Ethic Issues

PURPOSE

To provide an organizational process to define and address ethical issues that arise in the care of patients.

POLICY

A group of qualified professionals will be designated by the Governing Body to review ethical issues as they arise. Management meetings, case conferences, performance improvement meetings, or oversight committees can serve as vehicles to consider, discuss and resolve ethical issues. Ad hoc ethics forums may also be established. Representation will include a multidisciplinary team comprised of a member of management, a physician, appropriate clinical personnel, consumer, clergy and an attorney or risk management representative. The organization will develop and maintain resources and provide education programs concerning ethical issues. (See also “Advance Directives” Policy No. 2-034, “Do Not Resuscitate/Do Not Intubate Orders” Policy No. 2-035, “Cardiopulmonary Resuscitation” Policy No. 2-036.)

The patient and family/caregiver or their representative has the right to participate in any discussion concerning a conflict or ethical issue arising from his/her care.

Definitions

Ethical issues in home care include, but are not limited to:

1. Withholding or withdrawal of treatment
2. Unsafe home situations and patient safety
3. Nonadherence to treatment plan or refusal of treatments
4. Choosing to stay in a neglectful or abusive environment
5. Over or under treatment by a physician/family/caregiver
6. Family/caregiver participating in medical decisions
7. Informed consent
8. Confidentiality and patient privacy rights
9. Care of patients without insurance or other payment sources
10. Any issue which causes an ethical conflict or moral dilemma
11. How the organization will address the care of patients that have elected to participate in the End of Life Option Act process
12. Ethical business practices that include issues for marketing of services, admission practices, transfer practices, discharge practices, and billing practices

PROCEDURE

1. The group designated by the Governing Body to review ethical issues will be responsiblefor:
   1. Promptly addressing issues as they arise
   2. Reviewing all aspects of the issue
   3. Requesting clarification of information where indicated
   4. Securing outside assistance from “ethical experts” as needed
   5. Resolving the ethical issue according to applicable law, community standards of practice, appropriate allocation of resources with consideration to the role of interested parties
2. Organization personnel may discuss any ethical concerns with their immediate supervisors. Further discussions may be held during management meetings, case conferences, performance improvement meetings, or oversight committee meetings.
3. Any organization personnel, physicians or other professionals involved in the care of the patient or the patient and family/caregiver may initiate a referral for an ethics consultation by notifying a Program Director or Executive Director/Administrator.
4. Organization personnel, patients, their representatives, and attending physicians may request, in advance, to attend a meeting of the selected committee whenever discussion may be relevant to the care involving an individual patient.
5. Minutes will be maintained for all meetings. To assure confidentiality, any discussions involving individual patient cases or organization personnel will not include names but will utilize identification numbers. Minutes will be kept in the Executive Director/Administrator’s Office.
6. Issues involving conflicts and ethical concerns will be tracked and reported through performance improvement activities and reported, at least quarterly, to the Governing Body as part of those activities.