on health insurance
2) increasingly accompanied by higher employee contributions
______ of Americans without insurance is in families with __________
Majority; an employed worker
The uninsured (before ACA) in the US ~
40-60 million people
In any 2-year period before ACA, ________ Americans were without insurance for at least part of the year.
80 million
Managed care programs
Have attempted to cut costs while securing “lower provider reimbursements” (lower insurance payments) and “regulating patient care.” (Decrease MD autonomy)
